CANTON, Ga. When Dr. Michael Anderson hears about his underprivileged patients struggling in elementary school, he usually gives them a taste of some powerful medicine: Adderall.
The pills boost focus and impulse control in children with attention deficit hyperactivity disorder. And although thats the diagnosis Anderson makes, he calls it made up and an excuse to prescribe the pills to treat what he considers the childrens true ill poor academic performance in the unequal education system.
I dont have a whole lot of choice, said Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. Weve decided as a society that its too expensive to modify the kids environment. So we have to modify the kid.
Anderson is one of the more outspoken proponents of an idea that other physicians are embracing. They are prescribing stimulants to struggling students in schools starved for money.
It is not clear whether Anderson is representative of a widening trend. But some experts note that a practice that started with elite students racing to raise already-good grades in colleges and high schools is appearing among disadvantaged elementary children with faltering grades and parents eager to see success.
We as a society have been unwilling to invest in very effective nonpharmaceutical interventions for these children and their families, said Ramesh Raghavan, a child mental-health services researcher at Washington University in St. Louis. We are effectively forcing local community psychiatrists to use the only tool at their disposal, which is psychotropic medications.
Dr. Nancy Rappaport, a child psychiatrist in Cambridge, Mass., who works primarily with lower-income children and their schools, said: We are seeing this more and more. We are using a chemical straitjacket instead of doing things that are just as important to also do, sometimes more.
Andersons instinct, he said, is that of a social justice thinker who is evening the scales a little bit. He said that the children he sees with academic problems are essentially mismatched with their environment square pegs chafing at the round holes of public education. Because their families can rarely afford behavior-based therapies such as tutoring and family counseling, he said, medication becomes the most reliable and pragmatic way to redirect the student toward success.
People who are getting As and Bs, I wont give it to them, he said.
For some parents, the pills provide great relief. Jacqueline Williams said she cant thank Anderson enough for helping her children Eric, 15; Chekiara, 14; and Shamya, 11 by prescribing Concerta, a long-acting stimulant, for them all. She said each was having trouble listening to instructions and concentrating.
My kids dont want to take it, but I told them, These are your grades when youre taking it, this is when you dont, and they understood, Williams said, noting that Medicaid covers almost every penny of her doctor and prescription costs.
Some experts see little harm in a responsible physician using Ritalin or its siblings to help a struggling student. Others fear that doctors are crossing a line and exposing children to unwarranted physical and psychological risks. Reported side effects of the drugs include growth suppression, increased blood pressure and psychotic episodes.
According to guidelines published last year by the American Academy of Pediatrics, physicians should use one of several behavior rating scales, some of which feature dozens of categories, to make sure that a child not only fits criteria for ADHD, but also has no related condition such as dyslexia or oppositional defiant disorder, in which intense anger is directed toward authority figures. However, a 2010 study in the Journal of Attention Disorders suggested that at least 20 percent of doctors said they did not follow this protocol when making their ADHD diagnoses, with many of them following personal instinct.
Dr. William Graf, a pediatrician and child neurologist who serves many poor families in New Haven, Conn., said that a family should be able to choose for itself whether Adderall can benefit a non-ADHD child, and that a physician can ethically prescribe a trial as long as side effects are closely monitored.
On the kitchen shelf at the Rocaforts house, next to the peanut butter and chicken broth, sits a wire basket brimming with bottles of the childrens respective medications, all prescribed by Anderson: Adderall for Alexis, 12, and Ethan, 9; Risperdal (an antipsychotic for mood stabilization) for Quintn and Perry, both 11; and Clonidine (a sleep aid to counteract the other medications) for all four, taken nightly.
Quintn began taking Adderall for ADHD about five years ago, when his disruptive school behavior led to calls home and in-school suspensions. He immediately settled down and became a more earnest, attentive student.
When pubertys chemical maelstrom began at 10, though, Quintn got into fights at school because, he pleaded, other children were insulting his mother. But they were not; Quintn was seeing people and hearing voices, a rare but recognized side effect. Anderson prescribed a week in a local psychiatric hospital and a switch to Risperdal.
While telling their story, the Rocaforts called Quintn into the kitchen and asked him to describe why he was being given Adderall.
To help me focus on my school work, my homework, listening to Mom and Dad, and not doing what I used to do to my teachers, to make them mad, he said.
Despite Quintns experience with Adderall, the Rocaforts decided to use it with their daughter, Alexis, and son, Ethan. These children dont have ADHD the drug is merely to help them in school.
Weve seen both sides of the spectrum, Rocky Rocafort said. Acknowledging that Alexis use of Adderall is cosmetic, he added, If theyre feeling positive, happy, socializing more, and its helping them, why wouldnt you? Why not?
Anderson said that every child he treats with ADHD medication has met qualifications. But he also has railed against medical criteria, saying it has been codified to make something completely subjective look objective.
Several educators contacted for this article consider the subject of ADHD so controversial the diagnosis is misused at times, but for many children it is a serious learning disability that they declined to comment. The superintendent of one major school district in California, who spoke on the condition of anonymity, noted that diagnosis rates have risen as sharply as school funding has declined.
Its scary to think that this is what weve come to; how not funding public education to meet the needs of all kids has led to this, said the superintendent, referring to the use of stimulants in children without classic ADHD. It could be happening right here. Maybe not as knowingly, but it could be a consequence of a doctor who sees a kid failing in overcrowded classes with 42 other kids and the frustrated parents asking what they can do. The doctor says, Maybe its ADHD, lets give this a try.