Ethical Human Psychology and Psychiatry, Volume 11, Number 1, 2009                      Attention Deficit Hyperactivity Dis...
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Attention Deficit Hyperactivity Disorder: Valid Medical Condition or Culturally Constructed Myth?


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Attention Deficit Hyperactivity Disorder: Valid Medical Condition or Culturally Constructed Myth?

  1. 1. Ethical Human Psychology and Psychiatry, Volume 11, Number 1, 2009 Attention Deficit Hyperactivity Disorder: Valid Medical Condition or Culturally Constructed Myth? J. M. Stolzer, PhD University of Nebraska–Kearney Over the last decade, Attention Deficit Hyperactivity Disorder (ADHD) diagnoses have increased dramatically in the United States. This unprecedented increase in ADHD across America has prompted scholars from various fields to question the scientific validity of this relatively recent childhood disorder. This article openly challenges the definition of ADHD as a legitimate medical condition and presents scientific evidence that corrobo- rates the risks associated with prescribing dangerous and addictive drugs in order to con- trol historically documented childhood behavior. According to published data, ADHD diagnoses have reached epidemic proportions in the United States—particularly among young males. Employing a multifaceted theoretical approach, ADHD typed behaviors will be defined not as a “neurobehavioral disorder,” but as highly adaptive strategies that have ensured the survival of hominid species across evolutionary time. Dissenting from the DSM’s medical definition of ADHD, this article provides scientific evidence that substan- tiates the economic and cultural factors that are associated with the ever increasing rates of ADHD diagnoses in America. Keywords: [Keywords here] [AuQ1] A ccording to the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV– TR), ADHD is defined as a “persistent pattern of inattention or hyperactivity— impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development” (American Psychiatric Association [APA], 2000, p. 85). Symptoms of ADHD must be present in two or more settings (e.g., at home and at school), and there must be verifiable evidence that the symp- toms associated with ADHD interfere with social or academic functioning (APA, 2000). Symptoms of ADHD include: careless mistakes in schoolwork, messy or incomplete assign- ments, failure to pay attention, failure to follow instructions, lack of organizational skills, lost or disorganized materials, and being easily distracted by extraneous stimuli (APA, 2000). According to the DSM–IV–TR, hyperactivity is confirmed by fidgetiness, squirming in one’s seat, or not remaining sedentary when instructed to do so. Symptoms of hyperac- tivity also include running, climbing, or refusing to play quietly. Children who are said to have ADHD often appear to be “on the go” or act as if they are “driven by a motor” (APA, 2000, p. 86). Fidgeting with objects, tapping hands or feet, talking excessively, and acting restless are also valid indicators of ADHD according to the DSM–IV–TR (APA, 2000). It is interesting to note that the DSM–IV–TR states unequivocally that it is highly —S unlikely children with ADHD will display the same level of dysfunction across contexts. —E —L © 2009 Springer Publishing Company 5 DOI: 10.1891/1559-4343.11.1.53072-167_02.indd 5 2/20/2009 3:51:41 PM
  2. 2. 6 Stolzer According to the DSM–IV–TR, ADHD typed behaviors worsen in environments that require sustained attention, sedentary activity, boring or mundane instruction, and monot- onous or repetitive assignments (APA, 2000). Most importantly, symptoms of this disorder typically cease to exist when: (a) the child is receiving frequent rewards for appropriate behavior, (b) is under close supervision, (c) is in a novel setting, (d) is engaged in interest- ing activities, or (e) is in a one-on-one situation with an adult (APA, 2000, pp. 86–87). Although ADHD is the most commonly diagnosed neurobehavioral disorder in Ameri- can children, many countries report little, if any ADHD among pediatric populations (Breggin, 2002). Historically speaking, ADHD in America is a relatively recent phenom- enon. In the 1950s, ADHD did not exist. During the 1970s, 2,000 American children (the vast majority were boys) were diagnosed as hyperactive and behavior modification techniques were the accepted method of treatment (Levine, 2004). Fast forward to 21st-century America, and ADHD diagnoses have skyrocketed as it is now estimated that 8–10 million American children have been formally diagnosed with ADHD and the vast majority of these children are prescribed daily doses of methylphenidate in order to con- trol undesirable behaviors (Baughman, 2006). While it is certain that ADHD is generally accepted by the majority of Americans as a valid neurological disorder, there exists no scientific evidence to substantiate this newly constructed hypothesis (Baughman, 2006; Furman, 2005). There are no neurologi- cal, metabolic, or attentional tests to confirm the existence of ADHD. Rather, formal diagnoses are based on the results of a standardized assessment questionnaire, and it has been suggested that the questionnaire is highly subjective and lacks scientific validity and reliability (Baughman, 2006; Carey, 2002). Scholars have postulated that one of the major flaws associated with current ADHD assessment procedures is that the status of the rater (e.g., the person who is responsible for filling out the questionnaire) is not controlled in any way. Tolerance level, understanding of normative developmental processes, gender, age, personality type, education, individual perception, and cultural background are all factors that influence rater perception, yet these critical variables are not taken into con- sideration during the diagnostic phase (Carey, 2002; Stolzer, 2007). According to the World Health Organization (WHO), diagnosing mental illness in child and adolescent populations is precarious at best as drawing boundaries between normal and abnormal child behavior is extremely difficult (Effrem, Hegg, Jackson, & Jacobs, 2005). Furthermore, the Surgeon General of the United States has stated cat- egorically that diagnosing mental disorders is problematic as there exists no definitive medical tests or abnormality within the brain that could indicate the existence of such disorders (Baughman, 2006; Effrem et al., 2005). Scientifically speaking, it is perplexing that Americans in general (including the American medical community) have accepted without question that ADHD is a verifiable neurological disorder when no neurological, metabolic, or any other biologic pathology can be confirmed (Baughman, 2006; Furman,[AuQ2] 2005). According to Jensen and Cooper (2002), “the assumption that ADHD symptoms arise from cerebral malfunction has not been supported even after extensive investiga- tions. The current diagnostic system ignores the contributory role of environment; the problem is supposedly all the child” (p. 3). How did Americans come to collectively accept the premise that ADHD is a verifiable medical condition when there is no scientific evidence to support this claim? In the fol- S— lowing sections, multifarious corollaries will be explored in depth in order to gain insight E— into the ADHD phenomenon as it exists in America today. L—3072-167_02.indd 6 2/20/2009 3:51:42 PM
  3. 3. Attention Deficit Hyperactivity Disorder 7 ECONOMIC COROLLARIES In 1975, legislation was enacted in America that allowed children with physical disabilities full access to the public education system. In 1991, this legislation was amended to include children with mental or learning disorders. Since the inception of the 1991 amendment, ADHD diagnoses have continued to increase at an alarming rate. Under the amended Americans with Disabilities Act, individual schools receive federal monies for each child that has been diagnosed with a behavioral or mental disorder (e.g., the more children who are diagnosed, the more money the school receives; Breeding, 2002; Stolzer, 2007). If one examines the Americans with Disabilities data, it becomes apparent that male children are disproportionately represented as U.S. Department of Education statistics reveal that 80% of public school students who have been diagnosed as behaviorally or emotionally disordered are male (Annual Report to Congress, 2003). The pharmaceutical industry also has a vested economic interest in promoting ADHD as a valid medical disorder as 99% of children who are diagnosed with ADHD are pre- scribed daily doses of pharmaceutical medication (Breggin, 2002). Relatively recently, the pharmaceutical industry has inundated the American consumer with a flood of advertising for ADHD medications. Parenting magazines, physician offices, television commercials, and radio advertisements all routinely carry messages about the necessity and effective- ness of psychotropic medications for children suffering with ADHD. This unprecedented deluge of advertising of ADHD medications has conned the American consumer into accepting not only the legitimacy of ADHD, but also of the medical necessity of prescrib- ing dangerous and addictive drugs to children and adolescents (Stolzer, 2005). Researchers from various fields have documented that an economic alliance exists between the medical community and pharmaceutical industry. Cosgrove and colleagues (2006) found that the majority of contributors to the Diagnostic and Statistical Manual have direct financial ties to the pharmaceutical industry. In addition, the pharmaceutical indus- try fallaciously refers to ADHD as a brain disorder although scientific evidence clearly refutes this claim (Baughman, 2006; Breggin, 2002). The pharmaceutical industry also rou- tinely funds major ADHD medical conferences; provides the majority of ADHD research funding; provides financial incentives for physicians who prescribe specific ADHD drugs; and funds groups such as CHADD (Children and Adults with Attention Deficit Disorder) who openly promote the use of psychotropic drugs in pediatric populations (Jureidini & Mansfield, 2001; Stolzer, 2005). While it is certain that an economic alliance exists between the medical community and the pharmaceutical industry, the public school system in America has also been implicated in this unethical financial alliance. In the following section, the public school system’s role in the ADHD epidemic in America will be explored in depth. EDUCATIONAL COROLLARIES Incredulous as it may seem, the vast majority of recommendations for ADHD diagnoses in pediatric populations comes directly from the United States’ public school system (Baugh- man, 2006; Breggin, 1999). Teachers and administrators routinely refer problem children for psychiatric evaluation as children who do not conform well to a sedentary learn- —S ing environment are suspected of being “neurobehaviorally impaired” (Phillips, 2006). —E —L3072-167_02.indd 7 2/20/2009 3:51:42 PM
  4. 4. 8 Stolzer Increasingly, disruptive behaviors are defined as pathological and are assumed to be the direct result of a chemical imbalance within the brain of the child. There is a scientific way to confirm the existence of a chemical imbalance, yet the public school system continues to perpetuate this scientific fallacy (Baughman, 2006). It is imperative that administrators, teachers, and school counselors are informed of the myriad of gender differences that exist in child and adolescent populations. At the present time, behaviorism, feminist theory, and standardized assessment classes monopo- lize teacher colleges across the United States, so it should come as no surprise that we find ourselves immersed in the “medicalization of boyhood” in the American education system. Behaviorism stresses that children are merely lumps of clay that can be molded at will. No consideration is given to gender differences, divergent neurological development, teacher–student fit, or esoteric mammalian behavior patterns. Feminist theory postulates that gender is, at its core, merely a social construct that can be recalibrated at will with the correct environmental influence. Assessment classes take the focus off of normative developmental stages, and instead focus on determining pathology through the use of standardized questionnaires. It should be noted that teachers and school administrators are not now, nor have they ever been, trained psychologists, psychiatrists, or neurologists, yet the vast majority of recommendations for psychiatric evaluation of our nation’s children continue to come from the public school system (Baughman, 2006; Stolzer, 2005). In the following sections, theories that are typically omitted from teacher college cur- riculum will be discussed at length. These include: bioevolutionary theory, innate gender differences, and divergent neurological and hormonal development. BIOEVOLUTIONARY THEORY Throughout human history, children and adolescents acquired cognitive acuity through active, hands-on experimentation. However, in the current day public school system, sed- entary learning has become the nucleus of academic instruction. This newly implemented “focused seat work” is clearly at odds with children’s bioevolutionary heritage and their natural tendencies to be active and explorative learners (Bjorklund & Pellegrini, 2002). Various scholars have suggested that the high incidence of ADHD in American culture may stem from the constraints and expectations of the public school system, and may be due in part to a lack of understanding of bioevolutionary development among teachers and administrators (Jensen et al., 1997; Stolzer, 2005). Across cultures, across mammals, and throughout evolutionary time, males have been documented to be more active, territorial, and aggressive than their female cohorts (Bjorklund & Pellegrini, 2002; Buss, 2004). This “art of maleness” was considered essen- tial to the survival of the hominid species, and was therefore, a highly prized trait through- out human history. After millions of years of honoring particular masculine traits, we are now immersed in a culture that eschews esoteric masculinity and has collectively pathol- ogized primordial male attributes—particularly in the American education system. As physicians, researchers, educators, parents, and concerned citizens, we must ask ourselves what the future will hold for millions of American boys who now conceptualize the self as “disordered.” Why do we continue to pathologize traits such as assertiveness, high activity S— level, and competitiveness, as most certainly, these are traits that will be useful in later E— developmental stages (McIntyre & Tong, 1998). L—3072-167_02.indd 8 2/20/2009 3:51:42 PM
  5. 5. Attention Deficit Hyperactivity Disorder 9 Clearly, the primal, bioevolutionary heritage of the human male is at odds with the cur- rent educational environment. Schools require stillness, docility, and protracted periods of silence. If a particular student can not, or will not adhere to these requirements, neurologi- cal atrophy is assumed to be the underlying cause. After referral from the school system for a supposed neurological abnormality, the majority of these children are officially labeled (and labels do not go away), and are prescribed daily doses of psychotropic drugs so that they can conform to the rules set forth by the American education system. While it is cer- tain that drugs such as methylphenidate (i.e., Ritalin) will reduce bioevolutionary derived behavior patterns, these types of drugs also reduce the desire to play and interact with oth- ers and have been documented to decrease neural and behavioral plasticity (Bjorklund & Pellegrini, 2002; Panksepp, 1998). Natural selection assumes that behaviors and cognitions are the result of selection pres- sures that occurred over the course of human evolution (Bjorklund & Pellegrini, 2002). According to this basic theoretical premise, males that exhibited the highest activity level would be more likely to survive in primordial environments, and thus, would be the genetic line that survived throughout evolutionary time (Jensen et al., 1997). According to evo- lutionary psychologists, ADHD is not to be conceptualized as “neurobehavioral dysfunc- tion,” but is more likely the result of millions of years of male adaptation (Bjorklund & Pellegrini, 2002; Jensen et al., 1997). Is it possible that the millions of American boys who have been labeled as ADHD are not chemically imbalanced but are in fact, displaying primal, evolutionarily induced hominid characteristics? The answer of course is a resounding yes, and it is time to demand that teacher colleges across the United States address this seminal theoretical postulate as it relates to male developmental trajectories. GENDER COROLLARIES For decades, it was assumed that the vast differences in male and female children and ado- lescents were the direct result of divergent socialization processes. However, ongoing data confirms that there exists significant and quantifiable differences with regard to male and female development. Throughout the various developmental stages, males and females across cultures follow divergent pathways. From gestation onward, males and females are distinct as illustrated in Table 1. In the current public school system, female development is held up as the gold standard, and boys who do not conform to this standard are systematically labeled and drugged (Stolzer, 2007). It is time to demand that gender diversity be honored throughout the American education system, and that historically documented male behavior patterns are once again accepted as a normative component of human development. The advent of high-tech brain imaging studies have confirmed that male and female brains are quantitatively different. While it is certain that outliers exist, data confirms that statistically significant gender differences can be detected with regard to neurological and hormonal development (Bear, Connors, & Paradiso, 1996; Kandel, Schwartz, & Jessel, 1995). Table 2 provides a summation of the scientific findings regarding brain gender dif- ferences. Why such differences exist in the human brain is open to discussion. What is clear at —S this time is that differences do exist, and these differences affect development trajectories —E —L3072-167_02.indd 9 2/20/2009 3:51:42 PM
  6. 6. 10 Stolzer[AuQ3] TABLE 1. Boys Girls Prebirth Develops testosterone Develops estrogen Immune to female hormones Immune to male hormones Fetus more active and restless Less active in womb Cortex develops slower at 6 weeks, colossal Cortex develops faster dose of male hormone that changes the brain permanently Greater idling in brainstem (reptilian brain) Greater idling in limbic system Infancy Prefers mechanical or structural toys Prefers soft, cuddly toys More pronounced large motor activity Play is more sanguine More easily angered More easily saddened Less bothered by loud noises Less tolerant of loud noises Toddlers Speaks later than girls Develops better vocabulary earlier than boys Less able to multitask Better able to multitask More physically impulsive Less physically impulsive Preschool and Kindergarten Occupies larger space on playground Congregates in smaller groups Play rough, vigorous, competitive, and aggressive Play quieter, less active, and more cooperative Games involve bodily contact, continuous action Games involve turn taking and indirect competition Use dolls for attack weapons and warfare Use dolls for playing out domestic scenes Express emotions through actions Express emotions with words Less attention span and empathy Great attention span and empathy Grades 1–3 Reading mastery later Reads better and sooner 95% of ADHD children 5% of ADHD children Grades 4–6 Primarily focused on action, exploration, Primarily focused on relationships and and things communication More likely to use aggression to resolve Unlikely to settle differences with aggression differences Primarily focused on action, exploration, Primarily focused on relationships and and things communication S— E— More likely to use aggression to resolve Unlikely to settle differences with aggression differences L—3072-167_02.indd 10 2/20/2009 3:51:42 PM
  7. 7. Attention Deficit Hyperactivity Disorder 11 TABLE 1. (Continued) Boys Girls Middle School Testosterone indisputably an aggression-inducing Estrogen generates greater activity in the chemical brain Amount of testosterone directly related to success Amount of estrogen directly related to success at traditional male tasks of traditional female tasks High School More likely to be involved in criminal behavior Less likely to be involved in criminal behavior Majority of males surveyed suggested “fighting” Majority of females surveyed suggested “talk- best way to resolve conflict ing things out” best way to resolve conflict Pursuit of power universal male trait Pursuit of comfortable environment universal female trait Note. From Boys and Girls Learn Differently: A Guide for Teachers and Parents (pp. 34–38), by M. Gurian, 2001, San Francisco: Jossey-Bass. Copyright 2001 by [Name of Copyright Holder]. Reprinted [or Adapted] with permission. [AuQ4] TABLE 2. Neurological / Hormonal Corollaries Part of Brain Function Gender Differences Basal Ganglia Controls movement Likely to engage more quickly in male Prefrontal lobe Associated with impulsivity Not fully developed in male until control 20–23 years of age Pituitary gland Secretes hormones Males fight or flight response more rapidly engaged Testosterone secretion Male sex hormone Increases aggression, competition, self- assertion, and self-reliance Thalamus Regulates emotional life and Data processed more quickly in physical safety females Amygdala Part of limbic system involved Larger in males; associated with in emotional processing aggression Estrogen secretion Female sex hormone Lowers aggression, competition, self- assertion, and self-reliance Note. From Boys and Girls Learn Differently: A Guide for Teachers and Parents (pp. 20–26), by M. Gurian, 2001, San Francisco: Jossey-Bass. Copyright 2001 by [Name of Copyright Holder]. Reprinted [or Adapted] with permission. [AuQ5] (Bear et al., 1996; Kandel et al., 1995). Evolutionary psychologists have hypothesized that brains differ by gender because of millions of years of adaptation. Throughout evolutionary history, males were required to be the hunter, the aggressor, and the protector if his genetic —S line was to survive (Bjorklund & Pellegrini, 2002; Gurian, 2001). Evolutionary biologists —E insist that gender is a biological construct and that theories supporting the notion that —L3072-167_02.indd 11 2/20/2009 3:51:42 PM
  8. 8. 12 Stolzer gender is simply the result of distinct socialization processes are perpetuating an outright scientific fallacy (Bjorklund & Pellegrini, 2002; Gurian, 2001; Moir & Jessel, 1990). We can no longer afford to assume that evolutionary based gender differences do not exist. Enough of feministic and behavioristic theories suggesting we can force males to follow female developmental patterns. We can not. Enough of drugging young males into a state of conformity, docility, and inactivity. Let us instead demand that scientific data be presented. Then, and only then, will we understand and appreciate divergent develop- mental processes. Decades of scientific data clearly demonstrates that males are more rebellious, are more likely to engage in conflict with authority, are more physically active than their female[AuQ6] cohorts, and are more likely to get into trouble at school (Bush Keller, 1994; McIntyre & Tong, 1998). It is common knowledge that the majority of public school teachers are female, and this fact has led researchers to hypothesize that teacher intolerance of evolu- tionary based male behavior may be contributing to the ever increasing referrals for ADHD diagnoses within the public school system (Bjorklund & Pellegrini, 2002; McIntyre & Tong, 1998). In the 1960s, Sexton asserted that American schools were beginning to feminize boys and this feminization was hypothesized to be in direct conflict with the development of positive manhood (1969). Combine the institutionalized feminization of maleness, the ever-increasing drugging of masculine attributes, the rise of the pharmaceutical industry, and the unwavering acceptance of mainstream psychiatry, and it is no surprise that the myth of ADHD has been unconditionally accepted by the American public (Stolzer, 2005). According to published research, 99% of children who are diagnosed with ADHD are prescribed psychostimulant drugs—the most common being methylphenidate (Baughman, 2006; Breggin, 1999). In the following section, the risks associated with methylphenidate use in pediatric populations will be discussed. RISKS ASSOCIATED WITH METHYLPHENIDATE Frequently, those who are invested in promoting the myth of ADHD will extol the effec- tiveness of methylphenidate use in pediatric populations. It is absolutely certain that methylphenidate decreases disruptive behaviors and increases compliance and sustained attention. What is rarely discussed is the multitude of risks that are associated with meth- ylphenidate use. It should be noted that the Food and Drug Administration (FDA) has classified methylphenidate as a Schedule II drug along with morphine, opium, and barbitu- rates as these classifications of drugs have been proven to be highly addictive and to cause a wide range of physiological atrophy (Baughman, 2006; Breggin, 2002; Furman, 2005). Methylphenidate has been documented to produce severe withdrawal symptoms, irri- tability, suicidal feelings, headaches, and Tourette’s Syndrome (Breggin, 1999; Novartis Pharmaceutical Corporation, 2006). This drug has also been associated with weight loss, disorientation, personality changes, apathy, social isolation, depression, insomnia, increased blood pressure, cardiac arrhythmia, tremors, weakened immune system, growth suppres- sion, agitation, fatigue, accelerated resting pulse rate, visual disturbances, drug dependency, S— anorexia, nervous disorders, aggression, liver dysfunction, heptic coma, angina, and toxic E— psychosis (Breggin, 1999; Novartis, 2006). L—3072-167_02.indd 12 2/20/2009 3:51:42 PM
  9. 9. Attention Deficit Hyperactivity Disorder 13 According to Novartis (2006), methylphenidate is a central nervous system (CNS) stimulant; however, the mode of therapeutic action is not known. Novartis (2006) states unequivocally that the specific etiology of ADHD is unknown, and that there is no diag- nostic test that can definitively confirm the existence of ADHD. Novartis concedes that the effectiveness of methylphenidate for long-term use (i.e., more than 2 weeks) has not been established in controlled trials, and has stated clearly that the safety of long-term use of methylphenidate in pediatric populations has not yet been determined (2006). The DSM–IV–TR (APA, 2000) states that the psychoactive effects of drugs such as methylphenidate “last longer than those of cocaine, and the peripheral sympathomimetic effects may be more potent” (p. 223). Psychostimulant drug use has also been associated with “panic disorders, generalized anxiety disorder, paranoid ideation, and psychotic epi- sodes that resemble schizophrenia” (APA, 2000, p. 225). In addition, withdrawal from psychostimulants can cause depressive symptoms that can resemble a major depressive episode (APA, 2000). It is indisputable that drugs such as methylphenidate are an effective tool in helping adults to control children’s evolutionary based response patterns as spontaneity, playful- ness, talking, socializing, and all types of physical activity are suppressed while children are under the influence of psychostimulant drugs (Breggin, 1999). However, it must also be acknowledged that these classifications of drugs are highly addictive and have been associated with “persistent brain dysfunction and potentially irreversible central nervous system damage” (Breggin, 1999, p. 29). CONCLUSION Careless mistakes in schoolwork, messy assignments, failure to pay attention, fidgetiness, squirming, and not sitting still are now accepted as valid indicators of a neurobehavioral brain disorder. Across cultures, across time, and across mammalian species, young, inexpe- rienced offspring were expected to be highly active, spontaneous, inattentive, nonconfor- mative, jubilant, restless, impetuous, and to run, jump, and irritate their elders. Truly, this was the hallmark of youth. Today, it is a multibillion dollar a year industry. Pharmaceutical companies, physicians, psychologists, and schools are profiting economically from norma- tive, historically documented behavior that has, over the last few decades, been redefined as pathological. Millions of American children are diagnosed with ADHD and are prescribed danger- ous and addictive drugs, all in spite of the fact that the DSM–IV–TR has stated empa- thetically that “there are no laboratory tests, neurological assessments, or attentional assessments that have been established as diagnostic in the clinical assessment of Atten- tion Deficit Hyperactivity Disorder” (2000, pp. 88–89). Millions of children diagnosed with a disease for which there exists no confirmatory evidence? This is the height of absurdity. After acknowledging that there is no valid way to confirm the existence of ADHD, the DSM then goes on to state how to eradicate ADHD. In order to cure the number one neurobehavioral disorder afflicting millions of American children, the fol- lowing steps must be implemented: (a) administer frequent rewards for the appropriate behavior; (b) keep the child under close supervision; (c) make sure the child is in a novel setting; (d) provide especially interesting activities; and (e) provide one-to-one —S situations (e.g., one-on-one interaction with an adult) (APA, 2000, pp. 86–87). Imagine —E —L3072-167_02.indd 13 2/20/2009 3:51:42 PM
  10. 10. 14 Stolzer medical textbooks stating that in order to completely eliminate childhood lymphoma, one must administer frequent rewards, keep the child under close supervision, provide novel and interesting activities, and provide an abundance of adult-child interaction. Of course, this is preposterous since no valid medical condition can be cured by altering relational processes. The DSM–IV–TR also appears to suggest that removing children from the current edu- cation system would alleviate the ADHD epidemic in America. With ever increasing student–teacher ratios, it would be impossible to implement the above mentioned strate- gies in the public school system, but most certainly, a competent, caring adult could pro- vide frequent rewards, close supervision, novel and stimulating activities, and one-on-one social interactions. Perhaps the answer to this unprecedented American epidemic is not pharmaceutical intervention, but a recalibration of our collective educational ideology. For those individuals who wish to concentrate on overhauling the current education sys- tem, perhaps they would be wise to follow the DSM–IV–TR’s recommendations and work unceasingly to prohibit sedentary activity, boring and mundane instruction, and monoto- nous and repetitive assignments (APA, 2000). Americans are famous for paying lip service to the adage “children are our future,” yet rarely are policies implemented that honor this ancient dictum. The time has come to demand that we will no longer tolerate the mass labeling and drugging of our nation’s children. No longer will we accept a premise that is based on pseudoscience. No longer will we tolerate the economic alliance that exists between the medical community, the pharmaceutical industry, and the American education system. Enough is enough. The time for action is now. REFERENCES American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author. Annual Report to Congress. (2003). The implementation of individuals with disabilities education act. Washington, DC: U.S. Department of Education. Baughman, F. (2006). The ADHD fraud: How psychiatry makes patients of normal children. Oxford, England: Trafford. Bear, M., Connors, B., & Paradiso, M. (1996). Neuroscience: Exploring the brain. Baltimore: Williams and Wilkins. Bjorklund, D., & Pellegrini, A. (2002). The origins of human nature. Washington DC: American Psychological Association. Breeding, J. (2002). True nature and great misunderstandings: How we care for our children according to our understanding. Austin, TX: Sunbelt, Eakin. Breggin, P. (1999). Psychostimulants in the treatment of children diagnosed with ADHD: Part I— Acute risks and psychological effects. Ethical Human Sciences and Services, 1, 13–34. Breggin, P. (1999). Psychostimulants in the treatment of children diagnosed with ADHD: Part II— Adverse effects on brain and behavior. Ethical Human Sciences and Services, 1(3), 213–231. Breggin, P. (2002). The Ritalin fact book. Cambridge, MA: Perseus Books. Buss, D. (2004). Evolutionary psychology: The new science of the mind. (2nd ed.). Boston: Allyn & Bacon. S— Carey, W. (2002). Is ADHD a valid disorder? In P. Jensen & J. Cooper (Eds.), Attention Deficit Hyper- E— activity Disorder: State of the science: Best practices. Kinston, NJ: Civic Research Institute. L—3072-167_02.indd 14 2/20/2009 3:51:42 PM
  11. 11. Attention Deficit Hyperactivity Disorder 15 Cosgrove, L., Krimsky, S., Vijayaraghavan, M., & Schneider, L. (2006). Financial ties between DSM-IV panel members and the pharmaceutical industry. Psychotherapy and Psychosomatics, 75(3), 154–160. Effrem, K., Hegg, D., Jackson, G., & Jacobs, B. (2005). The reauthorization of individuals with dis- abilities act: It’s impact on the diagnosis and treatment of children with mental and emotional disorders. International Center for the Study of Psychiatry and Psychology. Retrieved July 12, 2008, from Fogel, A. (2001). Infancy: Infant, family and society. Belmont, CA: Wadsworth Publishing. [AuQ7] Furman, L. (2005). What is attention deficit hyperactivity disorder (ADHD)? Journal of Child Neu- rology, 20(12), 994–1003. Gurian, M. (2001). Boys and girls learn differently: A guide for teachers and parents. San Francisco: Jossey-Bass. Jensen, P., Mrazek, D., Knapp, P., Steinber, L., Pfeffer, C., & Schowalter, J. (1997). Evolution and revolution in child psychiatry: ADHD as a disorder of adaptation. Journal of the American Acad- emy of Child and Adolescent Psychiatry, 36(12), 1672–1681. Jureidini, J., & Mansfield, P. (2001). Does drug promotion adversely influence doctor’s abilities to make the best decisions for patients. Australasian Psychiatry, 9(2), 95–99. Kandel, E., Schwartz, J., & Jessel, T. (1995). Essentials of neural science and behavior. Norwalk, CT: Appleton and Lange. Levine, B. (2004). Mental illness or rebellion: How biopsychiatry diverts us from examining a society toxic to well being. Paper presented at the International Center for the Study of Psychiatry and Psy- chology (ICSPP) Conference, New York. McIntyre, T., & Tong, V. (1998). Where the boys are: Do cross-gender misunderstandings of lan- guage use and behavior patterns contribute to the overrepresentation of males in programs for students with emotional and behavioral disorders? Education and Treatment of Children, 21(3), 321–332. Moir, A., & Jessel, D. (1990). Brain sex. New York: Dell. Novartis Pharmaceutical Corporation. (2006). Ritalin LA drug insert. East Hanover, NJ: Elan Hold- ings, Inc. Panksepp, J. (1998). Attention deficit hyperactivity disorders, psychostimulants, and intolerance of childhood playfulness: A tragedy in the making? Current Directions in Psychological Science, 7, 91–98. Phillips, C. (2006). Medicine goes to school: Teachers as sickness brokers for ADHD. Public Library of Science Medicine, 3(4), 1–9. Sexton, P. (1969). The feminized male: Classrooms, white collars, & the decline of manliness. New York: Random House. Stolzer, J. (2005). ADHD in America: A bioecological analysis. Ethical Human Psychology and Psy- chiatry, 7(1), 65–74. Stolzer, J. (2007). The ADHD epidemic in America. Ethical Human Psychology and Psychiatry, 9(2), 37–50. Correspondence regarding this article should be directed to J. M. Stolzer, PhD, University of Nebraska, Kearny. E-mail: [AuQ8] —S —E —L3072-167_02.indd 15 2/20/2009 3:51:42 PM
  12. 12. [AuQ1] Please provide four to six keywords. [AuQ2] Please provide a full reference entry for this in-text citation Jensen and Cooper (2002). [AuQ3] Please provide title for Table 1. [AuQ4] Please check copyright information for Table 1. Is the table reprinted or adapted from Gurian? Who hold the copyright? [AuQ5] Please check copyright information for Table 2. Is the table reprinted or adapted from Gurian? Who hold the copyright? [AuQ6] Please supply a full reference for this in-text citation of Bush Keller, 1994 or delete here. [AuQ7] Please insert an in-text citation for Fogel (2001) or delete here. [AuQ8] Please provide full mailing address for Stolzer.3072-167_02.indd 16 2/20/2009 3:51:42 PM