ADHD: Classroom Crutch?
Increased demand has caused national shortages of Attention Deficit Hyperactivity Disorder (ADHD) drugs. According to MedMD.com, “One reason for the shortage is extremely high demand for the drugs. While people with ADHD make up nearly all of the legitimate market, there’s a huge demand for off-label and illicit use of stimulant drugs. Many companies say they simply can’t keep up with this demand.”
A recent New York Times article addressed the increasing rate of Attention Deficit Hyperactivity Disorder diagnoses among American children. The author doubts biological or environmental causes account for the increase and instead focuses on sociological factors, including “changes in the way we school our children, in the way we interact with doctors, and in what we expect from our kids.” The unintended consequences of federal laws passed to help individuals may also bear partial responsibility for increased diagnoses. (10-15-13)
According to surveys of parents, 11% of U.S. school-aged children (about 6.4 million children) had been diagnosed with ADHD by a health care provider by 2011. The average age of ADHD diagnosis is seven years old and 6.1% of American children across all age groups were taking ADHD medication in 2011. (CDC.gov).
While the Times author does not doubt that ADHD is an actual disorder, she states that the “epidemic” began once diagnosis was “incentivized.” In 1991, the Individuals With Disabilities Education Act included ADHD, giving students with an ADHD diagnosis not just medication, but “access to tutors and extra time on standardized tests.” In 1997, the Food and Drug Administration began allowing pharmaceuticals to be directly marketed to the public. For the first time parents were hearing directly from drug companies offering to help their children.
The No Child Left Behind Act (NCLB) may have also contributed to increased diagnoses. Psychology professor Stephen Hinshaw at the University of California, Berkeley found that in 2007 15.6% of children in North Carolina had ADHD diagnoses, while California’s rate was only 6.2%. He found no differences in the two states “between diagnostic tools, types of health insurance, cultural values, and public perceptions of mental illness.” He did find that North Carolina was among the first states to “punish or reward” schools for standardized-test results under NCLB, while California was one of the last. Dr. Hinshaw found a correlative link that held nationwide: “ADHD diagnosis increased by 22% in the first four years after NCLB was implemented.”
The New York Times author says, “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.” She adds that test scores of children with ADHD are even removed from testing results in some school districts. (10-15-13)
So, parents ask doctors for the amazing medicine they have seen advertised, doctors take an attitude of “let’s see if it helps,” teachers get quieter classrooms, school districts receive more funding, and it’s a win all around. Except for the child who is drugged into submission. Many more males than females are said to suffer from ADHD. According to the Centers for Disease Control, “boys (13.2%) were more likely than girls (5.6%) to ever be diagnosed with ADHD.” (CDC.gov, 5-16-13) Some say that parents and teachers are unable to deal with the natural activity level of young boys and wish they would act more compliant, or more like girls.
More evidence of American overdiagnosis comes from abroad. According to the New York Times article, “In 2003, when nearly 8% of American kids had been given a diagnosis of ADHD, only about 2% of children in Britain had.”
More surprising still is the low rate of ADHD diagnosis in France. According to an article in Psychology Today, which also links French parenting to lower levels of ADHD amongst French children, less than 0.5% of French children were diagnosed and medicated for ADHD in 2012. French families and physicians are more likely to ascribe behavioral symptoms to social problems and to avoid potential nutritional causes like food dyes, and are generally much less likely to prescribe medication to treat behavioral issues. American parents, physicians, and schools are more likely to attribute rowdy or unacceptable behavior to a biological-neurological disorder, and to attempt to treat the behavior with medicines like Ritalin and Adderall. (Psychology Today, 3-8-12)
For every 2,000 children, France reports just one case of ADHD, while America reports a minimum of 100 children, using the American Psychiatric Association rate of 5%, which is the lowest estimate available from the Centers for Disease Control. (CDC.gov, 11-13-13)
Classroom management, ADHD diagnoses, the mishandling of the exuberance of boys, and misuse of ADHD medications are complex issues that deserve further study and attention from parents and the education community.