The Business of Attention Deficit Disorder

Hugh Pickens DOT Com writes "Alan Schwarz writes in the NYT that the rise of ADHD diagnoses and prescriptions for stimulants over the years have coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. 'The numbers make it look like an epidemic. Well, it's not. It's preposterous,' says Dr. Keith Conners, a psychologist who has led the fight to legitimize attention deficit hyperactivity disorder for more than fifty years. Few dispute that classic ADHD, historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, work and personal life. But recent data from the CDC show that the diagnosis had been made in 15 percent of high school-age children, and that the number of children on medication for the disorder had soared to 3.5 million from 600,000 in 1990." (Read on for more.) "Behind that growth has been drug company marketing that has stretched the image of classic ADHD to include relatively normal behavior like carelessness and impatience, and has often overstated the pills' benefits. Advertising on television and in popular magazines like People and Good Housekeeping has cast common childhood forgetfulness and poor grades as grounds for medication that, among other benefits, can result in 'schoolwork that matches his intelligence' and ease family tension. The FDA has cited every major ADHD drug — stimulants like Adderall, Concerta, Focalin and Vyvanse, and nonstimulants like Intuniv and Strattera — for false and misleading advertising since 2000, some multiple times. And although many doctors have portrayed the medications as benign — 'safer than aspirin,' some say — they can have significant side effects and are regulated in the same class as morphine and oxycodone because of their potential for abuse and addiction. Meanwhile profits for the ADHD drug industry have soared. Sales of stimulant medication in 2012 were nearly $9 billion, more than five times the $1.7 billion a decade before, according to the data company IMS Health. 'This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels,' concludes Conners."

Comments

Re:American Culture?

[swb]

I think there's a bunch of interrelated issues in American culture, many tied to economics.

Parents want to their kids to be successful, and the general theory on this is that you have to do well in school early so that you can get into the right college so you can get the right degree so you can get a good job.

I think this leads to relentless pressure on kids, especially boys, to be "perfect" in school. Deviation from this leads parents to wonder what's wrong, when, in fact, what's wrong may be "he's an 8 year old boy." Parents believe and our culture does everything to reinforce the idea that if you screw up early you won't make it into the right schools, activities, college, etc. There's no room for error, no room to be an 8 year old boy for whom its perfectly normal to have a ton of physical energy and not a lot of focus on sit-still studies.

The educational system, especially in urban areas. There's this relentless focus on "the achievement gap" -- mostly blacks, but often including hispanics, not achieving the same test scores, grades, etc. as other students, mostly whites (although you could include Asians, they often outscore whites).

Fighting the "achievement gap" has led to two things. One, more testing and more focus on elementary education test scores, which has led to more intensive focus on reading and writing, which is challenging for all boys of elementary school age. We've taken something hard for young boys and kind of made it harder for them.

The second thing is that schools have tried to become social welfare delivery mechanisms. It's beyond obvious that the MAIN reason low-income blacks do poorly in schools is the absolute train wreck of urban black culture -- broken families, incarcerated parents, dangerous, crime-ridden neighborhoods. School districts can't solve this but they have devoted a lot of resources to it -- social workers, free meals, all kinds of social benefits to overcome the insurmountable problems when mom is on welfare or underemployed, dad is in jail or unknown, the neighborhood is a war zone, etc.

This well-intentioned but myopic attempt to solve the insoluble has led to schools losing their focus on kids generally, especially boys, as well as causing them to burn a lot of resources that could be better spent on programs that boys find engaging even though they might not contribute to the political issue of low test scores for black kids.

The last thing I'd add in is our culture's relentless, zero-slack atmosphere where everybody has to be plugged in all the time and there's no time for anything but work and more work. I hate it and I think it has a lot to do with why so many people, especially young people, are fucking snapping and going batshit with guns.

Combine it all together and you have parents terrified that their kid, performing poorly in 2nd or 3rd grade, needs to straighten out NOW or he won't go to college and will wind up poor and destitute.

It's a crazy conclusion but I tell you as a parent of an 8 year old who was in that same situation it absolutely flashes through your mind. My son was basically refusing to do assignments in class and when he did do them doing a very slapdash job, yet was scoring so high on standardized test we got a letter from the district that said he was in their "gifted" category! Of course we did everything we could (pediatric ADHD screening is an absolute joke, they don't even white-out that the screening questionnaire is made by the drug company) and went all out for a neuropsychiatric evaluation that basically said "Your son is really high IQ, school bores him and the tasks he does poorly on are really pretty poorly matched to 8 year old boys. He doesn't need ADHD meds." I'm glad we spent the money to basically learn the obvious because from a pediatrician perspective we could have easily been talked into meds, although even on the drug company ADHD screener we were iffy in terms of ADHD.