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鈥檚 behavior and performance in the classroom.
The federal Centers for Disease Control and Prevention, in Atlanta, estimates that more than 7.5 percent鈥攐r 5.4 million鈥攐f the nation鈥檚 school-age children have ADHD. The condition is characterized by inattention, impulsivity, and hyperactivity鈥攂ehavior 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.
鈥淕enerally, parents have managed to get the medication, but they鈥檝e had to go to three or four pharmacies before they can find it,鈥� 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.
鈥淭he drug is pretty much out of a child鈥檚 system in 10 to 12 hours, so the child is reverting back to whatever behavior problems they were having that medication was helping with,鈥� 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鈥檛 know about a students鈥� medication status, misbehaviors may be misperceived. It may seem that 鈥渢he child has failed. You might see a child that was managing their ADHD now can鈥檛 and is disruptive in classroom, has difficulty learning,鈥� 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 鈥渨alking around the classroom, juggling his gloves. If he was on his medication, it would have been defiance.鈥�
But when Ms. Leavengood-Boxer reached out to his mother, she learned that the pharmacy was out of his medication鈥攁nd would be for a few days. 鈥淚f I鈥檇 known, maybe he wouldn鈥檛 have gotten in trouble,鈥� 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鈥檚 鈥渁ctive pharmaceutical ingredient,鈥� 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. 鈥淭hey are anticipating resolution of this shortage by the end of March,鈥� 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, 鈥淭here is some product out there, but it鈥檚 not necessarily the product a patient is used to taking.鈥�
Not all stimulants work for all patients. 鈥淥nce you鈥檝e found a drug that works, you don鈥檛 want to change it,鈥� 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. 鈥淏ecause there鈥檚 a shortage of one drug, people look to the alternatives,鈥� the ASHSP鈥檚 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鈥檛 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鈥檚 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. 鈥淭here are a lot of barriers in the way,鈥� he said.
It is left to parental discretion whether to share a child鈥檚 medication status. 鈥淧arents on one hand will say, of course ... everyone should know. But there are parents who don鈥檛 inform the school their child is taking stimulants,鈥� Mr. Giuliani said.
鈥淭eachers try to implement so many things to support students who are on meds and who aren鈥檛, but when a parent doesn鈥檛 communicate, it is hard to help a child navigate through their lows and highs,鈥� 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.
鈥淚 can understand a parent鈥檚 hesitation to disclose information about medication. There has to be trust,鈥� she said. 鈥淏ut failure to disclose really only hurts the child more.鈥�
