Church4EveryChild

The New York Times has published a story making the sensational claim that 15-40% of students attending elite college preparatory schools in the Northeast corridor are abusing stimulant medication on a regular basis to improve their scores on college entrance exams and grade point average to gain admission to the most competitive colleges. The story begins with the story of a boy from a prestigious high school in suburban New York City and eight of his friends snorting Adderall in the parking lot on the morning of the SATs.

In addition to smearing the reputations of kids attending elite private high schools  and casting doubts upon the legitimacy of their academic accomplishments, the author of the story relies completely upon anecdote in using the platform offered by one of our “newspapers of record” in propagating misinformation that leads parents to unnecessarily fear seeking help for teens who are struggling academically…and often emotionally.

Some observations about the story from the perspective of a child and adolescent psychiatrist whose practice serves a significant population of kids and families from equally competitive schools in suburban Cleveland…accompanied by supporting data:

Kids are under extraordinary pressures to succeed in school and the college admissions process is intensely more competitive than in my generation. U.S. students are competing with kids throughout the world for limited positions in our elite universities. Given the state of the economy and uncertainty about the future, kids are under more pressure from parents to seek admission to prestigious universities. Once accepted, they’re competing against peers for limited scholarships to help pay the exorbitant tuition charged by those institutions. But I can’t say that I see many kids illegally obtaining stimulants to enhance academic performance. I would say I see at least five kids regularly using marijuana to self-medicate anxiety associated with the pressures from school for every kid illicitly using stimulants.

Here’s data from the 2011 National Survey on Drug Use and Health, conducted by the U.S. Substance Abuse and Mental Health Services Administration examining illicit drug use among youth ages 12-17:

The rate of illicit use of psychotherapeutic medication (predominantly stimulants) has been decreasing over the past ten years. Narcotics obtained from drug cabinets at home and from the homes of friends are far more likely to be used illicitly than stimulants prescribed for ADHD.

A small percentage of kids at highly competitive schools will procure stimulants from peers who had been prescribed medication for ADHD. My teenage daughters have told me this happens.  Many kids who seek out medication for ADHD do turn out to meet criteria for the disorder following careful evaluations. There is evidence that students in fraternities and sororities with poor grades at highly competitive colleges in the Northeast are more likely than other college students to misuse stimulants.

If a child has ADHD and is treated with stimulant medication, they are no more (or less) likely to develop a substance use disorder than persons with ADHD who aren’t treated medically. Here’s a link to the highest quality study examining the relationship between ADHD treatment and future substance abuse.

A physician who takes the time to conduct a complete evaluation, involving input from teachers and parents (in addition to the student) and a thorough review of educational records is significantly less likely to be fooled by a kid coming in to get a prescription for medication that they don’t otherwise need. When I’m evaluating an older kid for ADHD, I ask parents to bring in their year end report cards from the time the child first entered school. There’s often a signature pattern for ADHD seen in the teacher comments year after year…problems with poor organization, less than optimal work habits, careless mistakes on papers and tests, excessive socialization, difficulty meeting deadlines, etc. A good clinician is going to look for corroboration from sources outside of the family (when available) prior to making a diagnosis. If anything, the child or family seeking medication for academic performance enhancement is going to seek out a busy primary care physician as opposed to a specialist with the time and inclination to do more thorough assessments.

To the extent that this type of illicit stimulant use occurs for cognitive enhancement, we as parents have to look carefully at what we communicate to our kids in terms of expectations for their academic success. Parents who send their kids to elite private schools have made a major investment in time and money in their education. My wife and I caught lots of flack from society folks she volunteered with when we decided to send our girls to public school. At the time, we calculated that we’d need to spend $500,000 after taxes to send them to one of the elite private girls’ schools in our area. In order to do private school, they would have lost their time with us. Kids pick up on the sacrifices their parents make to provide them with the opportunities to attend the best schools and don’t want to disappoint them…or fail to achieve their affirmation and blessing.

I’d like to think that we’ve tried to communicate what’s most important to our girls through our actions…they’ve seen my wife become very active in our local public school while serving as Board President at two major non-profits in our area and she’s almost always at home to greet them at the end of their day. They’ve seen me serve in leadership at church and through Key Ministry. And most nights, they’ve seen both of us at dinnertime.

Most parents I meet don’t seem to have a plan to guide their kids to the best possible future. To the extent that this type of medication misuse occurs, I wonder what we’re communicating to our kids about priorities and where to seek security?