Poor kids with ADHD

An article in the NY Times, Attention Disorder or Not, Pills to Help in School (via Seth Roberts), discusses the use of drugs like Ritalin and Adderall to help “poor” children do better in school.

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.”

ADHD may very well be “made up”, since kids didn’t seem to suffer from this disorder a couple generations ago, and one even feels sympathetic to the idea that prescribing drugs can help these kids get through school. After all, lots of the big kids are doing it.

But what is it about “poor” children that they seem to need these more than those from wealthier households? The article never says, hoping that we won’t notice that the lack of money is unlikely to be the reason that drugs are needed to improve scholastic performance.

One possible explanation is that “poor” children’s lower IQs, inherited from their parents, cause them to be uninterested in school. To the rejoinder that, if Ritalin makes them get better grades, then they’re not dumb, I would reply that a minimum of attention in the modern public school will earn passing grades. Smarts aren’t necessary.

Another is that the parents are probably feeding their kids fast food and sodas all day long every day, perhaps seriously messing with neurological function. Plus TVs and video games are on nearly 24/7 in most of these households, providing a constant source of attention disruption. There’s a lot of childhood obesity in this demographic too. Of course the doctors never mention these things, and instead prescribe stimulants.

In the doctors’ (and Big Pharma’s) defense, the vast majority of people won’t make any lifestyle changes anyway. Doctors know very well to go always with the pills if they want to see any results.

However, after all this, one still has to ask what is so important about school that it requires drugging children. In contrast to the constant handwringing over education and its “gaps” in the mainstream press, I doubt that school does much of anything for the majority of the population. For most, it’s just a convenient babysitting arrangement for the parents, as well as full employment for teachers as well as a vast bureaucracy.


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Anonymous says October 14, 2012

A few real issues you are glossing over:

-other than stimulants, teachers do not have any practical means to control out of control children in today’s classrooms
-the demise of smoking means that people with concentration issues have fewer means to boost their concentration, and taking Ritalin is healthier than cigarrettes.
-people with ADHD tendencies have high breeding rates – hence the percentage of the population with ADHD may very well be increasing – certainly at least one ADHD expert believes so.

You are of course right that many lower IQ kids are being labelled as learning disabled, but this doesn’t necessarily mean society shouldn’t
be treating people with frontal lobe problems.

If Ritalin stops some impulsive idiot crashing into me on the motorway, I’m all for it.

bgc says October 14, 2012

This is not central to your argument, but the effectiveness of stimulants in some kids with behaviour problems is a very solid and obvious finding which dates back to the 1930s and the beginning usage of amphetamine. So although the specific name of ADHD is recent (especially 1980 DSM III, I think, made it popular) the problem and stimulant as treatment is pretty ancient, by medical standards.

The clue to ADHD lies in personality, rather than intelligence, I think – it is a heterogenous phenomenon, and perhaps includes a range of pathologies – but quite of lot of it is high Psychoticism trait (low Agreeableness, low Conscientiousness, high schizotypy).

Hence more common in men (who have higher P) and more common in groups which have not have many generations of selection in stable agricultural societies, high latitude, complex sedentary social systems etc.

High P often goes with lower average IQ at a population level, but within populations but is often separable (dissociable) – eg. smart but ADHD boys; dull but docile girls.

Mangan says October 14, 2012

Thanks for both comments. One point I was trying to make was that, while I’m not as alarmed as some others at amphetamines and the like being prescribed for ADHD, some very obvious factors that could be causative are being overlooked, sometimes deliberately. Diet, esp. when loaded with sugar and caffeine (soft drinks), hours in front of TV and video games, the former of which is known to cause behavior problems such as depression, plus the fact (I believe) that ADHD is found more among lower SES groups. Also let me repeat that I find it hard to take elementary and high school seriously, given the way that they’re taught to the LCD. I believe that modern public school benefits few people; thus, when someone doesn’t do well at it, there’s no cause for alarm.

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