Prescribing to boost performance

[Anahi Ortiz M.D.]

I was shocked to read this article from the NY Times about physicians prescribing meds for children in lower economic school districts to boost performance since the school could not provide adequate resources. It sounds like it is being done from the heart but ethically I would never prescribe to someone who does not have ADHD. I would be interested in hearing comments. The comments after the article are interesting also.

http://www.nytimes.com/2012/10/09/health/attention-disorder-or-not-...

[doug puryear]

i surely agree.

doug puryear

[zahir ibrahim]

does medicaid or health insurances cover VISION  in the US ? there must be vision centres that work with colour filters to enhance concentration and focus. These have no side effects that i am aware of.

I also work with children in a deprived school who are struggling with reading and writing and i work with colour filters in spectacles to boost their performance. with the right colour filter combination in their glasses their attention ,focus ,reading and writing improve immensley, this automatically boosts the childs self esteem and confidence in the classroom and encourages them to perform better, with no side effects yet. This could be something worth trying.

[Margaret]

HI

This is bad, and seriously ticks me off!!

Okay, deep breath and start logically

1) Yes, university students do abuse adderall to get better grades. However, my understanding was that it is mostly a study aid - it keeps them awake so they can study more and better.

2) At one point in my career (about 10 yrs ago) when I had just started, I had arranged with a pharmacy in town to do blinded med trials for my ADHD patients. They had a week of bottle a and a week of bottle b. Conner scores were filled out by parents and teachers both weeks. The interesting part is that about 90% of them came back saying they knew which bottle was the actual medication, and they were right. The scales reflected it as well. (The meds were put into capsules, with the same placebo capsules in the other bottle, so they looked the same). The kids that had no differences were the kids where I wasn't completely convinced of the diagnosis anyway, or it was extremely complex ADHD with some big co-morbidities. Point is, it only worked if the child had ADHD.

3)Pills don't teach skills. If you have mild ADHD and are in a school with a lot of extra help to teach you the skills, then you may do okay without pillls. If, however, you are in an overcrowded classroom, with a large number of high needs or special needs students, you are not going to get the help, and your ADHD will cause you more issues, and be more apparent. Meds will help in this case.

4)As for the family in the story - I am willing to bet their other 2 children who "don't have ADHD" but do well on Adderall probably DO have mild ADHD, possibly PI - they just don't look like it compared to their more severe siblings. As for the child with the risperdol - if he was hallucinating on the adderall, then he may very well also be incredibly anxious. Anxiety is the most common cause of hallucinations in children. As for the attitude, he sounds like he MAY (and I can't really say, as I have never seen him or evaluated him) meet criteria for ODD. This often goes along with ADHD, and responds quite nicely in a lot of cases to risperdol. My question is, what are they doing for his ADHD? Risperdol does not help with focus, attention,etc.

The main physician in the story doesn't really seem to even believe in ADHD; he is treating it, and probably mostly appropriately, but since he doesn't believe it is a real entity, to him, he is prescribing unneeded medication. Strange sort of situation, really.

[Gittel]

Hi.  I so hated that article.  I can't believe the picture they included at the top, it looks like a spaced out boy, who of course, takes Risperdal.  I'm sure the camera just caught him at a bad angle, and he shouldn't be labled like that. 

I've encountered a number of doctors though who will prescribe medication for something other than what was intended. I think that occurs across the board.  And practically, sometimes you have to compromise on medical treatment: You might need physical therapy, but the only thing your insurance covers is painkillers. Not ideal, but it happens.

I feel like the article is re-attaching the awful stigma to ADHD...

[Anahi Ortiz M.D.]

I agree with you there. The connotations in this article were pretty negative in reference to ADHD.