The A.D.H.D. Industrial Complex

The NYTimes reviews Alan Schwartz, ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic:

The boundaries of the A.D.H.D. diagnosis have been fluid and fraught since its inception, in part because its allegedly telltale signs (including “has trouble organizing tasks and activities,” “runs about or climbs in situations where it is not appropriate” and “fidgets with or taps hands or feet,” according to the current edition of the DSM) are exhibited by nearly every human being on earth at various points in their development. No blood test or CT scan can tell you if you have the condition — the diagnosis is made by subjective clinical evaluation and screening questionnaires. This lack of any bright line between pathology and eccentricity, Schwarz argues, has allowed Big Pharma to get away with relentless expansion of the franchise.

Numerous studies have shown, for example, that the youngest children in a classroom are more likely to be diagnosed with A.D.H.D. Children of color are also at higher risk of being misdiagnosed than their white peers. One clinician quoted in the book more or less admits defeat: “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

Schwarz has no doubt that A.D.H.D. is a valid clinical entity that causes real suffering and deserves real treatment, as he makes clear in the first two sentences of the book: “Attention deficit hyperactivity is real. Don’t let anyone tell you otherwise.” But he believes that those who are disabled by the condition deserve a wider range of treatment options than an endless litany of stimulants with chirpy names like Vyvanse and Concerta.

And Big Pharma has been using ADHD to push pills:

While other books have probed the historical roots of America’s love affair with amphetamines — notably Nicolas Rasmussen’s “On Speed,” published in 2008 — “ADHD Nation” focuses on an unholy alliance between drugmakers, academic psychiatrists, policy makers and celebrity shills like Glenn Beck that Schwarz brands the “A.D.H.D. industrial complex.” The insidious genius of this alliance, he points out, was selling the disorder rather than the drugs, in the guise of promoting A.D.H.D. “awareness.” By bankrolling studies, cultivating mutually beneficial relationships with psychopharmacologists at prestigious universities like Harvard and laundering its marketing messages through trusted agencies like the World Health Organization, the pharmaceutical industry created what Schwarz aptly terms “a self-affirming circle of science, one that quashed all dissent.”

Over a decade ago I wrote up some notes of my own: Music and the Prevention and Amelioration of ADHD: A Theoretical Perspective. Here's the abstract:

Russell A. Barkley has argued that ADHD is fundamentally a disorientation in time. These notes explore the possibility that music, which requires and supports finely tuned temporal cognition, might play a role in ameliorating ADHD. The discussion ranges across cultural issues (grasshopper vs. ant, lower rate of diagnosis of ADHD among African-Americans), play, distribution of dopamine and norepinephrine in the brain, neural development, and genes in culture (studies of the distribution of alleles for dopamine receptors). Unfortunately, the literature on ADHD does not allow us to draw strong conclusions. We do not understand what causes ADHD nor do we understand how best to treat the condition. However, in view of the fact that ADHD does involve problems with temporal cognition, and that music does train one’s sense of timing, the use of music therapy as a way of ameliorating ADHD should be investigated. I also advocate conducting epidemiological studies about the relationship between dancing and music in childhood, especially in early childhood, and the incidence of ADHD.

From the notes:

ADHD and its treatment have engendered much controversy. The deepest controversy concerns the long-term use of amphetamine medication in treating ADHD — a matter I won’t address in these notes. There is also, however, considerable controversy about the nature of ADHD. Much of this discussion seems reminiscent of Aesop’s fables about “The Ant and the Grasshopper” and “The Hare and the Tortoise.” 

Aesop favored the steady and workmanlike ant and tortoise over the flighty grasshopper and quick hare. There is a considerable popular ADHD literature that tends to favor the grasshopper over the tortise. This conflict, whatever it is ultimately about, has been in our culture for a long time. Whatever else is going on with ADHD children – and I am reasonably sure there is something biological at work for at least some of them – we are using them and their health as a vehicle to work over one of the deep and ongoing conflicts in our culture.