Notes from a Healer

Reining in the Rx

Brian T. Maurer

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Despite a 7 percent decline in the number of overall prescriptions written for children under the age of 18 from 2002 to 2010, there was a 46 percent increase in the number of prescriptions specifically for ADHD medications for teenagers and children over the same period.

When I read this disturbing statistic, Dylan came to mind.

Dylan’s mother raised concerns about the possibility of ADHD after Dylan had failed one of his subjects in the 7th grade.  Midway through the 8th grade he was failing five subjects and barely holding C’s in the other two.  Curiously, he had passed a summer school course in the interim, turning in outstanding work.

“His behavior is the problem,” his mother told me.  “He can’t sit still in class; he can’t stay focused at school.”

“How does he do at home?” I asked her.

“At home he’s fine.  He plays X-box in his room for hours and doesn’t bother anyone.”

His mother confided in me that her brother was the same way when he was in school.  He ended up dropping out his junior year and never got a high school diploma.  She told me that she herself was an average student, admitting that she had to work hard for B’s and C’s.  She dropped out when she got pregnant.  Dylan’s father also quit high school.

Dylan’s maternal grandmother didn’t think that Dylan had a learning problem.  No one in the school system had ever suggested that he be tested for a learning disability.

When I revisited these concerns with Dylan’s mother at a follow-up consultation appointment, she told me that things had gotten much worse.

“He’s close to getting himself expelled,” she said.  “Hardly a day goes by that I don’t get a call from the school.  Dylan’s disruptive in class; he jumps out of his seat.  He’s argumentative with his teachers.”

“How are things at home?” I asked.

“Not much of a problem, although he did get into a fight with a neighborhood boy.  It was self-defense: the kid jumped him and broke his thumb.”

“Does it look as though he’ll pass the year?”

She shrugged her shoulders.  “I’ve been thinking of trying to get him into counseling to see if that might help.  I know he misses his dad.  Up till now his father really hasn’t been a part of his life.  Do you think he should go on some sort of medication for ADHD?”

“I’m not convinced that that’s necessarily the answer for Dylan.  It sounds like he does have some difficulty keeping on task in the classroom, but he doesn’t have that problem at home.  Try the counseling first.  See how that goes, and if he’s still having issues, give me a call and we can discuss it further.”

The mother agreed.  I waited expectantly for her phone call, but it never came.

The next time I saw Dylan was for his annual physical exam.  He had just finished the 9th grade with A’s and B’s.  In short, he had completed a stellar year.

“What turned him around?” I asked his grandmother.

“No one knows for sure,” she said.  “It might have been the change in schools.  This was his first year in high school.  I guess he decided that he was going to start the year off on the right foot.  He kept up with his work and stayed out of trouble.”

“Excellent,” I said.  “That’s what we like to hear.”  Then to Dylan I said, “Great job!”

It took quite a while to sort things out and get Dylan the help he needed, but in the end I was pleased that we had managed to salvage one more youngster from the tyranny of a stimulant prescription.


About the Author

  • Photo of Brian T. MaurerBrian T. Maurer has practiced pediatric medicine as a Physician Assistant for the past three decades.  As a clinician, he has always gravitated toward the humane aspect in patient care—what he calls the soul of medicine.  Over the past decade, Mr. Maurer has explored the illness narrative as a tool to enhance the education of medical students and cultivate an appreciation for the delivery of humane medical care.  His first book, Patients Are a Virtue, recently reviewed in The Yale Journal for Humanities in Medicine, is a collection of patient vignettes illustrating what Sir William Osler called “the poetry of the commonplace” in clinical medical practice. Interested readers can read more of the author's writings at his website and blog.

  • Published: July 4, 2012