Although tracking the misuse of prescription stimulants such as Adderall among college and high school students is nearly impossible, experts and students agree more people are turning to stimulants to perform better on exams. Local experts also say the trend is making its way onto high school campuses now.
“I think that’s a phenomenon that we see, is the trickle-down effect,” said Vanessa Tilney, University of Houston Student Health Center executive director and chief physician. “I think the shift in our society and the expectations, I feel like it goes down and down to a lower age group. I would not be surprised if it’s being passed around at middle schools even.”
Study drug culture
Attention deficit hyperactivity disorder, or ADHD, can be lifelong, and taking stimulants regularly can result in dependency, Tilney said. For students who are not prescribed ADHD medication and use it anyway to excel in school, the consequences can be severe.
Side effects for people who misuse prescription stimulants include anxiety, depression and hallucinations said Dr. Iram Kazimi, a pediatric psychiatrist at McGovern Medical School at UTHealth.
“[The side effects] can actually even [lead to]suicide if you are using them [stimulants]in the wrong population,” Kazimi said.
Continual misuse of prescription stimulants can also lead to physical side effects such as decreased appetite, increased heart rate, hypertension and tremors, said Dr. Carlos Guerra, medical director of adolescent psychiatry at the Memorial Hermann Prevention and Recovery Center. Despite these side effects, national trends show more college students are using these drugs.
According to a 2012 study from the Journal of American College Health, 61.8 percent of 1,253 college students surveyed were offered prescription stimulants for nonmedical use by their fourth year, and 31 percent used a stimulant that was offered. About three-fourths of students surveyed used stimulants to study.
“It’s real popular in high school and in college,” Guerra said. “It’s like baseball players and steroids: If everybody’s doing it then I’m not going to be able to win, so I might as well do it, too, so I’m at an even par with everybody else.”
Data provided by Katy ISD makes it impossible to know the extent of prescription stimulant misuse because all drug infractions are grouped together under a marijuana/controlled substance category. The data does not outline prescription stimulant misuse, but it does speak to the fact that drugs are not uncommon in the district.
During the 2017-18 school year, there were 305 drug- related behavioral incidents that occurred on KISD campuses. The majority of those incidents involved sophomore-level students, with 79 incidents reported.
KISD officials declined to comment on this article.
While it is difficult to gauge how prevalent prescription stimulant misuse is in high schools, experts said competitive districts are not immune from the study drug culture.
“The top 7-8 percent rule in Texas is hard, especially when the schools like Memorial High School, Katy Taylor, Sugar Land Clements—those high schools are just ultra-competitive schools,” Guerra said. “… it’s hard to be in the top 10 percent of the class.”
Adderall—a stimulant used to help people with ADHD—increases dopamine levels in the brain, resulting in heightened alertness and focus, according to UH Sugar Land associate professor Shainy Varghese.
Experts said even though the side effects of Adderall misuse can be severe, students are still willing to take them to perform well on high-stakes exams.
For high school students, standardized tests that decide a student’s ability to pass onto the next grade level and SAT exams that determine college acceptances create additional stressors that can lead high-achieving students down the path to stimulant misuse.
“All of that competitiveness leads us to what we may call ways to enhance cognitive performance, and use of stimulants is one way to do that,” Kazimi said. “There is a lot of prescription sharing that happens in school, especially around exam time.”
KISD parent Sarah Storts has two sons in KISD schools, one of whom was diagnosed with ADHD four years ago. She said she expects the trend has reached her community.
“I can’t speak to Adderall specifically, but my high school student has reported seeing and hearing prescription pills being sold that helps student pass tests,” Storts said. “He does not know the names of what is being sold or the specifics, but I can only assume they are some form of ADHD medications.”
Kazimi said while requests for ADHD evaluations have always been consistent, she noticed during testing times, inquiries for ADHD evaluations by parents increase.
“[When] it’s time [for a student]to test into high school, or time to test into middle school, those are times in early adolescence that we will see a peak where parents will request an evaluation,” Kazimi said.
As stigmas surrounding mental health have started to diminish, ADHD diagnoses have become more common, and more parents are open to medicating their children, Guerra said. According to data from the Centers for Disease Control and Prevention, ADHD diagnoses in children increased from 5.5 percent in 1997 to 9.9 percent in 2015.
Kazimi warned that while requests for ADHD evaluations may increase during test times, it is critical parents rule out any other possibilities that may explain a child’s behavior. One snapshot of being seen by a provider cannot give an accurate diagnosis of ADHD, Kazimi said.
“Some schools will require certain types of performance tests like IQ tests before a middle school or a high school, and so a lot of times we see parents who want their children assessed for ADHD,” Kazimi said. “And really that time is the time for us as providers to really educate the families about what ADHD actually looks like.”
Kazimi said it is unfair to assume students diagnosed with ADHD have an advantage over others. Students with ADHD who take stimulants are still not on the same playing field as other students without the disorder, she said.
Knowing the signs
Students might argue they perform better on a test because of a stimulant, but they are probably misguided.
“Kids may feel that they need to stay up three, four nights in a row to get all of their work done, and so a lot of prescription sharing happens to accomplish that,” Kazimi said. “But sleep is needed for memory consolidation. Staying up for four, six nights in a row is not going to help you do better on an exam.”
There are warning signs parents should look for when deciding if a child might be resorting to stimulants.
“[Make] sure that your child knows that one test is not a measure of who they are as a person,” Kazimi said. “Sudden changes in mood, irregular or erratic sleep patterns around exam time—those are all red flags.”
Kazimi said while health classes that focus on ADHD awareness and alternative ways to focus could help address stimulant misuse, lack of school funding make it unlikely such programs will be created.
“If schools could get someone to volunteer and teach mindfulness every morning, those are programs that would not overburden the district,” Kazimi said.
Kazimi said the most important consideration is for parents to pay attention to warning signs and have an open dialogue with their children about their stress levels and expectations.
After witnessing the side effects different ADHD medications had on her son, Storts said she thinks it is important parents are aware of the consequences misuse of prescription stimulants can bring.
“Parents that bury their heads in the sand with a ‘not my kid’ attitude and don’t have these conversations are missing key opportunities to help their child,” Storts said. “The last thing we want, as parents, is kids feeling helpless and taking matters into their own hands.”
Additional reporting by Beth Marshall