ADHD on the Rise: Real, or Just Really Good Business?
ADHD, once a disorder affecting less than 5% of children, has had a skyrocketing rate of diagnosis over the last decade. This has led some to speculate whether this is due to more accurate detection methods, more rigid learning environments focusing solely on the test, or, considering spending on medication for the disorder can run upward of $260 billion a year, just really good for business.
According to the Center for Disease Control and Prevention (CDC), there has been a substantial rise in the number of children, especially high school students, smacked with ADHD label. Nearly 11 percent of kids, with boys getting diagnosed more often than girls (1 out of 11 girls vs. 1 out of 5 boys), are now diagnosed with this disorder, and 66% of these kids are currently taking some sort of ADHD medication.
Many are questioning why the numbers are climbing. Are kids receiving the proper diagnosis, with thorough medical and psychological evaluations, as opposed to a quick visit to a pediatrician? Are there other biological or environmental factors at play? What about the medications themselves? Are they really benefitting the children who take them, or are they being used by schools to maintain control in an ever increasingly restrictive atmosphere, or by parents who just can’t control their child? Are the medications even safe?
The answer may not lie in any one factor.
The History of ADHD
While ADHD as an actual disorder has only been recognized since 1987 (with its predecessor, ADD, added to the Diagnostic and Statistical Manual of Mental Disorders, or DSM, in 1980), there have been many reports throughout history of the disruptive and disorderly child; however, treatments for such children didn’t involve medication. Instead, the child often found himself whipped or sat in the corner with the dunce hat atop his head. This line of thinking changed in the early 1900s when the symptoms commonly associated with ADHD, such as distractibility and restlessness, were connected to another known disease – encephalitis. In 1937, Dr. Charles Bradley introduced the use of a stimulant, Benzadrine, to counteract hyperactivity. He didn’t know why it worked; just that it did. This discovery laid the groundwork for the medications and treatments most commonly used today.
In the 1950s, the disorder referred to as “hyperkinetic syndrome”, and by 1968, the “hyperkinetic reaction of childhood”, took on a new perspective. It was during the 60s and 70s that doctors and scientists began to realize that what is now known as ADHD was not due to bad upbringing, but instead was a biological and often genetic discordance in the neurological functions of the brain. However, while recognized, the diagnosis wasn’t nearly as common then as it is now; even by the mid 1990s, only 4-5% of children had been diagnosed with ADHD.
ADHD and Schools
While there is no definitive proof, there appears to be some correlation between the increase of ADHD diagnoses and the implementation of No Child Left Behind in 2002. One of the biggest complaints with NCLB was that it forced a standardization of the teaching method, thereby leaving children with different learning styles, both on the high-end and low-end of the learning spectrum, feeling lost. Not only that, but children who are exceptionally bright, and who use to find an outlet in the now almost nonexistent talented and gifted programs, can often find themselves distracted, discouraged, and downright bored, and bored children tend to be disruptive children. Now with the implementation of CORE standards, who some describe as NCLB on steroids, there is a chance the ADHD numbers may climb even more.
Another study, published by the Child Mind Institute, states there might be another incentive behind the rise, and that is the financial benefit to schools. Many schools, especially those where the tax base is much poorer, such as southern states like Mississippi and Kentucky, rely heavily on federal funding to operate. Long before NCLB was enacted, many of these districts had already enacted “consequential accountability statutes”, which penalized a school when children failed; however, often scores for children diagnosed with ADHD are not counted, the child is given extended time for testing, or the child is segregated, thereby helping to ensure the passing test scores of the class as a whole. Geographically speaking, children in the South are diagnosed far more often with ADHD than children living in Western states by a rate of nearly 63%. North Carolina, one of the first states to implement consequential accountability statutes, stands at a ADHD diagnosis rate of over 16%; California, one of the last states to implement these policies, ranks at only 6.2%. The difference is staggering.
ADHD and Business
ADHD has been recognized as a disorder for a long time, but in 1991 and 1997, two big changes took place which pushed ADHD to the front and center of American society. The first was when ADHD was listed not just as a disorder, but actually incorporated under the Americans with Disabilities Act; this gave those diagnosed with ADHD certain protections in both a societal and learning environment.
Then In 1997, The Food and Drug Administration revamped its policies, and for the first time, drug companies were allowed to market directly to consumers. Now the average person could find out about medications once only known about by doctors, and ADHD medications were no exception. Once parents and teachers became more aware of the pharmaceuticals available to control the out of control child, it opened the door for an increase in ADHD diagnoses. Pharmaceutical companies were right there to offer incentives to doctors who prescribed their medications. The change in FDA policy made ADHD really good for business.
As with anything, there is an upside and a downside, and the question is whether the downside is actually a downslide. An ADHD diagnosis does allow for things like more individualized learning environments, access to tutors and access to sociological and psychological help, as well as medications to control the behavior and help the child focus.
However, those medications can carry serious risks.
ADHD medications fall into the stimulant and non-stimulant categories. Stimulants, such as Ritalin, can cause mood swings, appetite loss, and even addiction, and there are reports that some kids may not need the drugs, but still take them to improve school performance. The stimulants also can disrupt a child’s sleep pattern, thereby requiring additional medication to help the child rest. Non-stimulants, such as Strattera, can give the patient one nasty and persistent bellyache. In some cases, the side effects are enough to cause a person to stop the treatment, especially when the cure is far worse than the cause.
But ADHD medications are a big, big business, and it is to the benefit of the pharmaceutical companies to get the drugs out there. As the maker of the drug profits, though, the family often loses, and not just in the cost of the medications, which can add up to over $1,570 per person annually, but because the loss of productivity for that family can bring that total to over $3,700 in losses. The cost also comes to tax payers in the form of Medicaid – 14% of Medicaid eligible children are diagnosed with ADHD, which is nearly 1/3 higher than the rest of the population. In Georgia alone, the cost for ADHD care averages $30 million a year. It is also interesting to note that America is, by far, the largest consumer of ADHD medications.
The biggest cost, though, may be to the children themselves; both those who are misdiagnosed, and those who truly suffer from ADHD. As the increase of diagnoses occur, so does the increase in skepticism, leaving many to consider ADHD the “disease of the moment”, thereby creating a stigma that can delay or prevent a child truly in need of help from getting the proper care. Some may be overly anxious to drag a child to the doctor for some meds that aren’t needed, while others may be hesitant to accept a diagnosis of ADHD. Either way, children are the ones accepting the consequences of adult decisions on their lives. This is why many experts are questioning whether the rise in ADHD is real, or just really good for business.
By Heather Pilkinton