Despite Stephen Colbert’s ‘Meducation’ endorsement – research shows that ADHD ‘smart drugs’ dumb down Aussie children

Stephen Colbert’s ‘Meducation’ plan for America’s third rate public schools – Don’t laugh too hard it is already happening (apologies for video quality – high quality video no longer available)

On October 10 2012 American comedian Stephen Colbert coined the term “meducation” to describe the growing practice of drugging with ADHD amphetamines, American children with mediocre school grades, who do not have a diagnosis of ADHD.

The catalyst for the mock right wing political commentator’s endorsement of ADHD drugs as smart pills was a front page article in the New York Times in which peadiatrician Dr Michael Anderson advocated their widespreade use to compensate for America’s third rate public education system. Doctor Anderson said “we’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.” Unlike Colbert, Dr Anderson is not a comedian but unfortunately for some of the children of Ganton Georgia he is their doctor.

In his comedic monologue Colbert argues the child drugging program should be extended beyond amphetamines. “Folks, I believe this is a great fiscally responsible answer, but we can do more.  I mean, we might be cutting arts programs, but one tab of acid, and your kid will be seeing colors you can’t find in a Crayola box.” Colbert’s mock rant concludes with a serious warning; “Now, of course, eventually it may turn out that drugging poor students creates more problems than it solves.  In which case, we’ll have to stop trying to change our children, and think about changing ourselves.”

Despite Dr Anderson’s claims and Colbert’s mock endorsement, ADHD amphetamines are anything but ‘smart drugs’. Unique long term (8 year) Australian research shows that children diagnosed ADHD and ‘ever medicated’ with amphetamines were a staggering 950% more likely to be rated by their teacher as “performing below age-level” than children diagnosed with ADHD and ‘never medicated’. (see far below) And as pointed out by Colbert the USA, the home of ADHD child drugging, lags most comparable developed nations (and a few second world nations) in terms of academic achievement.

The message is pretty clear – if you want to dumb down - speed up!

(A full transcript of Colbert’s ‘Meducation’ rant is available at http://www.dailykos.com/story/2012/10/11/1143009/-Stephen-Colbert-on-medicating-children-to-improve-their-grades )

Excerpt  from ‘Attention Disorder or Not, Pills to Help in School’

by Alan Schwarz New York Times, page 1, October 9, 2012

full text available at http://www.nytimes.com/2012/10/09/health/attention-disorder-or-not-children-prescribed-pills-to-help-in-school.html?pagewanted=1&_r=1&emc=eta1

When (American paediatrician) Dr. Michael Anderson hears about his low-income patients struggling in elementary school, he usually gives them a taste of some powerful medicine: Adderall (a mixture of four amphetamine salts¹)…

Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder “made up” and “an excuse” to prescribe the pills to treat what he considers the children’s true ill — poor academic performance in inadequate schools. “I don’t have a whole lot of choice…We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”…

Dr. Anderson’s instinct, he said, is that of a “social justice thinker” who is “evening the scales a little bit.” He said that the children he sees with academic problems are essentially “mismatched with their environment” — square pegs chafing the round holes of public education…

About 9.5 percent of Americans ages 4 to 17 were judged to have it (ADHD) in 2007, or about 5.4 million children, according to the Centers for Disease Control and Prevention²…

According to guidelines published last year by the American Academy of Pediatrics, physicians should use one of several behavior rating scales, some of which feature dozens of categories, to make sure that a child not only fits criteria for A.D.H.D., but also has no related condition like dyslexia or oppositional defiant disorder, in which intense anger is directed toward authority figures. However, a 2010 study in the Journal of Attention Disorders suggested that at least 20 percent of doctors said they did not follow this protocol when making their A.D.H.D. diagnoses, with many of them following personal instinct…

Dr. Anderson said (ADHD diagnostic criteria)…were codified only to “make something completely subjective look objective.”…

“This is my whole angst about the thing,” Dr. Anderson said. “We put a label on something that isn’t binary — you have it or you don’t. We won’t just say that there is a student who has problems in school, problems at home, and probably, according to the doctor with agreement of the parents, will try medical treatment.”

He added, “We might not know the long-term effects, but we do know the short-term costs of school failure, which are real. I am looking to the individual person and where they are right now. I am the doctor for the patient, not for society.”

Martin Whitely’s Comment – I am torn between loathing Doctor Anderson for his blatant disregard for the long term welfare of the children he is supposed to be helping; and respecting him for his honest assessment of the unscientific nature of an ADHD diagnosis and the American public education system. However, his justification for using Adderall on children with mediocre or worse grades is built on a very flawed premise; that is the belief that amphetamines are an academic performance enhancer.

 Australian study shows ‘Smart Pills’ a Dumb Claim

Published in February 2010 the Raine Study ADHD Medication Review provided the world’s first independent data on the long-term effects (eight years) of psychostimulant medication. (full opy available at http://www.health.wa.gov.au/publications/documents/MICADHD_Raine_ADHD_Study_report_022010.pdf)

The two most significant findings of the Raine Study ADHD Medication Review were:

1.   School failure: ‘In children with ADHD, ever receiving stimulant medication was found to increase the odds of being identified as performing below age-level by a classroom teacher by a factor of 10.5 times.”³

2.   Long-term cardiovascular damage: ‘The most noteworthy finding in the study was the association between stimulant medication and diastolic blood pressure. Compared to not receiving medication, the consistent use of stimulant medication was associated with a significantly higher diastolic blood pressure (of over 10mmHg)…These findings indicate there may be a lasting longer term effect of stimulant medication on diastolic blood pressure above and beyond the immediate short-term side effects.’⁴

In addition the report indicated that there was a marginally negative outcome for both ADHD symptoms (inattention and hyperactivity) and depression with the long-term use of stimulant medication.⁵

The finding was that past stimulant use increased the probability of an ADHD child falling behind at school by a massive 950 per cent completely undermines the hypothetical basis of medicating for ADHD. As stated in the Raine Medication Review report, the basis of the belief that amphetamines have long-term benefits is short-term studies, which ‘indicate that immediate management of ADHD symptoms allows children to function more effectively within a classroom. It is hypothesised that this makes children more available for learning and allows children to learn skills and concepts which are necessary to function well within a classroom in the future.’⁶ The analysis of the Raine Study data was the first time this hypothesis had been tested.

The finding that amphetamine use may permanently raise diastolic blood pressure is also of great significance. It had been previously recognised that while stimulants were in the patient’s system, heart rate and blood pressure were elevated, leading to the associated risks of heart attacks and strokes. But it was assumed that when the short-term stimulant effects wore off the cardiovascular system returned to normal.

An advantage of using data from the Raine Study is that it reduces the risk of design bias as the original designers of the study had no idea the data would eventually be used to study ADHD.  In addition the body that commissioned the ADHD review, the Western Australian Ministerial Implementation Committee on ADHD (MICADHD), was an extremely diverse group. Opinions as to the safety and efficacy of stimulant medications within MICADHD were highly divergent.  This lack of consensus, was a strength of the study, as it limited the potential for ‘publication bias’ where there is a collective decision to bury results that are not in keeping with the consensus position of participants.

The suggestion that the Raine Study would be a possible source of long-term data on stimulant medication was first made by MICADHD members with a long history of prescribing and advocating the use of stimulants. They were obviously expecting very different results. I expected the results to show no long-term educational benefits or some adverse educational outcome from stimulants, but even I was surprised by the strength of the negative outcome. Initially, the medication proponents on MICADHD tried to claim that the outcomes for the medicated children were most probably worse than those for un-medicated children, because the medicated children had more severe ADHD. However, as a member of the MICADHD committee I insisted on a comparison of the groups at age five, which was prior to any of the children having been medicated. This analysis established that there were no statistically significant differences in developmental, behavioural and health measures before the children were medicated.

As with all studies there are limitations with the ADHD medication review. While the sample size (131) was small, ‘it was larger than those in many short-term studies that supported the use of stimulants as a safe and effective treatment for children with ADHD’.⁷ Although the evidence now available from the Review does not prove that amphetamines cause failure at school and permanent cardiovascular damage, it is significant because there is so little other long term research to guide clinical practice.

The lack of enthusiasm for the findings of the research demonstrated by some of its authors diminished its impact when it was first published in February 2010. If not for the robustness of MICADHD Committee processes and the integrity of its chairperson, Professor Lou Landau, it challenging findings may have never been published. Follow up findings for the children at age 17 and 20 are expected to be published within the next twelve months.

To read more about the methodology and findings of the Raine Study ADHD Medication Review see One year on from the Raine Study ADHD Medication Review – Will the analysis of this unique long term data source continue and if so can we trust those doing the analysis?