Control Parts Manual

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Control Parts Manual

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Bambi Bucket Operators manual part 5 - Control Head parts replacement

Doctor's orders: a new prescription for ADHD medication abuse.

"Th[is] stuff [Adderall] is like an ...

." --Mitch (1)

In a society that never stops, discovering a quick fix grants one
an immeasurable competitive edge whether it be in the academic or
professional arena. The world of athletics has grappled with the use of
anabolic steroids for years, finally implementing anti-doping laws (2)
and strict guidelines for athletes. However, in the academic setting, a
similar problem has arisen that cannot be solved by random drug testing
or other anti-doping mechanisms. Since the genesis of ADD/ADHD in the
early 1980s, affected individuals have been able to procure medications
that enhance cognitive capabilities: the ability to focus, concentrate,
and retain information. Those truly suffering from

Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder characterized by distractibility, hyperactivity, impulsive behaviors, and the inability to remain focused on tasks or
 reap the
benefits of these medications while many non-affected people now acquire
the drug for themselves to get ahead, primarily within academic
settings. The prevalence of Adderall and the ease with which
individuals, particularly students, can obtain it, through a diagnosis
or illegal procurement, is alarming and presents ethical issues. Various
solutions, including random drug testing, heightened disciplinary
procedures, and education programs, have been proposed but do not attack
the crux of the issue. Instead, this Note posits that to stem the abuse
of ADHD medications in academic settings, the Individuals with
Disabilities in Education Act (IDEA) should be amended to include ADHD
as a specific learning disability and to develop a mandatory
standardized diagnostic test that must be performed prior to the
diagnosis of ADHD and the prescribing of Adderall that focuses on the
adverse educational effect the disorder has on individuals. Currently,
individuals can obtain an ADHD diagnosis and an Adderall prescription
without much effort by meeting highly subjective criteria. By addressing
the high rate of ADHD diagnoses and the ease with which this Schedule II
Controlled Substance is obtained, only those requiring the drug will be
able to obtain it and those seeking a competitive edge will be out of
luck. This Note will proceed in five parts. Part I will identify
background information on ADHD including diagnosis and treatment. Part
II will address the current problem surrounding ADHD medications,
specifically Adderall, focusing on the misuse/abuse on college and
university campuses. Part III will discuss the Individuals with
Disabilities in Education Act (IDEA) as well as [section] 504 of the
Rehabilitation Act and the services provided to students with
disabilities and/or ADHD. Part IV will propose a two-pronged solution to
A going or being beyond what is needed, desired, or appropriate; an excess:
 of Adderall and the subsequent misuse by students. By
amending IDEA and implementing a standard diagnostic test for ADHD,
access to Adderall will decrease and the potential for abuse will be
greatly lowered. Finally, Part V will address the implications of this
alteration as well as aspects that cannot be addressed by a legislative
mandate. The inclusion of ADHD as an enumerated learning disability
under IDEA combined with a standardized identification and diagnosis
procedure will allow individuals suffering from ADHD to receive
appropriate treatment while preventing the illegal use of Adderall by
those seeking an academic boost.


"The drugging of children for A.D.H.D. has become an
epidemic." (3)

Attention Deficit Hyperactivity Disorder
 (ADHD), formerly called hyperkinesis or minimal brain dysfunction, a chronic, neurologically based syndrome characterized by any or all of three types of behavior: hyperactivity, distractibility, and impulsivity.
 (ADHD) is one of the most
common neurobehavioral disorders diagnosed in children that can persist
into adulthood. (4) Since its induction into the American Psychiatric
Association's (

) Diagnostic and Statistical Manual-IIIR
(DSM-IIIR) in 1987 and its replacement of
Attention Deficit Disorder

 (ADD) in the DSM-IV in 1994, ADHD diagnoses have risen an average 5.5%
per year from 2003-2007. (5) ADHD manifests in various types dependent
upon the primary behavior exhibited. (6) Currently, about 3-7% of
school-age children suffer from ADHD; however, since 2007, about 9.5% of
children aged four to seventeen have been diagnosed with the disorder.
(7) In addition, though the disorder primarily appears in childhood,
many older students and adults have been diagnosed with ADHD. (8)
Adderall sales increased 3135.6% over a four year period from 2002-2006.
(9) In a study conducted at the University of
New Hampshire
 one of the New England states of the NE United States. It is bordered by Massachusetts (S), Vermont, with the Connecticut R. forming the boundary (W), the Canadian province of Quebec (NW), and Maine and a short strip of the Atlantic Ocean (E).
, researchers
discovered that 50% of the students were first diagnosed with an
attention disorder while in high school or college. (10)

Because there is no known cause for the disorder,11 there is not an
objective and standardized mechanism for diagnosing individuals with
ADHD. (12) As specified by the American Academy of Pediatrics (AAP) in
its diagnostic guideline, other diagnostic tests "contribute little
to establish[] the diagnosis of ADHD." (13) Since the discovery of
the disorder, the diagnostic criteria have evolved with guidelines
issued by both the APA and the AAP. The APA's DSM-IV-TR established
criteria to be utilized by medical professionals when diagnosing ADHD.
(14) The APA's Diagnostic Guideline outlines the following factors:
the persistence of symptoms of either inactivity or
hyperactivity/impulsivity for a period of at least six months--symptoms
which must be evaluated by parents or educators as many symptoms do not
present in a clinical environment; the manifestation of symptoms prior
to age seven; the presence of symptoms in two or more settings and
"clear evidence of interference with developmentally appropriate
social, academic, or occupational functioning." (15) The most
important provision of the DSM-IV-TR states that children who meet the
diagnostic criteria for the behavioral symptoms of ADHD but who
demonstrate no functional impairment do not meet the diagnostic criteria
for ADHD. (16)

The AAP's clinical practice evidence-based guideline (17)
outlines the diagnostic and evaluative techniques that should be
utilized in the process of diagnosing a child with ADHD. This guideline
encompasses six recommendations including the satisfaction of the DSM-IV
criteria. (18) The recommendations are as follows:

Recommendation 1: In a child six to twelve years old who presents
Lack of attention, notice, or regard.

Noun 1. inattention - lack of attention
basic cognitive process - cognitive processes involved in obtaining and storing knowledge
, hyperactivity, impulsivity, academic underachievement,
or behavior problems, primary care clinicians should initiate an
evaluation for ADHD.

Recommendation 2: The diagnosis of ADHD requires that a child meet
DSM-IV criteria.

Recommendation 3: The assessment of ADHD requires evidence directly
obtained from parents or caregivers regarding the core symptoms of ADHD
in various settings, the
age of onset

, duration of symptoms, and degree
of functional impairment.

Recommendation 4: The assessment of ADHD requires evidence directly
obtained from the classroom teacher (or other school professional)
regarding the core symptoms of ADHD, the duration of symptoms, the
degree of functional impairment, and coexisting conditions. A physician
should review any reports from a school-based multidisciplinary
evaluation where they exist, which will include assessments from the
teacher or other school-based professional.

Recommendation 5: Evaluation of the child with ADHD should include
assessment for coexisting conditions.

Recommendation 6: Other diagnostic tests are not routinely
indicated to establish the diagnosis of ADHD. (19)

The first recommendation specifically mentions "academic
underachievement" as a factor while the following recommendations
rely on data obtained from the home and school environments and provide
for the identification of other disorders. (20) By identifying other
disorders--primarily "conduct and
oppositional defiant disorder

Oppositional defiant disorder (ODD) is defined by the Diagnostic and Statistical Manual of Mental Disorders
mood disorders, anxiety disorders, and learning
disabilities"--health care professionals can recommend special
education services that are tailored to the coexisting disability rather
than only to ADHD. (21)

The AAP addresses the limited scope of the DSM-IV-TR criteria in
effectively diagnosing ADHD, (22) again reinforcing the subjective
nature of the process. As highlighted in Recommendation 2,
"[f]urthermore, the behavioral characteristics specified in the


[-TR], despite efforts to standardize them, remain subjective and
may be interpreted differently by different observers." (23) The
subjective nature of the diagnosis and the failure to have a mandatory
procedure for diagnosis are major factors in the rise of ADHD medication
access by non-sufferers. A key component that is required by the
DSM-IV-TR, yet is only part of the guideline, is that there must be some
adverse impact upon the individual in a social, academic, or
occupational environment.

Though these two prominent guidelines exist (in addition to
numerous rating scales), (24) studies have shown that medical providers
do not routinely follow either the AAP or APA's standards for
diagnosing ADHD. (25) A 2002 study of Michigan primary care physicians,
found that only 25.8% utilized all "4 diagnostic components in the
survey." (26) Though a majority of physicians were familiar with
the guidelines, few utilized the DSM-IV-TR criteria routinely in
practice. (27) Many selected a few of the recommendations promulgated by
the AAP but adherence to the Clinical Algorithm for diagnosing ADHD was
quite low. (28) Though the guidelines were not followed as specified by
the AAP, "[n]early every (97.8%) respondent had prescribed a
medication for ADHD in the past year." (29) Physicians, especially
primary care doctors, are faced with overcrowded waiting rooms, short
appointments, and a variety of other factors that prevent a thorough
evaluation prior to diagnosis. In addition, the multi-step process for
diagnosis places a strain on physicians and because the procedures are
simply guidelines, many doctors circumvent them. Furthermore, the need
for concert between educators, parents, and health care professionals in
order to ascertain an individual's diagnosis consumes more time
than a one visit consultation. The lack of a standardized and mandatory
procedure for physicians allows the ADHD diagnosis and medication to be
easily obtained by both sufferers and non-sufferers alike.

Another issue contributing to this problem encompasses individuals
who fake ADHD symptoms to obtain the ADHD diagnosis. Some individuals
desire an ADHD diagnosis for educational assistance such as extra time
on tests and assignments or additional assistance in the classroom. (30)
"Students may also be motivated to exaggerate or
v. feigned, feign·ing, feigns
a. To give a false appearance of:

 symptoms in
an effort to obtain stimulant medication, either as a study aid or for
recreational purposes as an inexpensive, prescription-based alternative
to cocaine." (31) Because the symptoms of ADHD are undetectable by
a specific medical test, they are easily manufactured by individuals,
especially those with the motivation to secure neuroenhancing
medication. (32) In a similar fashion, because ADHD symptom checklists
do not incorporate mechanisms for identifying those who exaggerate or
fake symptoms, it is relatively simple for adults and/or children to
look at criteria from the DSM-IV-TR or the AAP Guideline and provide
answers that will result in an ADHD diagnosis. (33) Studies have shown
"that symptom checklists for ADHD lack specificity and are prone to
over-identifying both students at the postsecondary level and adults in
the general population as having ADHD when they do not." (34)
Criteria for evaluation are posted on numerous websites including the
National Institutes of Health (

) and the AAP, providing a wealth of
information for individuals looking to obtain an ADHD diagnosis and
treatment plan. (35) Moreover, because physicians do not adhere strictly
to the DSM-IV-TR criteria when diagnosing ADHD or prescribing
medication, students do not necessarily have to demonstrate an adverse
effect upon their education when presenting symptoms. (36)

Treatment plans for students suffering from ADHD incorporate a wide
variety of non-medical alternatives to prescribing an ADHD drug. As
highlighted by the Acting Director of the National Institutes of Mental
Health in 2002, "[m] ost often, the first treatment used should be
psychosocial, including
behavioral therapy

See behavior therapy.
, social skills training,
support groups [,] and parent and educator skills training." (37)
Some of the components of a treatment plan may include: parent training,
classroom supports,
behavior modification

1. The use of basic learning techniques, such as conditioning, biofeedback, reinforcement, or aversion therapy, to teach simple skills or alter undesirable behavior.

2. See behavior therapy.
, and if necessary, medication.
Behavior modification is the sole nonmedical treatment supported by a
large basis of scientific evidence. (38) Behavioral modifications
include assistance with organization, scheduling, stress relief, and
relaxation techniques. (39) Though numerous options exist for the
treatment of ADHD, medication provides the fastest and most effective
way to reduce the unwanted behaviors. (40) "Adderall
over-stimulates the brain allowing for super-enhanced focus with a
simple pill." (41) Adderall (Amphetamine-dextroamphetamine) is the
most common ADHD psycho-stimulant prescribed. (42) Since its approval by
the Food and Drug Administration in 1996, its usage has steadily
increased. (43) "Amphetamines, such as Adderall and Ritalin, mimic
 , one of the intermediate substances in the biosynthesis of epinephrine and norepinephrine. See catecholamine.


One of the catecholamines, widely distributed in the central nervous system.
 chemical that transmits information across the junction (synapse) that separates one nerve cell (neuron) from another nerve cell or a muscle. Neurotransmitters are stored in the nerve cell's bulbous end (axon).
 in the brain," (44) and it has a
time-release formula that allows for an individual to be medicated for
an entire day, a change from previous intermediate-release formulas that
required multiple dosages. (45) Adderall is also listed as a Schedule II
Drug in the Controlled Substances Act which provides:

(2) Schedule II.--

(A) The drug or other substance has a high potential for abuse.

(B) The drug or other substance has a currently accepted medical
use in treatment in the
United States
 officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area.
 or a currently accepted medical
use with severe restrictions.

(C) Abuse of the drug or other substances may lead to severe
psychological or physical dependence. (46)

"[P] ossession of
Schedule II drugs

 can result in up to one
year in prison and a maximum fine of $1,000 for the first offense."
(47) Because of Adderall's placement in the Schedule II category,
the Attorney General issues an annual quota and drug manufacturers apply
for a certain portion of the quota. (48) Adderall also has "the
desired effect" of enhancing concentration and energy levels on any
user regardless of the presence of ADHD symptoms and/or a diagnosis.
(49) Any user can acquire a "super human ability to focus for long
periods of time," only contributing to the widespread abuse of
these drugs in post-secondary education and beyond. (50)


"I'm constantly being bombarded with requests. People can
get desperate."

--Libby (51)

Alcohol use by college students has continued at a steady pace in
recent years, yet "nontherapeutic use of prescription drugs has
soared--now second only to marijuana as a form of
illicit drug
 Street drug, see there
 use." (52) Because Adderall produces positive effects, especially
in an academic setting, the potential for misuse and abuse is very high.
Students without the disorder take advantage of the cognitive
enhancement Adderall provides to those diagnosed with ADHD: increased
levels of concentration and productivity, longer periods of undistracted
work, and the heightened ability to focus. (53) Students interviewed
about their illicit use of Adderall during a 2005-06 research study
mentioned that Adderall was a
miracle drug

A usually new drug that proves extraordinarily effective.
 that allowed them to
"grasp ideas ... be[] smarter[, and] ... recall information
quicker." (54) Overall, these students, and other participants in
similar studies, (55) stress that "ADHD stimulants [are] a salient
part of their university culture," a "normal" activity
that pervades college campuses across the country. (56) At this
particular university, 34% of student respondents had taken Adderall
illegally while only 4% had a legitimate prescription for the
medication. (57) Though the drive behind illicit use of Adderall centers
on the ability to work harder and essentially become
"smarter," many students also took advantage of the
nonacademic "perks" the drug can offer, from appetite
suppression to additional energy for long nights spent partying. (58)

Surprisingly, the supply of this wonder drug is not usually a
problem for students as "the stuff [Adderall] is everywhere."
(59) About 89% of student respondents obtained Adderall from friends who
had a legal prescription, paying anywhere from nothing to ten dollars
per pill. (60) Though a small percentage of students have actual
prescriptions (in comparison to those using the drug without a
prescription), the supply remains constant because those diagnosed with
ADHD take their medications strategically rather than following the
prescribed dosage. (61) Because some of the students surveyed
experienced the adverse
side effects

 (increased heart rate, sweating,

loss of appetite
 Medtalk Anorexia, see there
, etc.) of daily use, they simply took the pills

 prn. See prn order.
 and sold or gave away the surplus. (62) Though Adderall is a
Schedule II Controlled Substance and can only be obtained in thirty-day
doses, (63) individuals create a large supply by taking the medication
on an as-needed basis and making a profit off non-ADHD users. (64) As a
surveyed student eloquently put it, "[w] hat am I going to do with
all those pills? So I figure, if I can help out some friends and make
some beer money, life is good." (65) Based on numerous research
studies done on college campuses, Adderall misuse and abuse appears to
be "stigma free" for both the suppliers and illicit consumers,
providing a barrier to traditional methods of deterrence. (66) Margaret
Talbot explored the growing misuse of Adderall, noting the ease with
which a supply could be obtained in a New Yorker article. (67) Talbot
highlighted student comments made at the BoredAt Websites, including,
"I have Adderall for sale 20mg for $15," and "I have some
Adderall--I'm sitting by room 101.10 in a grey shirt and
headphones." (68) During interviews with
Columbia University
 mainly in New York City; founded 1754 as King's College by grant of King George II; first college in New York City, fifth oldest in the United States; one of the eight Ivy League institutions.
 students in 2005,
Andrew Jacobs

 found that "the prevailing ethos is
that Adderall, the drug of choice these days, is a legitimate and even
hip way to get through the rigors of a hectic academic and social
life." (69)

In addition to violating federal law, these individuals are
cheating their way into colleges, graduate schools, and professional
careers. As Jennifer Schiffner highlights, Adderall abusers gain
"[h]eightened senses during testing time combined with an increased
ability to focus" and can therefore access their "learned
knowledge faster and more efficiently than their peers, giving them a
particular advantage during timed exams." (70) Most admissions
programs rely on standardized tests to weigh and differentiate between
candidates coming from various schools, backgrounds, and geographical
areas. Yet, with candidates abusing Adderall and other psycho-stimulants
during test administrations, scores can no longer be considered
accurate, posing a problem for schools and students. (71) In addition,
students continue to abuse the drugs while enrolled in undergraduate and
graduate programs in order to compete for honors and jobs. This presents
an even more vexing problem as many programs rank students based on how
they compare to their classmates--a system thrown off by Adderall misuse
and abuse. As
Benedict Carey

 noted in the
New York
 Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of
 Times, a survey
conducted by the journal Nature addressed abuse (use for non-medical
purposes) of prescription drugs, including Adderall, by academia. (72)
Though the abuse by academia is not as widespread--or at least has not
been determined to be as widespread--the high percentage of abuse by
current higher education students will most likely
tr.v. per·vad·ed, per·vad·ing, per·vades
To be present throughout; permeate. See Synonyms at charge.

[Latin perv
 academia and
other professions in the near future. (73) The temptation to use
Adderall and similar medications stems from a culture that values
cognitive enhancement, possibly more so than physical beauty or athletic
prowess. (74) Because obtaining Adderall and other psycho-stimulants is
relatively easy with such a saturated market, students without
disabilities can obtain a "quick-fix" of neuroenhancement,
propelling them ahead of non-users at a low cost. In addition, the abuse
of psycho-stimulants by off-label users threatens the integrity and
success of students who truly suffer from ADHD. By most standards, it
constitutes cheating. Finally, non-sufferers who misuse medications like
Adderall can set themselves up for possible problems with addiction as
Adderall has a high likelihood of abuse. (75)


"Statistically speaking, two out of every 30 children in an
elementary level classroom[] have an ADD/ADHD diagnosis." (76)

This Part will discuss the passage of IDEA and the implications of
a diagnosis of ADHD. In addition, it will also highlight the [section]
504 plan and its importance in the diagnosis and provision of services
to individuals suffering from ADHD.

The Individuals with Disabilities in Education Act (IDEA) was
enacted "to ensure that all children with disabilities have
available to them a free appropriate public education that emphasizes
special education and related services designed to meet their unique
needs and prepare them for further education, employment, and
independent living." (77) IDEA covers children between the ages of
three and twenty-one with specifically identifiable disabilities and
grants them an education in the
least restrictive environment

(78) Students who are deemed appropriate for services under the act are
given an Individualized Education Plan (

) that outlines the
disability and any services they will receive while in school. (79) To
satisfy the requirements of IDEA, educational personnel must play an
active role in determining if a student has a disability and in
administering appropriate services if specific criteria are satisfied.
Not all students with learning disabilities are covered under IDEA and
therefore do not receive services. IDEA defines a student with a
disability as one having "
mental retardation
 below average level of intellectual functioning, usually defined by an IQ of below 70 to 75, combined with limitations in the skills necessary for daily living.
, hearing impairments
(including deafness), speech or language impairments, visual impairments
(including blindness),
serious emotional disturbance

 (referred to in
this chapter as 'emotional disturbance'), orthopedic
 , developmental disability resulting from a neurological disorder that affects the normal functioning of the brain. It is characterized by the abnormal development of communication skills, social skills, and reasoning.
traumatic brain injury

, other health impairments,
or specific learning disabilities." (80) In addition, IDEA requires
that a student's disability have an adverse effect on the
child's academic success in order for educational services to be
provided. (81) ADHD does not fall under the narrow scope of enumerated
disabilities outlined in IDEA; students suffering from this disorder can
obtain services under the category of Other Health Impairments if the
ADHD symptoms "adversely affect[] a child's educational
performance." (82) Students who are denied services under IDEA may
still qualify under [section] 504 of the Rehabilitation Act. (83) In
order to obtain [section] 504 services, students must show that their
impairment "substantially limits one or more ... life
activities," (84) requiring that the "disability interferes
with" a major life function including breathing, seeing, learning,
hearing, speaking, working, and performing manual tasks, (85) However,
placement in this category does not provide a clear method for
diagnosing ADHD--it simply allows students with this diagnosis, who
would otherwise be denied services under IDEA, to receive services in an
educational setting. Federal special education laws allow for school
personnel to initiate an evaluation for a learning disability or ADHD,
(86) but this is simply for the allocation of services within the school
setting. The actual medical diagnosis and treatment with
 /psy·cho·tro·pic/ () exerting an effect on the mind; capable of modifying mental activity; said especially of drugs.

 drugs--the main concern of this Note--fall outside the

 of IDEA
and [section] 504, as neither statute focuses on the medical diagnosis.
By connecting the diagnosis of ADHD with federal special education laws,
we can achieve consistency in diagnosis and effective treatment and
thwart off-label usage.


"There are big cultural pressures to get these drugs....
That's because everyone is in an arms race of accomplishment."

As mentioned above, the misuse and abuse of ADHD medications is a
large problem affecting various areas of society from young school
children to the adult workforce. (88) Abuse and misuse present ethical
issues regarding how society views cognitive enhancement. (89) One
primary concern focuses on the unfair professional or academic advantage
that non-ADHD sufferers obtain while taking Adderall. (90) As previously
discussed, (91) Adderall provides all users--those with ADHD and those
without--a heightened ability to focus and complete tasks at a faster
rate. This increased efficiency is instrumental in an academic or
high-pressured work environment. Students and professionals are usually
rewarded through scholarship and bonuses based upon achievement. But if
the achievement is dependent upon an illegal prescription, should it be
rewarded? (92) Should cognitive-enhancement drugs be an acceptable
method of attaining academic success? Specific professions might
actually benefit from Adderall use, "such as... air-traffic
controllers, surgeons and nurses who work long shifts." (93)

Some commentators draw correlations between Adderall use and the
consumption of caffeine and other energy drinks (94) or the use of
tutors in an academic setting, (95) but caffeine is not classified as a
Schedule II substance under the

 and tutors are not illegal without a
valid prescription. Similarly, not all advantages that individuals can
gain constitute a form of cheating. An analogy can be drawn to
steroid use


Anabolic steroids are drugs containing hormones, or hormone-like substances, that are used to increase strength and promote muscle growth.
 in athletics, where, though steroids increase strength and
size, an athlete's ability to play depends on skill. However, these
drugs are banned within athletics through anti-doping regulations. (96)
Adderall provides the same advantage within the academic context--it
aids in the ability to focus and study for long periods of time--yet, in
the end, success is dependent upon the student's knowledge and
thinking ability. If athletic and academic steroids provide the same
advantage, why are athletic steroids stigmatized while academic ones are
lauded and used pervasively? The carefree, unprescribed, and
"stigma-less" use of cognitive enhancers like Adderall among
students and adults eviscerates standards of conduct in academic and
professional settings as doping does in the athletic arena.

Because the prevalence of abuse across college campuses in
particular is so high, some colleges and universities have amended their
discipline policies to address the problem. (97) Though changes have
been made to extend the definition of cheating to include the use of
prescription drugs for academic enhancement, these policies will be
incredibly difficult for school officials to enforce. (98) Many other
solutions have been proposed to manage distinct aspects of this issue
from random drug testing prior to standardized tests, (99) more training
for health care professionals about ADHD, (100) as well as regulatory
measures for prescriptions. (101) One solution that is similar in nature
to the one proposed here recommends that state legislation create and
implement guidelines for physicians in diagnosing ADHD as well as other
neurobehavioral disorders in children. (102) A state-centered solution
is distinct from the current proposal because it focuses on physician
training and the harmful effects of psychotropic drugs on children. The
federal standard aims at ensuring accurate diagnosis across the country
rather than on a state-by-state basis as well as addressing the
increased use and abuse among older students. Though states play an
active role in the identification of individuals with disabilities, a
federal standardized test is necessary to adequately combat the problem
of misuse and abuse of ADHD medications. (103) In addition, this
Note's proposal is not limited to children diagnosed with
neurobehavioral disorders and prescribed psychotropic medication.
Instead, the concern lies with older students who manufacture symptoms
or obtain medication for misuse or to pass along to fellow
non-sufferers. The state legislative solution addresses the concern that
educators require children to be placed on psychotropic medication
without adequate informed consent from parents. (104) This Note argues
that because there has been such a drastic increase in the rate of
diagnosis of ADHD in older children as well as adults, in addition to an
increase in the manufacturing of ADHD symptoms, (105) health care
professionals should
adhere to

verb 1. , keep, maintain, respect, observe, be true, fulfil, obey, heed, keep to, abide by, be loyal, mind, be constant, be faithful

 federally-mandated testing measures at
all age levels to curb incorrect usage of medication. (106) This Note
proposes an amendment to IDEA to add ADHD to the list of disabilities
covered under the act specifically because it is one of the most common
neurobehavioral disorders in children. (107) Though [section] 504
provides for services if an individual's learning is substantially
impacted by his or her mental or physical impairment--which includes
ADHD (108)--IDEA specifically requires an adverse effect on the
individual's education and covers the most widely diagnosed
disabilities. This will alter the current structure of including ADHD
under the
umbrella term

 of Other Health Impairments and reinforce the
requirement of having an adverse effect on education before a diagnosis
and medication are obtained. In conjunction with including ADHD within
[section] 1401 of IDEA, Congress should implement a standardized
diagnostic test for ADHD to be used by health care providers who
diagnose ADHD and prescribe medication in both children and adults. This
federal measure would go hand-in-hand with IDEA--and be required for
services under IDEA as well as for outside diagnosis--in that a student
may not obtain an ADHD diagnosis or corresponding medication without
satisfying the requirements of the diagnostic test, providing more
accuracy in diagnosis and treatment with prescription medications. This
diagnostic test will correlate directly with the IDEA amendment, as the
statute will require satisfaction of the testing measure prior to both a
diagnosis and the rendering of services in the academic environment. Any
standardized measure should be created along the lines of the DSM-IV-TR
criteria promulgated by the APA, a nationally known and well-regarded


 for psychological disorders. Though guidelines exist for the
diagnosis of ADHD, (109) they do not demand adherence before medication
is prescribed; instead they are non-mandatory rubrics. By implementing a
mandatory standardized diagnostic test, physicians will be better able
to identify ADHD symptoms accurately and prescribe medication only when
necessary--cutting off the source of improper use of Adderall and its
counterparts. (110) Though there is no perfect solution to Adderall
abuse, by only prescribing medication to individuals who require it, the
amount available for consumption would be limited. Because those who
obtain an unnecessary prescription tend to use Adderall in specific
circumstances, they have a larger quantity available for sale. Removing
this Adderall supply reduces the opportunities for individuals to obtain
the pills without a prescription and can curb abuse substantially. These
proposed mechanisms will prevent students from obtaining unnecessary
medication while also ensuring that students who truly suffer an adverse
educational impact will obtain the services and medication that they
need. When students are correctly diagnosed, the educational system can
better serve their needs through classroom services, and health care
professionals can accurately and safely prescribe medication. This will
also provide a barrier to students trying to secure an ADHD diagnosis by
"faking" symptoms and then violating the CSA by distributing
medication to others without a prescription.

In creating a standard diagnostic test for ADHD, educational
professionals, physicians, and psychologists must collaborate to
effectively identify the primary and essential symptoms necessary for a
diagnosis. (111) The guidelines from both the APA and AAP contain the
necessary information for accurate diagnosis. (112) By creating a
mandatory procedure to follow prior to diagnosis, individuals truly
suffering from ADHD will be identified and provided services, including
medication, and malingerers will be turned away. As the DSM-IV-TR
criteria are included in the AAP guideline, this would be the necessary

starting point

 in finalizing a standardized measure. As explained above,
(113) most guidelines identify a variety of factors to be taken into
account when diagnosing ADHD. These range from parent/teacher surveys,
behavior scales, and interviews with the individual all focused on
identifying ADHD outside the biological context. One factor that must be
included in a new ADHD diagnostic test is the adverse effect on the
child's education--a factor utilized by both IDEA and [section] 504
and included within the DSM-IV-TR and AAP criteria. (114)

In addition, a new standardized diagnostic test must include a
mechanism for reevaluation of symptoms within a specific time frame.
(115) Typically symptoms dissipate as a child reaches adulthood, though
the disorder can persist throughout a person's lifetime. (116)
Though this measure will most likely be published and made widely
available to the public, the requirement of the adverse effect on
education will be an adequate safeguard against manufactured diagnoses.
Students would have to demonstrate a marked decrease in achievement over
a period of time no less than six months in order to obtain a diagnosis.
For those seeking a cognitive boost without suffering from ADHD, they
would have to perform poorly in school--a contradictory move for a
student concerned about academic success.

Since IDEA is a federal mandate for educational institutions,
creating a standardized mechanism for diagnosing and treating ADHD will
aid in the detection and appropriate treatment of children and
adolescents with ADHD. Because Congress has already placed federal
strictures on the treatment of individuals with disabilities, (117)
amending IDEA to

 ADHD as a covered disability is merely an
extension of current policy. This amendment and the creation of a
standardized diagnostic measure will aid in the effectiveness of IDEA to
extend services to those students who need them, while enabling health
care professionals to navigate an increasingly difficult disorder to
identify and treat effectively.

Amending IDEA to include ADHD as an enumerated disability and to
require use of the standardized diagnostic measure--which itself will
demand a showing of an adverse effect on education--will adequately
address the issue of k-12 students misusing or abusing Adderall.
However, a large segment of the population--college and university
students as well as adults not enrolled in an academic program--obtain
ADHD diagnoses and medication at a high rate. (118) By standardizing the
diagnostic procedures, physicians and health care professionals can
accurately diagnose individuals regardless of age and restrict the
amount of Adderall prescribed. Though the standardized measure would
include a provision mandating that ADHD cause an adverse effect on
one's education, this can easily be adapted for adults in the
workforce (for instance, requiring a decrease in performance at work
over an extended period). (119)


"Ultimately, it's a clinical diagnosis. You can interpret
an individual patient's symptoms any way you want." (120)
Amending IDEA and implementing a standardized diagnostic test will
combat future

n. pl. mis·di·ag·no·ses
An incorrect diagnosis.

 and abuse of ADHD medications; however, it
will not be able to make a drastic impact upon current misusers and
abusers. In order to curb current off-label usage, health care
professionals should reevaluate individuals with an ADHD diagnosis
and/or a medication treatment plan to determine if they truly require
the ADHD label. Once the standardized diagnostic measure is in place,
physicians will be able to retest their patients of all ages to screen
out individuals who do not require medication. For those individuals who
already have a diagnosis of ADHD, a modified version of the diagnostic
measure can be used for reevaluation and an assessment of the current
diagnosis. Rather than requiring these individuals to demonstrate an
adverse effect on education, physicians can evaluate their performance
on attention-related tasks without the use of their prescriptions. This
modified test can assist physicians in monitoring patients with ADHD and
in correctly re-diagnosing them.

By implementing a national standardized measure, physicians will
lose some discretion in the diagnosis and treatment of ADHD. Because an
ADHD diagnosis (and subsequent treatment with medication) will require
satisfaction of federally mandated standards, health care professionals
will gain a bright-line measure at the expense of professional
decision-making. However, the diagnostic test does not require
physicians to certify a diagnosis or prescribe medication; instead it
only requires that prior to diagnosing ADHD, the strictures of the test
be satisfied. After the test is satisfied, a physician can deny an ADHD
diagnosis, choose to prescribe medication, regulate the dosage, or
devise a different treatment plan. This standardized test will simply
provide the necessary guidance for medical professionals as they
navigate an uncertain area of
 /psy·cho·pa·thol·o·gy/ ()
1. the branch of medicine dealing with the causes and processes of mental disorders.

2. abnormal, maladaptive behavior or mental activity.
. Professionals in the
field will still maintain a level of discretion and judgment when
developing a treatment plan for an individual presenting with the
standardized symptoms of ADHD.


Adderall misuse and abuse is increasing across the nation through
both the misdiagnosis of ADHD and the procurement of the medication
illegally. The cognitive boost that individuals gain while taking
Adderall has driven students, as well as professional adults, to misuse
the drug to gain an advantage in concentration and focus over non-users.
Though Adderall provides treatment for individuals who truly suffer from
ADHD, its
 Health care The common use of a particular intervention even when the benefits of the intervention don't justify the potential harm or cost–eg, prescribing antibiotics for a probable viral URI. Cf Misuse, Underuse.
 in recent years is problematic and raises ethical
issues for society. Numerous measures have been proposed to combat this
staggering increase in both ADHD diagnoses and prescriptions for
Adderall and its relative drugs. However, none of these adequately
address the vast nature of the problem and the need for a federal
response. Because Adderall is a Schedule II drug under the Controlled
Substances Act due to its highly addictive nature, it is imperative that
nationwide standards be adopted and included under IDEA so that accurate
diagnosis and treatment of ADHD can follow. Though other neurobehavioral
disorders do not require mandatory diagnostic tests, the medications for
these are not as highly regulated, nor is the abuse level as high as
that of Adderall. By requiring physicians and other health care
professionals to follow a national testing rubric to diagnose, and
therefore prescribe, Adderall and other ADHD medications, individuals
who truly suffer from ADHD will receive the necessary treatment and
non-sufferers will be unable to circumvent the testing procedures to
obtain a fake diagnosis and subsequent medication. Finally, these
measures will begin to combat the unethical, illegal, and dishonest
abuse of ADHD medications within the academic and professional climate.

(1) Alan D. DeSantis et al., Illicit Use of Prescription ADHD
Medications on a College Campus: A Multimethodological Approach, 57 J.
AM. COLL. HEALTH 315, 319 (2008). Mitch's comment mimics that of
many of his classmates surveyed during the study. Students regularly
misuse/abuse Adderall for academic purposes. Id. at 317-19.

(2) Margaret Talbot, Brain Gain, THE NEW YORKER (Apr. 27, 2009),
http://www. ("The demand is certainly there: from an aging population
that won't put up with memory loss; from
1. Excessively nervous or excited; agitated.

2. Extremely elaborate or ornate; overdone:

 giving their children every possible edge; from anxious employees in
an efficiency-obsessed, BlackBerry-equipped office culture, where work
never really ends.").

(3) Peter R. Breggin, A Misdiagnosis, Anywhere, N.Y. TIMES (Oct.
13, 2011, 8:52 P.M.), (arguing that ADHD symptoms "are the
spontaneous behaviors of normal children" and when they become age
inappropriate, "the potential causes are limitless").


. FOR DISEASE CONTROL, Attention Deficit/Hyperactivity
Disorder (ADHD): Facts About ADHD, (last visited Nov. 12, 2012)
[hereinafter CDC Facts About ADHD].

(5) CTR.
 Vestibulo-ocular reflex, see there
 DISEASE CONTROL, Attention Deficit/Hyperactivity
Disorder (ADHD): Data & Statistics, (last visited Nov. 12, 2012)
[hereinafter CDC Data About ADHD].


 /Di·ag·nos·tic and Sta·tis·ti·cal Man·u·al of Men·tal Dis·or·ders/ (DSM) a categorical system of classification of mental disorders, published by the American Psychiatric Association, that delineates objective
 87, 93 (4th ed., text rev. 2000) [hereinafter
DSM-IV-TR]. The DSM-IV-TR spells out four subtypes of ADHD: combined,
Exhibiting a lack of attention; not attentive.

, predominantly hyperactive-impulsive, and not
otherwise specified.

(7) CDC Data About ADHD,

 note 5 (noting that the DSM-IV-TR
cites 3-7% of children suffer from ADHD while parents report about a
9.5% rate of diagnosis); see also Ethan Watters, An Expression of Our
Culture, N.Y. TIMES (Oct. 13, 2011, 2:23 P.M.), adhd/american-culture-and-adhd (discussing various reasons why there
"might be ... an upwelling of psychopathology").

(8) See Linda Carroll, Adults Who Claim to Have ADHD? One in Four
May Be
Faking It

, MSNBC.COM (Apr. 25, 2011, 8:59 A.M.),


("[B]etween 2 percent and 4 percent of the adult population is
estimated to have ADHD....").

(9) Joel Garreau, A Dose of Genius, WASH. POST (June 11, 2006),
http://www. (noting that a reason for the increase is that Adderall is
"the winner's edge-- the difference between a 3.8 average and
a 4.0, maybe their ticket to Harvard Law-- these 'brain
steroids' can be purchased on many campuses for as little as $3 to
$5 per pill, though they are often obtained free from friends with
legitimate prescriptions").

(10) Barbara Prudhomme White et al., Stimulant Medication Use,
Misuse, and Abuse in an Undergraduate and Graduate Student Sample, 54 J.
AM. COLL. HEALTH 261, 265 (2006).

(11) NAT'L RESOURCE CTR. ON ADHD, About AD/HD, en/about/causes (last visited Nov. 12, 2012)
("Although precise causes have not yet been identified, there is
little question that
 transmission from generation to generation through the process of reproduction in plants and animals of factors which cause the offspring to resemble their parents. That like begets like has been a maxim since ancient times.
 makes the largest contribution to the
expression of the disorder in the population. In instances where
heredity does not seem to be a factor, difficulties during pregnancy,
prenatal exposure to alcohol and tobacco,
premature delivery

The birth of a premature baby.

The birth of a live baby when a pregnancy ends spontaneously after the twentieth week.

Mentioned in: Stillbirth
significantly low birth weight, excessively high body lead levels, and

 /post·na·tal/ () occurring after birth, with reference to the newborn.

Of or occurring after birth, especially in the period immediately after birth.
 injury to the
 /pre·fron·tal/ () situated in the anterior part of the frontal lobe or region.

 regions of the brain have all been
found to contribute to the risk for AD/HD to varying degrees.");
see also

, OUR POSTHUMAN FUTURE 47 (2002) ("It is a
pathology recognized only by its symptoms.").

(12) See Craig S. Lerner, "Accommodations" for the
Learning Disabled: A
Level Playing Field

Affirmative Action
 in the United States, programs to overcome the effects of past societal discrimination by allocating jobs and resources to members of specific groups, such as minorities and women.
Elites?, 57 VAND. L. REV. 1043, 1068 (2004) ("What is the
difference, then, between the ordinary mix of mind-wandering,
exuberance, and boredom that is part and parcel of 'growing
up,' and the abnormal
Exhibiting a lack of attention; not attentive.

adj. jit·ter·i·er, jit·ter·i·est
1. Having or feeling nervous unease:

 that merits
accommodation and even medication?").

(13) AM.

ACAD Acadia National Park
ACAD Atherosclerotic Coronary Artery Disease
PRACTICE GUIDELINE]. The tests discredited by the AAP include blood lead
levels, thyroid levels, and brain wave assessments. Id.

(14) See DSM-IV-TR, supra note 6, at 85-93.

(15) Id. at 85-88. This is a change from the previous editions
where symptoms were those that should "appear in most situations,
including at home, in school, at work, and in social
[hereinafter DSM-III-R]; see Doris Derelian, The Legal
Yin and Yang


two complementary principles of Chinese philosophy: Yin is negative, dark, and feminine, Yang is positive, bright, and masculine [Chinese yin dark + yang bright]
Attention Deficit/Hyperactive Disorder, 5 U.C.
 city (1990 pop. 46,209), Yolo co., central Calif.; settled in the 1850s, inc. 1917. It is an education center with light industry; machinery, processed foods, and computer equipment are produced. The extensive Univ.

. L. &
POL'Y 245, 250 (2001) ("This
v. lib·er·al·ized, lib·er·al·iz·ing, lib·er·al·iz·es
To make liberal or more liberal:
 of criteria means
greater numbers of children (and adults) carry this diagnosis in
today's schools and workplaces.").

(16) DSM-IV-TR, supra note 6, at 93. This provision will feature
prominently in my argument that without the adverse effect on education,
specifically school performance, a diagnosis of ADHD should not be


 by a health care professional. See
 Part IV.

(17) AAP PRACTICE GUIDELINE, Supra note 13.

(18) The DSM-IV-TR Criteria provide these factors:

A. Either (1) or (2)

(1) six (or more) of the following symptoms of inattention have
persisted for at least 6 months to a degree that is

Unsuitable or counterproductive; for example, maladaptive behavior is behavior that is inappropriate to a given situation.

Mentioned in: Cognitive-Behavioral Therapy
inconsistent with developmental level:


(a) often fails to give close attention to details or makes
careless mistakes in schoolwork, work, or other activities

(b) often has difficulty sustaining attention in tasks or play

(c) often does not seem to listen when spoken to directly

(d) often does not follow through on instructions and fails to
finish schoolwork, chores, or duties in the workplace (not due to
oppositional behavior or failure to understand instructions)

(e) often has difficulty organizing tasks and activities

(f) often avoids, dislikes, or is reluctant to engage in tasks that
require sustained mental effort (such as schoolwork or homework)

(g) often loses things necessary for tasks or activities (e.g.,
toys, school assignments, pencils, books, or tools)

(h) is often easily distracted by extraneous stimuli

(i) is often forgetful in daily activities

(2) six (or more) of the following symptoms of
hyperactivity-impulsivity have persisted for at least 6 months to a
degree that is maladaptive and inconsistent with developmental level:


(a) often fidgets with hands or feet or squirms in seat

(b) often leaves seat in classroom or in other situations in which
remaining seated is expected

(c) often runs about or climbs excessively in situations in which
it is inappropriate (in adolescents or adults, may be limited to
subjective feelings of restlessness)

(d) often has difficulty playing or engaging in leisure activities

(e) is often 'on the go' or often acts as if 'driven
by a motor'

(f) often talks excessively


(g) often blurts out answers before questions have been completed

(h) often has difficulty awaiting turn

(i) often interrupts or intrudes on others (e.g., butts into
conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms that caused
impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or more
settings (e.g., at school [or work] and at home).

D. There must be clear evidence of clinically significant
impairment in social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of a

Pervasive Developmental Disorder

Any of several disorders, such as autism and Asperger's syndrome, characterized by severe deficits in many areas of development, including social interaction and communication, or by the presence of repetitive,
, Schizophrenia, or other

A mental disorder characterized by delusions, hallucinations, or other symptoms of lack of contact with reality. The schizophrenias are psychotic disorders.
 and are not better accounted for by another
mental disorder

Mood Disorder

Any of a group of psychiatric disorders, including depression and bipolar disorder, characterized by a pervasive disturbance of mood that is not caused by an organic abnormality. Also called affective disorder.
Anxiety Disorder

Any of various psychiatric disorders in which anxiety is either the primary disturbance or is the result of confronting a feared situation or object.
Dissociative Disorder

See multiple personality.

Noun 1. dissociative disorder - dissociation so severe that the usually integrated functions of consciousness and perception of self break down
, or

Personality Disorder

). DSM-IV-TR, supra note 6, at 92-93.

(19) AAP PRACTICE GUIDELINE, supra note 13, at 1160-68.

(20) Id. Much of the information utilized in making a diagnosis is
obtained from parents and teachers. Recommendation 3 utilizes
"evidence directly obtained from parents or caregivers regarding
the core symptoms of ADHD in various settings, the age of onset,
duration of symptoms, and degree of functional impairment." Id. at
1163. Recommendation 4 utilizes, "evidence directly obtained from
the classroom teacher (or other school professional) regarding the core
symptoms of ADHD, the duration of symptoms, the degree of functional
impairment, and coexisting conditions." Id. at 1165. The AAP also
provides a clinical algorithm within its criteria outlining the process
for diagnosis. This algorithm includes the DSM-IV criteria, reiterating
that symptoms must be present in more than one setting and last for
longer than six months. Id. at 1162 tbl.1.

(21) Id. at 1166.

(22) Given the lack of methods to confirm the diagnosis of ADHD
through other means, it is important to recognize the limitations of the
DSM-IV TR definition. Id. at 1162.

(23) Id. at 1163.

(24) AM. ACAD. OV

ACTION, Practice Parameter for the Assessment and Treatment of Children
and Adolescents with Attention-Deficit/Hyperactivity Disorder, 46 J. AM.
ACID. CHILD ADOLESCENT PSYCHIATRY 894, 899 (2007) [hereinafter AACAP
Practice Parameter] (discussing a practice parameter that provides
information on the
clinical evaluation
 Medtalk An evaluation of whether a Pt has symptoms of a disease, is responding to treatment, or is having adverse reactions to therapy
, research, and treatment of

(25) Laurel K. Leslie et al., Implementing the American Academy of
Pediatrics Attention-Deficit/Hyperactivity Disorder Diagnostic
Guidelines in Primary Care Settings, 114 PEDIATRICS 129 (2004); Jerry L.
Rushton et al., Use of
Practice Guidelines
 Medical practice A set of recommendations for Pt management that identifies a specific or range of range of management strategies. See Peer review organization, Practice standards. Cf 'Cookbook' medicine.
 in the Primary Care of
Children with Attention-Deficit/Hyperactivity Disorder, 114 PEDIATRICS
e23, e23 (2004) (This "study sought 1 [.] to describe primary care
diagnosis and management of ADHD, 2[.] to determine whether the care is
in accordance with American Academy of Pediatrics (AAP) practice
guidelines, and 3[.] to describe factors associated with guideline

(26) Rushton, supra note 25, at e23.

(27) Id. at e24-e25. This presents the primary problem with
diagnosing ADHD. Physicians and other health care professionals are
focusing more on the subjective parent/teacher rating scales rather than
the APA's criteria--specifically the provision that requires an
impairment in social, occupational, or academic functioning. 28

(28) Id. at e23.

(29) Id. at e24; see also Prescribed Stimulant Use for ADHD
Continues to Rise Steadily, NAT'L INST. OF MENTAL HEALTH, (Sept.
28, 2011), continues-to-rise-steadily.shtml [hereinafter Press
Release] ("Stimulant medications work well to control ADHD
symptoms, but they are only one method of treatment for the condition.
Experts estimate that about 60 percent of children with ADHD are treated
with medication." (quoting Benedetto Vitiello, M.D.)).

(30) A primary motivation for obtaining the diagnosis of ADHD
originates with securing extra-time on tests including
admissions tests

 to secondary education institutions. See Melana Zyla Vickers, A Role in
Admissions, N.Y. TIMES (Oct. 12, 2011 ), http:/
/ role-of-adhd-diagnoses-in-college-admissions ("[T]here is
[a] small subset of cases involving parents who may be abusing recent
expansions in psychologists' terminology, as well as in disability
law, to seek a diagnosis of attention deficit or learning disability for
their child not because their child is disabled but because the
diagnosis can provide academic advantages.").

(31) Allyson G. Harrison et al., Identifying Students Faking ADHD:
Preliminary Findings and Strategies for Detection, 22 ARCHIVES OF


 577, 579 (2007) (citing
Sean P

. Barrett et al.,
Characteristics of
 /meth·yl·phen·i·date/ () a central stimulant, used in the form of the hydrochloride salt in the treatment of attention-deficit in children and narcolepsy.
 Misuse in a University Student
Sample, 50 CAN. J. PSYCHIATRY, 457--461 (2005)).

(32) Id. ("Self-report inventories are notoriously vulnerable
to exaggeration or feigning of symptoms [and] [r]ecent studies
demonstrate how simple it is to fake symptoms of ADHD, especially when
filling out self-report checklists." (internal citation omitted));
see also, White, et al., supra note 10, at 265 ("This finding [of
students stockpiling ADHD medication] also raises the question of
whether students might fake ADHD or ADD symptoms to obtain stimulants
for planned misuse or abuse or for resale.").

(33) See Harrison et al., supra note 30, at 579.

(34) Id. ((citing Allyson G. Harrison, An Investigation of Reported
Symptoms of ADHD in a University Population, 12 ADHD REPORT 6, 8-11
(2004); Barbara S. McCann & Peter Roy-Byrne, Screening and
Diagnostic Utility of Self-Report Attention Deficit Hyperactivity
Disorder Scales in Adults, 45 COMPREHENSIVE PSYCHIATRY 175, 175-183

(35) How is ADHD Diagnosed?, NAT'L INST. OF HEALTH,

health/publications/attention-deficit-hyperactivity-disorder/how-is-adhd- diagnosed.shtml (last visited Nov. 12, 2012); Clinical Practice
Guideline, AM. ACAD. OF PEDIATRICS,;128/5/

1007 (last visited Nov. 12, 2012). This phenomenon is not limited to
students seeking an edge over classmates. See Carroll, supra note 8
("Twenty-two percent of adults in the study who claimed they
suffered from attention-deficit/hyperactivity disorder tried to

 test results to make their symptoms look worse,
according to

1. As stated or indicated by; on the authority of:

2. In keeping with:

 a new
report based on the medical records of 268 patients and published in the
journal The Clinical

A clinical psychologist who specializes in assessing psychological status caused by a brain disorder.

Mentioned in: Post-Concussion Syndrome

(36) See Carroll, supra note 8 ("'I had a patient who was
prescribed Adderall by another doctor,' one physician wrote.
'I asked her [for] her medical history pertaining to ADD. She
explained how she had difficulty concentrating at home and how the meds
had helped her maintain the A grades she had been having all

(37) Attention Deficit/Hyperactivity Disorder--Are We
Overmedicating Our Children?: Hearing Before the H. Comm. on Gov't
Reform, 107th Cong. 72 (2002) (statement of Richard Nakamura, Acting
Director, National Institute of Mental Health, U.S. Dept. of
Health and
Human Services


(38) Behavioral Treatment, NAT'L RESOURCE CTR. ON ADHD,
http://www.help4adhd. org/en/treatment/behavioral (last visited Nov. 12,

(39) See Behavioral Treatments for ADHD,

hyperactivity_disorder/hic_behavioral_treatments_for_adhd.aspx (last
visited Nov. 12, 2012).

(40) See Amanda Slater & Ronald E. Reeve, The
"Tug-Of-War" Over
Attention-Deficit Hyperactivity Disorder

A condition in which a person (usually a child) has an unusually high activity level and a short attention span. People with the disorder may act impulsively and may have learning and behavioral problems.
Balancing the Interests of Parents and Schools (and Don't Forget
the Kids), 27 DEV. MENTAL HEALTH L. 1, 4 (2008) ("Indeed, numerous
studies conducted across a [wide] range of settings have found that
stimulant medications effectively reduce the core symptoms of
ADHD." (citing studies from the American Academy of Child and
Adolescent Psychiatry and the
New England Journal of Medicine

)); see
also AACAP Practice Parameters, supra note 24, at 903 (discussing
research reviews of pharmacological and non-pharmacological treatments
and noting "the superiority of the stimulant over the nondrug

(41) Jennifer Schiffner, Harder, Better, Faster Stronger:
Regulating Illicit Adderall Use Among Law Students and Law Schools 2
(January 2010) (unpublished manuscript) available at (emphasis removed); see
infra Part I for a discussion of health care professionals'
tendency to prescribe medication for ADHD sufferers.

(42) See Dextroamphetamine and
 , any one of a group of drugs that are powerful central nervous system stimulants. Amphetamines have stimulating effects opposite to the effects of depressants such as alcohol, narcotics, and barbiturates.
12, 2012). The combination of dextroamphetamine and amphetamine are
classified as
central nervous system stimulants

Central nervous system (CNS) stimulants are medicines that speed up physical and mental processes.
 that alter natural
substance amounts within the brain. Ritalin (Methylphenidate) was the
drug of choice for ADHD treatment prior to Adderall but was found to be
less effective in controlling the negative behaviors of ADHD. See
William E.

, et al, A Comparison of Ritalin and Adderall: Efficacy
and Time-Course in Children With Attention-Deficit/Hyperactivity
Disorder, 103 PEDIATRICS 1, 1 (1999) ("The doses of Adderall that
were assessed produced greater improvement than did the assessed doses
of Ritalin, particularly the lower dose of Ritalin, on numerous but not
all measures.").

(43) See Garreau, supra note 9 ("Total sales have increased by
more than 300 percent in only four years, topping $3.6 billion last

(44) Shawn Romer, Note, Combatting the Unfair Competitive Edge:
Random Drug Testing Should Be Implemented in Standardized Testing to
Deter Illicit and Unfair Use of Prescription Stimulants, 21 J.L. &
HEALTH 151, 156 (2008) (citing Nora Volkow et al., Evidence That
Methylphenidate Enhances the
   also sa·li·en·cy
n. pl. sa·li·en·ces also sa·li·en·cies
1. The quality or condition of being salient.

2. A pronounced feature or part; a highlight.

Noun 1.
 of a Mathematical Task by
Increasing Dopamine in the Human Brain, 161 AM. J. PSYCHIATRY 1173-80
(2004)). Volkow also notes that increased dopamine levels correlate with
a heightened interest and focus in the task at hand which explains the
augmented academic functioning. Id. at 1173, 1179; see also Jessica
Feinstein, Adderall: The Academic Steroid,

 (Jan. 24,
2005), ("It comes in dosages of 5, 10, 20, 25[,] and 30
milligrams, is relatively inexpensive and lacks both the harsh up and
down--as well as the street stigma--of the better-known ADHD drug

(45) See AACAP Practice Parameter, supra note 24, at 904 (2007)
("Immediate-release stimulant medications have the disadvantage
that they must be taken two to three times per day to control ADHD
symptoms throughout the day."). Extended release formulas allow for
medication to be released at a gradual rate, controlling how much
medication enters the body. Long-acting formulas allow the medication to
remain in the body for longer periods of time.
Attention-Deficit/Hyperactivity Disorder, NAT'L INST. OF MENTAL
deficithyperactivity-disorder/complete-index.shtml#pub6 (last visited
Nov. 12, 2012).

(46) Controlled Substances Act, 21 U.S.C. [section] 812(b)(2)
(2006). Other drugs included under Schedule II are cocaine (and its
derivatives) as well as opium and opiates. 21 U.S.C. [section] 812(c)
(2006); see Ritalin among Youth: Examining the Issues and Concerns,
Before the Subcomm. on Early Childhood, Youth, and Families of the Comm.
on Educ. and the Workforce, 106th Cong. (2000) (statement of Terrence
Woodworth, Deputy Director, Office of Diversion Control, Drug
Enforcement Agency Office of Diversion Control, Drug Enforcement
Agency), available at

("[Adderall has been classified under] Schedule II of the CSA since
1971. Schedule II of the CSA contains those substances that have the
highest abuse potential and dependence profile of all drugs that have
medical utility.").

(47) See Romer, supra note 44, at 157-58 (citing 21 U.S.C.S.
[section] 844 (LexisNexis 2006)). Romer addresses the abuse of
prescription stimulants upon entrance exams for educational institutions
and proposes drug testing as a solution. See infra Part IV.

(48) 21 U.S.C. [section] 826 (2006). In May 2011, an Adderall
shortage was reported by the Wall Street Journal. See Peter Loftus,
Attention Disorder Drug Shortage Prompts FingerPointing, WALL ST. J.,
(May 5, 2011), available at
SB10001424052748703992704576305482186274332.html. The shortage has
continued through the fall and affected both legal and illegal use of
the drug. See Amanda Gardner, ADHD Drug Shortage Has Patients, Parents
Scrambling, HEALTHDAY, May 11, 2011, h ttp: / /health.usnews.

health-news / family-health /brain-and- behavior /
articles/2011/05/12/adhd-drug-shortage-has-patients-parents- scrambling;
Foster Kramer, The Great Adderall Shortage of 2011 Rages On, N.Y.
OBSERVER, (Nov, 16, 2011),;.

(49) Lerner, supra note 12, at 1069 (quoting SUZANNE H. STEVENS,
176 (1996)).

(50) Romer, supra note 44, at 155 (quoting Andrew Conte, More
Students Abusing Hyperactivity Drugs, PITTSBURGH

TRIB Transmission Rate of Information Bits
. REV. (Oct. 25,
2004), available at http:// 265518.html.).

(51) Andrew Jacobs, The Adderall Advantage: Abuse of Prescription
Drugs Is More Than Common, It's Hip. But Is It Fair?, N.Y. TIMES
(July 31, 2005),
2005/07/31/education/edlife/jacobs31.html?pagewanted--all. Libby was
diagnosed with ADHD when she was in first-grade. She now sells her pills
to classmates as she only uses Adderall infrequently. This is a common
and frightening occurrence among higher-education students who were
diagnosed with ADHD at a young age and now "recycle" their
pills for other students.

(52) Matt Lamkin, A Ban on Brain-Boosting Drugs Is Not the Answer,


. OF HIGHER EDUC. (Feb. 27, 2011),

(53) DeSantis et al., supra note 1, at 317-20.

(54) Id. at 319 (internal quotation makes omitted). This study took
place at a large, public southeastern research university during the
2005-06 school year where the researchers conducted surveys and in-depth
interviews with a select number of students. See also Joshua Foer, The
Adderall Me: My Romance with ADHD Meds, SLATE MAG. (May 10, 2005), ("I felt like I was clearing away underbrush
that had been obscuring my true capabilities.").

(55) See Christian Teter et al., Illicit Use of Specific
Prescription Stimulants Among College Students: Prevalence, Motives, and
Routes of Administration, 26
 /phar·ma·co·ther·a·py/ () treatment of disease with medicines.

Treatment of disease through the use of drugs.
 1501 (2006); Kristy
Kaloyanides et al., Prevalence of Illicit Use and Abuse of Prescription
Stimulants, Alcohol and Other Drugs Among College Students: Relationship
with Age at Initiation of Prescription Stimulants, 27 PHARMACOTHERAPY
666 (2007); Sean Esteban McCabe et al., Non-Medical Use of Prescription
Stimulants Among U.S. College Students: Prevalence and Correlates from a
National Survey, 99 ADDICTION 96 (2005).

(56) DeSantis et al., supra note 1, at 317.

(57) Id. at 316.

(58) Id. at 319-20.

(59) Id. at 320; see also Garreau, supra note 9 (noting that this
abuse goes relatively unnoticed because "[t]hese 'drug users
may be at the top of the class, instead of the ones hanging around the
corners'" (quoting Richard Restak, a Washington neurologist
and president of the American
The medical study of disorders with both neurological and psychiatric features.


(60) DeSantis et al., supra note 1, at 320-21.

(61) Id. at 321.

(62) Id. In 2007, the FDA required ADHD drug manufacturers to
include information about possible psychiatric and cardiovascular side
effects, especially for individuals with preexisting heart problems. The
psychiatric problems range from hallucinations and hearing voices to
having suicidal thoughts. Cardiovascular problems include increased risk
of stroke or heart attack. NAT'L INST. OF MENTAL HEALTH, ATTENTION
DEFICIT HYPERACTIVITY DISORDER (ADHD), http://www.nimh. shtml#pub3 (last visited Nov. 12, 2012). Other harmful
effects include the high potential for abuse because the medication
increases dopamine levels in a similar fashion to cocaine, leading to
increased addiction.
Prescription Drug
 Prescription medication Pharmacology An FDA-approved drug which must, by federal law or regulation, be dispensed only pursuant to a prescription–eg, finished dose form and active ingredients subject to the provisos of the Federal Food, Drug,
 Abuse: What Is Being Done to
Address This New Drug Epidemic?: Hearing Before the Subcomm. on Crim.
Justice, Drug Policy, & Human Res., 109th Cong. 27 (2006).

(63) 21 U.S.C. [section] 812(b) (2) (2006); see SUBSTANCE ABUSE
, ADMIN., Adderall & College Students, 17 Number_3/Adderall.aspx
(last visited Nov. 12, 2012) ("Adderall is among the group of
legally approved drugs classified as having the highest potential for
dependence or abuse.").

(64) U.S. DRUG ENFORCEMENT ADMIN., Drug Scheduling, dea/druginfo/ds.shtml (last visited Nov. 12,

(65) DeSantis et al., supra note 1, at 321.

(66) Id. at 322. The idea of actual ADHD sufferers selling or
giving their medication to other students is not only alarming but also
unintelligent. Adderall combats the impulsivity and inattention that
ADHD causes and ADHD sufferers are simply widening the gap between their
learning capacity and those who do not suffer every time they
"share" their extra Adderall.

(67) Talbot, supra note 2.

(68) Id.

(69) Jacobs, supra note 51.

(70) Schiffner, supra note 41, at 28. Schiffner specifically looks
at the abuse of Adderall within a law school setting and examines this
abuse in the context of the ethical standards of the legal profession.

(71) See Greg Crapanzano, Cracking Down on Academic Steroids,
CAVALIERDAILY.COM (Sept. 3, 2007), ("It would be almost impossible to say that pulling an
all-nighter is cheating and very difficult to argue that the use of
coffee or caffeine pills are methods of cheating[.] But using a
prescription drug without a doctor's approval quickly crosses the
line into submitting work that is not of the student's own merit
because they used an illegal performance enhancer to do the work. The
line of cheating is not necessarily where the law makes a product
illegal, but where the effects of these drugs become the primary factor
in a student's ability to perform the work."). But see Phillip
Brettschneider, Adderall Aids Studying, Not Academic Steroids,
REDANDBLACK.COM (Mar. 18, 2010),

(72) Benedict Carey, Brain Enhancement Is Wrong Right?, N.Y. TIMES,
Mar. 9, 2008, at WK1. This article also discussed the abuse of

 a sleep disorder characterized by excessive daytime sleepiness and recurring unwanted episodes of sleep ("sleep attacks"). People with narcolepsy may abruptly fall asleep at almost any time, including while talking, eating, or even walking.
 drugs, specifically Provigil, by academics and the "era
of doping [that] may be looming." Id.

(73) Id.

(74) Id.

(75) One of the reasons Adderall is a Schedule II substance is
because it has the high likelihood of addiction and abuse. 21 U.S.C.
[section] 812 (2006); see also Carroll, supra note 8 (mentioning an
individual who abused Adderall to succeed in medical school, then
flunked out because of a subsequent addiction to the medication).

(76) Jennifer Orr, Adderall Use a Growing Problem Among Students:
Pill-Popping Epidemic Spreads to Suffolk, SUFFOLK J. (Apr. 14, 2010),


(77) 20 U.S.C. [section] 1400(d)(1)(A) (2006).

(78) 20 U.S.C. [section] 1411(a)(2) (2006).

(79) 20 U.S.C. [section] 1414 (2006).

(80) 20 U.S.C. [section] 1401(3) (A) (i) (2006).

(81) 20 U.S.C. [section] 1401(3) (A) (ii) (2006).

(82) 34 C.F.R. [section] 300.8(c)(9)(i) (2009).

(83) 29 U.S.C. [section] 794(a) (2006) (providing for
nondiscrimination in education for all individuals).

(84) 29 U.S.C. [section] 705(20)(B)(i) (2006).

(85) Connie Lenz, Prescribing a Legislative Response: Educators,
Physicians, and Psychotropic Medication for Children, 22 J. CONTEMP.
HEALTH L. & POL'Y 72, 86 (2005).

(86) 20 U.S.C. [section] 1414(b) (2006).

(87) Carroll, supra note 8 (quoting Dr. Anjan Chatterjee, a
professor of neurology at the
University of Pennsylvania


(88) Amphetamine abuse has been around for many years and not just
among the younger generations. See Foer, supra note 54 ("The drug
also has a distinguished literary pedigree.... James Agee, Graham
Greene, and
Philip K. Dick

 all took the drug to increase their output.
Before the FDA made Benzedrine [an over-the-counter amphetamine similar
to Adderall] prescription-only in 1959, Jack Kerouac got
hopped up
 Drug slang A popular phrase for being influenced by drugs
 on it
and wrote On the Road in a three-week 'kick-writing' session.
'Amphetamines gave me a quickness of thought and writing that was
at least three times my normal rhythm,' another devotee, John-Paul
Sartre, once remarked."). Though these Adderall substitutes aided
the creative development of these literary giants, many psychologists
and researchers believe that Adderall use stifles creativity. See
Talbot, supra note 2 ("Cognitive psychologists have found that
there is a trade-off between attentional focus and creativity. And there
is some evidence that suggests that individuals who are better able to
focus on one thing and filter out distractions tend to be less
creative." (quoting Martha Farah, a psychologist at the University
of Pennsylvania and the director of its Center for Cognitive

(89) See generally Barbara Sahakian & Sharon Morein-Zamir,
Professor's Little Helper, 450 NATURE 1157, 1159 (2007) (presenting
ethical dilemmas stemming from cognitive enhancement medications
including unfair advantages in academics and the fear of "an
overworked 24/7 society pushed to the limits of human endurance");
Romer, supra note 44, at 159 ("Anyone [abusing or misusing]
prescription stimulants are [sic] put at an unfair competitive edge
vis-a-vis those who take the tests in a legal manner.").

(90) See Crapanzano, supra note 71 ("Much like baseball's
new rule banning performance-enhancing drugs, Adderall and similar
drugs, when used without a prescription, violate the tenets of honor
because they create an unfair advantage for the users who are willing to
break the law in order to gain an edge.").

(91) See supra Part II.

(92) See Nicholas W. Schieffelin, Maintaining Educational and
Athletic Integrity: How Will Schools Combat
Performance-Enhancing Drug
 Ergogenic drug Sports medicine An agent–eg, amphetamines, androstendione, erythropoietin, hGH, testosterone, known or thought to improve performance in a particular activity. See Anabolic-androgenic steroids, 'Stacking.'.
 Use?, 40 SUFFOLK U. L. REV. 959, 974 (2007) ("Students, who
illegally use performance-enhancing drugs in classes, exams,
standardized tests, and athletic competition, are cheating the
educational system and other students by gaining an unfair advantage and
breaking the law."); see also Michelle Trudeau, More Students
Turning Illegally to "Smart" Drugs, NAT'L PUB. RADIO
(Feb. 5, 2009), ("It takes away your own coping skills and your own ability
to evolve your own study skills and work ethic. So it's kind of an
easy way out." (quoting a college senior interviewed for the

(93) Sahakian & Morein-Zamir, supra note 89, at 1158.

(94) Id.; see also Lerner, supra note 12, at 1070 ("In fact,
students have for some time recognized that Ritalin [as well as
Adderall] stimulates the brain and promotes alertness more than
substitutes such as caffeine and nicotine...."); Schiffner, supra
note 41, at 29 (countering arguments that Adderall is equal to test
preparation courses or tutors by asserting that "[u]nlike the
tennis coaches and tutors of opponents' queries, Adderall imparts a
direct and immediate physical benefit to its user, allowing them to
perform more efficiently").

(95) See Michael Ruse, Are Tutors the Academic Equivalent of
Steroids?, CHRON. OF HIGHER Enuc. (June 10, 2011, 9:04 AM),

are-tutors-the-academic-equivalent-of-steroids/36121 (pondering the
"moral difference between a baseball player on steroids and a
high-school kid stuffed to the gills to achieve higher results on the
SAT's or grades in class").

(96) See U.S. ANTI-DOPING AGENCY, (last
visited Nov. 12, 2012). The Agency notes that its mission encompasses
"preserv[ing] the integrity of competition," which should
inspire a legislative response to preserve the integrity of academic
institutions in a similar vein. Id.

(97) Duke University has altered its discipline policy to include
prescription drug abuse as cheating rather than just as a drug policy
violation. "[T]he unauthorized use of prescription medication to
enhance academic performance constitutes cheating." DUKE

PRACTICE: A GUIDE FOR UNDERGRADUATES (2011). This type of prescription
drug abuse also violates the University of North Carolina's drug
(2000), available at http://www.unc.

(98) See Lauren Carroll, Conduct Policy Changes Reflect Drug Abuse,
THE CHRONICLE (Sept. 6, 2011), ("Enforcement is difficult, and the students who proposed this
addition recognize this. They wanted to at least symbolically make a
statement." (quoting Associate Dean of Students and Director of the
Office of Student Conduct Stephen Bryan) (internal quotation marks
omitted)); see also Schiffner, supra note 41, at 36-38 (proposing
heightened disciplinary consequences for violators as well as drug abuse
and prevention focus groups, student coalitions, and orientation
activities to combat the illegal prescription drug use).

(99) See Schieffelin, supra note 924, at 979 (advocating for the
expansion of "suspicionless drug testing programs to detect and
regulate drugs that deprive un-enhanced students from enjoying an
educational and athletic experience where their skills are judged on
natural ability and not according to what drugs they are abusing").
But see Lamkin, supra note 52 (arguing that prohibitions and penalties
for prescription drug use is not an adequate solution).

(100) See Lenz, supra note 85, at 104 ("Legislation should
address training required for physicians who will diagnose and treat
children with ADHD and other neurobehavioral disorders. This training
should include all facets involved in the diagnosis and treatment of
neurobehavioral disorders, including the prescription of psychotropic
medications as well as alternative treatments.").

(101) DeSantis et al., supra note 1, at 322. DeSantis proposes
focusing on the students with actual legal prescriptions of ADHD in
combating misuse by non-sufferers. One component of this solution would
be to "limit[] the monthly allotment of pills to 20--except in
cases where patients can clearly show the need for daily use. Id. In
addition, DeSantis also advocates for information programs such as
"campus-wide campaigns that educate the student population about
the health risks and legal penalties associated with illegal stimulant
use." Id.; see also White et al., supra note 10, at 266
("Medical personnel, university leadership, parents, and students
should take steps ... to ensure that university students are informed
about the dangers of stimulant medications...."). Another solution
mentioned by many involves lessening the demands of the academic
environment--however, this is not the answer. There are students who can
handle rigorous course loads, activities, and personal lives without
dependence upon stimulant medication--success does not (and should not)
depend upon a little orange pill.

(102) The idea of legislation requiring guidelines for physicians
when diagnosing ADHD and other neurobehavioral disorders has been
suggested. See Lenz, supra note 85, at 104 (arguing that "state law
should require state medical boards or panels to adopt and implement
policies regarding training of physicians who prescribe psychotropic
medication as well as guidelines and procedures for diagnosis and

(103) In addition, there are discrepancies in the prescription of
ADHD medications across age, ethnic, gender, and geographic barriers
suggesting that a national mandatory test is needed to maintain
consistency among diagnoses. See Statement of Terrence Woodworth, supra
note 46 ("ARCOS [Automation of Reports and Consolidated Orders
System] data indicates that there is wide variability in the use of
methylphenidate and amphetamine from one state to another and from one
community to another within the states. This variability are noted in a
number of data sources and suggests both under and over-identification
of ADHD."); Press Release, supra note 29 ("These persistent
differences in prescribed stimulant use related to age, racial and
ethnic background, and geographical location indicate substantial
variability in how families and doctors approach ADHD treatment
throughout the United States." (quoting Dr. Zuvekas) (internal
quotation marks omitted)).

(104) See Lenz, supra note 854, at 104-05.

(105) See Carroll, supra note 8 (noting that many adults who
believe they have ADHD are struggling "simply [because of]
depression, anxiety or lack of sleep" or are having a difficult
time dealing with their workloads and lives (quoting Paul Marshall, a
clinical neuropsychologist with Hennepin Faculty Associates)).

(106) A federal diagnostic measure will also aid in curbing
post-secondary misuse by preventing inconsistent diagnostic standards
across the nation.

(107) See CDC Facts About ADHD, supra note 4. This may be due to
the fact that, as I am arguing, ADHD is misdiagnosed, and a diagnosis is
relatively easy to obtain under current physician practice. However,
irrespective of this fact, ADHD should be included under IDEA. To
illustrate, Autism Spectrum Disorders, a specified disorder under IDEA,
occurs in about one percent of children in the United States. Autism
Spectrum Disorders (ASDs),

CTRS Containers
CTRS Certified Therapeutic Recreation Specialist
CTRS Conventional Terrestrial Reference System
CTRS Center for Technology Risk Studies  
. FOR DISEASE CONTROL (June 19, 2012),
http://www. ADHD occurs in one in
ten children. Mike Stobbe, 1 in 10 Kids in U.S. Has ADHD, New Study
Says, A.P. (Nov. 10, 2010), http://

(108) See Protecting Students with Disabilities, Frequently Asked
Questions About Section 504 and the Education of Children with
Disabilities, U.S. DEP'T OF EDUC. (Mar. 17, 2011),

(109) See infra Part I.

(110) One other component of this standard diagnostic measure
should be a validity scale to screen out those individuals who are
faking symptoms. See Harrison et al., supra note 31, at 586 (suggesting
that there is a need "to develop a validity scale to embed within a
self-report inventory, composed of items that look similar to the
symptoms of ADHD, and yet are not often endorsed by individuals with
this disorder").

(111) This will most likely be a long, protracted process. However,
it is necessary to ensure accurate diagnosis and treatment especially
when ADHD medication is involved. The Schedule II classification for the
active ingredient in Adderall places an even higher importance on
designing correct prescription procedures. See supra notes 46-49.

(112) Because the AAP Practice Guideline contains the DSM-IV-TR
criteria, it measures displayed behaviors of inattention, hyperactivity,
and impulsivity over a specific period of time in addition to requiring
presence of these behaviors in two or more settings. See DSM-IV-TR,
supra note 6, at 92-93.

(113) See supra Part I.

(114) See AAP PRACTICE GUIDELINE, supra note 13; DSM-IV-TR, supra
note 6.

(115) Rushton et al., supra note 25, at e27 ("[L]ittle
attention has been paid to the ongoing evaluation and long-term
treatment of children and adolescents...."). Therefore, more
research is necessary to ensure that those diagnosed with ADHD are
accurately monitored and treated to effectively manage their symptoms.

(116) See CDC Facts About ADHD, supra note 4.

(117) See 20 U.S.C. [section] 1400 (2006).

(118) See Garreau, supra note 9 ("[M]ore than 7 million
Americans used bootleg prescription stimulants, and 1.6 million of those
users were of student age.").

(119) The measure focuses on an educational impact because the
majority of diagnoses and prescriptions are obtained by individuals
currently enrolled in elementary, high schools, and post-secondary
programs and because the ethical implications are so high in these
environments. In addition, educational impact can encompass social
impairment as well which can be recognized in adults. There are various
ways to evaluate adult behavior in the workplace, specifically through
social interactions, overall focus, attention to detail, and ability to
complete tasks.

(120) Feinstein, supra note 44 (quoting Dr. Carl Baum, director of
the Center for Children's Environmental Toxicology at Yale-New
Haven Children's Hospital).

Erinn L. Rigney *

[c] 2012 Erinn L. Rigney. Individuals and nonprofit institutions
may reproduce and distribute copies of this Article in any format at or
below cost, for educational purposes, so long as each copy identifies
the author, provides a citation to the Notre Dame Law Review, and
includes this provision in the copyright notice.

* J.D. Candidate,
Notre Dame Law School

, 2013; M.Ed.,
University Chicago

, 2006; B.A., University of Notre Dame, 2004. I would
like to thank Meghan Rigney, my sister and Notre Dame Law School J.D.
Candidate, 2015, for her inspiration on the topic, Professor Leslie
Callahan for her support and mentoring, and the staff of the Notre Dame
Law Review, In addition I would like to thank my father Bob Rigney
(Notre Dame Law School J.D., 1973) and my mother Mimi Rigney for their
continued love and encouragement.

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