This is an important issue. According to Centers for Disease Control and Prevention (CDC), the percentage of children with an ADHD diagnosis continues to increase, from 7.8% in 2003 to 9.5% in 2007 and to 11.0% in 2011. The CDC also notes that the base rates for ADHD varies substantially by state ranging from a low of 4.2% in Nevada to a high of 14.8% in Kentucky.
Since the prevailing belief about ADHD is that it is caused by an underlying biogenetic delay, it is imperative for those who ascribe to the biological determinist view to account for the increased prevalence of ADHD by asserting that we are simply getting better at identifying people who possess the disorder. For zealots of biological determinism, we are merely getting better at “discovering” the hidden ADHD which exists out there in the world. However, they caution that diagnosis should always be done by a professional who truly understands the specific criteria necessary to make the diagnosis; it is imperative that evaluations are accurate.
Alternatively, if the increased prevalence of ADHD originates from psychosocial factors, the biological determinist belief system tarnishes. The diagnostic label would no longer imply a diluted biological system spouting from genetics, but an artifact of societal emphasis.
It is therefore not surprising that advocates of ADHD biological determinism assert that the high frequency rates of ADHD are due to improvements in identifying people who “have” ADHD. They believe that there is substantially more ADHD to be found, and that the real problem is getting treatment for people with the disorder who are not yet detected.
A Different View
ADHD has always been a relatively popular diagnosis so it is not surprising that its rate of occurrence is relatively high. However, important socio-political trends may help to explain the sharp increase in the base rates for ADHD that we are currently seeing.
These trends include:
- With so much talk about ADHD in the media, and with doctors, family, and friends, people wonder if the diagnosis pertains to them. And the more people hear about ADHD the more they see it in themselves and others.
- People who struggle want to know why they struggle and they want a remedy. The diagnosis helps to rationalize failures and it permits quicker access to accommodations and services.
- Researchers seek diagnoses to help them organize their investigations of etiologies and treatments for problematic behaviors.
- Pharmaceutical companies seek diagnoses so that they can coordinate medicinal treatments with specific kinds of functional impairments. A diagnosis helps to create a marketplace.
- Schools seek diagnoses to justify giving individuals extra services and to excuse achievement scores that do not meet performance expectations.
- Doctors (and other practitioners) seek diagnoses so they can recommend appropriate therapies (including giving a pill).
- Insurance companies insist on diagnoses to legitimize payments for “medical necessity.” If providers of health care want payment, they must assign a diagnosis.
- With early intervention in mind, many facilities and practitioners are now utilizing “screening tools” to identify unrecognized diagnoses in people. While there are merits to this endeavor, quite often there are high rates of false positives when relying on these tools. The end result is greater numbers of people receiving a diagnosis such as ADHD.
- Many different groups promote the assignment of an ADHD diagnosis, and the outcome is more ADHD. Other ways to classify, understand, and help individuals fall by the wayside. Since diagnosis coordinates with scholarly research, medication, accommodation, and financial reward, there is great interest in utilizing the extant diagnostic system.
- It is not surprising that the base rates for ADHD are exceptionally high. The diagnostic category encompasses behaviors that are prevalent throughout childhood (e.g., negligence of the perspective of others, lack of responsibility, intrusiveness, desperation, antagonism, and avoidance). Since these behaviors occur so frequently with so many people, it is not shocking that large numbers of people qualify for the diagnostic category. And when there are more people finding it difficult to meet societal expectations, there will be more people qualifying for the diagnosis.
A final note: The base rate for ADHD always depends on the criteria employed. If the criteria are lenient, then more people will receive the diagnosis. And if there is societal backlash protesting the excessively high rates of ADHD, then people will advocate for more stringent criteria. However, when that endeavor lowers the frequency rates, we will not be discovering less ADHD, we will simply be changing the rules.
Akinbami, L. J., X. M. Liu, P. N. Pastor, and C. A. Reuben. 2011. “Attention Deficit Hyperactivity Disorder among Children Aged 5–17 Years in the United States, 1998–2009.” NCHS Data Brief No. 70. August.
Are Schools Driving ADHD Diagnoses? How accountability laws may influence the rising rates of kids with the disorder. Child Mind Institute.
Wiener, C., Parenting Your Child with ADHD: A No-Nonsense Guide for Nurturing Self-Reliance and Cooperation. Oakland, CA. New Harbinger Publications. 2012.
Wiener, C. Attention Deficit Hyperactivity Disorder as a Learned Behavioral Pattern: A Return to Psychology. Lanham, MD: University Press of America, 2007.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Self-identification–what to make of this. I’ve met a young person who decided to accept the label for ADHD, and grew certain that this was to his advantage. It got him the drugs, of course, and gives him rationale for regulating his use. But since the principle of psychoactive drugs is to achieve a desired experiential effect that is remedial or life-enhancing in the balance, regulation of use just is quasi-objectively achievable. Sensitivity to your suffering and your means to control your actions tends to fade behind the labelled attributes of the disorder right along with the impairment from the drugs. Anyone who decides to make medication a dietary supplement for maintaining mental well-being has lifetimes worth of research to do, and misinformation and suppressed information and perspectives to sort out, and I can’t see yet how the psychiatric labels that we get support that cause. With PTSD we at least had President Bush say “No-just PTS”. So when I saw a group of veterans with recalcitrant “symptoms” they employed helpful language such as calling the label what it technically is, a mere “explanatory redescription”, not the name of an entity there in the world. But President Obama conveniently sees mental illness as like diabetes.
“explanatory redescription” it kind of applies to all “mental illness” diagnosis.
Simply describe the symptoms (or a fraction of them) and call it progress.
Conventional medicine does it too (chronic fatigue syndrome for instance – a label for “I have no idea what’s wrong with you but I acknowledge you feel like s*t) but to a lesser degree and it usually has in mind to find what is causative.
Describing a behavior as a disease is wrong. Behaviors can be learned and changed. Many are eager to sell a drug, and there are few profiting from not selling a drug solution.
Zealots of pharmaceutical prescription items marketing is more the actual situation we are presented with here. (For zealots of biological determinism)
Among people actually truly interested in science and people’s medical welfare (rather than Wall Street investor’s and smaller or larger pharmaceutical company’s yearly profits a great new addition is neurologist Natasha McBride, whose son had autism which set her on the trail to find actual Medical information. Natasha adds to the knowledge of how cumulative mulch-generational impacts on people’s health is resulting in people’s health failing in various ways.
Actual Medical information and insight of this kind – in a sense makes true – the propaganda pretense of drug company and Psychiatry marketing propaganda about there supposedly being interested in genetic “causes.” Because people are the ‘canaries in the coalmine’ – after bottle feeding babies with caro syrup, giving people over-processed factory foods, cadmium aluminum copper mercury and lead, huge amounts of sugar, marijuana, tobacco, prescription drugs with flourine or chlorine in them, multiple vaccinations, multiple treatments with antibiotics, damaged oils and a lack of omega 3 fats – they start having CFS, psychosis, retardation, birth defects, senility, autism, diabetes – then the companies set up a political situation where their agents say look at all these different diseases, these different conditions can be correlated to people’s individual genetics. It’s their gene’s that are to blame for these different diseases that our people will “diagnose” (with a naming classification) and “treat” with our factory made pills (may be processed on same machines that make soda pop, toaster tarts and puffed rice cereals).
After 5 generations of this they may be able to make up named categories, relate manufactured drug products to those categories (stain drugs for high-cholesterol, Vioxx for arthritis, Risperdal for autism), and even link genes to the naming-system-categories to a degree. With enough continuous simple mind-numbing propaganda from supposedly independent official sources (Big Universities, Library Books, Leading Experts, Gad-Fly Renegade E. Fuller Torrey, NAMI, scientific American, Public Radio shows) it almost resembles the truth.
As people’s systems break down from the mulch-generational impact they probably can somewhat link genes to the different ways they break. Anyway it sounds like they are interested in science and doing significant science stuff. The propaganda is the exclusive purpose for the sociopathic capitalists. (Given that Harvard led Psychiatry was lying about being scientific with its DSM naming system and drugs for the last 5 decades – then now the NIMH director should announce last year that, now they are really really serious this time – and they are going to investigate genetics!)
Carl C. Pfeiffer, Ph.D., M.D. wrote Mental and Elemental Nutrients in 1975 in which he describes the ever increasing psycho stimulant sales as “an epidemic.” Clearly with all the leaded gas and paint, the sugar, pollution and junk food in the USA that children were exposed to there was no need for Psychiatrists to be labeling children with a imaginary DSM diagnosis done entirely on a behavioral/psychological “assessment” by Professional basis – and “treatment” consisting of exclusively centrally acting drugs (lucrative, patented, supplied by privately owned companies).
Daniel Burdick Eugene, Oregon USA
The 6 Types of Pills Big Pharma Wants You Hooked On for Life
May 14, 2012
Natasha Campbell-McBride, M.D. – GAPS Gut and Psychology Syndrome
Vioxx only the beginning; antidepressants and statin drugs are medication timebombs
Tim Bolen on Merck
Our Daily Meds – Part 1 Mike Papantonio, J.D. of Air America’s Ring of Fire
John F. Kennedy, Jr. Show
“Unfortunately for anyone who lives and breathes,
pharmaceutical companies have lost interest in curing diseases, and have
now focused on creating “blockbuster pills” that generate billions in
Nutrition by Natalie – ADHD WARNING
PSYCHIATRY WARNING by Lawrence Stevens, J.D.
Abram Hoffer, M.D. Interview with Jefferey Bland, M.D. (After Thorazine was marketed in 1954 the tranquillizer drugs were so hugely profitable that the big drug companies overwhelmed the field of Psychiatry after 1957. That is what has happened to Psychiatry today.)
Lendon Smith, M.D. Attention Deficit Hyperactivity is a pseudo or quasi diagnosis
and Ritalin actually works.
The idea that there are “false positives” and “over diagnosis” inherently and tacitly endorses the proposition that NIMH, NAMI, APA “diagnoses” are an acceptable valid way for life in the USA to be proceeding.
The NIMH and APA merged with Big Pharma in 1973 with the publication of the APA Task Force 7 Report. Since 1973 only, exclusively, prescription, patented chemicals are discussed, as chemotherapeutic items being of any interest, by the Official Leadership of USA Psychiatry.
(What medications are used? What possible mediation breakthrough is on the Wall Street hopeful horizon?).
In this political and propaganda set-up their have crafted for themselves the Professional clinician gets to do an interview and do ome Psychological word tests then pluck a name out of thin-air and this constitutes the whole of DSM “diagnosis” for now 35 years. Diagnosis is done non-Medically – as these are Psychiatric diagnoses (not Medical diagnoses). While, therapy is done Medically (…using patent centrally acting drugs) as “We are employing the Medical model.”
Extremely profitable propaganda system. The NAZI Big Lie approach. Note the inherent anti-rational aspects, rote cant quality, and enforcement by authority stance and threat.
Evelyn Pringle is an excellent investigative writer on Political issues.
Psychotropic Drug Makers Bankroll Prescribing Shrinks Part I
August 30, 2007
Janet Wozniak, M.D. The Authority at Cambridge The diagnoses are Valid, Because — “Criticizing the diagnoses is insulting to Clinicians!” (Commoners, Laypersons, Non-Professionals have no right! Harvard- Veritas!)
Dan Burdock, Double BRAVO ! We should all thank you !
Thank You ,