ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic

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This landmark piece of legislation provides tens of millions of Americans who were previously denied care with access to mental health treatment. Today, Rep. On this edition of ST, we listen back to an interview from April of this year. At that time, we spoke with Dr.

Stephen P. Copyright NPR.


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By the time they're in elementary school, some kids prove to be more troublesome than others. They can't sit still or they're not socializing or they can't focus enough to complete tasks that the other kids are handling well. Sounds like ADHD. But it might be that they're just a little young for their grade.

In fact, over the past decade or so, use of the drugs by adults has grown at a far faster rate than it has for children, according to data from drug benefits manager Medco. Video games can be a haven from the world, and it's easy to imagine that they would appeal to children who struggle with social interaction.

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Boys with autism spectrum disorders or with ADHD are both prone to problematic use of video games, according to a study. The researchers asked the parents of boys ages 8 to 18 to report on their child's video game use, including hours of use and the types of games they play. When Cathy Fields was in her late 50s, she noticed she was having trouble following conversations with friends. Fields was worried she had suffered a stroke or was showing signs of early dementia.

Instead she found out she had attention deficit hyperactivity disorder, or ADHD. Men who were diagnosed with ADHD as children are more likely to be obese in adulthood, according to a new study. Public Radio Classical Not everyone, of course, then or now, sees a problem in these developments. One conventional medical explanation is that the rising diagnostic rates simply represent greater disorder awareness and screening.

The actual incidence of disorder, in this view, is not going up, nor is there any significant overdiagnosis; rather, better identification is finally bringing the number of those diagnosed into alignment with the true prevalence of the condition. Even in the face of the current higher rates, that argument continues to be made. Many observers, however, have been less sanguine.

The diagnosis and drugging, in this view, are simply new strategies for the control of unruly children.

"ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic"

From a completely different angle, the physician Richard Saul argues in ADHD Does Not Exist that all the many symptoms currently associated with the category of ADHD can better be accounted for by some twenty other conditions, from poor eyesight and sleep disorders to learning disabilities and depression.

ADHD is being falsely diagnosed and wrongly treated in every case because it is not a separate disorder at all. A more common position has been to accept some medicalization of these problems and grant that there are legitimate cases, but then posit some key social factors to explain overdiagnosis and overtreatment. Since then many others have done so as well. Across this considerable literature, the social factors commonly identified as contributing to the ADHD spike include:.

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Nearly every critical discussion of the social dynamics involved in the rise of ADHD diagnosis and treatment includes some mix of these contributing factors. An investigative reporter for the New York Times , Schwarz is best known for his extensive coverage of concussions in sports. From to , he also wrote a series of important articles in the Times on ADHD diagnostic trends, illicit stimulant use by high school and college students, direct-to-consumer advertising of ADHD medications, and professional regrets about the poor design and interpretation of a crucial government-sponsored ADHD-treatment study the so-called MTA study that purported to find that stimulant medication by itself yielded better outcomes than behavioral or combined interventions.

From his articles, readers of the Times will also have been exposed to some tragic stories of addiction behind the statistics. Schwarz makes such stories a central thread of his engaging book. He gives substantial treatment to the relentless marketing of stimulant medications, from bestselling books by doctors to glossy medical-journal ads and ubiquitous direct-to-consumer marketing on the airways.

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All these, he argues, have peddled misleading claims and seductive promises. Schwarz also has critical things to say about a complacent and culpable news media, too quick to parrot P. To the other commonly cited factors, however, he gives only passing attention: government regulatory actions, trends in medical practice including the role of the DS M , and broader features of our competitive society and its regime of the self all escape largely unscathed.

On my reading, this is why Schwarz tells the story in the way that he does.

Doctors Just Legal Drug Dealers!

Optimistic of top-down reform, he aims to get a hearing within psychiatry by staying within the medical model of the disorder and identifying the culprits as industry, a few prominent bad apples, and the lack of training that pediatricians and family-medicine doctors have in this area. He does not contest the use of stimulant medications, at least when prescribed after a thorough assessment for ADHD.

He accepts it so long as it stays within the proper, medically defined bounds. The problem for Schwarz, the whole problem, lies in the misdiagnosed cases, the cases that lie beyond the proper diagnostic boundary. Drawing that boundary requires some fairly clear-cut way to distinguish between those with and without the disorder. Schwarz believes psychiatry already has the proper tools, its best-practice guidelines.

Nothing is perfect, he argues, but with these guidelines good doctors make correct diagnoses all the time. This is why he is optimistic of reform. Psychiatry knows what ADHD is and knows how to identify it. That knowledge, Schwarz believes, also means the field has a pretty accurate idea of exactly how prevalent the condition really is.

It is 5 percent of children, which is the number that appears in the fifth and current DSM. The real epidemic, he argues, is in the overdiagnosis — in the difference between the actual prevalence, 5 percent, and the rate of diagnosis. The rate of diagnosis, according to the NSCH data mentioned above, is 11 percent of children, a figure that Schwarz bumps up to 15 percent by estimating the diagnoses that might happen in the future when children, who at the time of data collection were still young, would reach the prime diagnostic ages. Regular clinicians too, in my experience, freely grant it.

ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic by Alan Schwarz

In an unpublished study of articles about ADHD in popular media between and , a colleague and I found that discussions of overdiagnosis were documented most of the time with concerns expressed by recognized experts. The statistics, especially rates of diagnosis that approach 30 percent among boys in some southern states, are a little hard to defend. Acknowledging overdiagnosis is one thing.

The numbers are rising every year. Now doctors and Big Pharma are targeting adults and the rest of the world to get diagnosed with ADHD and take medications that will "transform their lives. Keith Conners, who spends fifty years pioneering the disorder and use of drugs like Ritalin before realizing his role in what he now calls "a national disaster of dangerous proportions"; a troubled young girl and studious, teenaged boy who get entangled in the growing ADHD machine and take medications that cause them serious problems; and a pharmaceutical industry that egregiously overpromotes the disorder and earns billions from the mishandling of children and now adults.

While demonstrating that ADHD is real and can be successfully medicated, Schwarz sounds an alarm and urges America to wake up and address this growing national problem"-- "A groundbreaking and definitive account of the widespread misdiagnosis of Attention Deficit Hyperactivity Disorder--and its serious effects on children, adults, and society" Language eng. Publication New York, Scribner, Edition First Scribner hardcover edition. Extent viii, pages. Isbn Label ADHD nation : children, doctors, big pharma, and the making of an American epidemic Title ADHD nation Title remainder children, doctors, big pharma, and the making of an American epidemic Statement of responsibility Alan Schwarz Creator Schwarz, Alan, Subject Attention-deficit hyperactivity disorder -- United States Diagnostic errors -- United States Language eng Summary "A groundbreaking and definitive account of the widespread misdiagnosis of Attention Deficit Hyperactivity Disorder--and its serious effects on children, adults, and society.

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