July 18, 2001 (Washington) -- In response to reports of parents being pressured by school officials to place their children on Ritalin or similar drugs to treat attention deficit hyperactivity disorder, or ADHD, several state legislatures are enacting or considering legislation that may discourage schools from playing doctor.
But these laws may do more harm than good, because schools can play vital roles in diagnosing ADHD as well as treating the condition, experts say.
According to the National Institute of Mental Health, approximately 4.1% of children between the ages of 9 and 17 have ADHD, which includes the symptoms of an inability to stay focused or finish tasks. Children with this condition may also have depressive and anxiety disorders or engage in drug abuse.
Connecticut recently became the first state to enact legislation that specifically prohibits school officials from recommending psychotropic drugs -- the class of drug that Ritalin belongs to -- to parents for their children. Under the Connecticut law, school personnel can, however, recommend that children be evaluated by a doctor.
Colorado's Board of Education enacted a resolution in 1999 to encourage the use of classroom management modifications to deal with behavioral problems rather than prescription medications.
Other states, including Washington, North Carolina, Hawaii, and Georgia, have passed legislation that calls for a closer look at the use of Ritalin and other ADHD drugs in children and their effect on learning.
"It's not the role of school psychologists or personnel to recommend medication," says Clarke Ross, DPA, CEO of the patient advocacy group Children and Adults with Attention-Deficit/Hyperactivity Disorder, or CHADD, which is supportive of the type of legislation that Connecticut enacted. School officials' role is "to identify learning problems of children and to encourage medical evaluation," he tells WebMD.
But Daniel Lieberman, MD, a psychiatrist and director of outpatient psychiatry at George Washington University in Washington, takes a different view. He agrees that "it's totally inappropriate for school officials to press a parent to place a child on medication." However, he doesn't believe that legislation is an appropriate response to this situation.
He fears that legislation may discourage teachers from taking action when they know there's a problem for fear of being punished under the law. Then "parents would never hear about what's happening in school [with their children]."
In some cases, a child with ADHD could go undiagnosed, Lieberman says. This is because the condition can sometimes only become apparent "in highly structured situations," such as school, and the parents may not pick up on the symptoms at home.
And when it comes to diagnosing the condition, even doctors can have difficulty. Some doctors are not familiar with proper guidelines for diagnosing ADHD and hence some underdiagnose the condition and others overdiagnose it, according to the National Institute of Mental Health.
Citing a 1999 report from the U.S. Surgeon General, Ross says that a proper diagnosis of ADHD requires a comprehensive and complete examination by a trained professional. "This is not something you do in one session," he says, noting that the doctor needs to be able to identify a pattern of behaviors that are repeated over time to accurately diagnose ADHD.
The American Academy of Pediatrics shares Lieberman's views that teachers may have a role to play in the management of ADHD. The AAP plans to release guidelines in October helping doctors determine the best way to treat ADHD, and one component of the guidelines will point out the importance of "teachers working with parents not only to diagnose the condition but to help treat it," a source at AAP tells WebMD.
This is because appropriate treatment of this condition should involve not only medication, such as the commonly prescribed Ritalin or Adderall, but behavioral and educational therapy. So schools can play a role in ensuring that ADHD children receive appropriate educational intervention, the AAP source says.
Another issue is whether schools pushing Ritalin is a widespread problem or a matter of a few isolated cases. Despite reports in the media of parents being pressed by school officials to place their children on ADHD medication, no formal surveys have ever been done to assess the extent of the problem. So "whether we have a few cases or a lot remains to be seen," Lieberman says.
But Lieberman says he has not had any of his patients complain about it, and Ross says no incidence like this has been reported by CHADD members. Ross, whose son has ADHD, adds that he doesn't really believe it's a problem across the country.
Even the Connecticut law was based on anecdotal evidence of parents complaining that schools were pressuring them, says David Wilkins, spokesman for Rep. Lenny Wilkins, who authored the legislation. No formal, scientific evaluations of the problem were ever done, Wilkins tells WebMD.
Ross notes that similar legislation has not been proposed at the federal level, and he doubts that it ever will be. This is because the federal government funds less than 10% of elementary and secondary schools, so the issue of ADHD drugs in these schools remains largely the purview of state and local governments, he says.