COMMENTARY

ADD and Stimulant Use: An Epidemic of Modernity

Michael E. Ruff, MD, FAAP

Disclosures

February 06, 2007

Time Spent With Parents

As stimulant use has rapidly escalated over the past 25 years, the amount of time that children spend with their biological parents has decreased by 40%.[50] A nationwide study of school principals found that regardless of income, educational failure and behavioral problems correlate more significantly with 1-parent households than with any other factors.[51] There is a growing body of evidence showing that children who grow up under the tutelage of people other than their natural parents are more likely to fail in school.[52] As we know, underperformance in school often results in a prescription.

Ten percent of the school-age population is classified as disabled.[53] The social needs of students have moved into the classroom, consuming scarce resources once allocated for education. The more children who are diagnosed as disabled, the fewer resources remain for the rest of the children -- thus pushing the next kid teetering on the precipice into frank failure.[54] A teacher may see the positive effects of a stimulant on this borderline child and collective classroom function and then, given the pressure to produce results on standardized tests and deal with increased class size, have a lower threshold to refer the next child.[55] Stimulant drugs work well and often lull us into not making an assiduous effort to look for reading or other disabilities that may masquerade as an attentional problem, or to be complacent with dysfunctional family situations and overcrowded classrooms.[23] Treating a child may be individually expedient but societally dangerous. Medication may permit poor conditions to continue or worsen. By distributing 15 tons of stimulants per year, we may be aiding and abetting the burgeoning problems of overcrowded classrooms, overwhelmed teachers and parents, parental deficiencies in discipline skills, escalating academic standards, unreasonable expectations, and the continuance of a culture detrimental to the development of good attentional skills.[56] Have we been seduced into an over-reliance on pharmaceutical solutions to kids' problems? The implications of this conundrum will take on even greater meaning in the near future as labs headed by investigators such as Eric Kandel and Timothy Tulley are tantalizingly close to perfecting drugs for memory enhancement. These drugs have superior efficacy compared with Aricept and Namenda, and will be on the market in 5 to 10 years.[57,58] Although these drugs will initially be approved for stroke victims, Alzheimer's disease, and head trauma patients, this is the tip of the iceberg. "Drug companies won't tell you this, but what they are really gunning for is the market of minimally and non-impaired people."[58] Long ago, Rapoport[59] conclusively demonstrated that stimulants work well in children without attentional problems. Undoubtedly, there are many who take these drugs because they are struggling with the pressure to achieve or just keep up. Is the vociferous stance on the part of the medical community to ban performance-enhancing substances in sports due to the danger of steroids relative to stimulants, or is there a fairness issue as well?

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