When the New York Times’ Alan Schwarz wrote about (at least relatively) well-off schoolkids using stimulants intended for attention deficit disorder to do better back in June, I thought he ran a great story but failed to emphasize a key point. I wrote:
Often you hear that if stimulants like Ritalin, Vyvanse, or Adderall help people stay calm, that means that they must have ADHD. This isn’t true. These drugs will help anyone focus and pay attention. Giving stimulants to a kid with ADHD is more like giving a child with a learning disability more time on a test — and advantage that might help anybody, but helps that child more — than fixing his brain.
Given that, it’s understandable that kids desperate for an academic advantage would turn to stimulants. Why shouldn’t they?
Today, Schwarz had the next front-page blockbuster on the topic, and this time I see nothing to be fussy about. It is an amazing piece. He introduces us to a doctor who is prescribing the ADHD medicines not just because they need them but also as a socioeconomic equalizer. “We’ve decided as a society that it’s too expensive to modify the kid’s environment,” the doc bluntly tells him. ”So we have to modify the kid.”
And for many kids, that helps. It also leads to consequences like this, in which Adderall proves a gateway to putting one boy on Risperdal, a powerful antipsychotic made by Johnson & Johnson. The package insert for the drug lists side effects including sleepiness, insomnia, parkisonism, and drooling, and says its safety and efficacy have not been established in schizophrenics younger than 13 or patients suffering from bipolar younger than 10; it is approved for treating aggression in autistic children ages five and older.
Quintn began taking Adderall for A.D.H.D. about five years ago, when his disruptive school behavior led to calls home and in-school suspensions. He immediately settled down and became a more earnest, attentive student — a little bit more like Perry, who also took Adderall for his A.D.H.D.
When puberty’s chemical maelstrom began at about 10, though, Quintn got into fights at school because, he said, other children were insulting his mother. The problem was, they were not; Quintn was seeing people and hearing voices that were not there, a rare but recognized side effect of Adderall. After Quintn admitted to being suicidal, Dr. Anderson prescribed a week in a local psychiatric hospital, and a switch to Risperdal.
While telling this story, the Rocaforts called Quintn into the kitchen and asked him to describe why he had been given Adderall.
“To help me focus on my school work, my homework, listening to Mom and Dad, and not doing what I used to do to my teachers, to make them mad,” he said. He described the week in the hospital and the effects of Risperdal: “If I don’t take my medicine I’d be having attitudes. I’d be disrespecting my parents. I wouldn’t be like this.”
Adderall, incidentally, is sold in a delayed release from by Shire and in its original, instant-release form by Teva, the generics giant. These drugs do help people study. But we’re overdue for more national conversation on how they should be used that gets beyond both the puritanical strain of saying drugs are bad and the utopian idea that we can use drugs to improve academic performance without other, potentially big, costs. Alternatives to these medicines can work. But how do we get those to kids? And can we avoid a world in which thinkers are forced into brain-doping in the same way athletes have been pushed to chemically modify their bodies? Schwarz is pushing an important conversation here, and I can’t wait to read his next piece.
Update: To be clear, I’m not sure we should be using these drugs more widely, and think, given the potential for long-term risk from lifetime medication, we should be looking for other solutions. But I don’t think naively pretending the drugs don’t work or that they can work for everyone is a good solution. For more, read Emily Willingham’s take.