Teachers Usually First to Report ADHD
Many Advocate ADHD Medications Merely to Keep Classroom Peace, Experts Say
"And now we're seeing a similar 20-fold increase in prescribing antidepressants in school-aged children, and many are being given to the same children on the stimulants," he tells WebMD.
When a teacher suspects ADHD in a child, parents are called in. "At that meeting, it's not uncommon for several teachers, the psychologist, and the principal to push for getting that child on medication, and it can be very intimidating for parents," says Sax. "The schools also know which doctors will rubber-stamp their recommendation. And when the parents want to go to another doctor, they may say, 'he's not a specialist.'"
Sax cites some of his own experiences, including one in which a second grader was suspected of having ADHD because he was inattentive in class. "The school wanted him on medication, but upon an examination, it turns out the child had obstructive sleep apnea and couldn't focus in class because he was sleep deprived. The teacher was correct that he was inattentive, but it wasn't because of ADD."
Another expert not involved in Sax's study says that while many schools indeed "overdiagnose" attention deficit disorders, others don't recommended ADHD medications enough for those who need it.
"Some schools and teachers definitely use medications as a form of behavioral control, so they overcall it, and some doctors prescribe the drugs more than they should to keep patients satisfied," says Edward Hallowell, MD, a Harvard psychiatrist who wrote Driven to Distraction, a best-selling book about ADD in children. "But there are other places where the mere mention of medication sends people through the roof, so they undercall it.
"Everybody wants to put an "either/or" label on this debate, but in reality, attention deficit disorders are both being overdiagnosed and underdiagnosed," Hallowell tells WebMD. "It all depends on where your child happens to go to school."
Both experts recommend that you get your own second opinion if your child is suspected of having ADD or ADHD -- either by you, school officials, or your family doctor. "And get it as far away from the school as possible -- ideally from a child psychiatrist," says Hallowell.