Hyperactive Prescribing? Ctd

Several readers sound off:

This thread has hit me a little close to home. I was misdiagnosed with ADHD when I was in preschool and was held back a year as a result. Because of the misdiagnosis, I’ve been a year older than most of my peer group for my whole life.

My parents sent me to a private Catholic school in suburban Philadelphia that required all of its kindergarteners to undergo a psychiatric screening for learning disabilities. I had previously been in the school’s pre-K program for a year. I remember the screening vividly. I was separated from my mom for what must’ve been a maximum of 10 minutes, and the doctor spoke to me for maybe half of that. He asked if I had a lot of friends, and I excitedly told him I did, and that I had memorized all of their phone numbers. I then went on to tell him each of those phone numbers for a minute or so.

Big mistake.

It turns out that in the report he filed with the school, and which my mom still has, he indicated that my hyperactivity was potentially indicative of ADHD, and recommended that I repeat pre-K. All based on the phone number recitation. Follow-up was recommended, but luckily my mom never had me go in for any prescriptions. I repeated the year because my parents thought it’d be too disruptive to force me to transfer schools, and the school wouldn’t budge on letting me go through.

So I was diagnosed as potentially hyperactive based on a 10-minute conversation with a psychiatrist who was paid on contract by my private school, and my parents were essentially forced to pay another year’s worth of tuition or transfer me to a different school. I’m not saying he probably had an incentive to diagnose kids coming to him from my school, but it certainly worked out for both him and the school. He’d get a lot of potential patients, in addition to whatever contract he had with them, and the school would get a few easy grade-repeaters.

I can say comfortably that the only net positive I ever got from the situation was being able to buy beer for my friend when we were sophomores in college. Aside from that, I’ve felt a year behind since I was a toddler, all because of this ridiculous over-diagnosis trend among the white upper class.

A similar story from another reader:

I have a 12-year-old son who is very bright and easily distracted. We have to stay on his butt about getting his homework done and being prepared for school, but we work hard at that, and he has gotten mostly straight-As this year, with no chemical assistance. It could have been a different story.

When he was entering third grade, he was assigned a teacher who I had heard wonderful things about, but when I went to parents’ night before school started, she scared the crap out of me. Within the first week of class, I’d already heard from her twice about how my son seemed distracted and had not gotten some assignment done. She treated it like a major crisis, so we set up a meeting with her. She said she’d looked through all his academic records and was surprised to see that he had not had academic problems in the past. She never used the words ADHD, but she strongly implied it. (My son had once had a preschool teacher who had implied something similar.)

I freaked out and we took our son to see his pediatrician, who after spending less than five minutes talking to us and to my son, offered to write us a prescription for Ritalin. Just like that. No recommendation for any further analysis or therapy, no discussion of the pros and cons. We said “No thanks.” Over the course of the next few weeks, everything settled down for my son, and by the time of our first parent/teacher conference his teacher seemed almost to have forgotten what she put us through in the first weeks of the school year.

I think boys and girls learn differently, and teachers are pressured to fit so much into every school day to keep up with all the standardized tests and so forth that they don’t have time to devote to different learning styles. So a lot of boys are drugged to make the day go more smoothly. It sounds harsh, but I believe it to be true.

A psychologist in training offers a different perspective:

As a third-year doctoral student in counseling psychology, I have some experience with testing for ADHD. I have spent two years working in my campus disability services office with an ADHD caseload, and I spent two semesters actually performing ADHD testing for a local medical school in my city. I realize what you posted was about children, but I think the overprescribing of ADHD meds to children is a symptom of a much larger cultural shift among their parents.

I was shocked when I started working at the medical school at how many students came in wanting to be tested for ADHD (and many were seeking meds). These were high-achieving students who had mostly sailed through private high schools and rigorous undergrad programs. A lot of them already had master’s degrees in things like biology and public health, but suddenly when they entered medical school they thought they might have ADHD. Why? Because medical school is hard. It is nearly impossible, and for the first time in many of their lives, they were being challenged. And they had no idea how to do it. So obviously they must have ADHD.

My caseload also includes a lot of students who do genuinely have ADHD, and they really, really struggle. If you truly have it, it is going to show up in your life long before you hit college, and it is going to be obvious. Those students deserve our compassion, and the accommodations they seek just to level the playing field.

But when I see (mostly privileged) medical students trying to game the system to gain a competitive edge, it makes me furious. But even worse, most of them truly believe they have it! Because suddenly something is difficult for them. This is the generation where everything is supposed to be easy, and if it’s not, there must be a problem.