Thursday, December 11, 2008

Extended Time, "Smart Drugs", and Why It's Not All About Making People Normal

I.

Recently I wrote about accommodations, and one of the accommodations I mentioned having (at least some of the time) in school was extended time on tests.

Well, yesterday I was flipping through a random magazine (I think it was "Family Circle" or something along those lines) and I came across a column in which the author described what she saw as an "alarming" trend toward parents trying to get their children falsely diagnosed with ADHD or learning disabilities so that they could get extra time on their SATs, etc.

I don't know if this is actually a real trend -- I suspect that it isn't -- but frankly even if it isn't, I think it's worth looking at in terms of what it could actually mean.

Personally I had the extended time accommodation because I have a lot of trouble pulling out specific information quickly on demand. It's not that I "don't know" the answers (or how to get them) when I've studied and learned the material, but that it takes me a long time to switch from one cognitive mode to another, and to turn internal signals into coherent output.

This is apparently quite common in autistic people, but it's not just autistic people who deal with it. If more kids are getting educational diagnoses of learning disability, it could very well be that the way schools are doing testing these days is producing disability.

Hopefully that doesn't come across as alarming. By "producing disability" I don't mean that schools and testing are doing things biologically to "normal" students' brains and giving them intrinsic difficulties they didn't previously have. Rather, I mean that there could very well be something about the standard school setup is hindering a lot of students in terms of letting them show what they know.

Functionally, if someone does better on a test when they have extra time -- regardless of whether they do or don't have any "medical" diagnoses -- the standard time limit can legitimately be seen as disabling for them.

In other words, if having more time on a test allows anyone to demonstrate more of what they've actually learned, I don't see why there ought to be any objection to granting them additional time.

While I don't much like the "pushy parent" mentality that causes some parents to frantically obsess over their kid's test scores, and while I don't advocate anyone actually being dishonest (i.e., actually lying to an educational psychologist or similar authority about one's child in order to get them some sort of diagnosis), I don't see what the big deal is about possibly thinking about extending time for everyone if it actually helps more students' scores actually reflect their knowledge and problem-solving abilities.

If someone does not really know the material they're being tested on, no amount of "extra" time will permit them to come up with correct answers. There are, after all, things one must have in one's brain in order to produce the answers to calculus problems that cannot just be summoned out of the aether as a function of having twenty or thirty extra minutes to complete a math test.

Hence, my guess is that a lot of the time limits on tests in educational settings are rooted more in administrative/logistical convenience than in educational value.

I understand that schools are faced with the task of educating many, many students whilst simultaneously coming up with some means of measuring what has been learned. Any time you have such a large-scale operation, some degree of standardization is likely going to come into play, as well as plenty of institutional inertia. I am therefore not suggesting that large scale reform could happen overnight if only people changed their minds about test administration techniques.

What I am suggesting is that people look carefully at what they are defending as valuable in education as it presently stands, and avoid confusing something that merely makes running a large system easier with something that actually benefits students (or their potential future employers!). It could very well be that the drive toward efficiency in education has gone a bit too far toward contracting and condensing testing, to the point where the value of that testing as it is currently administered is questionable.

Not that it was ever ideal before, and I am not proposing a return to some nonexistent "golden age" (or suggesting a plan for a utopian future); I just think that people ought to be wary when they hear statements to the effect of, "Well we can't give all these students extra time, because then they might actually have the opportunity to think!"

As I see it, the skills required to carefully consider the instructions one is given, interpret the nature of the problem, and figure out how to access what one knows (regardless of whether that takes five or fifteen or fifty minutes) are a lot more useful and valuable in the world outside the classroom than the skills required to regurgitate an answer from short-term memory that might not even reflect actual comprehension.

II.

An interesting offshoot from the accommodations discussion is the discourse surrounding the ethics of supposedly "normal" people making use of certain medications thought or demonstrated to improve certain cognitive abilities.

Personally I think that all adults (which would include many college students) should be able to take medications like methylphenidate (Ritalin), modafinil (Provigil), etc., regardless of whether they are diagnosed with anything so long as these drugs are made available in an environment of informed, noncoerced consent.

The main concerns I'd have about wider use of these drugs would be (a) safety (but my guess is that making them more widely accessible through legitimate channels to more people would help safety in its discouragement of black and gray-market traffic where you could end up getting something that turns your eyeballs green), and (b) keeping the scene void of coercion.

It would not be ethically acceptable, for instance, for employers to require that employees take stimulant medications (so that they could work, say, 18-20 hour shifts) or risk being fired because they had to go home to sleep. I am also quite bothered by the idea of young children being medicated before environmental adjustments are even attempted, or in situations where the medication is clearly being used in the manner of a "restraint" (especially when the children in question have communication difficulties that make it harder for them to report side effects, etc.).

What I am not concerned about, though, is the idea that if a "normal" person uses a drug that improves some cognitive skill (albeit temporarily, at least when it comes to presently-existing medications), this somehow constitutes "cheating". This worry -- which I've seen stated in multiple places over the past few years -- seems to be based in several fallacies.

III.

One such fallacy is the idea that when people with diagnosed differences/conditions take these drugs (or for that matter, receive accommodations!), they are just being brought up to "normal" levels and types of performance. This is not actually the case, though, as things aren't nearly that linear or specific when it comes to brains and what they can do under different circumstances.

In college, some of the classes I ended up receiving accommodations in were classed in which my un-accommodated test scores had been in the low C, D, or even F range. However, when I was able to get "time and a half" or double-time on later tests in the same class, I would often achieve scores in the high B or even A range.1

Furthermore, for some people, certain medications (and I am presuming hypothetically that we are talking about adults here who have chosen and consented to take medication for their own reasons and in the context of accurate information about the medication in question being freely available) probably also mean the difference between not being able to do something at all, and possibly being able to do something very well.

I take one medication currently (Adderall XR) that helps me a lot with something that has been a tremendous challenge my whole life -- frustration tolerance. Now some might suggest I could try to just structure my life in ways that avoided (what would be for me) excessively frustrating situations -- and I have indeed done that to some extent. However, right now my goals and priorities are such that I can't avoid those situations consistently (and I've not found any really effective non-medication method of dealing with them), and hence I choose to get my prescriptions filled.2

And...in light of that, I guess I just don't see why other people, regardless of whether they've been deemed "sufficiently impaired" by whoever is in charge of controlling who gets which medications and when, shouldn't be able to make the same choice.

Certainly safety and consent and autonomy issues must be accounted for in the administration of any drug, device, or other brain-affecting tool within a society, but I don't see for a minute how it could be "cheating" for someone else (who isn't diagnosed with anything necessarily) to access medication similar to what I take.

IV.

Another fallacy that seems to linger behind the "cheating" notion is pretty much exactly the same for medications as it is for accommodations. This fallacy seems to be based in the belief that a particular tool (whether it be a desk in a quiet corner, earplugs, extra time, or Ritalin) somehow grants the person using it an "unfair" advantage in the same manner that something like a "cheat sheet" or a small speaker that whispered the answers in their ear would.

But in reality, if someone doesn't actually know their stuff, neither medication or extended time will magically put the knowledge into her head.

Something that helps a person take best advantage of what is already in their head -- meaning their brain and acquired knowledge -- is not the same as something that permits the person to be deceptive about what they actually know.

If you understand a subject, you understand it, period -- you may or may not benefit from the application of some tool to help you show what you understand, but there's a big and obvious (at least to me) difference between demonstrating actual understanding and faking the appearance of understanding (as occurs in academic cheating).

In other words, regardless of what tools are available to them, people still need to determine how best to study and prepare for assignments and other tasks. If someone really wants to learn and perform well, why shouldn't they have whatever tools help facilitate this? And why should that person have to prove that s/he is somehow "deficient" or "broken" or "sick" in order to access those tools?3

V.

Behind basically all of the preceding discussion is something else that I think merits being brought to light -- and that is the usually-unspoken presumption that the goal of a civilized, inclusive society is to first and foremost get people up to average.

While this apparently sounds to many like a nice, fair, efficient way to go about doing things, it assigns far too much value to the idea of a "standardized" human -- an idea which in turn results in both needless restrictions of particular options from individuals who might otherwise benefit from them, and in unjust coercion of persons with non-normative configurations toward a false ideal of normality.

Hence people making arguments that extended time on tests for students without medically-diagnosed conditions (or what are assumed to be "intrinsic deficits") and the allowance of certain sorts of medications (such as low dose stimulants) to individuals who don't have "clinical" levels of impairment unmedicated comprise "cheating" are in fact subscribing to what I'd consider a fairly destructive standardization mentality.

Furthermore, wanting things to be fair and equitable is all well and good, but in widening access to modification methods and medications it is important to implement checks against status-quo bias so that opportunities do not become obligations. And accommodations -- along with the widening of access to them -- seems like a pretty darn good example of just such a check.



1 - This seems to be another common autistic thing (but which may occur in other neurologies as well; I've just noticed a lot of other autistic people noting similar phenomena) -- our learning and performance curves can have an almost exponential quality to them, sometimes to the point where it only takes one seemingly minor variable change to get us beyond the flat part of the curve.

2 - My official diagnosis is Asperger's (and/or "Pervasive Developmental Disorder"; the documentation is a bit confusing, which is yet another reason I'm often compelled to just use the terms "autistic" or "autistic spectrum"). I am not technically currently diagnosed with ADHD, at least not per my most recent evaluation (which said "ADHD is unlikely"). However, in working with the doctor(s) I've seen over the past few years, there has pretty much been agreement that I benefit from the medication often prescribed to people identified as having ADHD.

Moreover, I do not feel "changed" in either personality or cognitive style or anything else when I take my current medication; it really does feel like this medication permits a very fine, very specific adjustment of something about my brain that makes aspects of my life needlessly difficult when not addressed. YMMV.


3 - In my conceptualization of disability, anyone who wants to achieve a particular goal and is facing barriers to achieving that goal is experiencing the effects of disability, regardless of whether they're considered to have a medical or other condition or not.

There ought to be no dichotomy between acknowledging disability and acknowledging that a person is not "broken", just as there ought to be no rule dictating that some conditions must be addressed through modifying the individual whereas others must be addressed through modifying the environment.

Different people are going to vary in how they address the difficulties they encounter throughout life, and restricting particular tools to particular populations labeled "deficient" is unfair both to those (often stigmatized) populations and those who are barred from accessing those tools due to not being considered deficient enough.

What I would like to see someday is a scene wherein if a person needs something, or perceives that they'd benefit from something (especially something that entails doing something in a nonstandard way), they will be helped on the basis of the fact of that thing benefitting them. Not on the basis of whether a doctor says that there is something "wrong" with them or not. And this applies equally to people who, right now, would be considered disabled and to those who would likely not.

9 comments:

abfh said...

I expect there would be much less substance abuse in our society if people could visit psychiatrists and get drugs that were prescribed for their individual problems and concerns, without having to prove that they fit into an official mental disorder category. Without that option, a lot of people just medicate themselves with alcohol and street drugs.

Both this post and your accommodations post do an excellent job of deconstructing the fallacy of the standardized human. :)

Kevin LeBleu said...

You wrote: If you understand a subject, you understand it, period -- you may or may not benefit from the application of some tool to help you show what you understand, but there's a big and obvious (at least to me) difference between demonstrating actual understanding and faking the appearance of understanding (as occurs in academic cheating).

Unfortunately, a large portion of people don't appear to care about actual understanding. They just care about getting a passing grade so they can get a diploma so they can list it on their resume. Or earlier on, they just care about getting a good score on the test so they can get into a better college.

To this type of person, faking the appearance of understanding in ways that are considered legitimate (such as cramming for tests, or schools artificially making the test easier for everyone) are all that matter. In some cases all that matters is that they get to fake the appearance without getting caught, and that others aren't able to fake it in ways they aren't allowed to.

AnneC said...

abfh: Indeed. I am often confused at how humans seem to have constructed a system of routes that permit only people who've gone through certain "gatekeepers" to pursue particular options. As I mentioned in my post, there are of course good reasons to implement safeguards so people don't actually get hurt in the process of solution-seeking, but frankly right now a lot of attempts at such safeguards look more like airport security (which seems to have become a bad joke as of late) than anything sensible.

And, yes, the "standardized human" fallacy is a perpetual bugbear I keep running into. The way I see "normal" being used at times looks about as nonsensical as people trying to insist that a given family really does actually have "1.5 children" just because it works out that way statistically when you consider large numbers!

AnneC said...

Kevin LeBleu: Well, if enough people without actual understanding manage to bluff their way into positions where understanding is expected and necessary, eventually things may end up coming crashing down. :/ One particular interest of mine (mostly because it confuses me so) is the phenomenon where people will go off in pursuit of something meant to merely mark progress toward a goal as if that thing is the goal itself. I read an article yesterday about people who do that with money -- that is, they get all wrapped up in accumulating money without thinking much about the fact that money ought to correlate with actual value.

Being a very concrete thinker myself, I am heartily confused by the degree to which many humans will latch onto symbols as if they are objects. If people are trying to get higher grades and diplomas without caring about whether they understand the material they're supposed to be learning, it is eventually going to bite them (figuratively speaking) the same way one will get bitten by relying on credit without anything real backing it.

PT said...

Ritalin, Provigil, meh - these are just low-grade uppers. Legal E, only 1/10 as effective and without the good feelings. If they came from the street instead of Big Pharma, they would have been outlawed immediately.

For real smart drugs, check out the cheap generics hydergine and piracetam. They don't give you a rapid lift, they don't alter your mood or perception. They just make your head clearer, your thinking sharper and your memory more retentive. They're supposed to be for the aged, but they work especially well in the young. The recommended hydergine dosage (3mg) is too low to be effective - I found 9mg was right for me.

Anderson said...

Anne (comments): "Being a very concrete thinker myself, I am heartily confused by the degree to which many humans will latch onto symbols as if they are objects. If people are trying to get higher grades and diplomas without caring about whether they understand the material they're supposed to be learning, it is eventually going to bite them (figuratively speaking) the same way one will get bitten by relying on credit without anything real backing it."

Absolutely. This sort of thing is discussed in depth here.

Anne (article): "If someone does not really know the material they're being tested on, no amount of "extra" time will permit them to come up with correct answers."

:p

Robert said...

Very nice article. I'm liking your blog since being shown it the other day.

Links tangent to part one of your article (The Hidden Curriculum):

http://en.wikipedia.org/wiki/The_Hidden_Curriculum
"The Hidden Curriculum (1970) is a book by Benson R. Snyder, the then-Dean of Institute Relations at the Massachusetts Institute of Technology. Snyder advocates the thesis that much of campus conflict and students' personal anxiety is caused by a mass of unstated academic and social norms, which thwart the students' ability to develop independently or think creatively."

http://en.wikipedia.org/wiki/Hidden_curriculum


These sorts of schooling issues have been identified for decades and yet, with exceptions such as yours of "additional time", are still around.

It's unfortunate that it's often easier to modify yourself instead of having a multi-path'ed enough system to buttress everyone's weaknesses and allow their strengths and interests to flourish.

How is the Adderall? In terms of side-effects and prognosis with ling-term usage? The idea of taking a drug such as amphetamines freaks me out - I hope to learn how to cope with academia without it.

Too bad school wasn't more like work, I'm great at work.

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Vipul Naik said...

Anne,

Your argument about time accommodations for tests makes sense if the test is meant to test people's knowledge and skill in applying that knowledge *without time constraints*. But most timed tests specifically test for the ability to recall knowledge and skills *within* time constraints. The fact that people can do substantially better on a test given more time does not mean that the time limit should be extended.

Whether a timed test is the right way to test knowledge and skills is a different question and the answer may vary based on what exactly needs to be tested. Some instructors offer take home tests and open book tests if the closed-book fixed-time test format is not suitable to what they're trying to measure. Other instructors may feel that the ability to quickly recall material in a subject is critical to "learning" the subject -- for instance, a language instructor may be of the opinion that the ability to quickly recall words and meanings of words in the language is critical to the attainment of fluency in the language. Even in cases where the ultimate application of the knowledge will not be in time-constrained situations, the ability to do things faster may be a big bonus and hence instructors may treat it as part of the skill set being tested.