Investigative journalist Alan Schwarz sounds the alarm on ADHD
By Gareth Cook
This article originally appeared in Scientific American
According to the American Psychiatric Association, about 5 percent of American children suffer from Attention Deficit Hyperactivity Disorder (ADHD), yet the diagnosis is given to some 15 percent of American children, many of whom are placed on powerful drugs with lifelong consequences. This is the central fact of the journalist Alan Schwarz’s new book, ADHD Nation. Explaining this fact—how it is that perhaps two-thirds of the children diagnosed with ADHD do not actually suffer from the disorder—is the book’s central mystery. The result is a damning indictment of the pharmaceutical industry, and an alarming portrait of what is being done to children in the name of mental health.
What prompted you to write this book?
In 2011, having spent four years exposing the dangers of concussions in the National Football League and youth sports for The New York Times, I wanted another project. I had heard that high school students in my native Westchester County (just north of New York City) were snorting Adderall before the S.A.T.’s to focus during the test. I was horrified and wanted to learn more. I saw it not as a “child psychiatry” story, and not as a “drug abuse” story, but one about academic pressure and the demands our children feel they’re under.
When I looked deeper, it was obvious that our nationwide system of ADHD treatment was completely scattershot—basically, many doctors were merely prescribing with little thought into whether a kid really had ADHD or not, and then the pills would be bought and sold among students who had no idea what they were messing with. I asked the ADHD and child-psychiatry establishment about this, and they denied it was happening. They denied that there were many false diagnoses. They denied that teenagers were buying and selling pills. They denied that the national diagnosis rates reported by the C.D.C.—then 9.5 percent of children aged 4-17, now 11 percent and still growing—were valid. They basically denied that anything about their world was malfunctioning at all. In the end, they doth protest too much. I wrote about 10 front-page stories for The New York Times on the subject from 2012-2014.
In what sense is ADHD an “epidemic,” and how was it “made”?
ADHD itself is not an epidemic—ADHD misdiagnosis is an epidemic. If the system functioned in such a way as to stay anywhere near the 5percent diagnosis rate that the American Psychiatric Association’s official definition suggests, we wouldn’t be in this mess. But the system doesn’t function properly, not by a long shot.
About 15 percent of American children turn 18 having been diagnosed with ADHD, 20 percent of boys, and 30 percent of boys in much of the South. It’s completely indefensible. It’s time to figure out how not to necessarily “fix” it, because the genie long left the bottle, but do a far better job in diagnosing the kids who really fit the construct and help the other kids in other ways.
Many kids have problems and need help—but those problems in many cases will derive from trauma, anxiety, family discord, poor sleep or diet, bullying at school and more. We must not abandon them. We must help. But we must also be more judicious in how we do that, rather than reflexively giving them a diagnosis of what is generally described as a serious, lifelong brain disorder.
Continue to Scientific American
According to an article in Psychology Today, French children don’t need medications to control their behavior.
In the United States, at least 9 percent of school-aged children have been diagnosed with ADHD, and are taking pharmaceutical medications. In France, the percentage of kids diagnosed and medicated for ADHD is less than .5 percent. How has the epidemic of ADHD—firmly established in the U.S.—almost completely passed over children in France?
Is ADHD a biological-neurological disorder? Surprisingly, the answer to this question depends on whether you live in France or in the U.S. In the United States, child psychiatrists consider ADHD to be a biological disorder with biological causes. The preferred treatment is also biological—psycho stimulant medications such as Ritalin andAdderall.
French child psychiatrists, on the other hand, view ADHD as a medical condition that has psycho-social and situational causes. Instead of treating children’s focusing and behavioral problems with drugs, French doctors prefer to look for the underlying issue that is causing the child distress—not in the child’s brain but in the child’s social context. They then choose to treat the underlying social context problem with psychotherapy or family counseling. This is a very different way of seeing things from the American tendency to attribute all symptoms to a biological dysfunction such as a chemical imbalance in the child’s brain.
French child psychiatrists don’t use the same system of classification of childhood emotional problems as American psychiatrists. They do not use the Diagnostic and Statistical Manual of Mental Disorders or DSM. According to Sociologist Manuel Vallee,the French Federation of Psychiatry developed an alternative classification system as a resistance to the influence of the DSM-3. This alternative was the CFTMEA (Classification Française des Troubles Mentaux de L’Enfant et de L’Adolescent), first released in 1983, and updated in 1988 and 2000. The focus of CFTMEA is on identifying and addressing the underlying psychosocial causes of children’s symptoms, not on finding the best pharmacological bandaids with which to mask symptoms.
To the extent that French clinicians are successful at finding and repairing what has gone awry in the child’s social context, fewer children qualify for the ADHD diagnosis. Moreover, the definition of ADHD is not as broad as in the American system, which, in my view, tends to “pathologize” much of what is normal childhood behavior. The DSM specifically does not consider underlying causes. It thus leads clinicians to give the ADHD diagnosis to a much larger number of symptomatic children, while also encouraging them to treat those children with pharmaceuticals.
The French holistic, psychosocial approach also allows for considering nutritional causes for ADHD-type symptoms—specifically the fact that the behavior of some children is worsened after eating foods with artificial colors, certain preservatives, and/or allergens. Clinicians who work with troubled children in this country—not to mention parents of many ADHD kids—are well aware that dietary interventions can sometimes help a child’s problem. In the U.S., the strict focus on pharmaceutical treatment of ADHD, however, encourages clinicians to ignore the influence of dietary factors on children’s behavior.