Attention Deficit Hyperactivity Disorder (ADHD) is not a new disorder; it has actually been around for many years. ADD (Attention Deficit Disorder) was added the Diagnostic and Statistical Manual for Mental Disorders (DSM) in 1980, and then changed to ADHD in 1987 in the DSM-IIIR, and ADHD as we know it today was conceptualized in 1994 with the publishing of the DSM-IV, which incorporates both inattentive behaviors as well as hyperactive ones, and then breaks the diagnosis into categories of predominantly inattentive, predominantly hyperactive or combined. Most people are familiar with the symptoms of ADHD, generally individuals diagnosed with this disorder are easily distracted, excessively fidgety, interruptive, and often have trouble focusing to an extent that is “disruptive and inappropriate for developmental level.” This disorder has been “growing” rapidly, according the Center for Disease Control diagnosis increased by an average of 3% every year from 1997-2006 and by an average of 5.5% every year from 2003-2007. Originally ADHD was a diagnosis reserved for school aged children, but as Conrad and Potter show, it has been medicalized to include adults through claims by the media, professionals and self-diagnosis among lay peoples1.
Although this disorder is not new by any means, the recent surge of diagnoses in the United States would indicate that “children went mad” over the last couple decades2. ADHD seems to have become the catch all phrase for disruptive children. Many people feel that ADHD and medicating for it has eclipsed parenting and mentoring, is over diagnosed and some think the disorder is a fraud all together. For example the article, “Are some ADHD-labeled kids just young for their grade?” points to two studies which indicate that some kids on the younger side of the age cut off for their grade are being diagnosed with ADHD when they just aren’t mature yet. The study found that “being young for [a] grade more than doubles the [chance] that a student is diagnosed with or treated for ADHD.” Which is odd since ADHD is allegedly a neurological problem and rates of diagnoses should not change dramatically from one age to the next3. Additionally, the film Generation Rx makes several claims that would discredit the prevalence of this disorder. Claiming that this vast and rapid increase is an economic endeavor, not a scientific one and that the drugs used to medicate for ADHD (among other mental disorders like depression) cause chemical imbalances in our children. They point to the fact that 90% of all Ritalin is consumed in the U.S. and the happy coincidence that 100% of the members of the FDA’s panel on mood and psychotropic drugs have financial ties to the pharmaceutical industry. Rx argues the growth in ADHD can be attributed to greed, corruption, and manipulation of the American public through advertising4. These accusations give rise to some very real fears of the over diagnosis of ADHD and over use of drugs to treat it.
On the other hand, there are proponents of the disorder who feel that people afflicted with this disorder benefit from a diagnosis and need the treatment that comes with it. One critic to the “backlash” against ADHD is Emily Willingham, saying that ADHD is “a real and often disabling disorder with limited but effective treatment options.5” Willingham mostly cites Dr. Harold S. Koplewicz’s rebuke of Dr. L. Alan Sroufe’s claim that ADHD drugs do more harm than good. In addition to Kopelewicz’s supporting argument, Willingham conveys her personal experience with her 9 year-old son experiencing “daily and persistent public humiliation for his ADHD.” She then claims that medication can reduce the behaviors of ADHD which bring on this humiliation and “improve a child’s life.” Another well known proponent of ADHD is Dr. Edward Hallowell, founder of “The Hallowell Center” and co-author of “Driven to Distraction.” Dr. Hallowell claims in an interview with “The Revolution News” on ABC that undiagnosed ADHD can ruin your family life, school life, cause unexplained underachievement, lead to prison, cause divorce, unemployment or even addiction. If you could only get the diagnosis you could “skyrocket,” “soar,” and “achieve your goals.” Additionally, according to Dr. Hallowell medication for ADHD is “safer than aspirin” if prescribed by a doctor that “knows what they are doing.”
There seems to be a lot of conflicting information out there about ADHD. The mind numbing amount of information circulating about ADHD and how to treat it, in addition to the various “experts” opposing one another; makes it difficult to ascertain the reality of the disorder. In order to help understand the situation at hand it is worth examining some of the social constructions that lead the diagnoses of ADHD. That is, what is “wrong” with an individual with ADHD compared to the rest of society, and more importantly how, when, and where we notice what is different about individuals with ADHD. If you watch the video in the link above or bother to read any of the other cited articles, you may notice that there seems to be reoccurring environment in almost every discussion, school. Katherine Harmon’s article is chiefly about diagnosis based on grade level. Emily Willingham’s experience points to her 9 year old sons humiliating experience at school or an “environment that require[s] a specific behavioral conformity.” In the interview with Dr. Hallowell ADHD causing problems in school is mentioned frequently. And the diagnostic criteria in the DSM as listed on the CDC website require that an individual’s behavior be “inappropriate for developmental level.” It’s as if the single most important indicator of a child’s development is their “date of manufacture,” i.e. how old they’re or what grade they’re in6. There seems to be an unnecessary emphasis on adherence to the strict behavioral conformity that is expected of that age group. It is worth noting that these concepts of behavioral conformity in children are created by us. There is no biological requirement for how children should behave. Sure age is a convenient frame of reference but all in all age is a social construction and the assumptions about how children should act given how old they are created by society. These inattentive, hyperactive behaviors seem to mostly be noticed in the classroom, a social construction itself, in an era that is the most stimulating time in history7. There are constant pulls for attention from video games, computers, movies, sports, and advertising. While school (at least to me) is a largely unexciting endeavor during K-12. The CDC states that parents reported 9.5 % of children ages 4-17 (essentially school aged children) have been diagnosed with ADHD, compared to 0.26% for people with diabetes under 20 or 8.3% of the U.S. Population. Which seems more reasonable, that a mental disorder like ADHD is more prevalent than diabetes in a population of people whom 35% are considered obese, or that some flaws in our rigid social constructions of how children behave in classrooms and the current dichotomy of academic and non-academic thinking cause a serious distortion of the ADHD “epidemic.”
Lastly I would like to consider the implications of the media and self-diagnosis in the emergence of the Adult ADHD phenomenon. Conrad and Potter point out that Dr. Hallowell and Ratey provided a great boost to Adult ADHD in 1994 with their publication of “Driven to Distraction.” They claim that although Hallowell and Ratey’s “affiliation with Harvard Medical School gave them some academic legitimacy,” they approached the area of Adult ADHD more as “entrepreneurs for the adult diagnosis” than as scientific researchers. This in combination with popular news clips about the disorder seemed to create a fad of self-diagnosis. “Virtually all children were referred by parents or schools to physicians,” while self-referral is commonplace with adult ADHD. They quote one psychiatrist as saying “Adult ADHD has now become the foremost self-diagnosed condition in my practice. I fear that the condition allows a patient to find a biological cause that is not always reasonable, for job failure, divorce, poor motivation, lack of success, and chronic depression.8” It’s frightening how nonchalantly the diagnosis is tossed around like at the end of the Hallowell interview. Six simple questions and I have adult ADHD. I too have trouble wrapping up projects, getting organized, remembering appointments, procrastinating, have and am overactive. The truth is most of those things are difficult to do for everyone, but nearly impossible for a much smaller number of people, I have trouble doing these things because following through on projects, being organized, and being disciplined are difficult tasks, while I’m good at these things most of the time, it’s not to say it comes without considerable effort. And I’m sure Dr. Hallowell doesn’t have a vested financial interest in his self founded center for treating mental disabilities or one of his two books on ADHD.
The financial conflicts of interests in the field are astounding and disgusting. Unfortunately, some people do have ADHD and real problems that stem from the disorder. However, the casualty with which the diagnosis seems given undermines the very real need of treatment for some individuals. The intense marketing campaign and nee-jerk reaction to medicate have caused a rapid over diagnosis and a backlash that the truly afflicted must deal with. The very looseness given to the disorder discredits its validity and can make some people who need help feel like they may not deserve it. Furthermore, it may be that the institutions that make the “disorder” noticeable need treating, not necessarily the individual with the disorder.
1, 8 Conrad, Peter and Deborah Potter. “The Emergence of Hyperactive Adults as Abnormal.” Readings in Deviant Behavior. Ed. Alex Thio, Thomas Calhoun, Addrain Conyers. Boston, MA: Hanson 2010. 138-143. Print.
6, 7 Robinson, Ken, perf. Changing Education Paradigms. RSA Animate, 2010. Film Clip.
2, 4 Generation Rx. Dir. Kevin P. Miller. Common Radius Films, 2008. DVD
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