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Oct. 11th, 2012 11:52 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
conulyNo Appetite for Good-for-You School Lunches
Outside Pittsburgh, they are proclaiming a strike, taking to Twitter and Facebook to spread the word. In a village near Milwaukee, hundreds staged a boycott. In a small farming and ranching community in western Kansas, they have produced a parody video. And in Parsippany, N.J., the protest is six days old and counting.
They are high school students, and their complaint is about lunch — healthier, smaller and more expensive than ever.
The Healthy, Hunger-Free Kids Act of 2010, which required public schools to follow new nutritional guidelines this academic year to receive extra federal lunch aid, has created a nationwide version of the age-old parental challenge: persuading children to eat what is good for them.
Because the lunches must now include fruits and vegetables, those who clamor for more cheese-laden nachos may find string beans and a peach cup instead. Because of limits on fat and sodium, some of those who crave French fries get baked sweet-potato wedges. Because of calorie restrictions, meat and carbohydrate portions are smaller. Gone is 2-percent chocolate milk, replaced by skim.
“Before, there was no taste and no flavor,” said Malik Barrows, a senior at Automotive High School in Brooklyn, who likes fruit but said his classmates threw away their mandatory helpings on the cafeteria floor. “Now there’s no taste, no flavor and it’s healthy, which makes it taste even worse.”
Students organized lunch strikes in a suburb of Pittsburgh, where in late August the hashtag “brownbagginit” was trending on Twitter, and outside Milwaukee, where the Mukwonago High School principal, Shawn McNulty, said participation in the lunch program had fallen 70 percent.
“There is a reduction in nacho chips, there is a reduction in garlic bread, but there’s actually an increase in fruits and vegetables,” Mr. McNulty said. “That’s a tough sell for kids, and I would be grumbling, too, if I was 17 years old.”
In New Jersey, more than 1,200 people have joined a Facebook group that urges Parsippany Hills High School students to boycott the school lunches. Despite the enticement of a Chinese-themed lunch a week ago Friday, the first day of the strike, only a few students bought anything from the cafeteria, according to the strike organizers.
The set lunch that cost $2.50 last year now costs $2.60. The cafeteria still offers pizza, French fries and chicken nuggets, but all of the servings have shrunk. And the packaged baby carrots and apples that each student must take before leaving the lunch line usually end up in the trash, said Brandon Faris, a boycott organizer.
“Everybody in the school’s like, ‘Have you seen the lunch prices? It’s ridiculous!’ ” said Brandon, who derided the Chinese food as a “bribe.” “The portion of the meal went down; the price should also go down.”
According to the new restrictions, high school lunches must be no more than 850 calories, middle school lunches no more than 700 calories and elementary school lunches no more than 650. Before, there were no maximums.
At the same time, prices have gone up about 10 cents in many districts for students who do not qualify for free lunch, both to pay for fresh fruits and vegetables and to obey a federal requirement that lunch prices gradually increase to help cover their cost.
In Sharon Springs, Kan., lunch protesters at Wallace County High School posted a video on YouTube, “We Are Hungry”; in it, students faint in the hallways and during physical education class, acting as if they had been done in by meager helpings of potato puff casserole and chicken nuggets. To the tune of the song “We Are Young” by Fun, one student on the video sings, “My friends are at the corner store, getting junk so they don’t waste away.”
Since it was uploaded three weeks ago, “We Are Hungry” has had nearly 900,000 views.
Callahan Grund, a junior who stars in the video, said, “My opinion as a young farmer and rancher is that we produced this protein and it’s not being used to its full advantage.” He wakes up early every morning to do chores, stays after school for two hours of football practice and returns home for another round of chores. If it were not for the lunches his mother now packs him, he said, he would be hungry again just two hours after lunch.
In New York City, where school officials introduced whole-wheat breads, low-fat milk and other changes several years ago, the most noticeable change this year is the fruit and vegetable requirement, which has resulted in some waste, according to Eric Goldstein, the Education Department official who oversees food services. It is not hard to see why. At Middle School 104 in Gramercy Park on Friday, several seventh graders pronounced vegetables “gross.”
“I just throw them out,” said Danielson Gutierrez, 12, carrying a slice of pizza, which he had liberally sprinkled with seasonings, and a pear. He also offered his opinion on fruit: “I throw them out, too. I only like apples.”
Courtney Rowe, a spokeswoman for the United States Department of Agriculture, which sets school food regulations, said that despite the complaints about lighter lunches, federal audits showed the average high school lunch before this year contained only 730 calories, less than the minimum number of calories they must now contain, 750.
Of course, students may not be eating all the calories they are being served, though Ms. Rowe noted that in most schools, students have the option of buying additional food à la carte.
Sandra Ford, president of the School Nutrition Association, said food service directors were using a variety of strategies to get students to embrace the new menus, including asking teachers to talk about healthy food in class, conducting taste tests, handing out free samples and educating students about how their food is grown and made.
But the most effective strategy, several food service directors said, may simply be waiting. Research shows that children must be exposed to vegetables 10 to 12 times before they will eat them on their own, said William J. McCarthy, a professor of public health and psychology at the University of California, Los Angeles.
“If our task is to get young kids to eat more fruits and vegetables, we have to be willing to put up with the waste,” he said.
Few school districts have been as extreme in their efforts as Los Angeles, which introduced a menu of quinoa salads, lentil cutlets, vegetable curry, pad Thai and other vegetarian fare last fall. When students began rejecting the lunches en masse, the district replaced some of the more exotic dishes with more child-friendly foods, like pizza with whole-wheat crust, low-fat cheese and low-sodium sauce.
But this year, even the whole-wheat pizza is gone, replaced by calzones, fajitas and other, smaller entrees with side dishes of fruits and vegetables.
Nicole Anthony, the cafeteria manager at one Los Angeles school, Nimitz Middle School in Huntington Park, estimated that out of the 1,800 students, almost all of whom qualify for a free or reduced-price lunch, only 1,200, “on a good day,” now eat the cafeteria’s offerings.
Ms. Anthony is not optimistic that the students will warm to their new lunches anytime soon — not as long as they can buy Flamin’ Hot Cheetos from the vending machines or brownies from the student store for lunch.
“Why would I come over here for a chicken and apple when I can get a cookie and some Gatorade and some gummies?” she said. “What would you choose?”
Juliet Linderman contributed reporting.
Attention Disorder or Not, Pills to Help in School
October 9, 2012
Attention Disorder or Not, Pills to Help in School
By ALAN SCHWARZ
CANTON, Ga. — When Dr. Michael Anderson hears about his low-income 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. Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder “made up” and “an excuse” to prescribe the pills to treat what he considers the children’s true ill — poor academic performance in inadequate schools.
“I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”
Dr. Anderson is one of the more outspoken proponents of an idea that is gaining interest among some physicians. They are prescribing stimulants to struggling students in schools starved of extra money — not to treat A.D.H.D., necessarily, but to boost their academic performance.
It is not yet clear whether Dr. Anderson is representative of a widening trend. But some experts note that as wealthy students abuse stimulants to raise already-good grades in colleges and high schools, the medications are being used on low-income elementary school children with faltering grades and parents eager to see them succeed.
“We as a society have been unwilling to invest in very effective nonpharmaceutical interventions for these children and their families,” said Dr. Ramesh Raghavan, a child mental-health services researcher at Washington University in St. Louis and an expert in prescription drug use among low-income children. “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, added: “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.”
Dr. Anderson’s 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 the round holes of public education. Because their families can rarely afford behavior-based therapies like tutoring and family counseling, he said, medication becomes the most reliable and pragmatic way to redirect the student toward success.
“People who are getting A’s and B’s, I won’t give it to them,” he said. For some parents the pills provide great relief. Jacqueline Williams said she can’t thank Dr. Anderson enough for diagnosing A.D.H.D. in her children — Eric, 15; Chekiara, 14; and Shamya, 11 — and prescribing Concerta, a long-acting stimulant, for them all. She said each was having trouble listening to instructions and concentrating on schoolwork.
“My kids don’t want to take it, but I told them, ‘These are your grades when you’re taking it, this is when you don’t,’ and they understood,” Ms. 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 A.D.H.D. medications to help a struggling student. Others — even among the many like Dr. Rappaport who praise the use of stimulants as treatment for classic A.D.H.D. — fear that doctors are exposing children to unwarranted physical and psychological risks. Reported side effects of the drugs have included growth suppression, increased blood pressure and, in rare cases, psychotic episodes.
The disorder, which is characterized by severe inattention and impulsivity, is an increasingly common psychiatric diagnosis among American youth: about 9.5 percent of Americans ages 4 to 17 were judged to have it in 2007, or about 5.4 million children, according to the Centers for Disease Control and Prevention.
The reported prevalence of the disorder has risen steadily for more than a decade, with some doctors gratified by its widening recognition but others fearful that the diagnosis, and the drugs to treat it, are handed out too loosely and at the exclusion of nonpharmaceutical therapies.
The Drug Enforcement Administration classifies these medications as Schedule II Controlled Substances because they are particularly addictive. Long-term effects of extended use are not well understood, said many medical experts. Some of them worry that children can become dependent on the medication well into adulthood, long after any A.D.H.D. symptoms can dissipate.
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 A.D.H.D., but also has no related condition like 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 A.D.H.D. diagnoses, with many of them following personal instinct.
On the Rocafort family’s kitchen shelf in Ball Ground, Ga., next to the peanut butter and chicken broth, sits a wire basket brimming with bottles of the children’s medications, prescribed by Dr. 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 A.D.H.D. 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 — a little bit more like Perry, who also took Adderall for his A.D.H.D.
When puberty’s chemical maelstrom began at about 10, though, Quintn got into fights at school because, he said, other children were insulting his mother. The problem was, they were not; Quintn was seeing people and hearing voices that were not there, a rare but recognized side effect of Adderall. After Quintn admitted to being suicidal, Dr. Anderson prescribed a week in a local psychiatric hospital, and a switch to Risperdal.
While telling this story, the Rocaforts called Quintn into the kitchen and asked him to describe why he had been 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. He described the week in the hospital and the effects of Risperdal: “If I don’t take my medicine I’d be having attitudes. I’d be disrespecting my parents. I wouldn’t be like this.”
Despite Quintn’s experience with Adderall, the Rocaforts decided to use it with their 12-year-old daughter, Alexis, and 9-year-old son, Ethan. These children don’t have A.D.H.D., their parents said. The Adderall is merely to help their grades, and because Alexis was, in her father’s words, “a little blah.”
”We’ve seen both sides of the spectrum: we’ve seen positive, we’ve seen negative,” the father, Rocky Rocafort, said. Acknowledging that Alexis’s use of Adderall is “cosmetic,” he added, “If they’re feeling positive, happy, socializing more, and it’s helping them, why wouldn’t you? Why not?”
Dr. William Graf, a pediatrician and child neurologist who serves many poor families in New Haven, said that a family should be able to choose for itself whether Adderall can benefit its non-A.D.H.D. child, and that a physician can ethically prescribe a trial as long as side effects are closely monitored. He expressed concern, however, that the rising use of stimulants in this manner can threaten what he called “the authenticity of development.”
“These children are still in the developmental phase, and we still don’t know how these drugs biologically affect the developing brain,” he said. “There’s an obligation for parents, doctors and teachers to respect the authenticity issue, and I’m not sure that’s always happening.”
Dr. Anderson said that every child he treats with A.D.H.D. medication has met qualifications. But he also railed against those criteria, saying they were codified only to “make something completely subjective look objective.” He added that teacher reports almost invariably come back as citing the behaviors that would warrant a diagnosis, a decision he called more economic than medical.
“The school said if they had other ideas they would,” Dr. Anderson said. “But the other ideas cost money and resources compared to meds.”
Dr. Anderson cited William G. Hasty Elementary School here in Canton as one school he deals with often. Izell McGruder, the school’s principal, did not respond to several messages seeking comment.
Several educators contacted for this article considered the subject of A.D.H.D. so controversial — the diagnosis was misused at times, they said, 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 of A.D.H.D. have risen as sharply as school funding has declined.
“It’s scary to think that this is what we’ve 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 A.D.H.D. “I don’t know, but 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 it’s A.D.H.D., let’s give this a try.’ ”
When told that the Rocaforts insist that their two children on Adderall do not have A.D.H.D. and never did, Dr. Anderson said he was surprised. He consulted their charts and found the parent questionnaire. Every category, which assessed the severity of behaviors associated with A.D.H.D., received a five out of five except one, which was a four.
“This is my whole angst about the thing,” Dr. Anderson said. “We put a label on something that isn’t binary — you have it or you don’t. We won’t just say that there is a student who has problems in school, problems at home, and probably, according to the doctor with agreement of the parents, will try medical treatment.”
He added, “We might not know the long-term effects, but we do know the short-term costs of school failure, which are real. I am looking to the individual person and where they are right now. I am the doctor for the patient, not for society.”
Outside Pittsburgh, they are proclaiming a strike, taking to Twitter and Facebook to spread the word. In a village near Milwaukee, hundreds staged a boycott. In a small farming and ranching community in western Kansas, they have produced a parody video. And in Parsippany, N.J., the protest is six days old and counting.
They are high school students, and their complaint is about lunch — healthier, smaller and more expensive than ever.
The Healthy, Hunger-Free Kids Act of 2010, which required public schools to follow new nutritional guidelines this academic year to receive extra federal lunch aid, has created a nationwide version of the age-old parental challenge: persuading children to eat what is good for them.
Because the lunches must now include fruits and vegetables, those who clamor for more cheese-laden nachos may find string beans and a peach cup instead. Because of limits on fat and sodium, some of those who crave French fries get baked sweet-potato wedges. Because of calorie restrictions, meat and carbohydrate portions are smaller. Gone is 2-percent chocolate milk, replaced by skim.
“Before, there was no taste and no flavor,” said Malik Barrows, a senior at Automotive High School in Brooklyn, who likes fruit but said his classmates threw away their mandatory helpings on the cafeteria floor. “Now there’s no taste, no flavor and it’s healthy, which makes it taste even worse.”
Students organized lunch strikes in a suburb of Pittsburgh, where in late August the hashtag “brownbagginit” was trending on Twitter, and outside Milwaukee, where the Mukwonago High School principal, Shawn McNulty, said participation in the lunch program had fallen 70 percent.
“There is a reduction in nacho chips, there is a reduction in garlic bread, but there’s actually an increase in fruits and vegetables,” Mr. McNulty said. “That’s a tough sell for kids, and I would be grumbling, too, if I was 17 years old.”
In New Jersey, more than 1,200 people have joined a Facebook group that urges Parsippany Hills High School students to boycott the school lunches. Despite the enticement of a Chinese-themed lunch a week ago Friday, the first day of the strike, only a few students bought anything from the cafeteria, according to the strike organizers.
The set lunch that cost $2.50 last year now costs $2.60. The cafeteria still offers pizza, French fries and chicken nuggets, but all of the servings have shrunk. And the packaged baby carrots and apples that each student must take before leaving the lunch line usually end up in the trash, said Brandon Faris, a boycott organizer.
“Everybody in the school’s like, ‘Have you seen the lunch prices? It’s ridiculous!’ ” said Brandon, who derided the Chinese food as a “bribe.” “The portion of the meal went down; the price should also go down.”
According to the new restrictions, high school lunches must be no more than 850 calories, middle school lunches no more than 700 calories and elementary school lunches no more than 650. Before, there were no maximums.
At the same time, prices have gone up about 10 cents in many districts for students who do not qualify for free lunch, both to pay for fresh fruits and vegetables and to obey a federal requirement that lunch prices gradually increase to help cover their cost.
In Sharon Springs, Kan., lunch protesters at Wallace County High School posted a video on YouTube, “We Are Hungry”; in it, students faint in the hallways and during physical education class, acting as if they had been done in by meager helpings of potato puff casserole and chicken nuggets. To the tune of the song “We Are Young” by Fun, one student on the video sings, “My friends are at the corner store, getting junk so they don’t waste away.”
Since it was uploaded three weeks ago, “We Are Hungry” has had nearly 900,000 views.
Callahan Grund, a junior who stars in the video, said, “My opinion as a young farmer and rancher is that we produced this protein and it’s not being used to its full advantage.” He wakes up early every morning to do chores, stays after school for two hours of football practice and returns home for another round of chores. If it were not for the lunches his mother now packs him, he said, he would be hungry again just two hours after lunch.
In New York City, where school officials introduced whole-wheat breads, low-fat milk and other changes several years ago, the most noticeable change this year is the fruit and vegetable requirement, which has resulted in some waste, according to Eric Goldstein, the Education Department official who oversees food services. It is not hard to see why. At Middle School 104 in Gramercy Park on Friday, several seventh graders pronounced vegetables “gross.”
“I just throw them out,” said Danielson Gutierrez, 12, carrying a slice of pizza, which he had liberally sprinkled with seasonings, and a pear. He also offered his opinion on fruit: “I throw them out, too. I only like apples.”
Courtney Rowe, a spokeswoman for the United States Department of Agriculture, which sets school food regulations, said that despite the complaints about lighter lunches, federal audits showed the average high school lunch before this year contained only 730 calories, less than the minimum number of calories they must now contain, 750.
Of course, students may not be eating all the calories they are being served, though Ms. Rowe noted that in most schools, students have the option of buying additional food à la carte.
Sandra Ford, president of the School Nutrition Association, said food service directors were using a variety of strategies to get students to embrace the new menus, including asking teachers to talk about healthy food in class, conducting taste tests, handing out free samples and educating students about how their food is grown and made.
But the most effective strategy, several food service directors said, may simply be waiting. Research shows that children must be exposed to vegetables 10 to 12 times before they will eat them on their own, said William J. McCarthy, a professor of public health and psychology at the University of California, Los Angeles.
“If our task is to get young kids to eat more fruits and vegetables, we have to be willing to put up with the waste,” he said.
Few school districts have been as extreme in their efforts as Los Angeles, which introduced a menu of quinoa salads, lentil cutlets, vegetable curry, pad Thai and other vegetarian fare last fall. When students began rejecting the lunches en masse, the district replaced some of the more exotic dishes with more child-friendly foods, like pizza with whole-wheat crust, low-fat cheese and low-sodium sauce.
But this year, even the whole-wheat pizza is gone, replaced by calzones, fajitas and other, smaller entrees with side dishes of fruits and vegetables.
Nicole Anthony, the cafeteria manager at one Los Angeles school, Nimitz Middle School in Huntington Park, estimated that out of the 1,800 students, almost all of whom qualify for a free or reduced-price lunch, only 1,200, “on a good day,” now eat the cafeteria’s offerings.
Ms. Anthony is not optimistic that the students will warm to their new lunches anytime soon — not as long as they can buy Flamin’ Hot Cheetos from the vending machines or brownies from the student store for lunch.
“Why would I come over here for a chicken and apple when I can get a cookie and some Gatorade and some gummies?” she said. “What would you choose?”
Juliet Linderman contributed reporting.
Attention Disorder or Not, Pills to Help in School
October 9, 2012
Attention Disorder or Not, Pills to Help in School
By ALAN SCHWARZ
CANTON, Ga. — When Dr. Michael Anderson hears about his low-income 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. Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder “made up” and “an excuse” to prescribe the pills to treat what he considers the children’s true ill — poor academic performance in inadequate schools.
“I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”
Dr. Anderson is one of the more outspoken proponents of an idea that is gaining interest among some physicians. They are prescribing stimulants to struggling students in schools starved of extra money — not to treat A.D.H.D., necessarily, but to boost their academic performance.
It is not yet clear whether Dr. Anderson is representative of a widening trend. But some experts note that as wealthy students abuse stimulants to raise already-good grades in colleges and high schools, the medications are being used on low-income elementary school children with faltering grades and parents eager to see them succeed.
“We as a society have been unwilling to invest in very effective nonpharmaceutical interventions for these children and their families,” said Dr. Ramesh Raghavan, a child mental-health services researcher at Washington University in St. Louis and an expert in prescription drug use among low-income children. “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, added: “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.”
Dr. Anderson’s 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 the round holes of public education. Because their families can rarely afford behavior-based therapies like tutoring and family counseling, he said, medication becomes the most reliable and pragmatic way to redirect the student toward success.
“People who are getting A’s and B’s, I won’t give it to them,” he said. For some parents the pills provide great relief. Jacqueline Williams said she can’t thank Dr. Anderson enough for diagnosing A.D.H.D. in her children — Eric, 15; Chekiara, 14; and Shamya, 11 — and prescribing Concerta, a long-acting stimulant, for them all. She said each was having trouble listening to instructions and concentrating on schoolwork.
“My kids don’t want to take it, but I told them, ‘These are your grades when you’re taking it, this is when you don’t,’ and they understood,” Ms. 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 A.D.H.D. medications to help a struggling student. Others — even among the many like Dr. Rappaport who praise the use of stimulants as treatment for classic A.D.H.D. — fear that doctors are exposing children to unwarranted physical and psychological risks. Reported side effects of the drugs have included growth suppression, increased blood pressure and, in rare cases, psychotic episodes.
The disorder, which is characterized by severe inattention and impulsivity, is an increasingly common psychiatric diagnosis among American youth: about 9.5 percent of Americans ages 4 to 17 were judged to have it in 2007, or about 5.4 million children, according to the Centers for Disease Control and Prevention.
The reported prevalence of the disorder has risen steadily for more than a decade, with some doctors gratified by its widening recognition but others fearful that the diagnosis, and the drugs to treat it, are handed out too loosely and at the exclusion of nonpharmaceutical therapies.
The Drug Enforcement Administration classifies these medications as Schedule II Controlled Substances because they are particularly addictive. Long-term effects of extended use are not well understood, said many medical experts. Some of them worry that children can become dependent on the medication well into adulthood, long after any A.D.H.D. symptoms can dissipate.
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 A.D.H.D., but also has no related condition like 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 A.D.H.D. diagnoses, with many of them following personal instinct.
On the Rocafort family’s kitchen shelf in Ball Ground, Ga., next to the peanut butter and chicken broth, sits a wire basket brimming with bottles of the children’s medications, prescribed by Dr. 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 A.D.H.D. 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 — a little bit more like Perry, who also took Adderall for his A.D.H.D.
When puberty’s chemical maelstrom began at about 10, though, Quintn got into fights at school because, he said, other children were insulting his mother. The problem was, they were not; Quintn was seeing people and hearing voices that were not there, a rare but recognized side effect of Adderall. After Quintn admitted to being suicidal, Dr. Anderson prescribed a week in a local psychiatric hospital, and a switch to Risperdal.
While telling this story, the Rocaforts called Quintn into the kitchen and asked him to describe why he had been 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. He described the week in the hospital and the effects of Risperdal: “If I don’t take my medicine I’d be having attitudes. I’d be disrespecting my parents. I wouldn’t be like this.”
Despite Quintn’s experience with Adderall, the Rocaforts decided to use it with their 12-year-old daughter, Alexis, and 9-year-old son, Ethan. These children don’t have A.D.H.D., their parents said. The Adderall is merely to help their grades, and because Alexis was, in her father’s words, “a little blah.”
”We’ve seen both sides of the spectrum: we’ve seen positive, we’ve seen negative,” the father, Rocky Rocafort, said. Acknowledging that Alexis’s use of Adderall is “cosmetic,” he added, “If they’re feeling positive, happy, socializing more, and it’s helping them, why wouldn’t you? Why not?”
Dr. William Graf, a pediatrician and child neurologist who serves many poor families in New Haven, said that a family should be able to choose for itself whether Adderall can benefit its non-A.D.H.D. child, and that a physician can ethically prescribe a trial as long as side effects are closely monitored. He expressed concern, however, that the rising use of stimulants in this manner can threaten what he called “the authenticity of development.”
“These children are still in the developmental phase, and we still don’t know how these drugs biologically affect the developing brain,” he said. “There’s an obligation for parents, doctors and teachers to respect the authenticity issue, and I’m not sure that’s always happening.”
Dr. Anderson said that every child he treats with A.D.H.D. medication has met qualifications. But he also railed against those criteria, saying they were codified only to “make something completely subjective look objective.” He added that teacher reports almost invariably come back as citing the behaviors that would warrant a diagnosis, a decision he called more economic than medical.
“The school said if they had other ideas they would,” Dr. Anderson said. “But the other ideas cost money and resources compared to meds.”
Dr. Anderson cited William G. Hasty Elementary School here in Canton as one school he deals with often. Izell McGruder, the school’s principal, did not respond to several messages seeking comment.
Several educators contacted for this article considered the subject of A.D.H.D. so controversial — the diagnosis was misused at times, they said, 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 of A.D.H.D. have risen as sharply as school funding has declined.
“It’s scary to think that this is what we’ve 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 A.D.H.D. “I don’t know, but 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 it’s A.D.H.D., let’s give this a try.’ ”
When told that the Rocaforts insist that their two children on Adderall do not have A.D.H.D. and never did, Dr. Anderson said he was surprised. He consulted their charts and found the parent questionnaire. Every category, which assessed the severity of behaviors associated with A.D.H.D., received a five out of five except one, which was a four.
“This is my whole angst about the thing,” Dr. Anderson said. “We put a label on something that isn’t binary — you have it or you don’t. We won’t just say that there is a student who has problems in school, problems at home, and probably, according to the doctor with agreement of the parents, will try medical treatment.”
He added, “We might not know the long-term effects, but we do know the short-term costs of school failure, which are real. I am looking to the individual person and where they are right now. I am the doctor for the patient, not for society.”
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no subject
Date: 2012-10-12 07:54 pm (UTC)This is so wrong I don't even have words for it.
no subject
Date: 2012-10-12 08:38 pm (UTC)I mean, sheesh, the shrinks have been routinely drugging-up the poor, the weird and the traumatized for half a century, on the specious pretext that their inability to thrive in a hostile and oppressive environment was an indication of mental illness, but now they've moved beyond that. Now they're saying openly that the hostile and oppressive environment is what's causing the 'illness', but Drugs Are Still The Answer because the schools are only going to continue to get worse, and most parents have no choice but to send their children to them. How refreshingly honest of them, just for a damn shame.
This country's getting more like Panem all the time. Hey, ya think the Tributes from District 2 - Clove and Cato - were on Adderal? Their behavior would certainly seem to fit the classic profile of addiction to ADHD meds, including the remorseless killing of other kids, which is a sadly common side-effect of those drugs.
As for the food? I say, first get all the junk-food out of the schools - all the vending machines, all the candy and chips and soda pop, all the bottled 'juice' products (including 100% fruit juice, usually meaning 80% apple) and fancy fizzy-water, and ALL the "kid-friendly" pizza, fries, and chicken nuggets. None of that stuff ever belonged in schools in the first place! Sure, children like treat-foods; they're fun and tasty - and that's fine as long as they're occasional treats; once in a while we order pizza or go through the drive-through; chips and soda pop are for picnics and parties, etc. Birthday cake is also a very "kid-friendly" food; that's not a good reason to serve it up weekly as an entree. Junk food go; no saving throw!
Then hire some real chefs - not steam-table cafeteria ladies whose culinary skills go no farther than following the instructions on a package, but the kind of people who can run a successful restaurant kitchen - pay them competitively, give them a proper budget for fresh, high-quality ingredients, let them hire their own help, design their own menus and set their own standards - voila, healthy AND delicious lunch every day.
Part of the reason these kids are fainting in the halls from hunger is that the high-calorie 'kid-friendly' junk food they like is served in small portions, and the healthy-but-uninspired fruit and veggies they get on the side are too boring to bother with, so get thown out. I say, go with casseroles, stir-fries etc. where the ingredients are all in together - then those who hate onions or mushrooms can pick them out, the same as previous generations had to do. Add a soup and salad bar, a choice of milk, water or iced herbal tea, and one tiny dessert per kid, and they're good to go.
no subject
Date: 2012-10-13 01:44 am (UTC)(Sidebar: the pizza I was served as a child wasn't friendly (http://marveen.livejournal.com/208865.html). Even now the memory makes me shudder.)
no subject
Date: 2012-10-13 07:20 am (UTC)no subject
Date: 2012-10-13 02:06 am (UTC)no subject
Date: 2012-10-13 07:54 am (UTC)If the schools don't even have kitchens, it's probably folly to hope for much improvement. The public-school system is so seriously broken in so many ways that nothing but drastically altering the whole public-education paradigm is going to do any good. Meanwhile, best to send children to school with their own lunch - too bad one can't send them with their own books and companions as well.
no subject
Date: 2012-10-13 02:16 pm (UTC)There are some groups which will help pay for you to equip a kitchen to your school and improve the lunches... buuuuuut not everybody can get a sponsorship that way, obviously.
no subject
Date: 2012-10-13 02:07 am (UTC)no subject
Date: 2012-10-13 03:25 am (UTC)SO OBNOXIOUS. If the government is providing the children with the food, I think the government has an obligation to make sure it's the healthiest food they can provide. Clearly a majority of the kids can provide their own lunches, as evidenced by the number of students boycotting, and clearly it's not hurting kids to go without, evidenced by the number of kids throwing away food. If they were really ACTUALLY hungry, they would eat it. I think the kids are spoiled and selfish, but I also wish the schools could make healthy AND appetizing foods. I could make super healthy, super yummy meals for $2.60 a meal (I can't determine if that's supposed to account for paying the lunch staff, or if that's included in the school budget and the lunch money is for food only. Even if it includes the lunch lady's wages, though, I STILL think I could do it).
no subject
Date: 2012-10-13 09:16 am (UTC)Kids have smaller stomachs and faster metabolisms. This means it doesn't take very much food to stop their hunger pangs, and if the food is not appetizing to them, they aren't motivated to keep eating when they' don't feel hungry. But when they don't eat enough to last them, they're very soon hungry again, and their mood and concentration goes to hell. From inside the actual classroom, it's clear that going hungry does hurt them; the difference between a good-lunch-day and a bad-lunch-day is notable all afternoon.
When students boycott lunch, that doesn't necessarily mean they're providing their own, unless you count spending their lunch money on junk food instead as providing. The kids who don't have any lunch money because they get free lunch are probably just going hungry all day, which totally negates the purpose of their being in school at all, because they can neither learn anything nor control their behavior when their bellies are empty.
The lunch ladies' wages would cost a great deal more if they were really cooking and washing up, rather than serving mass-produced packaged food out of steam tables. Even cooking for a family of four, compare the time-difference between making real mashed potatoes or instant mashies out of a box - let alone for a class of forty; which is just one class. Fresh food has to be bought fresh, takes more storage space and a lot more prep time. Fresh food is easier to ruin, too.
It could be done, but not easily, and not inexpensively. The kind of chef who'd be able to manage a kitchen turning out several thousand high-quality, well-prepared lunches five days a week can't be hired for cafeteria-lady wages, and anyone capable of doing the job right would be capable of getting a better job. Also the usual chef mentality (LOL, megalomania) isn't very compatible with the public school system's attitudes toward employees. If the only people who can do the job properly can get paid twice as much elsewhere, to work half as hard, and with twice as much autonomy, the job is not likely to be done properly.
The real lesson here is that factory-farming children is as bad an idea as factory-farming anything else: when quantity goes up, quality goes down. In the Waldorf schools, the children are involved in helping to prepare their own lunches from the very start, as part of their essential life-skills education, but that won't work in public school because there are too many kids, not to mention too many insurance issues about letting them near sharp or hot things.
no subject
Date: 2012-10-13 02:14 pm (UTC)no subject
Date: 2012-10-13 05:27 pm (UTC)Here's a radical notion: y'know how almost all American schools have acres of grass that has to be tended by paid employees with gas-powered equipment, all to provide space for moronic chase-the-ball team sports that teach us/them competitive attitudes and lead to thousands of injuries every year....? WHY should we taxpayers pay for all this useless grass, and all the expenses that go with team sports? Especially since the funds are apparently lacking to pay for quality food, which is far more important to developing bodies than chasing a stupid ball around a field.
So, "physical education" being expanded and revised to mean "learning how to take care of one's physical needs on a lifelong basis" would include doing the physical work to turn all that useless grass into beautiful perma-culture kitchen gardens. That whole "research shows" bit about kids needing ten or twelve exposures to a vegetable? Yeah right; teach them to grow snow peas and cherry tomatoes, watch how quick they nom those down. Strawberries, raspberries, radishes, carrots - all kinds of easy-to-grow, kid-friendly food that doesn't need to be cooked. Gardening is excellent exercise, and growing one's own healthy real food naturally leads to eating that food. Therefore stop wasting good land on sports and start subsidizing school gardens instead.
Afternoon snack for everyone, and mid-morning snack as well for the little guys, would be a good idea. Raw veggies go down a lot quicker when kids are hungry and that's all that's being served (with yogurt-dill dip, of course.)
Teens... their appetites vary wildly, and so does the type and amount of food they require. Consider also the implications of that other article: by their teens, a great many students are on psychoactive prescription drugs just to enable them to survive the stress that is high school. A lot of their parents are no better off, and feed the kids whatever's easiest because they don't have the spoons to do anything else.
I was hungry all through high school, and since I lived there, I had no home-cooked meals to go home to, nor was there a school store or any nearby shops. The food at school was not terrible by today's steam-table standards, and there was no shortage of it, but I didn't much like it, so I often didn't eat it. Then later I'd be utterly ravenous. LOL,
Anyway, it might be true of SOME children, that they'll eat whatever's given them if they're hungry enough, but for many children it's definitely not true: if the food looks, smells, tastes or feels unpleasant to them, they won't eat it. And then they'll be fractious, scattered and sullen for the rest of the day, because their stomachs are growling. Might just as well send them home for tea at that point, because they're getting no good from the class..
no subject
Date: 2012-10-18 10:44 pm (UTC)(Then again, I also sometimes dream of cheez whiz grilled cheese sandwiches, and I *know* how gross those are now that I'm no longer seven. My family always bought real butter, but cheez whiz? That was just fine.)
NYC don't have acres of grass around them, generally. NYC schools are lucky to have any amount of greenery around them.
no subject
Date: 2012-10-13 02:12 pm (UTC)