As a shortage of the stimulant medications used to treat attention deficit hyperactivity disorder continues into its second year, educators, doctors, and parents of children with the disorder have been struggling to manage the effects of an unpredictable drug supply on children’s behavior and performance in the classroom.
The federal Centers for Disease Control and Prevention, in Atlanta, estimates that more than 7.5 percent—or 5.4 million—of the nation’s school-age children have ADHD. The condition is characterized by inattention, impulsivity, and hyperactivity—behavior that can interfere with learning.
According to the CDC, 2.7 million of those children had prescriptions for stimulant drugs as of 2007, treatment that helps control their behaviors.
The shortage, which began in early 2011, worsened later that year.
“Generally, parents have managed to get the medication, but they’ve had to go to three or four pharmacies before they can find it,” said Dr. Mark L. Wolraich, the chief of developmental and behavioral pediatrics at the University of Oklahoma Health Sciences Center, in Oklahoma City. But in some cases, it can take a week for medication to come back into stock.
Being off medication for even a day can make a difference, though.
“The drug is pretty much out of a child’s system in 10 to 12 hours, so the child is reverting back to whatever behavior problems they were having that medication was helping with,” explained Dr. Wolraich. In the meantime, he said, whether a child is on medication is not always communicated to teachers or the school.
Gauging Misbehavior
When a teacher doesn’t know about a students’ medication status, misbehaviors may be misperceived. It may seem that “the child has failed. You might see a child that was managing their ADHD now can’t and is disruptive in classroom, has difficulty learning,” said Ruth Hughes, the chief executive director of Children and Adults with Attention Deficit/Hyperactivity Disorder, or CHADD, a Maryland-based advocacy group.
Julia Leavengood-Boxer, a 4th grade teacher in a charter school in Washington, described a student who she knew was on medication for ADHD “walking around the classroom, juggling his gloves. If he was on his medication, it would have been defiance.”
But when Ms. Leavengood-Boxer reached out to his mother, she learned that the pharmacy was out of his medication—and would be for a few days. “If I’d known, maybe he wouldn’t have gotten in trouble,” the teacher said.
Stimulant drugs are defined as controlled substances by the U.S. Drug Enforcement Administration, which means that a limited amount of the drug’s “active pharmaceutical ingredient,” or API, is released to manufacturers each year. Manufacturers say that demand for such ingredients has outpaced the increase in federal quotas, making it hard to produce enough medication, said Shelly L. Burgess, a spokeswoman for the U.S. Food and Drug Administration.
At the beginning of 2012, companies received a new allotment of the API, and are now in full production, said Ms. Burgess. But it takes time for the product to hit the market. “They are anticipating resolution of this shortage by the end of March,” Ms. Burgess said.
Cynthia Reilly, the director of the practice-development division of the Maryland-based American Society of Health Systems Pharmacists, or ASHSP, said, “There is some product out there, but it’s not necessarily the product a patient is used to taking.”
Not all stimulants work for all patients. “Once you’ve found a drug that works, you don’t want to change it,” said Roxanne Ryan, a Philadelphia-area parent of a 10-year-old boy who takes medication for ADHD.
The initial shortage of amphetamine salts, the generic form of Adderall, has led to shortages in other ADHD medications, including Ritalin and its generic forms. “Because there’s a shortage of one drug, people look to the alternatives,” the ASHSP’s Ms. Reilly said.
ADHD can be treated without medication, but, according to George A. Giuliani, the executive director of the National Association of Special Education Teachers, in Washington, many children with the disorder don’t get special education services. Neither ADHD nor ADD, the non-hyperactive form of the disorder, is recognized as a classification under the main federal special education law, though schools can make accommodations for students based on other federal law.
Also, the development of longer-acting stimulant medications has meant that schools and teachers are not always aware that a child is using such drugs, said CHADD’s Ms. Hughes.
Communication Barriers
Privacy laws, such as the Health Insurance Portability and Accountability Act and the Family Educational Rights and Privacy Act, also keep teachers and doctors from communicating without parental consent, said Robert Gellman, a privacy consultant in Washington.
Dr. Wolraich said he often does not communicate with the teachers of children in his practice. “There are a lot of barriers in the way,” he said.
It is left to parental discretion whether to share a child’s medication status. “Parents on one hand will say, of course ... everyone should know. But there are parents who don’t inform the school their child is taking stimulants,” Mr. Giuliani said.
“Teachers try to implement so many things to support students who are on meds and who aren’t, but when a parent doesn’t communicate, it is hard to help a child navigate through their lows and highs,” said Autumn Figueroa, a 4th grade teacher at Two Rivers Public Charter School, in Washington.
Ms. Ryan, the Philadelphia-area parent, said she had encountered supportive and unsupportive teachers, but she had always erred on the side of communicating with the teachers.
“I can understand a parent’s hesitation to disclose information about medication. There has to be trust,” she said. “But failure to disclose really only hurts the child more.”
