“I was the kind of kid who would get up and walk around, look at the goldfish, read the encyclopedias in the back of the room, talk to neighbors,” Peter Conrad, a professor of sociology, said in regard to his childhood. “Had ADHD been an option as a diagnosis in the ’50s, which it wasn’t, I would have been probably labeled and gotten a trial and medications.”
Professor Conrad has researched ADHD, short for attention deficit hyperactivity disorder, since he wrote his dissertation on identifying hyperactive children 40 years ago. While only three to five percent of school children were diagnosed with ADHD when he started his research, today, that number has increased to 11 percent. “That’s a lot of kids,” Conrad commented.
ADHD is a psychiatric diagnosis based on behavior and attention, Conrad explained in an interview. It has three main aspects: impulsivity, inattention and hyperactivity. Over the past 50 years, it has become the most common psychiatric diagnosis of children. While the disorder initially focused on hyperactivity, it has more recently been linked to problems with attention. Because of this, starting in the ’90s, ADHD has transitioned from solely being a childhood disorder to an adolescent and adult disorder. Or rather, as Conrad described, “a lifelong disorder.”
To correct the widespread diagnosis of ADHD, stimulant medications such as Ritalin and Adderall became popular solutions. Although the medication improves behavior, it only works so long as patients continue to use it. Once the medicine stops being taken, there is not necessarily any improved performance on tasks. “Sixty-five to 75 percent of people who are diagnosed take those medications,” Conrad stated. The medicine is now prescribed to approximately 4.5 million people in the United States, a fact that deeply concerns Conrad, whose studies have focused mainly on the medicalization of society.
“My concern is about the medicalization of society. It’s turning all differences, and in this case, behavioral and cognitive differences, into some kind of pathology that needs to be treated,” Conrad said. He continued, “Anytime somebody is underperforming in school or not doing as well on standardized tests, or not doing as well in their behavior in paying attention in classrooms, well, they may have ADHD.”
While the increase in the diagnoses of ADHD over the past 20 years can be connected to a wide range of things, the drug companies have played an important role in the process. Because they have such a large investment in the drugs, they continually push to increase the market in which their drugs can be used. Yet, the drug companies are not the only ones to blame.
In the 1990s, ADHD began to be seen as a learning disability. This created a situation in which “the diagnosis can buy you something,” said Conrad. “If you have the diagnosis it can get you untimed tests, it can get you special situations where you take tests, or it can get you certain kinds of individual learning plans.” The usage of new medication to treat ADHD also encouraged people to get the diagnosis, Conrad explained.
In Conrad’s most recent article, “The impending globalization of ADHD: Notes on the expansion and growth of a medicalized disorder,” published on Oct. 8 of this year, he discuses how the diagnosis has spread and become prevalent in other countries. “Until the 1990s,” Conrad wrote, “the U.S. consumed about 90 percent of all the Ritalin (methylphenidate) produced, the signature psychoactive treatment for ADHD. As other countries adopted the treatment, this dropped to 75 percent in 2010.”
Despite this spread in the prescription of ADHD medications, countries such as France have been slow to medicalize the disorder. In France, Conrad stated, they are more likely to do some sort of psychotherapy or family interventions first. Medication is a last resort.
“There are a lot of people who believe this is a real disorder. But, when you talk about 11 percent of some school age population—that’s a whole lot of people—you begin to wonder if it’s a disorder or just a variant.” As Conrad continues to research ADHD and the medicalization of disease, he wonders if in 30 or 40 years from now, we are going to look back on giving stimulant medications to kids with this so-called disorder, ADHD, and ask, “Why were we drugging those kids?”