Since 1990, the number of American children on medication for ADHD has risen precipitously (from 600,000 to 3.5 million) (Schwarz, 2013). Dr. Keith Connors, one of the early advocates of the legitimacy of the diagnosis, recently expressed grave concerns about current rates of diagnosis, calling the epidemic numbers “a national disaster of dangerous proportions" (Schwarz, 2013).
An article which appeared this week in the New York Times, focuses on the drug companies’ role in perpetuating the diagnosis and, essentially, in fabricating new cases through suggestion, manipulation, and (more to my interest) the implication that normal behavior is abnormal (Schwarz, 2013).
Stimulant advertisers lump carelessness, impatience, and the unwillingness to take out the trash with other ADHD “symptoms.” But even diagnostic criteria used by doctors include all kinds of normal child behavior that falls into the category. Symptoms include not listening when directly spoken to, disliking or avoiding homework, losing things, talking a lot, having trouble waiting for a turn, and fidgeting (DSM-V, 2013). These symptoms alone describe, well, every young child I’ve ever met.
There’s a real problem with overdiagnosis and overmedication, clearly. For one, there’s no way to get a medically accurate diagnosis, no identifiable biomedical markers of the condition. For another, we don’t have adequate data on the effects of these drugs on developing brains in the long-term. And, overdiagnosis threatens to delegitimize the experience of people who are really suffering and are really helped by medication.
But even beyond these problems, our very ideas about our children and ourselves are threatened.
We’ve come to expect that even young kids will be able to sit still for long periods of time, focusing single mindedly and tuning out distractions. We expect them to listen and be organized. We expect them to tread perfectly the line between “active” and “hyperactive” (though we’ve lost track of where that line even is). We expect the same things from ourselves, which is why it’s particularly traumatic when certain phases of our lives strain our concentration. Stress, for example, is known to eat up our concentrating resources, as are major life events, hormonal changes, lack of sleep. When my first child was born, I was easily diagnosable. I could barely have an adult conversation; I didn’t ever know where my keys were or where my car was parked; I couldn’t read novels.
One big problem with this loss of perspective on normal attention deficits is that it comes at a cultural moment least amenable to concentration. Richard DeGrandpre (2000) characterizes contemporary Americans as always in a rush, indulgent of boredom, and addicted to speed and stimulation. He describes our culture as a “hyperculture,” in which we’re “strung out on excitement,” always wanting something new and easily frustrated. He defines ADHD as a “culture-induced brain dysfunction that results from our growing addiction to speed” (DeGrandpre, p. 16). Just imagine if he’d written his book AFTER we all became addicted to our smart phones.
As of 2000, Americans consumed 80 to 90 percent of the world’s Ritalin (DeGrandpre, 2000), a trend which has continued to present. This phenomenon is evidence that the ADHD “disorder” is culturally-bound. It also suggests that we need to do more to unpack the connections between the definitions of illness we are being offered, the ways of being that technology is promoting, and the way we view ourselves and our loved ones.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
DeGrandpre, R. (2000) Ritalin nation: Rapid-fire culture and the transformation of human consciousness. New York: W. W. Norton.
Schwarz, A. (2013). The selling of attention deficit disorder. New York Times. Accessed at http://www.nytimes.com/2013/12/15/health/the-selling-of-attention...