ADHD medications: Performance enhancing drugs of the mind

There are interesting double standards that we apply to different fields of human endeavor. In sports the use of performance enhancing drugs is forbidden. Whilst that does not necessarily stop athletes using them at least it is not condoned.   Efforts are made to try and catch and sanction those who are found to be using such drugs.

The rationale behind this is that sporting contests are meant to be about who is the fastest or strongest or best because of their ability and the effort they have made through training to harness that ability.

With academic performance we are not fussed at all and indeed make special allowances for those who use “performance enhancing” drugs. It is well known that mind altering substances such as amphetamines and their cousins the ADHD drugs alter the mind. They can enhance focus, keep you awake to enable more study and sharpen the mind. This is regardless of whether the person has ADHD or not.

Reports out of the USA (and I am sure this occurs in Australia and elsewhere too) describe students faking ADHD symptoms to get diagnosed and hence prescribed stimulant medication. In addition to this once ‘diagnosed” some of these students are given extra time to do their exams because of their “disease.”

The Daily Beast reports: “Coached by parents, and by some competitive guidance counsellors, these students then ‘fake-fail’ the test, are branded as hyperactive, and are granted leniency, ranging from extra days to complete homework to extra time to take the SATs.” Many get a full neurological work up.

The end goal is to get a higher grade and get into elite universities such as Harvard.

Imagine the same type of approach being used so you can run faster, so that you make the sports team!

At a less “sophisticated” level other students are swallowing or snorting drugs like Adderall prior to exams. One lad told the New York Times, “Everyone at school either has a prescription or has a friend who does.” The US Drug Enforcement Agency (DEA) lists prescription stimulants as Class 2 controlled substances as they are amongst the most addictive substances with medical usage. By comparison Valium is class 4.

Like all substances the amphetamines have effects that we may like and seek but also those we don’t. After the high passes people can become depressed and even suicidal.  Longer-term use of these drugs in younger children can affect growth and the heart. It can raise blood pressure and also trigger rage and violence.

Just to round out the picture it is estimated that at least one in three Australian adults assessed as having ADHD have faked their symptoms. The reason may be to get hold of drugs, get on a disability pension or avoid criminal prosecution (or at least play the medical card as defense). A conference in Hobart was told the fairly obvious that anyone can Google the symptoms of ADHD and that it was very easy to get diagnosed.

When one considers that the criteria for diagnosis are vague and broad reaching this is not a surprise.

So whilst we punish those who seek to chemically enhance their physical performance we reward those who chemically enhance their academic performance.

Is there something wrong with that? The answer is a resounding yes.

Some people can run faster than others and some can do mathematics better than others. This is life. We should be encouraging our children to do their best and not pressuring them so that they need to resort to amphetamine type drugs.

Universities, schools and parents are to blame for creating this toxic environment, which rewards faking “disease” and drugging teenagers.

One option would be to dope test students sitting exams in the same way that Olympic athletes are dope tested. This will be expensive and the obvious question is who will oversee it. A random testing system, like applies in various workplaces could be used. This would be cheaper but if done correctly creates enough concern that you may be caught to not do it. At the very least it would lessen the problem.

There is another solution though. We need to support our teenagers to be the best they can in whatever field they are suited to. We do not all have to go to university. We are not all scholars. Some of us are creative, some are good with their hands some are good with people. The current education systems in Western countries support only one type of learning – the verbal IQ type.

Some will go on to be musicians, others to be successful entrepreneurs. Some will be become writers and others inventors. These do not come from cookie cutter university courses.

We need to support, respect and honor the different talents that our children have rather than try to make them something they are not.

Joe Kosterich is a physician in Australia who blogs at Dr. Joe Today.

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  • Ryan Thomas Cook

    I take it that this doctor never used the performance-ehancing drug caffeine?

  • megan

    so what about the kid who is depressed and takes an SSRI. or anxious. he’s just increasing a neurotransmitter in order to ‘enhance’ his function. and it’s ten times easier to get diagnosed with depression/anxiety than ADHD.

    • Dr Bucky

      Not that I agree with the author, but there are numerous examples where drugs are not allowed in athletics but are allowed in other fields. Take beta blockers for example. They have the potential to alleviate the “jitters” and as such are tested for and banned from olympic sports (especially archery/shooting). However it is perfectly acceptable for a violinist to take one before performing at Carnegie Hall or a CEO to pop a propranolol before a stressful speech. So there is a double standard at work. Personally, I’d be fine with anyone using whatever substances they want as the line between therapy and enhancement is extremely blurry.

  • Dr Bucky

    I don’t buy the people getting extra time on the SAT’s bit. All standardized tests report such accommodations. Even though I have ADD, I didn’t even consider applying for accommodations on either the MCAT’s or USMLE’s as: 1. I didn’t want such reported to everyone and 2. their standards for such are quite onerous. Now I will admit I have had accommodations that allow me to take exams in quiet, isolated rooms; mainly so that I don’t have the urge to stab the guy tapping his foot behind me with my pen.

    Oddly enough I rarely take ADD drugs for exams or to study for them as I enjoy what I study. My main struggle with ADD is “boredom intolerance.” If I have to sit through a meeting (or morning rounds) it is generally physically painful and exhausting. I will be as tired after a boring two hour meeting as I am after working a 36-hour shift and it just plain sucks without the drugs. Tests on the other hand are stimulating and I have no problems completing them without drugs and actually do better without them in my system. I have heard similar stories from other professionals with ADD as well.

  • WhatPaleBlueDot

    Yep. All of us medicated ADHD types are just misunderstood geniuses who are trying to get ahead in a things we’re not cut out for. We certainly aren’t people who are struggling to keep track of our own thoughts. No one ever asks for medication or accommodations because we actually need them. No one is just trying to get by. Nope. It’s all performance enhancing. Thanks. Your help is so meaningful.

  • Andee Bateman

    Hang out on a college campus the week before finals. It’s harder to find a stick of gum than it is to find focus meds, and that was at a private Catholic University. There was even a posting in the library about making sure that if you take them to study, you take them to test. ‘Rampant’ is not an overstatement.

    • Karen

      Andee ,
      Since I am not exposed to campus life, I am curious to know if these focus meds are Rx meds ? If so ,The parents pay for those? Are you talking about Ritalin, Adderall etc.??. How easy is it to obtain these meds ? Scary comment about it being Rampant on a college campus.

    • drjoekosterich

      Your observations match that of the NY Times piece.

  • Karen

    Dr. Bucky,
    I agree. My 16yr old junior son who is taking all AP courses this yr. is begging me if he can be tested for ADD to qualify for more time on his tests because a majority of his peers have done so & that he is a very slow test taker. Granted my hyper-kinetic son has been a straight a student maybe now high b’s this semester but I am still appalled that it is a very common & expensive practice @ his school. Now I have no idea whether his peers who are diagnosed w/ add or adhd just to qualify for more test time are taking any meds.
    My son is also very bored in class & hence very talkative. The teachers find him disruptive or a nuisance b/c of his behavior.
    I am very hesitant about diagnosing him w/ add( even though he may be borderline) for more test time or placing him on meds. If he is adhd ,He has compensated beautifully & is doing well w/o the meds.

    • drjoekosterich

      Your approach is spot on Karen. Remain hesitant about labels. It is about helping teens be the best they can be rather than trying to force them to be what they are not.We are not all scholars.Some are creative and some work better with their hands

    • Dr Bucky

      While you might not want to “label” your child it is not a bad idea. It is much, much harder to get diagnosed with ADD later in life, due to the reasons stated in this article. If you can get the diagnosis now I’d do it. Just because your son is “diagnosed” doesn’t mean he has to take any meds or get accommodations, however if his ADD becomes a problem later in life (college, graduate school, professional school, etc.) he’ll have the diagnosis and it’ll be much easier all around.

  • Sheli Lowrie

    Easy for you to say. Do you have a child that since she was 4 years old has been struggling with violent outbursts, and the inability to sit still or pay attention? It was not with ease that we decided to even have our child tested for ADHD, let alone have medication prescribed for her. She was born extremely premature and at 7 1/2 years old will tell you she feels so much better on her new medicine. We are also teaching her the behavior modifications she needs to learn how to better manage her feelings. I am not just her mother, I am a teacher who is obtaining her masters in special education. I will not stand by why you blanket blame all parents and teachers etc… for the people out there that make it even more difficult for my child who actually doe have the disease and struggles every day. Until you sit by and watch your child cry every day because she doesn’t understand why she does the things she does or says the things she says, don’t preach to me or any other parent/teacher who is truly dealing with this disease!

    • Medstudent

      I don’t think the authors intent was that nobody should have these medications.

    • drjoekosterich

      The article was not actually about 4 year olds.It was about teenagers who have no problems ,faking symptoms to get drugs and how easy it is to do this

      • Sheli Lowrie

        Yes, but 4 year olds grow up. My daughter is almost 8 and like all children, will eventually be a teenager. It wasn’t the teenagers faking the symptoms that caused me to make a comment, as normally I rarely do. The teenagers are appalling and quite frankly they are making life much harder on those that do in fact have the disease. What upset me was the blanket comment that by medicating our children we are trying to make them something they are not. That was the main reason I struggled with medication in the first place, because I don’t want my daughter to be someone different that who she is.

  • Diana McCoy

    A topic that certainly merits consideration. One doesn’t have to be in the field of psychiatry for very long before encountering the college student who is suddenly “wondering” if he / she may have ADD despite a history of (admittedly) excellent academic and other accomplishments throughout the elementary and high school years. A little more conversation reveals that stimulants have become common “study and testing aids” on campuses, ranging from a primarily liberal arts school to schools of pharmacy and everything in between. Sadly, the non-stimulant users begin to wonder if they are going to be at a learning / testing DISadvantage if they do not also have access to these drugs.

  • Matt Weidman

    First let me agree with the author that abuse of ADHD medications is a mounting problem. However, the author made some generalizations about stimulant medications that require some clarification.

    “The US Drug Enforcement Agency (DEA) lists prescription stimulants as Class 2 controlled substances as they are amongst the most addictive substances with medical usage. By comparison Valium is class 4.”

    OK, the DEA “scheduling” of drugs has more to do with politics than pharmacology. Stimulants do not induce physiologic tolerance or addiction. Psychological addiction, certainly – if you’re taking these meds in a abusive pattern, not as directed. I have NEVER seen a significant withdrawal reaction when a kid stopped their stimulant. Saying that ADHD meds are more addictive than benzodiazepines just because of their government scheduling is ludicrous.

    I’d also like to see some citations on some of the statements made in this piece, especially in regards to these statements: “After the high passes people can become depressed and even suicidal. Longer-term use of these drugs in younger children can affect growth and the heart.”

    The first sentence, IMO, only applies to those who ABUSE these medications, not those who use them as directed. Oh, I’ve certainly seen kids get moody in the afternoon & evening as the stimulants wear off, but linking their use (as directed) to outright depression or suicidality? Where’s the evidence for that???

    Re: growth – yes, stimulants do affect growth in a dose dependent fashion. Certainly stimulants are appetite suppressants and can affect weight gain, but they can affect height as well. Mostly this is only a delay in growth, but there can be very modest effects on final height. I’ll give the author a pass on this one.

    BUT, where is the evidence that “longer-term use of these drugs in younger children can affect … the heart”? Two large studies have recently shown NO difference in cardiac mortality among children treated with stimulant medications (1. Schelleman et al. Cardiovascular events and death in children exposed and unexposed to ADHD agents. Pediatrics. 2011 Jun; 127(6): 1102-1110. 2. Cooper et al. ADHD Drugs and Serious Cardiovascular Events in Children and Young Adults. N Engl J Med 2011; 365: 1896-1904).

    I’m not saying there isn’t a valid concern re: cardiac toxicity with long-term use of sympathomimetic agents, but currently there is no direct evidence to support that concern. Again, let me emphasize that I’m talking about the use of stimulants as directed, not abuse.

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