cross-posted from howtheuniversityworks.com
I’m working on a piece about undergraduate academic freedom that relates changes in campus culture to changes in the culture of schools. One area of particular interest is the medicalization of youth relations with authority. In a previous section, I discussed the 1980 introduction to the DSM IV of Oppositional Defiant Disorder (ODD).
College faculty will be more familiar with another intersection of pharmacology and curriculum, the widespread diagnosis of attention deficit and hyperactivity disorders (ADD and ADHD), and the corresponding prescription of amphetamines and cognate medicines. In 2003, six million American schoolchildren—about 15 percent—took methlphenidate (Ritalin) alone. Methylphenidate has replaced Prozac as the drug defining an entire cohort, with authors beginning to speak of a “Ritalin nation,” a “generation Ritalin,” and the like.
Students themselves actively seek the ADHD diagnosis. The pills have many uses related to the spectacularized culture of testing, overwork, stress, and body-consciousness—they aid in concentration, provide wakefulness, suppress appetite, assuage certain emotions, and improve athletic performance. They can be crushed and snorted or smoked recreationally in ways similar to methamphetamines. The diagnosis itself directly addresses high-stakes testing: medicated or not, ADD and ADHD-diagnosed students can request additional time in many testing circumstances.
Many more students than diagnosed use the medication: There is an active black market in Ritalin in every educational environment from primary school through graduate degrees. Students pay up to $10 a dose for “vitamin R.”
Just as thematized in the mass culture of the professional-managerial class (in TV shows like Desperate Housewives), there are widespread reports of parents using Ritalin prescribed to their children to meet the demands of their own “standards-based” existences. In families trapped in low-wage jobs, parents may also take Ritalin to meet the demands of their own working lives in the service economy or, sometimes, illegally sell it to make ends meet.
Leonard Sax reports one case of a teacher fired for stealing his students’ Ritalin. After belatedly banning amphetamines in 2005, diagnosis of Major League Baseball players with ADHD quintupled.
Though NCAA has banned “illicit” use of ADHD medications, college athletes are routinely issued “exemptions” upon showing a diagnosis, in many cases continuing usage patterns begun in high school or earlier. I have had former high-school athletes describe to me their decisions not to continue in college sport as in part a decision to stop taking medication to keep up with the demands of teams, tests, and employment.
The use of methylphenidate and related drugs has exploded in close relation to standards-based education reform (what we call “the assessment movement” in higher education). Between 1990 and 1997, production increased 700 percent, and two million children were using it; between 1997 and 2003, use tripled again, to six million. In recent years, the FDA has restricted some ADHD medications and required its most serious black-box warning on others, and questions have emerged about the late-90s studies urging medication over therapy. Better-designed studies have raised questions about those studies and suggest that in many cases therapy may be more effective, certainly with fewer side effects, but usage continues to soar. With the wide availability of ADHD drugs direct to children and small dealers via offshore Internet pharmacies, usage becomes more difficult to track.
A coalition across the admittedly narrow political spectrum of the United States has begun to question the relationship between educational practice & policy and medication, bringing together the readership of The New York Times with figures like Phyllis Schlafly and John Silber.
(Image adapted from a photo by Flickr user thp365)