The Trouble With Adderall

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Focusing in on teenagers who don't even have ADHD: They're self-medicating in record numbers in order to get ahead in school.

 

According to a 2012 University of Michigan poll, roughly 10 percent of high school seniors reported using Adderall or Ritalin — drugs commonly prescribed for Attention Deficit Hyperactivity Disorder (ADHD) whether or not they actually had ADHD. What’s more, Adderall use is on the rise among 12th graders, increasing more than 1 percent from 2011. High school seniors feel the pressure to compete for coveted slots at prestigious universities and vie for limited scholarships. And they believe that these stimulants give them the boost to set themselves apart or even just to stay in the game. In 2013, nearly one-third of parents believe stimulants can improve academic performance — even for teens without ADHD, regardless of the medications’ long-term effects which are currently unknown regarding the adolescent brain.

“Teens feel the need to take prescription stimulants just to compete,” says Daniel Bober, M.D., a psychiatrist and assistant clinical professor at the Yale Child Study Center in New Haven, Conn. Overachieving parents may even be in on the act. “They come in, saying they want their teens on some kind of stimulant medication simply because many of their child’s classmates are taking it,” Bober says.

Prescription stimulants are legitimately prescribed for patients with ADHD. So why are teens without ADHD taking Adderall? Because there’s a widespread perception that these stimulants help you pull all-nighters and hyper-focus during high-stakes tests like finals or the ACT or SAT. Not true, says Joe Austerman, D.O., head of Cleveland Clinic’s Section of Child and Adolescent Psychiatry. “These medications work well if you have ADHD, but they actually don’t work very well if you don’t,” he says.

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SIGNS AND SYMPTOMS OF ADHD

The signs and symptoms of ADHD, which must habe been present for at least 6 months before diagnosis anc occur before age 12, may include:

• Difficulty paying attention
• Forgetfulness
• Can’t follow instructions
• Interrupts or talks excessively
• Has trouble playing quietly in a group
• Restless or jittery
• Has trouble focusing on a task at school or home
• Has difficulty forming or keeping friendships

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Good-Grade Pills?

Individuals with ADHD typically don’t produce enough dopamine, which can lead to distractedness and impulsivity, the hallmarks of the condition. That can impact many of the activities required for success in school, including organization, planning, time management and self-regulation. Stimulant medication makes up for the deficit, allowing students with ADHD to perform as well as their non-ADHD peers. “It helps 70 – 80 percent of the time in kids and about 70 percent of the time in adults,” Austerman says. “That’s a really high response rate.”

Teens without ADHD have sufficient dopamine. Without a medical reason to take a prescription stimulant, the positive results they get won’t last or weren’t real to begin with. “Stimulant drugs actually diminish a teen’s ability to focus over time,” says Lora Brown, M.D., medical director of the WAKE UP! Campaign, an initiative to prevent prescription drug abuse among teens and communities.

In part, that’s because the side effects of stimulants, which include sleeplessness, can interfere with academics. But, there’s also a placebo effect here.

“People think when they take these medications, they’re doing better,” Austerman explains. “But, research shows that people who don’t have ADHD don’t do any better grade-wise, and they don’t do any better test-taking wise.”

Worrisome Side Effects

There are very real side effects of taking stimulants, even for those with ADHD. These include agitation, irritability, weight loss and sleeplessness. Long-term use can also lead to dependence.

“Some teens can become addicted the first time they take a prescription stimulant. Others can take a drug for a year before having problems,” says Brown. While most teens won’t become physically addicted at all, the drugs can still mess with their heads.

“When teens use medication and get a much better result on an exam, they credit the medication and think they can’t study without the meds,” says Kevin Roberts, an academic turn-around specialist and author of Mirrors, Dreamers and Risk Takers: Unlocking the Power of ADHD (Hazelden; 2012).

In rare cases, the misuse of stimulant drugs may cause sudden cardiac death in those with a pre-existing heart condition. A 2010 study in the journal, Circulation, found that screening children diagnosed with ADHD for heart problems with an electrocardiogram before prescribing drugs like Adderall or Ritalin will prevent 13 deaths from sudden cardiac death per 400,000 kids older than 10 years. Of course, teens who misuse stimulants aren’t evaluated for potentially lethal heart problems.

Say No to Doping 

Teens often get Adderall or Ritalin from friends diagnosed with an ADHD diagnosis who sell or give away their pills. Brown urges parents to watch for signs of prescription stimulant abuse.

“Most parents don’t think the problem applies to their kid,” Brown says. Is your teen suddenly pulling all-nighters? Have his grades shot up or down? Other common stimulant side effects to watch for include stomach upset, loss of appetite, insomnia and mild anxiety. If you suspect your teen is using, call your pediatrician for a referral to an addiction specialist.

If your teen has ADHD, does he suddenly have his own money? Talk to your teen about the importance of taking his medication as prescribed and the dangers and illegality of supplying a controlled substance to others. Similarly, don’t pressure your doctor for a prescription. Physicians are being urged not to give in to parents seeking a prescription for stimulant medication for their non-ADHD teens.

“In our society, we tell people they have to be number one at all costs. But it’s not safe to put your teen in a position to abuse a medication,” says Bober.  Austerman agrees, adding that when teenagers (and parents) arrive in his office asking for stimulants, it’s rarely ADHD that’s the problem. “What’s happening is the teenagers are filling up their plates too much. They are overscheduled with academic and extracurricular activities, and now they also have this college pressure. So, their anxiety is increasing, and when your anxiety increases, your ability to concentrate goes down. They mislabel the anxiety and stress as ADHD and want to use medication to get back on track, instead of cutting back. That’s one of the hardest things to do, and most of the time, that pressure’s coming from the parents, not the student.”

 

Sandra Gordon is a freelance writer for this publication.

 

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