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October is ADHD awareness month. Now that the biological model espoused by the DSM-5 is beginning to resemble the Titanic post iceberg—with biological causes of "disorders" remaining elusive and hypothetical—it’s a good time to look at new ways of understanding how the ADHD diagnosis came to achieve its current prominence in our country.
A fresh perspective on how societal factors may have influenced the ballooning of the ADHD epidemic comes from science writer Maggie Koerth-Baker in this week’s New York Times Magazine. She takes a hard look at how three specific changes in American educational policies may well have facilitated the spread of the diagnosis.
One of these changes is The No Child Left Behind Act, signed into law by President George W. 
Bush in 2002. This law was the first federal effort to link school financing to students’ performance on standardized-tests. Various states had been adopting a similar policy in the decades leading up to No Child Left Behind. Ms Koertz-Baker suggests that the best way to see the connection between the new policies and the rise of the ADHD diagnosis in the 90’s, is to follow the money.
After laws were enacted that tied financial rewards to test performance, school districts that were lagging behind in test scores soon experienced a burgeoning of ADHD diagnoses. In North Carolina, for example, in 1997,15.6 percent of children had received an ADHD diagnosis. This contrasts with California, where the percentage in the same year was 6.2. North Carolina was one of the first states to link school financing to standardized test scores. California was one of the last.
When states passed laws punishing or rewarding schools for high standardized test scores, ADHD diagnoses in those states soon increased. Since ADHD drugs enhance children’s ability to concentrate on even the most mind-numbing of tasks, and hence tend to raise their scores on standardized tests, the financial incentives work to “boost the diagnosis of the disorder, regardless of its biological prevalence.”
Ms Koerth-Baker finds two other "not so hidden" sociological explanations for skyrocketing ADHD diagnoses in the 90’s. First, there was a change in FDA policy in 1997 that allowed drug companies to more easily market directly to the public. Second, in 1991 children with ADHD were included under the Individuals with Disabilities Education Act. Children with an ADHD diagnosis were allowed more time than their peers on standardized tests, received free tutoring, and were eligible for free higher education. Enhanced marketing of ADHD medications raised awareness and demand for the drugs.
Explantions and correlations are not causal links, as Koerth-Baker is quick to point out. However, she argues, education policies, disability protections, and new advertising freedoms granted to drug companies "wink suggestively at one another." These policies, together with the broader trend in the United States to medicalize traits that would have appeared to previous generations to fall within the spectrum of normal childhood, have all contributed to the phenomenal rise in the ADHD diagnosis in this country.
Copyright © Marilyn Wedge, Ph.D.
Marilyn Wedge is the author of Pills are not for Preschoolers: A Drug-free approach for Troubled Kids. Her latest book is A Disease Called Childhood: Why ADHD became an American Epidemic
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