A new study out of Yale University shows that kids are 30 percent more likely to fill prescriptions for attention deficit hyperactivity disorder drugs during the school year than over summer breaks, but that number significantly varies by socioeconomic background and geography.
The study looked at medication data for kids which an active prescription a year before and a year after the study period, to control for people who have discontinued taking the stimulants. It also suggested that even during the school year, students were less than perfect in following their doctor’s orders.
This work adds to a growing body of evidence that social and environment considerations impact ADHD diagnosis and treatment. Lead author Marissa King says while poor kids are more likely to be diagnosed with ADHD, “school-based stimulant use is more common among middle-class and upper-middle-class kids.” That means more children on ADHD medications from low-income familes were less likely to let their prescriptions go unfilled during the summer.
The prescription data also showed “larger school year increases in states with strict school accountability policies and strenuous academic environments.”
This relationship between school policy and ADHD diagnoses supports findings from University of California-Berkeley that broke earlier this year. In a series of studies, Berkeley psychologists Dr. Stephen Hinshaw and Dr. Richard Scheffler demonstrated a significant variation in the diagnosis and treatment of ADHD across the United States. Hinshaw and Scheffler mapped ADHD diagnoses over time, as compared to the adoption of stricter “No Child Left Behind” testing. States with no prior accountability laws saw as much as a 50 percent increase in diagnoses.
Dr. Tony Rostain, a child and adolescent psychiatrist at the Children’s Hospital of Philadelphia, studies ADHD. He said the findings about socio-economic background and school policy are new and important, but the study does not prove people are stopping the stimulants altogether during the summer.
It also doesn’t prove that people are taking the medications just to get ahead in school, said Rostain. “One implication there is that this is a cognitive enhancer, I think that would be a dangerous conclusion.”
“For some percentage of children, ADHD seems to be a disorder of academic performance,” said Rostain. So, kids who need the medication during school might get by without it in the summer.
Rostain said taking a break from the meds can be beneficial. “When I first started practicing in the 1980s, drug holidays were common.” He said the time off of medication can be used to recalibrate a child’s dosage or give children a break from some of the side effects, which include loss of appetite and insomnia. “Medically speaking, there is no medical problem with starting and stopping a stimulant,” said Rostain.
But, he cautions that pressure to prescribe should not come from teachers, and that drugs are not the only way to treat ADHD. “I think that there is a lot of important discussion we need to have as a society about the proper diagnosis of ADHD — that we not allow the pressure of school performance to lead people to make a decision a child needs ADHD medication,” said Rostain. “Maybe they need something else to help them perform better.”
About one in ten children was diagnosed with ADHD in 2012 according to the Centers for Disease Control.