An article in the Wall Street Journal has re-started public discussion on why so many students are taking medication to treat attention deficit hyperactivity disorder (ADHD). It’s a thorny issue with implications for the kind of schools we have, the kind of schools we want and how we view students and their learning.
New research, conducted by the National Bureau of Economic Research and published in June, studied how taking Ritalin, a medication commonly prescribed for ADHD, affected students in Quebec. According to the study, taking Ritalin caused “…increases in emotional problems among girls, and reductions in educational attainment among boys…”. This is disturbing news for students, parents and educators.
There has been an explosion in the use of medication to treat ADHD in children in recent years. In March, 2013 the Center for Disease Control reported “…a 16 percent increase since 2007 and a 41 percent rise in the past decade…” in the number of US children diagnosed with ADHD. Currently nearly one in five high school boys and 11% of all school age children are diagnosed with ADHD. In the wake of these revelations some critics are suggesting that prescribing ADHD medication (and the resultant side effects) to children, without gains in learning constitutes “malpractice”.
I can’t find Canadian stats, but my own classroom experience suggests a similar pattern of use. My class last year, which was typical, had 16% of students taking ADHD medication. All of these students were boys. In fact, the majority of students diagnosed with ADHD are boys. Boys are five to nine times more likely to be diagnosed with ADHD, leading some to suggest that this is evidence of a ‘war on boys’ in our schools.
The high rates of ADHD, and the resultant medication use, says a lot about the culture in schools. Students who don’t progress are pathologized, and schools only accept or allow for deviation if it’s supported by a label. There used to be an understanding that schools can’t meet every student’s needs, but no longer. We devote extensive resources to finding out why a student isn’t learning and ensuring they have every chance to be successful. This process, along with the need for labels, leads to higher rates of diagnosis.
Learning is a complex process and it’s difficult to determine whether it occurred. Standardized tests are unreliable indicators of the many ways learning happens. Further, just because a student can sit still and pay attention doesn’t mean they have the skills to learn. Students struggle with ADHD for years causing a skills deficit and layers of coping strategies that interfere with learning. Prescribing and using medication is merely the first of several steps in helping a student with ADHD to learn.
The presence of a student with ADHD often impacts on the learning of the whole class. Students with ADHD can be disruptive, making learning more difficult for other students. Teachers devote time to managing and supporting students with ADHD, meaning less time and support is available for other students. It’s likely that the learning of the class improves when a student with ADHD is successfully treated with medication, even though their individual learning may not.
The value of ADHD medication is not exclusively in improving academic learning. Students with ADHD struggle daily to meet basic expectations leading to lower self-esteem. Medication helps students with ADHD to improve their quality of life, with more friendships and a more positive attitude about school and life. That may, in the long run, be more important than a gain in academic learning.
I prefer using methods other than medication to support students with ADHD whenever possible. A classroom environment where students work in collaborative small groups and have the freedom to move around if needed can be helpful. A well constructed and implemented IEP (Individual Education Plan) with useful accommodations and strategies is also recommended.
The decision of whether or not to use medication to treat ADHD is a difficult one for parents. There are multiple factors to consider and every case is different. It is especially complicated for parents without the resources to provide the extensive support a child with ADHD may need. Constantly taking time off work to deal with problems at school isn’t a viable option for most parents. Sometimes it isn’t a matter of choosing the best solution, but rather finding the right option given the many constraints. And sometimes, that’s medication.