Don't Give ADHD Meds to Undiagnosed Kids, Experts Urge
WEDNESDAY, March 13 -- Some people call it "brain doping" or "meducation." Others label the problem "neuroenhancement." Whatever the term, the American Academy of Neurology has published a position paper criticizing the practice of prescribing "study drugs" to boost memory and thinking abilities in healthy children and teens.
The authors said physicians are prescribing drugs that are typically used for children and teenagers diagnosed with attention-deficit/hyperactivity disorder (ADHD) for students solely to improve their ability to ace a critical exam -- such as the college admission SAT -- or to get better grades in school.
Dr. William Graf, lead author of the paper and a professor of pediatrics and neurology at Yale School of Medicine, emphasized that the statement doesn't apply to the appropriate diagnosis and treatment of ADHD. Rather, he is concerned about what he calls "neuroenhancement in the classroom."
The problem is similar to that caused by performance-boosting drugs that have been used in sports by such athletic luminaries as Lance Armstrong and Mark McGwire, he explained. "One is about [enhancing] muscles and the other is about enhancing brains," Graf said.
In children and teens, the use of drugs to improve academic performance raises issues including the potential long-term effect of medications on the developing brain, the distinction between normal and abnormal intellectual development, the question of whether it is ethical for parents to force their children to take drugs just to improve their academic performance, and the risks of overmedication and chemical dependency, Graf noted.
The rapidly rising numbers of children and teens taking ADHD drugs calls attention to the problem, Graf said. "The number of physician office visits for ADHD management and the number of prescriptions for stimulants and psychotropic medications for children and adolescents has increased 10-fold in the U.S. over the last 20 years," he pointed out.
Recent parent surveys show about a 22 percent increase in ADHD, a 42 percent rise in the disorder among older teens and a 53 percent increase among Hispanic children, according to the paper.
While Graf acknowledged that the data about rising numbers associated with ADHD includes a number of cases that have been appropriately diagnosed as ADHD, he said the increase -- especially among older adolescents -- suggests a problem of overdiagnosis and overmedication.
"We should be more cautious with healthy children in treating them with drugs they don't need," he said. "The ethical balance tips against overuse and toward caution because children are still growing and developing and there's a lot we don't know."
The position paper, published online March 13 in the journal Neurology, was also approved by the Child Neurology Society and the American Neurological Association.
Dr. Mark Wolraich, a professor of pediatrics at the University of Oklahoma Health Sciences Center and chairman of the subcommittee that wrote ADHD guidelines for the American Academy of Pediatrics, said that his group was not consulted in the development of the position paper Graf developed. Wolraich noted that the AAP also did not recommend the use of stimulant medications for performance enhancement or pleasure.
Yet Wolraich said he is concerned that recommendations against the use of ADHD drugs may confuse parents, who already are frequently hesitant to give prescription medications to their children for ADHD.
"The paper may have an unfavorable impact," Wolraich said. "I worry that we're focusing too much on the downside and it will deter people from getting the help they need. We have a lot of good evidence about the use [of medications] and it is clearly effective in the short term for treating the symptoms you see with ADHD."
Learn more about ADHD from the U.S. National Library of Medicine.
Posted: March 2013