Many Ivy League students don't view ADHD medication misuse as cheating

Nearly one in five students at an Ivy League college reported misusing a prescription stimulant while studying, and one-third of students did not view such misuse as cheating, according to a study to be presented Saturday, May 3, at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia, Canada.

Stimulants are used to treat attention-deficit/hyperactivity disorder (ADHD). Recent studies have shown that students without ADHD are misusing these medications in hopes of gaining an academic edge. This study looked at the prevalence of medication misuse at a highly selective college and whether students believe misuse of ADHD medications is a form of cheating.

Researchers analyzed responses from 616 sophomores, juniors and seniors without ADHD who completed an anonymous online questionnaire in December 2012.

Results showed:

• 18 percent reported misusing a prescription stimulant for an academic purpose at least once while in college, and 24 percent of these students said they had done so on eight or more occasions;
• juniors reported the highest rate of stimulant misuse (24 percent);
• 69 percent of those who misused stimulants did so to write an essay, 66 percent to study for an exam and 27 percent to take a test;
• more students who played a varsity sport and were affiliated with a Greek house reported stimulant misuse compared to students affiliated with only one or neither; and
• 33 percent of students did not think stimulant misuse for academic purposes was a form of cheating, while 41 percent thought it was cheating and 25 percent were unsure.

"While many colleges address alcohol and illicit drug abuse in their health and wellness campaigns, most have not addressed prescription stimulant misuse for academic purposes," said senior investigator Andrew Adesman, MD, FAAP, chief of developmental and behavioral pediatrics at Steven & Alexandra Cohen Children's Medical Center of New York. "Because many students are misusing prescription stimulants for academic, not recreational purposes, colleges must develop specific programs to address this issue."

Survey results also showed that students who misused stimulants were more likely to view this as a common occurrence on their campus compared to students who had never misused an ADHD medication. Specifically, 37 percent of those who had misused an ADHD prescription thought that more than 30 percent of students had done the same compared to only 14 percent of students who had never misused a stimulant.

The findings from this and similar studies pose a challenge to pediatricians, Dr. Adesman said. "To the extent that some high school and college students have reported feigning ADHD symptoms to obtain stimulant medication, should physicians become more cautious or conservative when newly diagnosing ADHD in teens? Additionally, should pediatricians do more to educate their ADHD patients about the health consequences of misuse and the legal consequences that could arise if they sell or give away their stimulant medication?"

It also is important to consider the ethical implications of prescription stimulant misuse in higher education, said principal investigator Natalie Colaneri, a research assistant at Cohen Children's Medical Center.

"It is our hope that this study will increase greater awareness and prompt broader discussion about misuse of medications like Ritalin or Adderall for academic purposes," she said. "It is important that this issue be approached from an interdisciplinary perspective: as an issue relevant to the practice of medicine, to higher education and to ethics in modern-day society."