Can a pill make up for underfunded schools, lackluster teachers, and overcrowded classrooms? That's the question The New York Times explored earlier this week with an article about doctors who are giving the drug Adderall to elementary school students who don't have Attention Deficit Hyperactivity Disorder.
The story understandably set off a firestorm — Wednesday, comedian Stephen Colbert pilloried Atlanta-area doctor Michael Anderson, who told the Times that "we've decided as a society that it's too expensive to modify the kid's environment. So we have to modify the kid."
His "Word" of the day was "Meducation."
"We have tried everything to improve our public schools — No Child Left Behind, Race to the Top. One thing we've overlooked is the most obvious answer of them all," The Colbert Report host joked. "Wonderdrugs."
New York Times national correspondent Alan Schwarz profiled Anderson and some of his patients, including Alexis and Ethan Rocafort, two children whose parents say they don't have ADHD but who have been prescribed Adderall by Anderson.
In a separate interview with U.S. News, Anderson says it's easy to understand why parents and experts have hammered him in the aftermath of the article.
"It's not just blowback, I'm getting hate mail," he says. Anderson claims he has never prescribed Adderall to a patient who he didn't believe had some form of the disorder, which can be tricky to diagnose. He won't prescribe Adderall to students who are already doing well in school.
Any time a doctor decides to prescribe [Adderall], he or she has to make a judgment call, he says. "I wasn't saying that ADHD doesn't exist, I'm saying a board of people came around and said 'This is what ADHD is and they voted on it.' It's not a broken nose, it's not a blood test."
"Anyone who reads the ADHD criteria would say 'Wow, this sounds like someone who is going to be having trouble in school,'" he adds. "This is multi-factoral, it's not a simple issue."
Ruth Hughes, CEO of Children and Adults with Attention-Deficit/Hyperactivity Disorder, says doctors like Anderson and articles about the misuse of Adderall are damaging to the ADHD community.
"There's no doubt a lot of people use stimulant medications who aren't prescribed them, but I would be shocked if it's widespread in elementary school," she says. With the Times covering the misuse of Adderall several times over the past few years, "you'd think the problem is growing rapidly," she adds.
Prescription drug misuse, including Adderall and other drugs used to treat ADHD, actually fell 14 percent among 18-25 year olds and remained flat among children aged 12-17 between 2010 and 2011, according to the just-released U.S. Department of Health and Human Services' National Survey on Drug Use and Health.
There's little doubt that Adderall helps students with ADHD focus and can even help students without ADHD study. Some of the experts quoted in the Times say that, on principle, Anderson's strategy should work.
"Contrary to some myths, stimulants work the same way for a person without ADHD as they do for people with it. They make the brain work more efficiently by making more dopamine available," Hughes says. "It's not surprising people without ADHD feel like they can focus better."
But Hughes says that prescribing the drug to people without ADHD "does people with ADHD a huge disservice. It reflects poorly on the people who really need these medications."
"We're seriously concerned that any physician would prescribe ADHD medication to someone they didn't deem had the disorder," she says. "That takes my breath away. I'm not sure what to say about that. It isn't a good medical practice."
Schwarz says that Anderson is a doctor who cares about his patients, and that "the point of the story was to show that different doctors have different approaches to assessing the disorder."
"It's quite clear that the line between who has ADHD and who is taking medication for ADHD without meeting criteria for the disorder has become dangerously blurred," he says. "The point behind these two stories and any future ones was to separate those two groups and to preserve respect for the very real disorder and the very real struggles by removing or by pointing out groups that are diluting their ranks."
Studies have shown that an increase in class size leads to an increase in the number of children diagnosed with ADHD, so Anderson says it makes sense that many students in his county, which he says is generally poor and has overcrowded schools, have ADHD.
"The world has decided we'll have to adjust the patient and not adjust the patient's environment … we as a society haven't come out and said 'Hey, we're making this worse with the classroom sizes,'" he says. "You don't have to be a quantum mechanics instructor to know that if you make an environment more difficult, complicated, and distracting, you're going to have an increase in this problem."
It's a point Colbert summed up Wednesday in his own manner: "The point is that students thrive when they get personal attention. Since we can't afford all the teachers it takes to give them that attention, we'll give them a pill that helps them pay attention," he joked. "I just hope they don't pay attention to how little attention we're giving them."
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Jason Koebler is a science and technology reporter for U.S. News & World Report. You can follow him on Twitter or reach him at firstname.lastname@example.org.