用兴奋剂提高孩子学习成绩？

Attention Disorder or Not, Pills to Help in School
By ALAN SCHWARZDecember 18, 2013
用兴奋剂提高孩子学习成绩？
基础教育ALAN SCHWARZ2013年12月18日
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阿曼达·罗克福德和她的儿子奎恩在佐治亚州伍德斯托克。奎恩将服用一种用于稳定情绪的安定药利培酮(Risperdal)。
Bryan Meltz for The New York Times
CANTON, Ga. — When Dr. Michael Anderson hears about his low-income patients struggling in elementary school, he usually gives them a taste of some powerful medicine: Adderall.
佐治亚州坎顿——当低收入家庭患者说在小学学习很费劲时，迈克尔·安德森(Michael Anderson)医生通常会给他们开一种强效药：阿得拉(Adderall)。
The pills boost focus and impulse control in children with [要查看本链接请先注册并登录]. Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder “made up” and “an excuse” to prescribe the pills to treat what he considers the children’s true ill — poor academic performance in inadequate schools.
这种药能增强患有[要查看本链接请先注册并登录](ADHD)的孩子的注意力和冲动控制力。尽管安德森医生的诊断是ADHD，但在他看来，该病只是家长的“编造”和“借口”，目的是开这种药来治疗孩子的真正疾病——差学校中的差成绩。
“I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”
“我没有太多的选择。”为亚特兰大北部切罗基县内许多贫困家庭服务的儿科医生安德森说，“就我们这个社会而言，改变孩子所处环境的成本太高了，所以我们只能去改变孩子。”
Dr. Anderson is one of the more outspoken proponents of an idea that is gaining interest among some physicians. They are prescribing stimulants to struggling students in schools starved of extra money — not to treat A.D.H.D., necessarily, but to boost their academic performance.
这是一个已经引起部分医生兴趣的观点：他们是给在学校中学习费劲而又没有闲钱的孩子开兴奋剂，其目的实质上并不是为了治疗ADHD，而是为了提升他们的学习成绩。而安德森医生是该观点较为坚定的支持者之一。
It is not yet clear whether Dr. Anderson is representative of a widening trend. But some experts note that as wealthy students abuse stimulants to raise already-good grades in colleges and high schools, the medications are being used on low-income elementary school children with faltering grades parents are eager to see them succeed.
目前并不清楚安德森医生是否代表着一种正在扩大的趋势。但一些专家注意到，由于富有的学生在大学和高中阶段可以用兴奋剂让成绩好上加好，因此低收入家庭中成绩落后的小学生也开始使用这类药物，而他们的父母则急切盼望着他们成功。
“We as a society have been unwilling to invest in very effective nonpharmaceutical interventions for these children and their families,” said Dr. Ramesh Raghavan, a child mental-health services researcher at Washington University in St. Louis and an expert in prescription drug use among low-income children. “We are effectively forcing local community [要查看本链接请先注册并登录] to use the only tool at their disposal, which is psychotropic medications.”
“我们这个社会一直不愿意在这方面投资，为这些孩子及其家庭进行非常有效的非药物干预。”位于圣路易斯的华盛顿大学(Washington University in St. Louis)儿童心理健康服务研究员拉梅什·雷加万(Ramesh Raghavan)医生是低收入家庭儿童处方药使用方面的专家，他说：“我们实际上是在迫使当地社区[要查看本链接请先注册并登录]使用他们可用的唯一工具，即精神类药物。”
Dr. Nancy Rappaport, a child psychiatrist in Cambridge, Mass., who works primarily with lower-income children and their schools, added: “We are seeing this more and more. We are using a chemical straitjacket instead of doing things that are just as important to also do, sometimes more.”
马萨诸塞州坎布里奇市的儿童精神科医生南希·拉帕波特(Nancy Rappaport)平时基本要跟低收入家庭的儿童及其学校打交道，她补充说：“我们看到这种事例越来越多。我们采用的是一种‘化学束身衣’，而没有去做同样重要的甚或某些时候更为重要的事情。”
Dr. Anderson’s instinct, he said, is that of a “social justice thinker” who is “evening the scales a little bit.” He said that the children he sees with academic problems are essentially “mismatched with their environment” — square pegs chafing the round holes of public education. Because their families can rarely afford behavior-based therapies like tutoring and family counseling, he said, medication becomes the most reliable and pragmatic way to redirect the student toward success.
安德森医生表示，他的直觉是一个“想让天平更加平衡一点”的“社会正义思想家”的直觉。他说他所看到的学习成绩有问题的孩子，实际上是“与他们所处的环境不匹配”——与公共教育格格不入。他表示，因为他们的家庭几乎无法负担基于行为的治疗方法，比如说辅导和家庭咨询，所以药物治疗成了将学生重新引向成功之路的最可靠和最务实的方法。
“People who are getting A’s and B’s, I won’t give it to them,” he said. For some parents the pills provide great relief. Jacqueline Williams said she can’t thank Dr. Anderson enough for diagnosing A.D.H.D. in her children — Eric, 15; Chekiara, 14; and Shamya, 11 — and prescribing Concerta, a long-acting stimulant, for them all. She said each was having trouble listening to instructions and concentrating on schoolwork.
“对于成绩获得了‘A’和‘B’的学生，我不会给他们开这类药物。”他说。对一些家长而言，这类药会让他们如释重负。杰奎琳·威廉姆斯(Jacqueline Williams)就表示，她非常感谢安德森医生为她的孩子——15岁的埃里克(Eric)、14岁的切奇拉(Chekiara)和11岁的沙姆亚(Shamya)——开具的ADHD诊断证明，以及为他们三人开的处方药专注达(Concerta)——一种长效兴奋剂。她说她的每个孩子在听课和做家庭作业方面都存在着注意力不集中的情况。
“My kids don’t want to take it, but I told them, ‘These are your grades when you’re taking it, this is when you don’t,’ and they understood,” Ms. Williams said, noting that [要查看本链接请先注册并登录] covers almost every penny of her doctor and prescription costs.
“我的孩子不想吃，但我告诉他们说，‘这是你们吃药之后的成绩，而这是你们不吃药的成绩，’他们懂了。”威廉姆斯女士说，并表示[要查看本链接请先注册并登录](Medicaid)可以支付几乎所有的就诊和医药费用。
Some experts see little harm in a responsible physician using A.D.H.D. medications to help a struggling student. Others — even among the many like Dr. Rappaport who praise the use of stimulants as treatment for classic A.D.H.D. — fear that doctors are exposing children to unwarranted physical and psychological risks. Reported side effects of the drugs have included growth suppression, increased [要查看本链接请先注册并登录] and, in rare cases, [要查看本链接请先注册并登录] episodes.
一些专家表示，一个负责任的医生用ADHD药物帮助成绩差的学生并没有什么坏处。另有一些专家——这其中甚至还包括很多像拉帕波特医生一样赞成使用兴奋剂治疗典型ADHD的人——则担心医生会将孩子们置于毫无必要的生理和心理危险中。关于这类药物，已知的副作用包括生长抑制、[要查看本链接请先注册并登录]，以及精神病发作，但后者较为罕见。
According to guidelines published last year by the American Academy of Pediatrics, physicians should use one of several behavior rating scales, some of which feature dozens of categories, to make sure that a child not only fits criteria for A.D.H.D., but also has no related condition like [要查看本链接请先注册并登录] or [要查看本链接请先注册并登录], in which intense anger is directed toward authority figures. However, a 2010 study in the Journal of Attention Disorders suggested that at least 20 percent of doctors said they did not follow this protocol when *** their A.D.H.D. diagnoses, with many of them following personal instinct.
据美国儿科学会(American Academy of Pediatrics)去年发布的指导原则，医生应使用多种行为评定量表——其中有的包含数十个类别——中的一种来确认一个儿童不但符合ADHD标准，而且也没有[要查看本链接请先注册并登录]或[要查看本链接请先注册并登录]等相关疾病，这类疾病患者会把强烈的愤怒发泄到权威人物身上。然而，据2010年《注意力障碍杂志》(Journal of Attention Disorders)的一项研究表明，至少20%的医生表示他们在诊断ADHD时并未遵循这一规程，其中很多都是靠个人直觉判断。
On the Rocafort family’s kitchen shelf in Ball Ground, Ga., , next to the peanut butter and chicken broth, sits a wire basket brimming with bottles of the children’s medications, prescribed by Dr. Anderson: Adderall for Alexis, 12; and Ethan, 9; Risperdal (an antipsychotic for mood stabilization) for Quintn and Perry, both 11; and Clonidine (a sleep aid to counteract the other medications) for all four, taken nightly.
罗克福德(Rocafort)一家生活在佐治亚州的鲍尔格朗德。在他们家的厨架上，花生酱和鸡汤旁边放着一个铁丝篮，里面装满了儿童药瓶——这些药是安德森医生开的：给12岁的亚历克西斯(Alexis)和9岁的伊桑开的阿得拉；给11岁的奎恩(Quintn)和11岁的佩里(Perry)开的利培酮(Risperdal)——一种用于稳定情绪的安定药；以及给他们4个人开的可乐宁(Clonidine)——一种用于抵消其他药物药效的助眠剂，夜间服用。
Quintn began taking Adderall for A.D.H.D. about five years ago, when his disruptive school behavior led to calls home and in-school suspensions. He immediately settled down and became a more earnest, attentive student — a little bit more like Perry, who also took Adderall for his A.D.H.D.
奎恩大约在五年前开始服用阿得拉治疗ADHD，那时他在学校的破坏性行为导致学校给他家里打电话，并给了他校内停学的处分。在服用了阿得拉之后，他立即安分了下来，并变成一名更认真、更专心的学生——这有点像佩里，他也服用阿得拉治疗ADHD。
When [要查看本链接请先注册并登录]’s chemical maelstrom began at about 10, though, Quintn got into fights at school because, he said, other children were insulting his mother. The problem was, they were not; Quintn was seeing people and hearing voices that were not there, a rare but recognized side effect of Adderall. After Quintn admitted to being suicidal, Dr. Anderson prescribed a week in a local psychiatric hospital, and a switch to Risperdal.
然而，当[要查看本链接请先注册并登录]的“化学物质”在10岁左右开始发生反应时，奎恩却在学校里和别的孩子打架，因为他说他们侮辱他的母亲。问题是，那些孩子并没有这么做；奎恩看到了不存在的人并听到了不存在的话，这是阿得拉一种较为罕见但却已知的副作用。在奎恩承认有自杀倾向之后，安德森医生让他在当地的一家精神病医院住了一个星期，并将阿得拉换成了利培酮。
While telling this story, the Rocaforts called Quintn into the kitchen and asked him to describe why he was had been given Adderall.
在讲这件事的时候，罗克福德夫妇把奎恩叫到了厨房，并让他说明为什么要给他吃阿得拉。
“To help me focus on my school work, my homework, listening to Mom and Dad, and not doing what I used to do to my teachers, to make them mad,” he said. He described the week in the hospital and the effects of Risperdal: “If I don’t take my medicine I’d be having attitudes. I’d be disrespecting my parents. I wouldn’t be like this.”
“为了帮助我把注意力集中在功课上、作业上，听爸爸妈妈的话，不再做以前让老师发疯的事，”他说。他讲了他在精神病医院的那个星期的情况以及利培酮的作用：“如果我不吃药，我就会产生敌对情绪。我会冒犯我的父母，我不会像现在这么乖。”
Despite Quintn’s experience with Adderall, the Rocaforts decided to use it with their 12-year-old daughter, Alexis, and 9-year-old son, Ethan. These children don’t have A.D.H.D., their parents said. The Adderall is merely to help their grades, and because Alexis was, in her father’s words, “a little blah.”
尽管有奎恩服用阿得拉的这种经历，罗克福德夫妇还是决定让他们12岁的女儿亚历克西斯和9岁的儿子伊桑服用这种药物。他们的父母说，这两个孩子并没有患ADHD，阿得拉只是为了帮助他们提高成绩，而用她父亲的话说，也是因为亚历克西斯“有点爱说瞎话”。
”We’ve seen both sides of the spectrum: we’ve seen positive, we’ve seen negative,” the father, Rocky Rocafort, said. Acknowledging that Alexis’s use of Adderall is “cosmetic,” he added, “If they’re feeling positive, happy, socializing more, and it’s helping them, why wouldn’t you? Why not?”
“我们已经看到了问题的两面：我们看到了它的正面，也看到了它的负面，”孩子的父亲洛奇·罗克福德(Rocky Rocafort)说。他承认亚历克西斯服用阿得拉只是一种“提升”。“如果他们感到更积极，更开心，也更愿意与人交往，那为什么不这样做呢？为什么不呢？这是在帮助他们。”
Dr. Anderson said that every child he treats with A.D.H.D. medication has met qualifications. But he also railed against those criteria, saying they were codified only to “make something completely subjective look objective.” He added that teacher reports almost invariably come back as citing the behaviors that would warrant a diagnosis, a decision he called more economic than medical.
安德森医生说，他用ADHD药物治疗的每一个儿童都符合用药标准。但同时，他也批评那些标准，说它们只是“让一些完全主观的东西看起来客观而已”。他补充说，老师返回的报告几乎无一例外地表示诊断改善了学生的行为，而在他看来，这种决定与其说是医学上的，倒不如说是经济上的。
“The school said if they had other ideas they would,” Dr. Anderson said. “But the other ideas cost money and resources compared to meds.”
“学校表示，如果有其他想法他们不会盖着，”安德森医生说，“但与药物相比，其他想法需要成本和资源。”
Dr. Anderson cited William G. Hasty Elementary School here in Canton as one school he deals with often. Izell McGruder, the school’s principal, did not respond to several messages seeking comment.
安德森医生举了一个例子，即他经常打交道的、位于坎顿当地的威廉·G·哈斯蒂小学(William G. Hasty Elementary School)。对于我们发出的多条置评信息，该校校长艾泽尔·麦克格鲁德(Izell McGruder)并未回复。
Several educators contacted for this article considered the subject of A.D.H.D. so controversial — the diagnosis was misused at times, they said, but for many children it is a serious learning disability — that they declined to comment. The superintendent of one major school district in California, who spoke on the condition of anonymity, noted that diagnosis rates of A.D.H.D. have risen as sharply as school funding has declined.
记者撰文期间联系的几位教育家认为，ADHD这个话题的争议性太大，所以他们不便评论。他们说，诊断有时会被误用，但对很多孩子来讲，ADHD是一种严重的学习障碍。一位不愿透露姓名的加州某主要学区的负责人说，ADHD确诊率的急剧上升与学校资金的急剧下降不无关系。
“It’s scary to think that this is what we’ve come to; how not funding public education to meet the needs of all kids has led to this,” said the superintendent, referring to the use of stimulants in children without classic A.D.H.D. “I don’t know, but it could be happening right here. Maybe not as knowingly, but it could be a consequence of a doctor who sees a kid failing in overcrowded classes with 42 other kids and the frustrated parents asking what they can do. The doctor says, ‘Maybe it’s A.D.H.D., let’s give this a try.’ ”
“一想到这种现状就让人感到害怕；由于公共教育资金无法满足所有孩子的需求，所以才会出现这种情况，”这位负责人表示，暗指给没有患典型ADHD的儿童服用兴奋剂。“我不清楚，但我们这里可能正在发生这种情况。或许这并不是有意的，可能是因为某个医生看到某个成绩差的孩子跟另外42个孩子挤在一个班里，而这个孩子沮丧的父母问怎么办时，这个医生说，‘这可能是ADHD，让我们先治治看。’”该负责人说。