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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.”
