Reporter's Notebook

Adderall For Healthy Kids: A Cost Shift To Medicaid?

By Jenny Gold

October 11th, 2012, 6:09 AM

Doctors in Georgia are prescribing ADHD medications to help low-income children struggling in elementary school, even when they do not have an attention deficit disorder, reports a front-page article in Tuesday’s New York Times.

Photo by Paul Pellerito via Flickr

The story focused on Dr. Michael Anderson in Canton, Ga., who said he had little choice in the matter if he wanted to help students boost their academic performance in under-funded schools. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid,” he told Times reporter Alan Schwarz. Dr. Anderson, Schwarz writes, is “one of the more outspoken proponents of an idea that is gaining interest among some physicians.”

Those extra prescriptions come at a high cost to both the state and the federal government. One of the mothers profiled in the article notes that Medicaid pays for nearly every penny of her children’s prescription costs. And it’s not just stimulants like Adderall — all four children in the Rocafort family profiled in the story are on also on clonidine, a nightly sleep med that helps to counteract the effects of the other drugs.

Georgia’s Medicaid program did not respond to requests for cost data. But Melissa Carter, executive director of the Barton Child Law and Policy Center at Emory University in Atlanta, says the program spends $28 million to $33 million annually on stimulants used to treat ADHD.

She points out that prescribing stimulants to kids without attention disorder is not necessarily a mainstream trend, but what is clear is that “parents, teachers, caregivers and even entire systems have a growing appetite to use drugs. There’s an avalanche leading towards meds as the only solution.” That may have something to do with the years of austerity cuts to education in Georgia, which have led to larger class size, shorter school days and furloughs for teachers, says Carter.

But she says that unlike investments in schools, which can give students lifelong skills for coping and adjusting, medications may offer “the immediate satisfaction of behavioral control, but you have side effects, and you’re not giving the child any skills to help them function. Are these kids going to have to be medicated for life?”

Tim Sweeney, director of health policy for the Georgia Budget & Policy Institute, a nonprofit think tank in Atlanta, adds that Dr. Anderson’s dilemma is “an indication of a big picture need for increased investment in secondary services around education, like tutors and counselors.” To the extent that additional costs are “being born by Medicaid for prescriptions that are replacing those services, there is potentially a cost shift.”

Unlike education, however, which is paid for by mostly by the state, Medicaid costs are shared by the federal government.

“The Medicaid programs spends significant dollars on medications for high-need populations like foster children, but I’d argue this is not the most cost-effective (or best) approach to treating these children,” Shadi Houshyar, who works for the child advocacy organization First Focus, wrote in an e-mail.

Instead, she asks, “why don’t we attempt to address the poverty, lack of school funding and social barriers that contribute to the poor academic performance of these children, rather than medicate them?”

Experts and advocates did not know of any studies comparing the cost of medication versus investing in schools.

5 Responses to “Adderall For Healthy Kids: A Cost Shift To Medicaid?”

  1. mRose says:

    this is so wrong!
    That’s what I’m talking about-LISTEN and ACT on Shadi Houshyar recommendation which bears repeating and eching a million times until we get it:
    “why don’t we attempt to address the poverty, lack of school funding and social barriers that contribute to the poor academic performance of these children, rather than medicate them?”
    geesh what the heck is wrong with us?

  2. Gina Pera says:

    It is ridiculous to conclude that the medications used to treat ADHD can in any way offset or compensate for poor education. What stupidly simplistic thinking.

    That New York Times piece was just more in a series of hit pieces, more fuzzy thinking from so-called progressives and their hysteria over “Big Pharma.” As much as they disparage the right-wing for their wacky conspiracy theories and rejection of evolution, these so-called progressives are just as anti-science when it comes to neuroscience. It has become so predictable.

    There are many reasons why conditions such as ADHD are over-represented in poor people. ADHD is a giant risk factor for dropping out of school, being unemployed or under-employed, falling victim to addictions, and even landing in jail. Because it is a highly heritable condition (76%, almost as heritable as height), that means the problems persist and further entrench generation after generation.

    Moreover, there are huge problems with access to care and the means to pay for it. No wonder poor people are more likely to “self-medicate”with alcohol, marijuana, and other street drugs.

    It would be nice if so-called progressives, especially science and medical reporters, took a science class or two — and even talked to kids and adults with ADHD who have been helped by ADHD treatment– instead of making their lives so much harder by perpetuating stupid and stigmatizing myths.

    Gina Pera, author
    Is It You, Me, or Adult A.D.D.?

  3. Gina Pera says:

    How about calculating the massive waste of money and time trying “behavioral” therapies and classroom techniques that allegedly counter the symptoms of ADHD.

    Imagine instead that we tried to do similar for children with vision problems that require corrective lenses. Would we deprive these children of eyeglasses and instead require teachers to write at 10x normal size at the board so these kids can see? Would we take all other kinds of extreme measures to make sure that these near- and far-sighted children could get through the day at school and through the rest of their day and night at home?

    No, we could give them eyeglasses to normalize their vision. So they can learn just like the other kids with normal vision.

    I would ask why would we deprive poor children of the medications available to wealthy kids Why would we deprive them of the chance to do better in life.

    ADHD medications are not just for paying attention in the classroom. They help people with ADHD to organize their thoughts, socialize more easily, think of consequences, drive more safely, eat more healthfully, exercise more regularly, be more prudent with finances, and much more.

    When it comes to information about ADHD, this culture needs to wise up.

  4. Ben says:

    Sheesh. Why isn’t anyone talking about parents? Kids will never do well in school unless parents are INVOLVED.

  5. HCC says:

    It would be nice if Gina Pera took a reading class. The article specifically states that children WHO HAVE NOT BEEN DIAGNOSED WITH ADD are being given ADHD drugs. To use Ms. Pera’s analogy, this is like giving glasses to kids with 20/20 vision and expecting it to help in the dark.