A New York Times article lifts the veil on what has become an open secret in many top performing high schools in the nation: Prescription stimulants used to help children with ADHD are being sold on the black market to healthy students seeking a quick fix to increase focus, concentration and test performance. The Times article, written by Alan Schwarz, describes the typical student involved in the illicit use of prescription stimulants as a model citizen. He already earns good grades, participates in a dizzying number of extracurricular activities, and thoroughly expects to attend an Ivy League institution. He just needs that extra boost to elevate his SAT scores or pass that AP Chem final. Obviously this is very concerning to parents of teenagers (and psychiatrists that are prescribing these medications). But is the New York Times increasing fears that are unjustified or overblown?
In my practice, which focuses on ADHD/ADD, I work with many teenagers attending highly competitive prep schools in Manhattan. The workload is enormous and the pressure to succeed can be daunting. It’s understandable why a student would turn to his friend’s Ritalin to get that added advantage. Forbes staff writer Matthew Herper, in a recent article, asks a number of penetrating questions regarding the growing use of ADD drugs: Is reliance on brain-enhancing drugs just another symptom of our society’s need for quick-fix solutions? Why do parents and children choose this route, rather than investigating other means of improving focus? Does easy access to such drugs provide an unfair advantage to kids who already have every advantage at their disposal?
It is clear from my clinical practice that there are many people suffering from the often debilitating symptoms of attention deficit disorder. For these children, teenagers and adults, medication is a lifesaver. But I also see a number of parents who come to my office wondering if their straight-A student has ADD. The parents claim their child is “not performing up to their potential.” They ask me, “If medication will help them improve their focus.” Of course it will. According to the Times report, drugs like Adderall and Ritalin help kids with ADD calm down, and non-affected kids experience something completely different. This is simply not true. ADD medications foster improved focus in all individuals by increasing the levels of the neurotransmitters norepinephrine and dopamine in the prefrontal cortex, the part of the brain that controls behavior and attention. Once these areas are snapped into place, so to speak, everything else gets controlled.
To quote from Nature.com: “For years, it was assumed that stimulants had paradoxical calming effects in ADHD patients. It is now known that low doses of stimulants focus attention and improve executive function in both normal and ADHD subjects.” So while we might all improve our focus on ADD medications, these drugs are a controlled substance, illegal without a prescription and dangerous if abused. If even a small percentage of teenagers are abusing ADD medications, it’s too many.
The remedy to this is for clinicians to do careful evaluations of teenagers to determine if they in fact have ADD or not. Limiting ADD drugs to those that truly need the medication is paramount. But how do we determine need? The main requirement for a diagnosis of ADD is an “impairment in functioning.” Getting B’s or getting denied admission to Harvard is not an impairment in functioning. It may be painful, but it is not debilitating. Crashing your car, getting arrested, destroying relationships (often the result of ADD) are painful and certainly an impairment in functioning.
At the Sachs Center we provide comprehensive evaluations for ADD, going much further than most doctors that simply read you a list of ten questions. In addition to an hour long clinical interview, looking at both childhood and current symptoms, we offer computer based assessments and tests of executive functioning. But even with this thorough assessment, the greatest determining factor for a diagnosis of ADD/ADHD is how impaired the individual is—not according to standard’s of the Manhattan top preparatory schools—but based on societal norms. By focusing on true impairment, improved diagnosis can be achieved and medications will be used by those that truly need them.