Some parents just say 'whoa' to school-required medications

At the same time, another part of the same study gave the use of medication a boost when it comes to the treatment of ADHD. The study showed that strict behavioral regimes, used without drugs, were not as successful as treatments involving stimulants. They suppressed ADHD symptoms in 34 percent of the children tracked over a two-year period, while medication worked in 56 percent of cases.

Yet if the study was reassuring to some who work with children, it was alarming to others.

"The study helps prove that the country is only hearing half the story about ADHD," says William Frankenberger, a professor at the University of Wisconsin, Eau Claire, who has been studying ADHD for almost two decades. "If these medicines suppress growth, you have to ask what else they are doing that we can't measure."

Dr. Frankenberger says pharmaceutical companies pitch ADHD medications in part as a way to help children improve academic performance. While stimulants immediately increase focus (for children with or without ADHD) and often lead to short-term betterment of classroom performance, Frankenberger says his longitudinal research suggests that ADHD medications caused no boost in academic achievement over the long run.

In addition, the length of time a student uses the medication and the type of test given can cloud test results, says Marc Atkins, director of psychology training at the University of Illinois at Chicago. Dr. Atkins, who sometimes works as a paid consultant for Alza, the maker of a popular ADHD medication, calls the NIMH study "cause for some concern" and says it should prompt the medical community to reevaluate the ease with which stimulants are prescribed.

But Atkins - who agrees that schools should not be allowed to mandate medication - takes issue with laws that prevent school healthcare professionals from offering recommendations or a diagnosis to parents.

"To cut schools off from giving parents good information is not what you want," he says.

Frankenberger says one of his research projects examined the origin of initial referrals to psychologists to explore the possible presence of ADHD in children.

"In about 80 percent of the time, we found that it came from teachers," he says.

But overreliance on teacher observations and recommendations to drive use of medication can be problematic, say some experts. It may make judgment calls all the more complicated for parents.

Teachers and school administrators interviewed for this story generally agreed that for some students diagnosed with ADHD, stimulants make a remarkable difference, calming internal storms and bringing normalcy to scattered young lives.

But several also noted worrisome trends in diagnosis, noting, for example, that teachers in crowded, cash-strapped classrooms are more likely to steer a disruptive child toward medication.

Several observed another complicating factor: white middle class or upper middle class boys form the majority of diagnosed cases while minorities - whether due to stigma or lack of access - often go untreated.

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