Running head: NOT ETHICAL TO PERSCRIBE CHILDREN STIMULANTS

Why it is not ethical to prescribe children stimulants

Maranda Carter
University of South Florida

Abstract
The purpose of this paper is to examine why it is not ethical for children to be prescribed
stimulants. The paper begins with the diagnostic criteria as it is presented in the fifth edition of
the Diagnostic and Statistical Manual of Mental Disorders. It then presents real life situations
about the push from parents and teachers to medicate children. It is followed by a discussion of
pharmaceutical companies influence on stimulant use and its current effect. There is then a
discussion of who is prescribing the medication and the current trend in general physicians
prescribing instead of physicians that have a vast knowledge of mental disorders. It ends with a
final discussion on the side effects of stimulants.

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It is not new news that many children in the United States are diagnosed with attention
deficit hyperactive disorder (ADHD). In fact, most of us can name multiple people we know that
are diagnosed with ADHD. The most common treatment for this disorder is the use of stimulants.
In recent years, the numbers of children diagnosed with ADHD has been on the rise and with
that, there has also been a rise in the prescribing and use of stimulants. While I do believe that
some children do need stimulants for treatment of this disorder, I believe that they are overprescribed and that they have side effects that need to be taken into consideration.
Criteria for Attention Deficit Hyperactive Disorder
The diagnostic criteria as stated in the Diagnostic and Statistical Manual of Mental Disorders
fifth edition (2013) has very specific criteria that a person has to meet in order to receive the
diagnosis of attention deficit hyperactive disorder. The criteria are as follows:
A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with
functioning or development, as characterized by (1) and/or (2):
1. Inattention: Six (or more) of the following symptoms have persisted for at least 6
months to a degree that is inconsistent with developmental level and that negatively
impacts directly on social and academic/.occupational activities:

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Note: The symptoms are not solely a manifestation of oppositional behavior,

defiance, hostility, or failure to understand tasks or instructions. For older adolescents
and adults (age 17 and older). At least five symptoms are required.
a. Often fails to give close attention to details or makes careless mistakes in
schoolwork, at work, or during other activities.
b. Often has difficulty sustaining attention in tasks or play activities.
c. Often does not seem to listen when spoken to directly.
d. Often does not follow through on instructions and fails to finish schoolwork,
chores, or duties in the workplace.
e. Often has difficulty organizing tasks and activities.
f. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained
mental effort.
g. Often loses things necessary for tasks or activities.
h. Is often easily distracted by extraneous stimuli.
i. Is often forgetful in daily activities.
2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have
persisted for at least 6 months to a degree that is inconsistent with developmental
level and that negatively impacts directly on social and academic/occupational
activities:

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Note: The symptoms are not solely a manifestation of oppositional behavior,

defiance, hostility, or a failure to understand tasks or instructions. For older
adolescents and adults (age 17 and older), at least five symptoms are required.
a. Often fidgets with or taps hands or feet or squirms in seat.
b. Often leaves seat in situations when remaining seated is expected.
c. Often runs about or climbs in situations where it is inappropriate.
d. Often unable to play or engage in leisure activities quietly.
e. Is often on the go, acting if driven by a motor.
f. Often talks excessively.
g. Often blurts out an answer before a question has been completed.
h. Often has difficultly waiting his or her turn.
i. Often interrupts or intrudes on others.
B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years
C. Several inattentive or hyperactive-impulsive symptoms are present in two or more
settings.
D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social,
academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of schizophrenia or another
psychotic disorder and are not better explained by another mental disorder.

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General Push for Medication

It appears that there is a strong push from multiple sources to medicate children. We hear
every day about teachers struggle to deal with hyperactive children in the classroom as well as
complaints from parents that their children are too impulsive and lack self-control. It seems that
more and more people are forgetting what it is like to be a kid.
Children are not meant to sit still for hours on end. It is quite normal for children to act on
impulse. Childhood is the time of the development of self-control. Adults are immediately
concerned when their children fail to do well in the classroom setting. Maybe the issue is not the
child; perhaps instead there is an issue with how school and classrooms are traditionally set up. I
learned in my cognitive psychology class in undergrad that most adults have an attention span
that lasts only about 15 minutes. It is not shocking to realize that if our attention span tops out
around 15 minutes that children have difficulty staying focused for long periods of time.
Although there has been a rise of ADHD diagnosis in children, there is a higher rate of
the disorder found in boys rather than girls. Only 4.9 percent of females are diagnosed with this
disorder compare to 12.9 percent of males (Merikangas et al., 2010). It has been noted in many
studies over the years that males attention span is lower than that in females at the same age.
It appears that we are punishing children for acting like children. We are demonizing
boys in particular. Females typically develop a longer attention span before boys do, and
therefore do better in settings such as a classroom. Boys, on the other hand are seen as having a
disorder that needs to be fixed. Based on a 12 year longitudinal study about the use of stimulants,
Zuvekas and Vitiello (2011) noted that stimulant use was higher in boys. The study also noted
that there has been a steady increase in stimulant use at an overall growth rate of 3.4 percent

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(Zuvekas & Vitiello, 2011). I am not denying that ADHD exists; I just believe the diagnosis is
given to children that do not fully meet the criteria for the diagnosis.
Pharmaceutical Companies Influence and Prescribing Doctors
A huge issue in regard to the diagnosis and the treatment of ADHD has to do with
pharmaceutical companies pushing doctors to prescribe stimulant medication. Also, another issue
arises from doctors who are not well informed on the disorder diagnosing and treating ADHD.
On the news we are constantly reminded of pharmaceutical companies influence on doctors
pushing certain medications. In the medical world this phenomenon is often referred to as big
pharmas influence.
Influence of Pharmaceutical Companies
I have heard reports of the influence of pharmaceutical companies within my own family.
Both my sister and my mother work in medical professions. They have shared with me multiple
occurrences where pharmaceutical companies took them out to lunch or paid for a catered lunch
just to talk about a new medication they wanted the staff to promote to their patients. Even when
I shadowed at a mental health agency, I was present when a pharmaceutical representative
stopped by to talk about a new drug.
Pharmaceutical companies send their representatives to medical offices to sell their
product and promise the doctors and staff rewards for pushing their product. In one study Adair
and Holmgren (2005) found doctors were more likely to prescribe a medication if they had
samples of the same medication in their office. By simply being exposed to a medication,
especially when it was well advertised, physicians were more likely to prescribe that particular
medication to their patients.

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The influence of pharmaceutical companies is truly astounding. A recent article in Time

magazine showed the amount of money paid out to physicians from pharmaceutical companies
(Rebala & Wilson, 2014). The article noted that physicians received 3.5 billion dollars in the
span of just a five month period in 2013 (Rebala & Wilson, 2014). That amount of money is
difficult for me to even conceptualize and that was not even for the whole year but just for five
months. Based on this, the amount of money that pharmaceutical companies spend in a single
year has to be astronomical.
A prominent researcher of ADHD, Dr. Joseph Biederman, has received huge payouts
from pharmaceutical companies (Schwarz, 2013). Many of his research projects have been paid
for by pharmaceutical companies and he has received an additional 1.6 million dollars in
speaking and consulting fees (Schwarz, 2013). His research is often cited on the posters and
pamphlets that advertise ADHD medications (Schwarz, 2013). Even though he denies that
monetary compensation has influenced his research, that very large sum of money does cause
many a great concern.
The Food and Drug Administration (FDA) has cited many pharmaceutical companies for
false advertising and misleading advertisements for ADHD stimulant medications (Schwarz,
2013). The FDA found that the pharmaceutical company that produces the drug Adderall XR- a
popular stimulant for the treatment of ADHD- overestimated the efficacy of the drug in their
advertisements (Chong, 2009). In the advertisement the drug claims to transform the patients
life as well as help them fit in (Chong. 2009). The advertisements also claimed that if the
disorder goes untreated it could lead to later life problems (Schwarz, 2013). The FDA stated that
there is not substantial evidence to support these claims (Chong, 2009). The Food and Drug
Administration has instructed pharmaceutical companies to take down the advertisements that

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make these exaggerated and false claims about the effect of the medication (Schwarz, 2013).
Shire pharmaceutical company agreed to pay 57.5 million dollars in fines to resolve the
allegations against the improper sales and false advertising of certain medications including the
stimulants Adderall XR and Daytrana (Schwarz, 2013).
Recently pharmaceutical companies have switched their focus when it comes to
advertising about ADHD. Instead of advertising to parents about their child having this disorder,
they have changed their focus on the parent or adult themselves. Lately there has been a
campaign for adults to check and see if they meet the criteria for the disorder (Schwarz, 2013).
Pharmaceutical companies have a huge influence on doctors to diagnose and prescribe their
medication for the disorder. It bothers me how much influence they have. They are now targeting
people who may have been functioning well on their own without medication for years. Now
these adults are being bombarded with advertisements saying that they also need medication to
maximize their full potential.
Prescribing Doctors
In order to get treatment for ADHD, patients have to speak to their doctor about their
symptoms. These days, it seems that all a person has to say is that he/she has difficulty staying
on task and a prescription for Adderall or some other stimulant is easily and quickly given. I have
heard from friends that even though they did not have symptoms of ADHD, their general
practitioner tried to prescribe them a stimulant. I had one person tell me they went to their
general physician to get treatment for poor sleep and he still prescribed her a stimulant.
Prescribing her a stimulant is the complete opposite of what she needed, it just made her more
awake.

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Attention deficit hyperactive disorder is a mental disorder and should be treated by a

physician who is well aware and very knowledgeable of mental disorders. Many general
practitioners are not well informed about mental disorders. Instead of doing a full assessment,
they generally rely on parent reports. The American Psychological Association states that if a
family is considering different treatment options for ADHD they should consult a qualified
mental health professional (Kazdin, 2000). I have heard from another friend that she went
through elaborate testing to confirm her diagnosis of ADHD because she sought out a mental
health professional. I believe that if patients were more careful in choosing where to seek
treatment for ADHD, that they would receive better and more effective treatment.
I think there would be less over-diagnosis if general physicians were better educated on
mental health disorders. It is important that doctors have a solid understanding of a disorder
before they attempt to diagnose and prescribe treatment. Many doctors rely heavily on
pharmaceutical companies information and fail to do their own research to find out for
themselves what is true (Schwarz, 2013).
Medication Side Effects
As with any medication, side effects need to be taken into consideration. Many times it
seems that doctors do not forewarn their patients of the potential side effects of the medication
that they are prescribing. Therefore, it is important that physicians disclose to their patients the
possible side effects associated with stimulants.
A commonly reported side effect associated with stimulant use was headaches (Charach,
Yeung, Volpe, Goodale, & dosReis, 2014). Other symptoms that were reported were moodiness
and feeling sick (Charach et al., 2014). The two most commonly reported side effects are

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suppressed appetite and sleep difficulties. The results on one study by Sonuga-Barke and
colleagues (2009) support that stimulants may not cause the symptoms of loss of appetite and
sleep difficulties. They instead believe it may be due to ADHD itself and the symptoms are just
exacerbated by the stimulant medication (Sonuga-Barke, Coghill, Wigal, DeBacker, &Swanson,
2009).
A big concern is the stimulants effect on overall cardiovascular health. In one study by
Vietello and colleges (2012), they found that although stimulant use did not increase the risk for
hypertension or tachycardia, they were more likely to have a higher heart rate. In another study
looking at the cardiovascular health of stimulant users, they found that although cardiovascular
events were rare, they were twice as likely in people taking stimulants than not (Dalsgaard,
Kvist, Leckman, Nielson, & Simonsen, 2014). They also found a time-dependent dose-response
relationship interrelationship between cardiovascular adverse effects (Dalsgaard et al., 2014).
Based on the above research it is critically important that physicians let their patients know the
potential side effects including the fact that they are twice as more likely than non-stimulant
users to have cardiovascular problems in the future.
Conclusion
Attention deficit hyperactive disorder is a growing diagnosis with more and more
children and adults diagnosed with it every year. It is important that patients and the society in
general knows all of the different factors that influence this growing diagnosis. A big push comes
from pharmaceutical companies directly. Billions of dollars are spent trying to sway doctors to
sell their product and convince the public to buy their product. Also, many of the physicians that
are diagnosing and prescribing treatments for ADHD do not have a good knowledge base in

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mental health disorders. To get effective care, it is important that individuals seek out a mental
health professional for testing to ensure the diagnosis is correct. The patients should be well
informed of the possible side effects associated with their treatment. Overall, it is important for
patients and their families to acquire a full understanding of the disorder, along with the criteria,
possible treatments, and potential side effects.

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Charach, A., Yeung, E., Volpe, T., Goodle, T., dosReis, S. (2014). Exploring stimulant treatment
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Chong, B.S. (2009). FDAs Division of Drug Marketing, Advertising, and Communications
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