Seeking straight A's, parents push for pills

Victoria Clayton • E-mail

A 15-year-old girl and her parents recently came in for a chat with Dr. James Perrin, a Boston pediatrician, because they were concerned about the girl's grades. Previously an A student, she was slipping to B's, and the family was convinced attention deficit hyperactivity disorder was at fault — and that a prescription for Ritalin would boost her brainpower.

After examining the girl, Perrin determined she didn't have ADHD. The parents, who had come in demanding a prescription, left empty-handed.

Perrin, a professor of pediatrics at Harvard Medical School and spokesperson for the American Academy of Pediatrics, and other physicians say this is an increasingly common scenario in doctors' offices around the country, though there are no hard statistics on it.

Parents want their kids to excel in school, and they've heard about the illegal use of stimulants such as Ritalin and Adderall for "academic doping." Hoping to obtain the drugs legally, they pressure pediatricians for them. Some even request the drugs after openly admitting they don't believe their child has ADHD.

“I spoke with [some] colleagues the other day and they mentioned three cases recently where parents blatantly asked for the medication so that their children would perform better in school, yet there were no other indications that the child had ADHD,” says Dr. Nick Yates, a pediatrician and director of medical ethics for Mercy Hospital in Buffalo, N.Y.

“I’m very concerned that there’s a fair amount — and we don’t know how much — [of ADHD drugs] being prescribed and used for off-label purposes," says Yates.

Academic doping — using these stimulant prescriptions in an effort to enhance focus, concentration and mental stamina — first started on college campuses, especially Ivy League and exclusive, competitive schools. Now, the problem is filtering down to secondary schools, Yates says, and more parents are playing a role in obtaining prescription ADHD medication for their teenagers.

Yates isn't entirely surprised that parents ask for it. He believes that most families simply have a heartfelt — if shockingly misdirected — desire for their children to do their best.

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Parents can be overly eager to blame poor grades on a medical condition rather than looking for other explanations, says Dr. Michael Rater, medical director of the Adolescent and Residential Treatment Program at McLean Hospital in Belmont, Mass. “It’s usually that parents are just trying to understand their children’s struggles in a narrative that makes sense to them,” he says.

Yet some parents will do whatever it takes to keep opportunities from slipping through a child's fingers — even outright lying to doctors to get the drugs, says Rater.

And some pill-eager parents aren't just seeking to level the playing field, they're trying to make their kids superstars, says Dr. Martin Stein, a professor of clinical pediatrics at University of California, San Diego.

“I see patients who come from privileged backgrounds and lower-level economic backgrounds and there’s a tremendous difference in parental expectations,” Stein says.

Privileged kids tend to have parents who will push them to be the academic cream of the crop and when they aren’t, they’ll start looking for reasons why, he says. “I tell them that honor roll, a merit scholarship or acceptance in an Ivy League school is not the end point. That would be poor medicine.”

Safety issues
The concerns with academic doping aren't just ethical.

"The medications in general have a long safety record for people who need them but when you use a drug for off-label purposes, there are additional safety concerns,” says Yates.

Although doctors generally agree that side effects from the medications are minimal for most kids, there is an extensive, and sometimes frightening, list of possibilities.

Commonly reported side effects include difficulty sleeping, loss of appetite, irritability, stomachaches, headaches, blurry vision, nausea, dizziness, drowsiness and tics and tremors. There have been concerns that ADHD medication temporarily delays growth, and one study found that up to 5 percent of children experience tactile hallucinations, often involving a sensation that bugs or snakes are crawling on their bodies. The FDA recently announced that certain ADHD drugs should caution users about the risks of serious heart problems and psychotic behavior.

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