Andrew Perlman on Ritalin in Law School

[Guest blogger Andrew Perlman, of Suffolk University Law School, has these thoughts about Ritalin use in law school.  NOTE: as originally posted, some text was out of order and has been corrected.]

You probably have read news stories over the last few years about Ritalin and its ability to improve academic performance, even among students who do not have any learning disabilities like attention deficit disorder.  You might also have read about how these non-learning disabled students are increasingly using Ritalin to improve their academic performance in school, including in law school.  The controversial and somewhat provocative question that I want to pose is whether law schools should randomly test students for Ritalin use and take action against those students who test positive and don’t have a prescription.

In support of the idea, one could argue that Ritalin taken without a prescription is illegal.  Schools, particularly law schools, should be concerned if their students are breaking the law.  Second, and more importantly, if students who illegally take Ritalin get an academic advantage over non-Ritalin takers, the law breakers are getting an unfair bump up in terms of law school grades and career options.

    Moreover, the existence of illicit Ritalin use puts pressure on non-Ritalin takers to use the drug, either through an illegal purchase or by faking symptoms to a physician to get a prescription.  Because Ritalin can have adverse side effects in some people and has unclear long term health consequences, unnecessary Ritalin use is not recommended. In short, to avoid unfairness and to discourage unnecessary Ritalin use, it seems reasonable to randomly test law students for Ritalin and the related drug, Adderall, and to take action against those students who have used the drug without a prescription.

    The situation seems to me to be similar to the one professional sports leagues face.  We know that steroids give athletes an unfair advantage and that steroids are illegal without a prescription.  As a result, all major sports now prohibit athletes from taking steroids.  Arguably, we should do the same when it comes to Ritalin.

    Of course, there are differences.  First, Ritalin does have some very therapeutic effects, whereas anabolic steroids are (to my knowledge) much more dangerous and of limited therapeutic value.  Also, given the number of students who genuinely need Ritalin, we would be invading their privacy by forcing them to reveal their legal use of the drug in order to be cleared after a positive test.  Despite these differences with steroids, there seems to be a strong case for student Ritalin testing, especially given the fairness concern.

    Another objection is that caffeine and even nicotine can enhance test performance, and we don’t ban those drugs.  But the key difference is that those drugs are completely legal without a prescription.  The problem with drugs like Ritalin is that they are both performance enhancing AND illegal without a prescription. 

    In the end, it seems that we have gotten to the point where athletic performance is not the only ability that can be enhanced through illegal drug use.  Unfortunately, the rules have not yet caught up to address these changes.  Is it time we do something about it?  Should we start testing law students for illegal Ritalin and Adderall use?  And if so, what should the punishment be for violators?  Expulsion?  Reprimand with a report to the relevant bar association regarding illegal drug use?  I look forward to comments.

Comments

[Larry]

Good point. But guess what? Most schools don't really care about cheating, especially if it does not embarrass the school. Time and time again, I have seen schools fail to take action, or take the course that would not expose the school to litigation, because law school is a high stakes game and most people who are punished by a school will probably sue.

I have seen this both as a law student and as a lawyer. Unless a professor is willing to name specific students and expose their school to messy, embarrassing litigation, your (quite perceptive) article is must one in a series of feel-good articles about how law schools “should” be clean.

[Mike]

I think the one thing that you're not taking into account is that Ritalin and Adderall don't often have the desired effect on people without ADD. More often it's like an overdose of caffeine. And sometimes the effects are little more than in the user's head.

I've used Adderall and Ritalin for years (with a script for it). And without it I really question my ability to get through college and into law school. That said, it's still incredibly difficult for me with pretty bad ADD. It's like channels keep switching in my head and somebody else has the remote control. It's frustrating.

I worry that a such a crackdown on Adderall and Ritalin would end up hurting people like me.

Besides, trying to make life 100% fair is impossible. Some people are just naturally brighter than others and some people do naturally have longer attention spans than others. Life is unfair. It's frustrating, but it's true.

[Andrew Perlman]

Thanks for the post. You've put your finger on the one major problem with the proposal. These drugs help quite a few students who really need them. And although you obviously wouldn't be someone who would be penalized for using the drug (presumably you have a prescription), you would be put in a position of having to reveal your prescription to your law school in the event you were tested. That's certainly an invasion of your privacy.

The question then becomes: is the privacy concern outweighed by the illegalities/health effects/unfairnesses that are caused when people use the drug without a prescription. Quite frankly, I'm not sure of the answer myself. In my mind, it turns on a number of empirical questions to which I don't have answers, such as how pervasive the problem is and just how much of a help these drugs are for those students who do not have ADD.

If law students are reading these comments, fill me in on how pervasive you think this problem is. And if anyone out there has the medical background, tell me how much these drugs help people who don't have ADD.

[Larry]

We could, of course, just not let people with mental problems (including ADHD) practice, and make it clear to law schools that these people are not welcome. After all, it might hurt the quality of practice if attorneys have mental defects. Connecticut, for example, has dabbled with a “zero tolerance for mental problems” rule, and perhaps it is time that other states consider that for every girl who is allowed to practice with a dependency on some drug, some defendant will be erroneously convicted.

[Mike]

Wow, that's insulting. So a learning disability is a "mental problem" now? I'm not exactly psychotic you know. I did pretty darned well as an undergrad at the Univ of Michigan. I'm pretty sure I have the capacity to be a good attorney.

But I suppose that's why I'd like to keep my medical history to myself.

[Andrew Perlman]

Mike,

Larry's offensive comments make me realize that I did not give proper weight to the privacy concerns. You may have convinced me that this is a bad idea after all.

[Mike]

It's good of you to remain open in your perspective.

But I do see where you're coming from. I know of a few people who tried Adderall in college to try to get an edge (without prescriptions). It's frustrating when you're paying so much for a college or law school education and when the stakes are so high for jobs. I understand this.

[Larry]

Oh, so let me get this straight: any comment I make that makes you think is "offensive." (At least one of my points was effective.) Is this the kind of legal argument your clients pay for? After opposing counsel makes the court see something in a new way, you deride their argument as “offensive.”

Now, let me tell all of you something else: I am concerned about the level of representation in this country. I consider people who are unable to concentrate or perform at a high mental level to be defective. Indeed, some people are FORCED to accept attorneys who, by your own admission, cannot operate without the benefit of these drugs.

You said, "I know of a few people who tried Adderall in college to try to get an edge (without prescriptions). It's frustrating when you're paying so much for a college or law school education and when the stakes are so high for jobs." Everyone in this category probably watches TV or goes to clubs or drinks. If you do any of these things you are not serious about studying, anyway. If you want to be a real student you have to start by living a pure life, not act like a fratboy all your life. Or ever.

I admit that in my family, going to a "mental health professional" or taking these drugs is unacceptable and will get you disowned, but in my culture (unlike the culture of spoiled rich kids that dominates law schools these days) you are expected to not be a whiney jerk.

So, in conclusion: not everyone grew up in Westchester.

[Mike]

Well, I'm very much middle class. In college I drove a '92 Chevy.

Not everything you say is offensive. But that one particular thing was offensive.

In any case, I can perform at a high level academically and I can concentrate well. So what if I do it with or without Adderall? Some attorneys need a wheelchair or a hearing aid. WOuld it be fair to say that an attorney with a hearing aid couldn't practice it because they'd be unable without it? That just makes no sense.

And I have news for you: I know emergency room doctors, professors, AND lawyers who use drugs for ADD. Some of the most intelligent people in our society have disabilities and learn to overcome them. SOmetimes it's with a wheelchair and sometimes it's with Adderall.

[Larry]

Well, if I ever found out that my personal doctor or lawyer had a mental defect that prevented them from concentrating, I would get another one. I am not going to trust my life to some nut that needs to see a shrink and get the kinds of drugs that people take for fun.

For the life of me I can’t how someone in law school could ever be offended by something. Granted, some girls like to say “I’m offended” but they are just doing that to troll for husbands. If you disagree with me say why, don’t just act like a girl. (My family disowned a sister for doing this, but my culture has very little tolerance for mediocrity.)

[Mike]

Right... okay. I think your response says enough about you that I have no need to respond.

[Scott Moss]

Conspiracy theory of the day: is "Larry" a real person, or a straw man set up by someone opposing Andrew's proposal?

Larry: "Yeah, Andrew is right because his proposal will be an excellent way for us to get rid of the defectives."

Andrew: "Uh, wait a minute..."

I'm just kidding, mostly. It's just that if I wanted to fake an Archie Bunker of the 2000s stereotyping mental conditions, my posts probably would look just like Larry's.

[S.cotus]

Larry raises a good point, and has done it effectively, because it has made some of you angry. I suspect that I am not going to make too many friends, but here goes:

First of all, one has to examine whether there is an absolute right to practice law in the US: no.
Felon's can't practice. Nor can people of "bad character" (which seems to be quite a vague term). Nor can babies. People who fail the bar can't practice, either. (Of course, if you happen to be the general counsel of a large Mormon university you can practice, and do whatever you want, because the culture is Utah is different.)

The courts have looked at the interests that the states seek to preserve in keeping some people out of the protection in order to determine if discrimination against a class is constitutionally permissible. Obviously race-based distinctions are judged under strict scrutiny, and we are pretty much familiar with the lower tiers (at least on a superficial level.)

A pretty good case can be made that prohibiting people that are dependant on a drug to act "normally" would be rationally related to quite a valid (and perhaps compelling) state interests. For example, in most states, indigent defense is conducted by lawyers who are not paid enough to hire assistants, secretaries, and everyone else who might be able to help those with disabilities cope. Indeed, many states seem to react with glee when a lawyer isn't paying attention and waives an making an argument that will send her client to jail for an unnecessary 20 years.

In fact, I have heard a few DA's literally cackle when making the argument that a lawyer who had difficulty concentrating (I don't know if he was diagnosed with one of these diseases) failed to make an objection which sent his client to jail for 15 years. Someone else later confessed, but that was only after the client died in jail. Now, this waiver could have probably been avoided if someone who didn't have mental problems was the lawyer, or he had an assistant. However, people argue against both of these things.

There are lots of stigmas in society, and mental illness of law students just don't seem to be in the same ballpark as most of them.

We stigmatize felons: even if their crimes are quite minor, and they don't have the social skills to know how to get out of trouble. For example, a black kid who has a ½ ounce in the car will probably be convicted of a felony if stopped, because he is more likely to be searched (or be asked for consent or searched) whereas a white kid might have one of those "PBA cards" that make the cops think he is good without any harassment. Heck, the white kid might not be stopped in first place. I know very few people that matter who argue against such a stigma.

We stigmatize teenage mothers.

We stigmatize people who drop out of school.

We stigmatize people who do badly on their LSATs.

We stigmatize veterans.

We stigmatize people who dress poorly, act gay, sound weak, etc. etc.

To me it sound utterly crazy to think that the first stigma that we want to rid ourselves of is one that: 1) doesn't hurt people too much (as there is no right to practice); 2) might serve a valid state interest; 3) seems only to effect spoiled rich girls (this was my experience in law school, and to this extent Larry is dead-on-correct); and 4) isn't nearly as bad as a lot of other stigmas.

[Andrew Perlman]

Scott,

I like your conspiracy theory, although I'm skeptical.

My position was never really set in stone. My proposal was meant to be a bit provocative. (I guess it worked.) I was curious to see what people think about this issue and to get a sense of how rampant the problem is.

Without better information about how widespread illegal Ritalin-taking is among law students and without more information about how these drugs affect non-learning disabled students, I really can't say how I feel about this issue.

All along (including in my initial post), I raised privacy as a serious concern. I think there is still a lot of misunderstanding about learning disabilities (reflected in "Larry's" posts), so I am very sympathetic to students who would not want to volunteer their learning disabilities unnecessarily.

That said, I could still favor the proposal despite the serious privacy concerns if (and this is a big if) there really is a lot of illicit Ritalin use among law students and the data suggests that students without learning disabilities really get a significant performance benefit from using the drugs. Without that information, I really don't know what the answer should be.

If anyone can offer more insights about the extent of illegal Ritalin use among law students or the effects of Ritalin on students without learning disabilities, I'd welcome the comments.

[S.cotus]

Okay, ignoring the widely-held perception that “learning disabilities” are a way that rich kids get to manipulate standardized tests in their favor, can you tell explain to me whether a learning-disabled lawyer is capable of providing effective assistance of counsel within the meaning of the sixth amendment, or will every trial he participates in be tainted ?

It is great to say that such defects/disabilities/handicaps/characteristics/etc. are “misunderstood,” but law school, in preparing lawyers to represent people, I would argue, NEEDS to mirror life. In real life, prosecutors, judges, and everyone else won’t make allowances for a slow lawyer.

[Mike]

"Larry raises a good point, and has done it effectively, because it has made some of you angry."

Under that logic you could just write the "N word" a hundred times and it would be a great point (because it makes someone angry).

The reason I'm so offended by Larry's and S.cotus's posts are because they're based on such a mischaracterization of what ADD really means. ADD is not a disease and it's certainly not a mental "defect."

And you pretty well outlined exactly what I would be afraid of if my privacy were invaded. The fact is that neither of you is a doctor, and neither of you understand the slightest bit of what you're talking about.

People with ADD thrive on high stimulation environments like an emergency room or a courtroom. These aren't the environments where a person is going to lose her concentration. Rather, it's the solitary reading and researching type activities that are so difficult for people with ADD.

Under your logic, I think it would be far more important to give an IQ test to lawyers. Because if I were a client I'd be much more concerned about knowing that an attorney was intelligent than knowing that an attorney could concentrate. And while we're at it, perhaps we should give a test of emotional intelligence; I certainly wouldn't want a jury to react the wrong way to my attorney. Actually what about hearing impaired people? Should they be banned from practicing law because they have to rely on something artificial to hear in the courtroom?

Last, some famous people with ADD. Would you call these people a deficit to society?

Albert Einstein
Nelson Rockefeller
Thomas Edison
Mozart
Gen. George Patton
John F. Kennedy
Gen. Westmoreland
Charles Schwab
F. Scott Fitzgerald
Walt Disney
John Lennon
George C. Scott
Winston Chruchill
Henry Ford
Dwight D. Eisenhower
Robert Kennedy
Jules Verne
George Bernard Shaw
Alexander Graham Bell
Beethoven
Woodrow Wilson
Carl Lewis
Hans Christian Anderson

[Mike]

A "slow" lawyer? This just shows how little you understand about ADD.

ADD had absolutely nothing to do with intelligence. In fact, it's not actually classified as a learning disorder by physicians at all.

Also, it's commonly suggested that those people who're able to make it to professions that require a great deal of school (doctors, lawyers, professors) who have ADD actually have substantially higher IQs than other people because they've had to compensate for the ADD for so long.

[Mike]

By the way, John Corcoran had ADD.

[S.cotus]

Mozart had ADD? Are you sure? What doctor diagnosed him with this? Can you tell me a biography of Mozart which would state that he had ADD? Did the emperor of Austria know this? Or rather do ADD-apologists just look at his quirkiness and conclude, "Well, he must have been just like the Westchester girls who try and get extra time on tests."?

Also, can you please name one surgeon with ADD. Does he tell his patients about this?

I read JC's bio. Never saw a mention of ADD in there. Where did you get this from ?

As to the generals that had ADD, the military is very careful now about allowing people to enlist who have difficulty concentrating. (Or rather, they instruct their recruiters to be, but they have been accused of looking the other way to meet their quotas.)

I admit that I don't know much about ADD, because, as I said, in my family and culture, it is unacceptable to claim to have such disorders. However, I do know that it is used as an excuse to get more time or special accommodations in completing tasks that other people have to do in the normal amount of time.

I don’t quite know what an “IQ” test is because most of them seem to be administered by psychologists to people with mental problems. Again, my culture looks down upon these people.

Yes, using the "N-word" 100 times can communicate a number of messages: 1) I don't like African Americans; 2) I am African-American and I want to mock people who hate us; or 3) people need to lighten up about the use of the N-word. In fact, I recently attended a piece of performance art in which the word was used about 200 times. So beat that !

Moreover, people who can’t concentrate are not, as a constitutional matter, a suspect class. But racial groups are.

[Mike]

"Mozart had ADD? Are you sure? What doctor diagnosed him with this?"

Of course the understanding of the brain wasn't advanced enough in his time to understand ADD. But he's widely seen as having most of the traits of a person with ADD (nodody with ADD has ALL of the symptoms of ADD, but rather people with ADD are diagnosed based on what can be observed).

One of the most common traits of ADD is actually the ability to hyperfocus. This is one reason that most of the people who study ADD don't classify it as a disorder, but rather a biochemical (in the brain) difference. There may be some very legitmate evolutionary reasons why people developed ADD (it's genetic, by the way). The ability to hyperfocus is something I have. It gives me the ability to very quickly master material if I'm really interested in it. Many kids with ADD are able to very quickly master computer codes, for instance, because they're really interested in them. A lot of professors have ADD. In fact, one of the more well known Engineering profs in the country (not retired from the University of Michigan) was diagnosed late in his life as having ADD. And it's this ability to hyperfocus that makes people with ADD such high performers in certain areas.

From a website on ADD:
http://64.233.167.104/search?q=cache:HickqDOAQiEJ:www.childrentoday.com/resources/articles/addp2.htm+mozart+%22attention+deficit%22&hl=en&client=ig

Always keep in mind that ADD is a difference and not necessarily a deficit or disorder. Many famous people who have made this world a better and more interesting place in which to live had ADD, such as Edison, Churchill and Mozart. Mozart was capable of going through an incredible state of hyperfocus so he could compose an entire opera in only a few weeks, yet he had problems completing many other tasks. He was socially impulsive, financially irresponsible and died a pauper. Edison is another example of the ability to hyperfocus. He was in perpetual motion in his seat and his mind would wander. All of these people used these ADD traits to their advantage.

As for getting extra time on tests, I'll have to say that a person with ADD should not get extra time. I think that people who have serious problems with getting something like an exam done on time probably should be tested for learning disabilities other than ADD. I know a lot about how ADD functions and I very much think that ADD doesn't affect a person's ability to get a test done on time. In any case, I've never asked for any accomodation (other than the ability to take adderall) for my ADD.

"As to the generals that had ADD, the military is very careful now about allowing people to enlist who have difficulty concentrating."

First, there aren't very many generals who ever started as enlisted men. But I would say that the ability to master large amounts of information and hyperfocus (like I said, common among people with ADD) would be valuable to the military.

"I admit that I don't know much about ADD, because, as I said, in my family and culture, it is unacceptable to claim to have such disorders."

Well, I hope your "culture" gets to the point someday that it won't be such a stigma to be different. But just b/c your "culture" says something, it doesn't mean it has merit for me.

"However, I do know that it is used as an excuse to get more time or special accommodations in completing tasks that other people have to do in the normal amount of time."

Like I said, I have never used ADD for this. And in my opinion there is no reason to give these types of special accommodations for a person with ADD alone.

"I don’t quite know what an “IQ” test is because most of them seem to be administered by psychologists to people with mental problems."

That's not at all true. IQ tests are used for a large variety of things. And even though I don't personally put a lot of weight in them (I consider other types of intelligence such as emotionally intelligence equally as important), they are occasionally useful.

"Again, my culture looks down upon these people."

Again, that has no bearing on what I think.

[Mike]

After reading my post it occured to me that it might seem confusing to say that people with ADD have problems concentrating and also have a tendency to hyperfocus. So let me explain that ADD is complex. People with ADD have an uncommonly hard time doing menial tasks quite often. So you'll often find that people with ADD need a good secretary and will have a messy office or house. You'd also find that people with ADD have trouble with research if they're not fascinated by it.

But people with ADD also have an ability to "hyperfocus" on things that they ARE fascinated with. Interestingly, more and more people who study ADD are finding correlations between OCD and ADD. But, like I said, ADD is complex and the connection isn't really understood yet.

[S.cotus]

Oh, okay, so most of your diagnoses of ADD are not based on actual medical examination. No MRIs were done. No clinical tests were administered. Instead, some people just heard fourth-hand accounts of some famous people and concluded that they must have had ADD.

By “enlist” I didn’t mean simply people who were not officers, but rather anyone who was recruited. Take a look at the application form for any military academy (or JAG) and you will have to disclose this. But even enlisted people will have some command responsibilities, and, for better or worse, military brass fear that they will be sending people all over the place in a combat situation.

Since we agree about extra time on tests, most of my differences with you are rather academic. Not pun intended. I really don’t care whether someone has ADD, herpes, or triskaidekaphobia: so long as they can perform like everyone else, they can be treated like everyone else.

Can you tell me 1) who administers the IQ test; and 2) show me a sample standardized IQ test; and 3) show me the scores from 2004 and the statistical breakdown.

[Mike]

"Oh, okay, so most of your diagnoses of ADD are not based on actual medical examination. No MRIs were done. No clinical tests were administered."

Honestly man. You should learn even a tiny bit about what you're talking about before you engage in such a debate about it. There aren't any clinical tests for ADD and you certainly can't diagnose it with an MRI. The way anybody is diagnosed with ADD is by tracking behaviors -- period! So it makes it very possible indeed that people who study ADD can look at a lifetime of behaviors of famous people and determine if they were very likely to have had ADD.

"Since we agree about extra time on tests, most of my differences with you are rather academic. Not pun intended. I really don’t care whether someone has ADD, herpes, or triskaidekaphobia: so long as they can perform like everyone else, they can be treated like everyone else."

Excellent. Much like a hearing impaired person can perform like anyone else with a hearing aid, I can do the same with Adderall.

"Can you tell me 1) who administers the IQ test; and 2) show me a sample standardized IQ test; and 3) show me the scores from 2004 and the statistical breakdown."

Huh? The statistical breakdown for what aspect of an IQ test? Normally it's Psychologists or Psychiatrists who give IQ tests. And if you want to see what an IQ test looks like, google it. This little argument is entertaining, but I'm not about to do research here.

[S.cotus]

Okay, since it is shrinks who administer the IQ tests to the kind of people who would see shrinks, it isn’t standardize and therefore of little statistical value. It might be of some diagnostic value, but since we don’t know what it looks like (and you didn’t provide a sample) it is difficult to even argue that point.

The rest of your argument seems to be: 1) you are wrong; because 2) I know so much about all sorts of mental disorders. However, you fail to demonstrate your knowledge because you don’t actually cite to any learned treatises, and you still seem to claim that people who have been dead for 200 years can be posthumously diagnosed with ADD. Anyway, as I said, my culture doesn’t really tolerate going to shrinks or whining.

I didn’t say, however, that you should be allowed to practice because you are dependant on a drug to function like any other law student. My fear is that: 1) you will reveal client confidences to your shrink (and the protections for communications with shrinks are much weaker than for communications with lawyers or priests); 2) you might forget your medicine and accidentally send someone to the execution chamber.

[Mike]

"Okay, since it is shrinks who administer the IQ tests to the kind of people who would see shrinks, it isn’t standardize and therefore of little statistical value."

While a Psychologist normally administers an IQ test, IQ tests themselves are fairly standard (although there are a few that are in common use). According to http://ldlink.coe.utk.edu/understanding_report.htm, "The most common IQ tests in current use are the Wechsler intelligence scales." With that link you can probably go and take a look at an IQ test if you want. But it might not make sense to you as you don't have quite the training that somebody who administers it would.

I do know a good deal about different learning differences and other mental health issues because both of my parents are mental health professionals, and because I've been affected with ADD for my whole life.

"Anyway, as I said, my culture doesn’t really tolerate going to shrinks or whining."

That's sad.

"My fear is that: 1) you will reveal client confidences to your shrink (and the protections for communications with shrinks are much weaker than for communications with lawyers or priests)"

First, I don't go to a "shrink" to chat about my life. Every couple months I see a psyciatrist to tell her how my meds are working -- that's all.

And secondly, why would somebody be more willing to tell a psyciatrist something than, for instance, a best friend?

Lastly, what would a random psyciatist care if they had confidential information about a legal case? I'm sure a hell of a lot of lawyers see shrinks (surely not just those with ADD). But if a psyciatrist were to reveal something confidential, they'd lose their license to practice medicine. You don't think that's harsh enough?

"you might forget your medicine and accidentally send someone to the execution chamber."

I'm really just starting to think I'm responding to a twelve year old...