The morning of October 21st, 2004, a fourteen-year-old named Matthew Hohmann took an Adderall XR pill for ADHD symptoms. His parents saw him down the pill with a cup of water; the next time they saw their son, he was prostrate on the bathroom floor. His lips were blue. He was nonresponsive. Matthew Hohmann died before EMTs could save him. Sudden death, the official cause of death in Matthew’s case, is one of the more severe possibilities in a slew of potential side effects for stimulant drugs; others include nervousness, insomnia, agitation, seizures, hallucinations, and depression. Despite the potential risks they pose to adolescents’ health, prescription of these drugs is only increasing, especially to treat primary school children. According to PBS Frontline, “The US drastically outpaces the rest of the world in its consumption of stimulant drugs used to treat the symptoms of ADHD; we produce and consume about 85 percent of the world’s methylphenidate (the active ingredient in Ritalin).” With such a painful disparity between our stimulant consumption and that of the rest of the world, it’s worth considering why Americans need Ritalin and Adderall so much, especially at younger and younger ages. The answer has more to do with the structure of American schools than the biological makeup of American children. Stimulant medication is seen as the solution for all behavioral issues in a problematic educational system that has neither the willpower nor budget to give students adequate behavioral therapy, compromises active learning for the sake of standardized testing, and quashes children’s natural propensity for physical activity by titling it “hyperactivity.”
Although many schools refer students to see doctors about the possibility of an ADHD diagnosis, it is rare that they encourage follow-ups with professional therapists; 75% of students diagnosed with ADHD do not receive behavioral counseling therapy, meaning that for many children, medication is their only treatment when really it should be the last resort. Behavioral counseling therapy may not be a perfect solution for ADHD, but it provides an alternative to medication or at least makes it possible to lower drug dosages. Since Adderall and Ritalin are both amphetamines with high addiction potentiality, physicians should embrace the chance to reduce their circulation. Yet the prevalence of medication-only ADHD patients attests to the cost and effort barrier that prevents many patients from seeking further help and many doctors from delivering it. The CDC’s National Survey of Children’s Health revealed that by the time high school rolls around, 10% of girls have been diagnosed with ADHD, and 1 in 10 boys are taking medication for it. Getting so many students access to behavioral therapy would require a gargantuan public investment in mental health—the kind of investment that isn’t attractive in the short term, compared to the cheaper and more convenient option of providing drugs. This should be where schools take a stand by providing access to quality psychological care, whether through trained counselors or connections to community resources. Some might argue that treatment of students with ADHD falls outside the purview of public schools, but this is an education issue because behavioral disorders have clear impacts on student learning. Too many teachers and administrators are content with the idea that a child, now medicated, will no longer be a troublemaker in the classroom.
Perhaps the most insidious challenge to the wellness of children diagnosed with ADHD comes from within schools. In the wake of budget cuts and school closures after No Child Left Behind, many school districts have cut opportunities for active learning like music, arts, occupational classes, or even lunch and recess in order to direct more money to test preparation. This happened despite overwhelming evidence pointing out the concrete learning gains made by children after having the chance to simply run around. The Wall Street Journal described results of multiple studies and concluded, “Regular, half-hour sessions of aerobic activity before school helped young children with symptoms of attention deficit hyperactivity disorder become more attentive and less moody.” Yet only 6 states require 150 minutes a week of physical education from students; worse yet, only three states make at least 20 minutes of recess per day mandatory for elementary schools. As increasing numbers of kids are growing up in environments where their natural desire to let off steam through physical activity is being circumscribed by long school days with few breaks, the real miracle may be that more kids aren’t diagnosed with ADHD.
Many Berkeley students themselves can probably attest to occasionally getting bored, distracted, or fidgety in a lecture; it’s almost inevitable. Like us, many elementary school students feel the same way in their classes; unlike us, they usually don’t have the luxury of planning their own schedules or occasionally skipping out on a lecture. So when a child is confronted with an under-stimulating classroom experience, often one rife with test prep packets and bullet-ridden PowerPoint presentations, they may engage in perfectly normal behaviors teachers label “disruptive” to try to stay awake in a sea of mind-numbing boredom. In addition, children could be acting out due to problems at home or other underlying conditions, but instead of dealing step-by-step with the complicated web of problems that may entangle a given student, we carpet-bomb the symptom with medication. In small classrooms with only a few students, a teacher could afford to give more personalized attention to each student. But our large classrooms perpetuate an industrial model focused on churning out information for students to regurgitate. This means the fastest way to deal with repeated “disruptive” behavior is often medication.
We don’t need more legislation that calls for better scores on high-stakes standardized tests; we need legislation that puts students’ health and wellness first. Addressing student health holistically instead of feeding them stimulants may be costly, time-consuming, and complicated, but it’s the right thing to do. We should feel ashamed that we are turning a blind eye to the 6.1% of Americans aged 4-17 taking ADHD medication simply because we would rather send children to school doped up on powerful amphetamines than confront the difficult and systemic problems of our education system.