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The Not-So-Hidden Cause Behind the A.D.H.D. Epidemic -

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Between the fall of 2011 and the spring of 2012, people across the United States suddenly found themselves unable to get their hands on A.D.H.D. medication. Low-dose generics were particularly in short supply. There were several factors contributing to the shortage, but the main cause was that supply was suddenly being outpaced by demand.

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The number of diagnoses of Attention Deficit Hyperactivity Disorder has ballooned over the past few decades. Before the early 1990s, fewer than 5 percent of school-age kids were thought to have A.D.H.D. Earlier this year, data from the Centers for Disease Control and Prevention showed that 11 percent of children ages 4 to 17 had at some point received the diagnosis — and that doesn’t even include first-time diagnoses in adults. (Full disclosure: I’m one of them.)

That amounts to millions of extra people receiving regular doses of stimulant drugs to keep neurological symptoms in check. For a lot of us, the diagnosis and subsequent treatments — both behavioral and pharmaceutical — have proved helpful. But still: Where did we all come from? Were that many Americans always pathologically hyperactive and unable to focus, and only now are getting the treatment they need?

Probably not. Of the 6.4 million kids who have been given diagnoses of A.D.H.D., a large percentage are unlikely to have any kind of physiological difference that would make them more distractible than the average non-A.D.H.D. kid. It’s also doubtful that biological or environmental changes are making physiological differences more prevalent. Instead, the rapid increase in people with A.D.H.D. probably has more to do with sociological factors — changes in the way we school our children, in the way we interact with doctors and in what we expect from our kids.

Which is not to say that A.D.H.D. is a made-up disorder. In fact, there’s compelling evidence that it has a strong genetic basis. Scientists often study twins to examine whether certain behaviors and traits are inborn. They do this by comparing identical twins (who share almost 100 percent of the same genes) with fraternal twins (who share about half their genes). If a disorder has a genetic basis, then identical twins will be more likely to share it than fraternal twins. In 2010, researchers at Michigan State University analyzed 22 different studies of twins and found that the traits of hyperactivity and inattentiveness were highly inheritable. Numerous brain-imaging studies have also shown distinct differences between the brains of people given diagnoses of A.D.H.D. and those not — including evidence that some with A.D.H.D. may have fewer receptors in certain regions for the chemical messenger dopamine, which would impair the brain’s ability to function in top form.

None of that research yet translates into an objective diagnostic approach, however. Before I received my diagnosis, I spent multiple sessions with a psychiatrist who interviewed me and my husband, took a health history from my doctor and administered several intelligence tests. That’s not the norm, though, and not only because I was given my diagnosis as an adult. Most children are given the diagnosis on the basis of a short visit with their pediatrician. In fact, the diagnosis can be as simple as prescribing Ritalin to a child and telling the parents to see if it helps improve their school performance.

That last sentence is chilling.

My views on ADHD are shaped by Ken Robinson.

First off, Sir Ken is amazing. I would like to shake his hand someday. He is truly inspirational. This is all true, every last bit of this. And there are more out there--seems everyone has some sort of book, blog, or manifesto...some opinion of how public education isn't where it needs to be, myself included... but Sir Ken is my favorite of all. 

But education policy creating an environment for lots of ADHD diagnoses?!

That one is new to me!

I like to file that under #unintendedconsequences. In the same way as high stakes teacher evals lead to gaming of #'s like Soviet Five Year Plans. Now, a prudent person looks at that and says, "Oh, my bad," and changes course, like you would in your business. That, I'd respect, but staying the course despite the potholes...not so much. 

Yeah, doesn't that violate the number one rule of learning, which is to take new information into account when making future decisions?

Holy carp, Jared, you left out the punchline: Educational Policy directly correlates with more ADHD diagnoses!

Hinshaw, as well as sociologists like Rafalovich and Peter Conrad of Brandeis University, argues that such numbers are evidence of sociological influences on the rise in A.D.H.D. diagnoses. In trying to narrow down what those influences might be, Hinshaw evaluated differences between diagnostic tools, types of health insurance, cultural values and public perceptions of mental illness. Nothing seemed to explain the difference — until he looked at educational policies.

The No Child Left Behind Act, signed into law by President George W. Bush, was the first federal effort to link school financing to standardized-test performance. But various states had been slowly rolling out similar policies for the last three decades. North Carolina was one of the first to adopt such a program; California was one of the last. The correlations between the implementation of these laws and the rates of A.D.H.D. diagnosis matched on a regional scale as well. When Hinshaw compared the rollout of these school policies with incidences of A.D.H.D., he found that when a state passed laws punishing or rewarding schools for their standardized-test scores, A.D.H.D. diagnoses in that state would increase not long afterward. Nationwide, the rates of A.D.H.D. diagnosis increased by 22 percent in the first four years after No Child Left Behind was implemented.

To be clear: Those are correlations, not causal links. But A.D.H.D., education policies, disability protections and advertising freedoms all appear to wink suggestively at one another. From parents’ and teachers’ perspectives, the diagnosis is considered a success if the medication improves kids’ ability to perform on tests and calms them down enough so that they’re not a distraction to others. (In some school districts, an A.D.H.D. diagnosis also results in that child’s test score being removed from the school’s official average.) Writ large, Hinshaw says, these incentives conspire to boost the diagnosis of the disorder, regardless of its biological prevalence.

Much as I hate to blame George W Bush, I blame George W Bush.

That's funny.  No child left behind was a leftist, school teacher's union project that was co-opted by Bush. If you hate NCLB, then common core would be worse by 10x. 

I enjoyed this Slate article on Common Core "Conservatives hate anything with the word 'national' in it, and liberals hate anything with the word 'test.'"

The standards themselves are reasonable, it is the tests (note: I'm fairly moderate) and high-stakes everything that is difficult for me. All the setting and measuring goals, standardizing goals to measure whether chosen standards have been met, and analyzing data. Then, we have high-stakes grad tests to boot. Sometimes, I take a break from my regularly scheduled testing, assessing, and data collection to...teach... 

Without tests how do we measure effectiveness?

RE ADHD: I tell students I am fairly convinced I'd have had ADHD if it'd been invented in my day...In my day they called it, "Shut up and work." Many times these students are simply different thinkers, and they're in the middle of a system that's increasingly standardizing. ADHD meds help active students behave. School bores them. Parents are not sure what to do with active kids who are defined by test scores. Also, sadly, I have encountered parents who get students diagnosed because Ritalin is their own coveted drug of choice--it has street value, too.  Sometimes there's an incentive to seek a diagnosis in order to get SSI for students. There is a huge med fraud problem in this area nationwide. 

As a teacher, it's getting more and more difficult to individualize instruction and engage kids in the face of so many standardized tests and high-stakes teacher evals. So, students can get bored. "All we do is test." 

I like to look at the way students learn. The world uses technology, yet most schools tell students to put away their devices and open an old book. I taught civics last year, and the Supreme Court justices in the book we had--were dead. I don't use books, and we don't have a progressive tech infrastructure or policy in my school, so I nixed the books and use WP blog I set up for school, Learnist and some Twitter, and lately I have them clipping things into Evernote. 

Students respond through quick snippets--it's how society runs. It's how TV shows are written. It's how we operate in a six-window open society. I know the research tells us multitasking is bad, but everyone does it. We have to reach and engage students by teaching in a way they understand. Sitting in rows doesn't cut it. Copying notes from the board and memorizing things they can Google doesn't cut it. Using century-old pedagogy doesn't help any student, let alone ADHD kids. 

And yes, there is an increase in diagnosis. I joke about this. I tell students it's no excuse. We've all got it, probably. Being a different thinker is actually a blessing. We all learn differently, and should be taught differently.  Unfortunately, the system often disagrees with me in regards to standardization and testing. Which is why I'll probably have a shameless link to my LinkedIn in due time. 

Interestingly, there is a direct correlation between successful entrepreneurs and ADHD. Tons of stuff out there about this. 

So ADHD might be a good thing?

some kids are obviously problem children...but are they problems because of nature? nurture? environment? how could we possibly experiment this out? (take a trouble kid away from undisciplined parent? haha) 

the definition of a good kid change with generations, so why not put more focus on our adult behavior and cultural decisions rather than blame kids?  


That is a very good set of questions.

haha...but I want answers...  =p

Jared, if you're talking about education there are no answers, only bells and rows:)  Adam, I don't think ADHD is a bad thing, certainly overdiagnosed in my non-medical opinion, but different thinking is a gift. Here are a couple articles:  and  

The first one tells how ADHD can be an advantage for its creativity. The Second "Why Some Entrepreneurs Call ADHD a Superpower," is very good. Schools need to embrace different thinkers rather than pressuring to medicate more than necessary. 

Doesn't that require more time than teachers have?

Yes, but so does all the red tape...I've spent hours and hours on the data I need to be evaluated for this year over the last month. Spreadsheets, talking to my evaluator, emails redos. If I'm going to have to do things that require more time than I have, it should be for students not data. 

Individualizing isn't trouble for me--I think in many directions at once (probably ADHD) It's a matter of building relationships. I might say, "So, you didn't like that assignment. You bombed. Here's what I'm trying to teach--the skill you need. What could you do to show me that?...Do it." Harder to do because ed's standardizing things.  The solution to all of education is relationships--really knowing the students, especially for students with strong interests or special needs. Sometimes kids have to do things they don't like (#realworldsucks) but other times I can customize. I have to sell the reasons. Ed doesn't recognize that students=customers. No different. My product=success, learning, maybe even content.

ADHD kids often get mistaken for school haters. 90% of the time they'll tell you that. If I rephrase the question, "If I could make school about one thing you love, but you'd still have to come 7 hours a day, what would it be?" I prove I can connect that interest to literacy/literature/writing, science, math, etc... Their one interest could, in fact, be an entire school. Those are the kids who'd hyperfocus and innovate.

I'm doing #geniushour where they get to design a long-term project on Fridays--provided it ties in w the class subject. "What breaks your heart--what would you solve if you could?" I was going to make them be experts in something, then I saw rockstar teacher/author Angela Maiers at the Business Innovation Factory conference (#BIF9). She took that question and made students iterate. That tweak made all the difference. Her organization Choose2Matter does just this type of thing. 

Jared wanted solutions: Engage students and the ones who are just bored will stop showing what we define as symptoms of ADHD. To truly engage, we have to take the excess of standardization away. I don't think we're committed to doing that as a nation. We want to measure. We want our data. We want to beat Finland. 

I like what you said. Has any school experimented with making it so?

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