The ADHD Epidemic in America


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The ADHD Epidemic in America

  1. 1. Ethical Human Psychology and Psychiatry, Volume 9, Number 2, 2007 The ADHD Epidemic in America J. M. Stolzer, PhD University of Nebraska–Kearney Over the last decade, ADHD diagnoses have reached epidemic proportions in the United States. Behaviors that were once considered normal range are now currently defined as [AuQ1] pathological by those with a vested interest in promoting the widespread use of psycho- tropic drugs in child and adolescent populations. Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed “mental illness” in children in the United States today, and approximately 99% of children diagnosed as ADHD are prescribed daily doses of methylphenidate in order to control undesirable behaviors. This article openly challenges the scientific validity and reliability of current ADHD assessment tools and questions the ethics involved in prescribing dangerous and addictive drugs to children. In addition, particular attention will be given to familial, political, economical, biological, ethological, historical, and evolutionary correlates as they relate to the myth of ADHD in America. The goal of this article is to offer a theoretically sound alternative to the current medical model and to challenge the existing ADHD paradigm that pathologizes histori- cally documented, normal-range child behavioral patterns. Keywords: [AuQ2] O ver the last 10–15 years, attention deficit hyperactivity disorder (ADHD) diag- noses have reached epidemic proportions in the United States (Baughman, 2006; Breggin, 2002). In 1950s America, ADHD did not exist. In 1970, 2,000 American children (mostly boys) were diagnosed as “hyperactive,” and the standard method of treat- ment was behavior modification (Levine, 2004). By 2006, approximately 8–10 million American children (again, the majority are boys) had been diagnosed with ADHD, and the vast majority of these children have been treated with daily doses of methylphenidate (Bredding, 2002; Breggin, 2002; Levine, 2004). What was once an unheard of “psychiatric disorder” is now commonplace in America. Millions of American children are diagnosed with a mythical disease, and the vast majority of these children are prescribed danger- ous and addictive drugs in order to control normal-range, historically documented child behaviors. It is a fact that American children are disproportionately diagnosed with ADHD as data indicates that 80%–90% of all methylphenidate produced worldwide is prescribed for American children in order to control ADHD-type behaviors (Leo, 2000). Scientists investigating the recently constructed ADHD phenomenon must begin to question why ADHD is alarmingly prevalent in 21st-century America. Why has this disease not been recorded across time? Across cultures? Across mammalian species? Proponents of the dis- ease model of ADHD (a pseudohypothesis at best) are adamant in their assertion that ADHD is the result of a chemical imbalance within the brain in spite of the fact that there is no scientific evidence to substantiate this hypothesis. If indeed ADHD is a neurological © 2007 Springer Publishing Company 373072012_05.indd 37 06/28/2007 14:41:23
  2. 2. 38 Stolzer in nature, perhaps those in the scientific community should begin to ask what biological mechanism could possibly account for the startling alteration of the neurological system of the American boy in the course of 10–15 years (Levine, 2004). RISKS ASSOCIATED WITH METHYLPHENIDATE USE Although The National Institute of Mental Health (NIMH) has reported that methyl- phenidate can reduce classroom disturbance and increase compliance and sustained atten- tion, seldom are the ill effects of methylphenidate discussed publicly (Breggin, 1995). Methylphenidate is pharmacologically classified as an amphetamine and therefore causes the identical type of effects, side effects, and risks that are associated with amphetamine use (Breggin, 1995). The American Psychiatric Association has established that methyl- phenidate is neuropharmacologically similar to cocaine and amphetamines and that abuse patterns are strikingly similar for these types of drugs (Breggin, 1995). The U.S. Food and Drug Administration (FDA) has classified methylphenidate as a schedule II drug, along with amphetamines, morphine, opium, and barbiturates, as these classifications of drugs have been proven to be highly addictive and have been documented to cause a wide range of physiological dysfunction (Breggin, 1995). Methylphenidate has been found to produce severe withdrawal symptoms, irritability, suicidal feelings, headaches, and Tourette’s syndrome (Breggin, 1995; Novartis Pharma- ceuticals Corporation, 2006). Methylphenidate use is also correlated with weight loss, disorientation, personality changes, apathy, social isolation, and depression (Breggin & Cohen, 1999; Novartis Pharmaceuticals Corporation, 2006). While it has been scien- tifically established that methylphenidate can decrease activity level and other disrup- tive childhood behaviors (e.g., talking out of turn, spontaneous physical activity), it must also be acknowledged that this classification of drug can produce insomnia, increased blood pressure, cardiac arrhythmia, tremors, weakened immunity, and growth suppression (Breggin & Cohen, 1999; Novartis Pharmaceuticals Corporation, 2006). According to Novartis (the pharmaceutical company that manufactures methylpheni- date under the trade name Ritalin), Ritalin is a central nervous system stimulant; how- ever, the mode of therapeutic action in ADHD is not known (Novartis Pharmaceuticals Corporation, 2006). Novartis (2006) clearly states that the specific etiology of ADHD is unknown, and that there is no single diagnostic test that can definitively diagnose ADHD in human populations. Novartis (2006) acknowledges that the effectiveness of methyl- phenidate for long-term use (i.e., more than 2 weeks) has not been established in con- trolled trials, and has stated unequivocally that sufficient data on the safety of long-term use of methylphenidate in children are not yet available. According to Novartis, methylphenidate use has been associated with agitation, fatigue, accelerated resting pulse rate, visual disturbances, drug dependency, anorexia, nervousness, angina, tachycardia, immune system malfunction, aggression, liver dysfunc- tion, hepatic coma, and toxic psychosis (Breggin & Cohen, 1999; Novartis Pharmaceuti- cals Corporation, 2006). Perhaps the time has come to question why such dangerous and addictive drugs are used to control child behaviors that have just recently been classified as atypical. Furthermore, it could be argued that prescribing children schedule II drugs (the most potent and highly addictive classification of drugs, according to the U.S. Drug3072012_05.indd 38 06/28/2007 14:41:27
  3. 3. The ADHD Epidemic in America 39 Enforcement Agency) may not be the most beneficial treatment program for children in the long term, as medical data indicate that the developing brain is the most susceptible to chemical toxicity. Do Americans truly believe that the biochemistry of the developing male brain has been altered to such an extent that it requires dangerous and addictive drugs in order to function properly? If this is the case, what has caused this unprecedented neurological dysfunction? And why is this neurological dysfunction reaching epidemic proportions in young males who live within America’s borders? SUBJECTIVITY OF ADHD DIAGNOSIS Although many American medical professionals insist that ADHD is neurologically induced, the fact of the matter is that there are no physiological, cognitive, or meta- bolic markers that would indicate the presence of ADHD (Baughman, 2006; Breggin, 1995, 2001, 2002; DeGrandpre, 1999; Leo, 2000). Presumably, if ADHD is the result of a dysfunctional brain, neurologists would be diagnosing this hypothesized brain atrophy using state-of-the-art, high-tech brain imaging. This, however is not the case, as ADHD is diagnosed using a checklist of behaviors. Teachers and parents fill out questionnaires, and their answers are limited to the following: 1. Never 2. Rarely 3. Sometimes 4. Often 5. Always. Herein lies the first problem in the reliability and validity of the ADHD diagnosis. What exactly is the operational definition of “rarely”? of “sometimes”? of “often”? It could be argued that these limited answers are highly subjective and vary tremendously from one rater to the next. Until these terms are universally and quantitatively defined, the validity and reliability of the ADHD diagnosis must be scientifically repudiated. It is also worth noting that the status of the rater (i.e., the parent or the teacher) is not controlled for in any way. Tolerance level, personality type, knowledge of developmental processes, education, gender, age, and cultural background are variables that heavily influence adult perception, yet this fact is oftentimes ignored by those individuals invested in perpetuat- ing the disordered brain pseudohypothesis (Carey, 2002). The questions contained in the ADHD assessment questionnaire are also highly subjec- [AuQ3] tive, as indicated by the following: • “Often fidgets with hands or feet” (What is the operational definition of “fidgets”?) • “Often runs about or climbs excessively” (How do we know when running or climbing becomes “excessive”?) • “Often has difficulty playing quietly” (What culture expects that children play “quietly”?) • “Often fails to give close attention to details or makes mistakes in schoolwork” (Children are notorious for paying “close attention” to that which interests them.) These questions (and others) are currently used to determine if a child has a neuro- logical disorder (i.e., ADHD); however, under close scientific scrutiny, it appears that [AuQ4] these questions may in fact be measuring adults’ frustration with typical and historically documented child behaviors. According to Fred Baughman (2006), pediatric neurologist, “In the overwhelming majority of cases, the underlying issue is either a clash between a normal child and the requirements of his adult-controlled environment or the product of diagnostic zeal in a newly deputized teacher-turned-deputy brain diagnostician” (p. 215).3072012_05.indd 39 06/28/2007 14:41:28
  4. 4. 40 Stolzer [AuQ5] Breggin and DeGrandpre (DeGrandpre, 1999) have hypothesized that the perception of what constitutes normal-range boy behavior has been critically altered in 21st-century America. Developmentally speaking, there is a broad range of normal child behavior that oftentimes is at odds with adult-controlled environments—but this in and of itself does not define the behavior as pathological, just highly inconvenient for those adults who wish to maintain order according to adult-mandated scripts (Baughman, 2006). Accord- ing to the recently constructed ADHD criterion, a behavioral checklist can definitively identify neurological dysfunction. While it is absolutely certain that a checklist of behav- iors (a checklist that has changed much over the past decade) can not identify neurologi- cal atrophy, it is a distinct possibility that this checklist may be a valid way to identify boy-type behavior patterns that do not fit in with our modern-day expectations (behaviors that have, nonetheless, been documented in males across cultures, across time, and across mammalian species; Baughman, 2006; Stolzer, 2005). ECONOMIC CORRELATES In 1975, Americans enacted legislation that allowed children with physical disabilities access to public education. In 1991, this legislation was amended to include children with behavioral and/or learning disorders. Since the inception of the 1991 amendment, there has been a monumental rise in ADHD diagnoses in America as there clearly exists an economic incentive to label children and adolescents with a myriad of behavioral and/or psychiatric disorders (Bredding, 2002). Under the 1991 amendment to the Americans with Disabilities Act, individual public schools receive additional federal monies for each child that has been diagnosed with a behavioral and/or psychiatric disorder. Clearly stated, the more children who are diagnosed, the more money the individual school receives (Cohen, 2004). As a direct result of the 1991 amendment, ADHD rates vary considerably from school to school in the United States. Private schools do not receive federal mon- ies for educating “disordered” students; hence the rates of ADHD in private schools in America are extremely low. Conversely, public schools are eligible to receive federal funds and typically have much higher rates of ADHD diagnoses in their student populations (Cohen, 2004). The pharmaceutical industry has a vested economic interest in promoting the wide- spread acceptance of ADHD medications in America. Parenting magazines, television commercials, radio advertisements, doctor’s offices, and medical journals routinely adver- tise psychotropic drugs for pediatric populations. This unprecedented flood of advertising in America has desensitized the American consumer and has led to the unconditional acceptance of ADHD as a legitimate and verifiable neurological disease (Stolzer, 2005). The pharmaceutical industry has also done much to alleviate parental guilt in America as pharmaceutical representatives continue to insist that ADHD is neurological in nature and has nothing whatsoever to do with current parenting practices, economic incentives, school systems, national policies, specific environments, and/or particular cultural ideolo- gies (Stolzer, 2005). In America, there exists an indisputable economic alliance between the pharmaceuti- cal industry and the medical community. The pharmaceutical industry routinely promotes ADHD as a neurological disorder; is the chief funding source for major medical conferences3072012_05.indd 40 06/28/2007 14:41:28
  5. 5. The ADHD Epidemic in America 41 dealing with ADHD; monopolizes ADHD research funding; provides financial incentives for physicians who prescribe specific drugs; advertises psychotropic medications intended for use in pediatric populations in prestigious American medical journals; and provides major funding for American-based groups (e.g., CHADD) who openly promote ADHD as a neurobiological disorder (Breggin, 2001; Stolzer, 2005). The economic alliance that exists between the pharmaceutical industry and the medi- cal community in America must be severed. The American consumer should be the ben- eficiary of authentic and scientifically validated research—not the pawn of an economic partnership. Laws need to be implemented that prohibit an economic alliance between an industry whose main goal is monetary profit and the medical community, whose major goal is to benefit human existence while doing no harm. Presently, it appears that this economic partnership is thriving, and will continue to thrive unabated, until which time Americans demand that scientific research (i.e., research that is not funded by the phar- maceutical industry) guide conventional therapeutic practice. AN EVOLUTIONARY PERSPECTIVE Throughout human existence, males and females have followed divergent developmental trajectories. Young males across cultures, across historical time, and across mammalian species have displayed unique and distinguishable traits (e.g., accelerated activity levels, dominance posturing, protectiveness). According to Jensen and colleagues (Jensen et al., [AuQ6] 1997), the most active of the species would most likely be the genetic line that survived throughout evolutionary time, thus it should come as no surprise that males in the 21st century are extremely active—particularly in childhood and adolescence. At present time, proponents of the disordered brain hypothesis would have us believe that in the course of 10–15 years, the male brain has been neurologically altered—hence the skyrocketing rates of ADHD in young males across America. Evolutionarily speaking, this hypothesis is highly suspect, as adaptations in the hominid species typically require thousands, if not millions of years (Jensen et al., 1997). If ADHD-type behaviors cannot be attributed to evolutionary alterations in the neu- rological system, what then could account for the meteoric rise in ADHD diagnoses across America? Generally speaking, childhood itself has been greatly altered over the last few decades (DeGrandpre, 1999). For 99.9% of our time on earth, humans have lived as hunter-gatherers, and high activity levels were not only highly desirable, but were in fact crucial to the survival of the human species (Jensen et al., 1997; Stuart-Mcadam & [AuQ7] Dettwyler, 1995). Children today remain sedentary for hours on end as televisions, com- puters, and electronic games have replaced the unrestricted outdoor roaming of the past. They are immersed in artificial light, confined by four walls, and have virtually no contact with the earth or the sun—elements that sustained them throughout evolutionary time (Wilson, 1993). Compulsory schooling has restricted movement, creativity, outdoor activ- ity, and unstructured play. Children’s diets have been altered dramatically as preservatives, dyes, antibiotics, and hormones are routinely ingested. American children typically begin day care at 6 weeks of age, and from this time, remain in the care of uninvested, under- educated, and underpaid strangers for the majority of their formative years (Fogel, 2001; Stolzer, 2005).3072012_05.indd 41 06/28/2007 14:41:28
  6. 6. 42 Stolzer Since it has been scientifically documented that males across mammalian spe- cies, across cultures, and across historical time have displayed ADHD-type behavioral traits, perhaps it is America’s perception of boyhood that has been dramatically altered (Breggin, 2001; DeGrandpre, 1999). It has been hypothesized that he behavior of boys has remained relatively constant over evolutionary time; what appears to have changed is (a) Americans’ perception of those unique and historically valued evolutionary behaviors, and (b) Americans’ willingness to unconditionally accept the newly formed disordered brain hypothesis (DeGrandpre, 1999; Jensen et al., 1997; Stolzer, 2005). It is most likely that males evolved in an environment that required high levels of activity, hunting, and combativeness. Males that were the most active and most adept at protecting their families were the males who ensured the survival of the human species (Breggin, 1995; DeGrandpre, 1999). While some behavioristically inclined theoreticians have been adamant in their assertion that environment is the sole cause of male and female behavioral differences, the fact remains that uniquely male traits have been docu- mented across thousands of years, across diverse geographical locations, and across mam- malian species (Stolzer, 2005). Attention deficit hyperactivity disorder? Or normal-range boy behavior? In our modern- day quest for political correctness, it appears that the majority of Americans have confused the terms equality and sameness (Hoff Sommers, 2000). Males and females are absolutely equal in that they are members of the human race and should be accorded every opport- unity for societal advancement, but to insist that they are the same in aptitude, behavior, activity level, or predisposition is to perpetuate a myth that has no biological or scientific credibility (Moir & Jessel, 1990). As our ancestors have known since the beginning of time, boys really are different than girls. Of course, there are always the outliers, but fundamentally speaking, there exists wide variance in boy and girl behaviors, learning styles, activity levels, and general predilection (Breggin, 1995). It appears that Americans are intent on patholo- gizing boyhood, and will continue to insist that male-type behavioral patterns are the result of an atypical neurological system as long as there exists a financial incentive to do so. Proponents of the disordered brain hypothesis insist that ADHD is a verifiable dis- ease although there exists no scientific evidence to support this supposition (Baughman, 2006; Breggin, 1995, 2001, 2002; Breggin & Cohen, 1999; DeGrandpre, 1999; Leo, 2000). What the diagnosis of ADHD does is takes the blame away from parents, teachers, and specific cultural practices, and instead places the blame squarely on the shoulders of the child (Carey, 2002). The ADHD model does not take into account the complexities associated with growing up in modern-day America, nor does it address our unique and ancient bioevolutionary heritage. Rather, the newly constructed ADHD model promotes the widespread use of psychotropic drugs in order to control undesirable child behaviors. Maybe we should be asking why American boys are inattentive, overactive, unfocused, and so forth. Is ADHD the result of a disordered brain? Or is it a possibility that ADHD is the direct result of the disordered world Americans have created for themselves and for their children? It is a question worth pondering (Breggin, 2002). CONCLUSION Hypothetically speaking, it is a possibility that millions of American boys suffer from a neurological condition known as ADHD. Scientifically speaking, it is much more3072012_05.indd 42 06/28/2007 14:41:28
  7. 7. The ADHD Epidemic in America 43 rational to assume that ADHD-type behavior is evolutionarily adaptive, has been per- fected over millions of years, and has ensured the survival of the human species. Could it be that our modern-day cultural perception of boyhood is the driving force behind the high incidence of ADHD in America today? Perhaps Americans have come to a place where they actually prefer the chemically altered boy brain over the non-chemically altered brain as normal-range, historically documented boy behaviors are not compatible with the frenzied world Americans have created for themselves and for their children (Breggin, 2004). Lastly, let us not forget that ADHD in America is big business. Pharmaceutical compa- nies, physicians, and public schools all have a vested economic interest in promoting the ADHD phenomenon in America. Furthermore, parental guilt is assuaged by the notion that ADHD-type behavior has nothing whatsoever to do with familial, societal, politi- cal, evolutionary, or cultural attributes, as the problem, according to the pharmaceutical industry and the American medical community, stems from a dysfunctional neurologi- cal system. Apparently, it is much easier to drug American children than to collectively address the multifarious variables associated with particular child behaviors in modern-day America. The time has come to question both the reliability and the validity of the ADHD diagnosis and to demand that dangerous and addictive drugs are universally prohibited as a means to control undesirable childhood behaviors. Perhaps America could benefit by seeking guidance from countries such as Denmark, Sweden, and Norway—countries who rarely prescribe psychiatric drugs to children and whose national policies clearly reflect the motto “Children first” (Breggin, 1995). REFERENCES Baughman, F. (2006). The ADHD fraud; How psychiatry makes “patients” of normal children. Oxford, England. Trafford. Bredding, J. (2002). True nature and great misunderstandings on how we care for our children according to our understanding. Austin, TX: Sunbelt Eakin. Breggin, P. (1995). The hazards of treating “attention deficit hyperactivity disorder” with methyl- phenidate (Ritalin). The Journal of College Student Psychotherapy, 10(2), 55–72. Breggin, P. (2001). Talking back to Ritalin: What doctors aren’t telling you about stimulants for children (Rev. ed.). Cambridge, MA: Perseus Books. Breggin, P. (2002). The Ritalin fact book. Cambridge, MA: Perseus Books. Breggin, P. (2004). Keynote address at the International Center for the Study of Psychiatry and [AuQ8] Psychology, New York. [AuQ9] Breggin, P., & Cohen, D. (1999). Your drug may be your problem: How and why to stop taking psychiatric medications. Cambridge, MA: Perseus Books. Carey, W. (2002). ADHD consensus statement. [AuQ10] Cohen, D. (2004). Contesting ADHD: Dissenting views on psychiatric diagnosis and treatment of chil- dren. Paper presented at the University of Nebraska–Kearney. [AuQ11] DeGrandpre, R. (1999). Ritalin nation. New York: Norton. Fogel, A. (2001). Infancy: Infant, family, and society. Belmont, CA: Wadsworth. Hoff Sommers, C. (2000). The war against boys: How misguided feminism is harming our young men. New York: Touchstone. Jensen, P. S., Mrazek, D., Knapp, P. K., Steinber, L., Pfeffer, C., & Schowalter, J. (1997). Evolution and revolution in child psychiatry: ADHD as a disorder of adaptation. Journal of the American Academy of Child and Adolescent Psychiatry, 36(12), 1572–1679.3072012_05.indd 43 06/28/2007 14:41:28
  8. 8. 44 Stolzer Leo, J. (2000). Attention deficit disorder: Good science or good marketing? Skeptic, 8(1), 29–37. [AuQ12] 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. Moir, A., & Jessel, D. (1990). Brain sex. New York: Dell. Novartis Pharmaceuticals Corporation. (2006). Ritalin LA drug insert. East Hanover, NJ: Elan Hold- ings, Inc. Stolzer, J. (2005). ADHD in America: A bioecological analysis. Ethical Human Psychology and Psychiatry, 7(1), 65–75. Stuart-Macadam, P., & Dettwyler, K. (1995). Breastfeeding: Biocultural perspectives. New York: Aldine DeGruyter. [AuQ13] Wilson, E. D. (1993). Biophilia and the conservation ethic. In S. R. Kellert & E. O. Wilson (Eds.), The biophilia hypothesis. Washington, DC: Island Press/Shearwater. Correspondence regarding this article should be directed to J. M. Stolzer, PhD, University of [AuQ14] Nebraska–Kearney, Otto Olsen 205 D, Kearney, NE 68845–2130. E-mail: stolzerjm@unk.edu3072012_05.indd 44 06/28/2007 14:41:28
  9. 9. [AuQ1] It seems that the meaning of normal range is clearly understood in this context without the need for quotation marks. OK? This has been done elsewhere below as well. If special emphasis is required, please use italics. [AuQ2] Please supply 4 to 6 keywords. [AuQ3] From which source are the following bullet points taken? Should there be a text citation and corresponding reference list entry present? [AuQ4] “(i.e., ADHD)”: Is i.e. intended here, or should e.g. be used? That is, or for example? [AuQ5] Specify a particular Breggin source year (or multiple) in parentheses following his name, then list only (1999) after DeGrandpre, as both authors have already been introduced, and it seems lopsided to give a text citation for only one. [AuQ6] In the parenthetical “accelerated activity levels, dominance posturing, protec- tiveness,” it seemed that the preceding abbreviation should be “e.g.” to indicate “for example” rather than “i.e.” (“that is”). OK? [AuQ7] Name is spelled “Stuart-Macadam” in the reference list but “Stuart-Mcadam” here. Please reconcile. [AuQ8] In Breggin’s 2004 entry, please follow the year 2004 with a month, placing a comma between, to indicate more precisely the date of the address. [AuQ9] Breggin (2004): Did the keynote address have a title? If so, please place in italics before “Keynote address at the . . .” Also, was this at a particular conference or meeting of an organization? Please list specifics after “Keynote address at the.” [AuQ10] Carey (2002): This reference entry does not provide enough information for the reader as is. Please indicate whether it was a published or unpublished source and format according to APA. [AuQ11] Was Cohen’s paper presented for a conference or meeting or symposium? If so, indicate that event name after “Paper presented at,” then follow the event name with a comma and the name of the school as is. [AuQ12] In Levine’s entry, please follow the year 2004 with a month, placing a comma between, to indicate more precisely the date of the conference. [AuQ13] Wilson (1993): Is the editor (E.O. Wilson) a different Wilson from the author of the chapter cited in this entry? (Here, initials are E. O., there, E. D.). Please verify. [AuQ14] Correspondence information: Please place a department name (e.g., “Depart- ment of Psychology”) before the street address if applicable.3072012_05.indd 45 06/28/2007 14:41:29