Dose Of Reality

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At least once a day at Barrington Middle School, Stephen LeClair sees them--fidgeting students lined up outside the nurse's office, waiting for the prescription medication they need to control the symptoms of attention deficit hyperactivity disorder.

LeClair, principal of the rural school on the edge of New Hampshire's seacoast region, says that only the nurse is allowed to dispense such medication. The drugs, which include stimulants such as Ritalin, Dexedrine, and Cylert, are otherwise locked in the health clinic.

Though such safeguards seem like common sense, a new survey of mostly rural schools in Wisconsin suggests many schools aren't nearly so careful. The lack of strict controls is troubling, the survey's researchers say, because the potential for abuse is considerable.

In their research, published recently in the Journal of Developmental and Behavioral Pediatrics, as many as 16 percent of the students taking stimulants for ADHD said classmates had asked them to give away, sell, or trade their drugs. "The message is: Don't have your head in the sand," says Dr. Frederick Theye, one of six study co-authors and a practicing neuropsychologist at the Marshfield Clinic's Medical Research Foundation in Marshfield, Wisconsin. "If you don't think abuse of these drugs is going on at your school, you're probably wrong."

Stimulants have been used for decades in the treatment of ADHD, a disorder marked by impulsivity and an inability to concentrate. The disability affects as many as 5 percent of children in the United States, according to estimates.

A boost in the early 1990s in the production of Ritalin, a trade name for methylphenidate and the most widely used drug for ADHD, prompted some fear that the drug was being abused. The Marshfield Clinic researchers surveyed 53 elementary, middle, and high school principals in the rural areas and small towns the clinic serves. They also asked 73 area students taking Ritalin as part of a long-term clinic study to fill out anonymous questionnaires. Those students ranged in age from 10 to 21.

Most of the schools--83 percent--had a policy for dispensing prescription drugs at school, the researchers found. But 44 percent of the students and 37 percent of the principals said medications were stored unlocked during school hours. And 10 percent of the schools allowed students to carry around and administer the drugs themselves. Teachers dispensed the medications in a quarter of the schools surveyed.

Only 4 percent of the schools followed Barrington Middle School's practice of requiring a school nurse to administer the medications. Barrington, which was not part of the Marshfield survey, requires students to bring their medications to school in the original prescription containers--a routine followed by only half the Wisconsin schools surveyed.

Though Ritalin is less addictive than some other drugs, the researchers say the findings surprised them. They contend the results point to the need for school boards and state legislators to set and enforce policies controlling medication use in schools.

--Debra Viadero

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