Don't give kids ADHD drugs as study aid, doctors warn

Kim Painter, Special for USA TODAY | USATODAY

Doctors should not give in to pressure to prescribe medications that might boost mental performance in healthy children and teens, leading neurologists say in a new position paper.

The report focuses mostly on inappropriate use of Ritalin, Adderall and other stimulant medications commonly used to treat attention deficit hyperactivity disorder (ADHD). The medications are sought out by some parents, teens and college students as grade-boosting "study drugs."

It's not clear how common such misuse is, but some data suggest it is increasing, says the report from the American Academy of Neurology, Child Neurology Society and American Neurological Association, published Wednesday in the journal Neurology.

Doctors have an ethical obligation not to be part of the problem, the paper says.

"Doctors need to be more aware of this," says lead author William Graf, a child neurologist from Yale University. While some might knowingly prescribe unneeded medication, others might not recognize parents seeking an edge for a healthy child or a teen faking symptoms to get pills for their own use or to distribute to others, he says.

The report cites a nationwide survey of high school students that found about 3% of 12th-graders used Adderall without a prescription in 2008; most got the medication from friends or relatives.

The report also notes that diagnoses of ADHD and prescriptions for stimulants have increased greatly over two decades. Those jumps may reflect actual increases in the condition or growing recognition of its toll, but the neurologists write that "it is generally believed that some portion of the increase in stimulant use is attributable to neuroenhancement, especially among older teens."

Graf says that the report should not be seen as a criticism of stimulant use for the treatment of ADHD, which affects 3% to 7% of children. "We've all seen kids who have benefited from treatment, who have gone from not being able to function in a mainstream classroom to being able to function," he says.

But healthy children should not be exposed to drug risks and side effects and are not mature enough to consider the consequences, the paper says. It says doctors might take more leeway with adults seeking the same kind of cognitive enhancement.

While the ethical arguments in the paper are on target, doctors struggle with the fact that many patients fall into a "gray area between having a clear disorder and being totally normal," says Ben Vitiello, chief of the treatment and intervention branch of the National Institute of Mental Health. Parents, he says, also struggle with doing the right thing for their children in "a culture that is pushing kids to excel."

The report points to a real problem, but it is also a problem that most children and teens who actually have ADHD are not adequately treated for it, says Mark Wolraich, a pediatrician at Oklahoma University Health Sciences Center. He helped write ADHD treatment guidelines for the American Academy of Pediatrics.

Wolraich says he also worries that the public may have a growing "sense that these are dangerous drugs." But, he says, "used appropriately, in the appropriate doses, they have a large margin of safety." The most common side effects, he says, are reduced appetite and disrupted sleep. Rarer side effects can include hallucinations. Some users become addicted.

The pediatrics academy also has urged doctors to watch out for misuse and to warn teens not to share or sell their medications.