Prof. Conrad of the sociology department at Brandeis has extensively studied and published on the topic of the medicalization of society, particularly the sociology of ADHD (attention deficit hyperactivity disorder) and how it can affect college students.
Conrad said that one phenomenon occurring in our society is that more kids, adolescents and adults are being diagnosed with various kinds of learning or behavioral disorders. When Conrad first began studying ADHD in the 1970s, about three percent of kids were diagnosed with the disorder, and “now we’re talking about 11 percent of the population [of children].”
Society is essentially medicalizing behaviors, but “we don’t know whether or not this improves children’s performance or not,” he explained. While the medication helps the children who have severe disorders, the three percent or so, for the other eight percent, Conrad believes it is “highly questionable.”
One reason for the increase in prescription medication, according to Conrad, is that parents and teachers actually want children to be diagnosed by a physician. They hope that the medication will act as a treatment to ADHD so that the children will do better in school or “be easier to manage.” Many physicians do not view them as particularly harmful, so they will give kids a trial run with drugs like Adderall or Ritalin, he explained.
However, kids have a “mixed reaction” to them. While some kids benefit from being on the drugs, others do not, saying that they do not feel like themselves. “There’s no question there are more kids [than in years past] defined as having some disorder and are medicalized and given psychoactive drug treatment,” Conrad summarized.
Furthermore, the diagnosing of children for ADHD has gotten both younger and older. When he first began studying ADHD, Conrad said people would diagnose kids from the ages of six to 12, and then many believed the children would outgrow the disorder. Now, he says, kids as young as two or three years old are diagnosed, some even being medicated.
He also studied adolescent and adult ADHD, in which case most adults self-diagnose, as they recognize traits in their children that they also portrayed when they were young. The definition of ADHD, he explained, has expanded “from very narrow definitions that focused on hyperactive behavior, to much broader definitions that focus on inattention, in a broad sense,” like at school or work. Also, the ratio of boys to girls who are diagnosed with ADHD has changed. In the 1970s, the ratio was about 10 boys to one girl, and now it is three boys to one girl. The boundary between inattention and ADHD is “really, really questionable,” Conrad explained.
Another phenomenon with the medicalization of ADHD occurs in older students, mostly those in college. The different kinds of psychoactive drugs, such as Ritalin and Adderall, are used as biomedical enhancements by people who are not necessarily diagnosed with ADHD but choose to use the medications as a way to “enhance cognitively,” such as by staying up later, writing faster and focusing harder.
“We don’t mind if these kids stay up late if they’re drinking coffee, but if they use prescription drugs without prescribing it, then there’s a greater deal of concern,” Conrad said. He also described how these study medications have what is known as a “gray market,” in comparison to the black market where items are only purchased illegally. The situation with study drugs is different because students can get the medication from other students, or through their pediatrician, the white market or legally over the counter by saying that they need something that will help them focus, in order to get a prescription. Conrad said he read a study which said that at some universities, the percentage of students who use the drugs regularly for cognitive enhancement is close to 20 percent.
One question that arose when thinking about the use of study medications by college students was if they do not have the disorder, will the pill have a placebo effect? Conrad said that while there is evidence that psychoactive medications help students in the short term, “there is zero evidence that these drugs help in the long term.” So while they might be able to help students get through a test or an essay, they do not actually learn any more than students who do not take the medications.
However, Conrad mentioned that despite this fact, it does not mean that students do not think that they do better. When Conrad was a college first year, he remembers being offered diet pills “that were basically made of Dexedrine, at that time,” in order to stay up late. They did not think that they were for cognitive enhancement, but just to be able to endure long hours of working. In this way, using medications for studying is not a new issue. “The new issue is that it’s so widespread,” Conrad explained.
Another question about students who use the medications for cognitive enhancement is whether or not it should be considered cheating. “It’s hard to draw the line where cheating begins,” Conrad said. He gave the example of a study group—if students study together and therefore do better on an exam, is that cheating? Conrad also brought up the difference between study medications and using drugs for sports, as he said he is “quite ready” to call the latter cheating. However, he does not see the same effect with study medication and brought up the point that even if it were considered cheating, it would be very difficult to catch somebody. “Grades are not the same thing as winning and losing and records … it’s very complicated.”
Regarding the consequences of taking cognitive enhancement medications when not diagnosed with ADHD, Conrad said some people can get spaced out from it while others feel more speedy or wired, but that overall, “it’s a fairly safe drug, especially if you take it periodically and not every day.”
There is some evidence that kids who take the medications for long periods of time can have growth suppression, but if they stop taking the medication, they return to their normal growth rate, so the adverse effects are “fairly minor,” not including the effects for the five to 10 percent of people who cannot take the medications in the first place. According to helpguide.org, stimulants are not recommended to those with any heart defects, high blood pressure, glaucoma or high levels of anxiety among other conditions as they can cause serious side effects.
Ultimately, society in general has medicalized ADHD and the number of people who are diagnosed with the disorder has greatly increased since the 1970s. With the phenomenon of college students taking them as biomedical enhancements on the gray market, many questions arise about whether or not the issue can be solved or improved.