The number of children diagnosed with attention deficit hyperactivity disorder (ADHD) has mushroomed to 10 percent of American children, which represents a significant increase over the past 20 years, according to a recent study. America has led the world in reported cases of ADHD, which has caused many experts to wonder whether there are more cases or whether it has simply become the go-to diagnosis for troubled kids in America.
The study was published in JAMA Pediatrics, using data from the National Health Interview Survey, an annual federal survey of about 35,000 households. It found a gradual but steady increase in diagnoses of ADHD among children from 1997 to 2016. In 1997 only about 6% of children were diagnosed with ADHD, compared to the present rate of 10%.
Dr. Stephen Hinshaw, who co-authored a 2014 book called The ADHD Explosion: Myths, Medication, Money, and Today’s Push for Performance, is one of the experts who thinks the disorder is over-diagnosed. In his book he compared ADHD to depression. He later said in an interview that neither condition has unequivocal biological markers, which makes it hard to determine if a patient truly has the condition without putting them through lengthy psychological testing. Such testing would look for symptoms of ADHD like inattention, fidgety behavior and impulsivity.
“It’s probably not a true epidemic of ADHD,” said Hinshaw, a professor of psychology at the University of California-Berkeley and a professor of psychiatry at the University of California in San Francisco. “It might be an epidemic of diagnosing it.”
The study found rates of ADHD among girls also rose from 3% to more than 6% over the same twenty-year period. The rise in ADHD in girls was explained as resulting partly from of a change in how the condition is classified. In recent years, the American Psychiatric Association, which puts out the DMS, a manual that classifies psychological disorders, added that the diagnosis should not just focus on hyperactivity, but also include children who are inattentive. That raised the number of girls who were diagnosed as having ADHD, since more girls are inattentive.
Over the years experts have debated whether ADHD is the result of nature or nurture. Many psychiatrists diagnose it as a psychological disease and prescribe medicines such as Ritalin. However, as Dr. Hinshaw pointed out, there are no clear genetic markers for ADHD, and if a disorder is genetic, the percentage of people who have the disorder does not change. The percentage of a disorder changes due to changes in environmental factors, not due to genetics.
What is missing in the discussions of ADHD are definitive explorations of environmental factors such as changes in parenting styles and non-medicinal treatments of the disorder. In my own practice as a psychoanalyst I have had experiences that have pointed to parenting as an important factor. In one case I observed that a parent was continually yelling at her 6-year-old child and blaming him for his bad behavior. She could never even contemplate the idea that her treatment of the boy might be driving him towards acting out a school. Eventually when he started hitting other kids and teachers at school, the school demanded that the boy see a psychiatrist. The psychiatrist diagnosed ADHD, prescribed medication, and the problem was, at least on the surface, solved.
I was attempting to treat the disorder by having family therapy sessions and encouraging constructive communication. The parents were not able to stop fighting long enough to engage in constructive communication, and the boy ran about the room out of control. I could see that the parents were not interested in why the boy was acting out, now in taking any responsibility for the boy’s behavior. I was prepared for a long process. The school kept calling to ask how things were going and I said it was going to take time. They then called for a psychiatrist.
It seems that diagnosing ADHD is a matter of convenience. It spares parents from having to acknowledge their part in the problem. We used to say, “Spare the rod, spoil the child.” Now it’s “Spare the parents, blame the child.” Diagnosing medication is a way of managing the disorder rather than getting to the root of it and healing it. Putting a child on ritalin doesn’t cure ADHD; it merely manages it. And it sets the child up for needing to be on a drug, often for the rest of his or her life.
Psychoanalysis began by doing something that hadn’t been done before: talking to patients about their struggles and thoughts and feelings. It sought to understand what had happened in children’s lives that had caused them to become depressed or anxious or angry or uncooperative. A lot can be accomplished when a parent takes notice of how he or she is treating a child and how that treatment has affected the child. Unfortunately, today man parents do not want to do that. And a lot of experts, such as physicians, protect the feelings of the parents rather than telling them that their parenting is causing a problem.
And so the percentage of diagnosed ADHD cases continues to rise. And so the policy of expediently diagnosing children with ADHD, rather than taking the time to look deeper into the what is going on in the homes and lives of children who are suffering from this type of anxiety and depression continues to flourish. And so the problem persists.