Oxford University Press's
Academic Insights for the Thinking World

ADHD: time to change course

By Susan C. C. Hawthorne

In March 2013, we learned that 11% of US children and teens have received an ADHD diagnosis, an increase of 41% in 10 years. Diagnoses among adults have sharply increased as well. Some ADHD experts welcome this change. They interpret these high rates as signs that much-needed attention is finally being given to people whose biology has been a disadvantage in work, school, and relationships. Other professionals have been taken aback by the current diagnostic rate and its purported repercussions, citing risks such as overprescription of drugs, medicalization of normal behaviors, and drug diversion to street use.

No general uproar has materialized, however. On the contrary, it’s looking like the upward trend will continue. Recent publications explain how to increase screening rates via computerized assessments, and how to hone diagnosis with a new EEG test. Most important, the new diagnostic guidelines in the American Psychiatric Association’s DSM-5 relax the diagnostic criteria, pulling more people, especially adolescents and adults, under the “ADHD” umbrella. The ADHD therapeutics market has responded enthusiastically, predicting high profits from increased diagnostic rates.

Children in a classroom
Children and their teacher in a classroom

One reason for the lack of outcry might be that people see this as the continuation of a steady trend: same old, same old. Diagnostic rates have been increasing for decades. Another might be the continued sway of the pharmaceutical business. It has effectively hyped the diagnosis for 40 years through targeted medical education; advertising to physicians, patients, and parents; and a smorgasbord of perks for “opinion leaders” and clinicians.

I think, though, that the reason for accepting this status quo involves much more than the drug industry. Basically, a lot of people—and a lot of the social systems in which they participate—like the diagnosis.

  • Teachers and education administrators like it: Within the strained education system, it addresses needs of overworked teachers and overcrowded classrooms.
  • Physicians and medical insurers like it: It’s a win-win in the medical system because the diagnosis (in the predominant interpretation as a biological dysfunction in individuals) falls in physicians’ purview; current care is quick and easy, often consisting only of a prescription.
  • Clinical scientists like it: Research dollars flow toward it because the diagnosis—hence the fruits of research—promises to solve problems.
  • And of course parents and adult diagnosees, who typically self-refer, like it: The short-term effects of medication help with behavior issues they deal with, and the promise of long-term effectiveness gives them hope. (Never mind that long-term effectiveness has not yet been demonstrated.)

If so many people like the diagnosis, what’s the problem? The much-discussed worry that we are overusing psychotropics, especially in children, is worth reconsidering. But two other issues also need to be aired

The first is that the continued reliance on ADHD as a research category puts clinical science in a rut—repeatedly studying ADHD and non-ADHD groups assumes that ADHD is a relevant and important category. More research should question that assumption. Investigating other hypotheses opens avenues of research that might better address clinical needs, as well as leading to more knowledge about mental health and illness.

The second issue is the stigmatization of those who are diagnosed as having ADHD. Years of research has shown that ADHD diagnosis correlates with multiple life choices and outcomes generally considered negative, such as increased rates of accidents, substance abuse, poor relationships, low educational and work achievement, and higher medical and education expenses. Drawing attention to “ADHD” as a contributor to these life tracks puts the blame on supposed biological facts about the individuals. Then, despite efforts to spin attitudes toward compassion for these (putatively) inborn circumstances, the opposite often occurs. The correlation between ADHD diagnosis and negatively perceived life tracks instead provides a medically and scientifically justified target for social disapproval—that is, ADHD-diagnosed people are stereotyped and stigmatized. Alternatives suggest that the biological claims are at best incomplete, and that social circumstances require investigation and intervention as well.

For these reasons, I think that it is time for new directions. More specifically, it is time to reassess clinical and research needs, and to find new ways to address both without relying on the “ADHD” catch-all. However, arguments pointing to evidence of progress via the current direction and arguments favoring the vested interests in the status quo—economic, educational, medical, scientific, and personal—weigh in the opposite direction.

Should we change course? I welcome your ideas.

Susan C. Hawthorne, author of Accidental Intolerance: How We Stigmatize ADHD and How We Can Stop, is Assistant Professor, Department of Philosophy, St. Catherine University.

Subscribe to the OUPblog via email or RSS.
Subscribe to only health and medicine articles on the OUPblog via email or RSS.
Image credit: Children in a classroom by Michael Anderson, National Cancer Institute. Public domain via Wikimedia Commons.

Recent Comments

  1. ADHD | Echte Vragen

    […] OUPBlog staat een interessant artikel van Susan C. Hawthorne die betoogt dat het voor wat betreft ADHD […]

  2. Andy

    Hi Susan, I found your article most interesting and agree with much of the issues you have looked at regarding supporting people with ADHD differences. I personally have ADHD, dyslexia and other neurological conditions. I would like to see ADHD, dyslexia and Asperger’s brought together under the same heading.

    I did take Ritalin for my ADHD a while and found it very beneficial for my severe dyslexia. However drugs doesn’t seem to have the ability to maintain that support long-term. I also understand there are various trials in the process for treating dyslexia with medication.

    I think the biggest difficulty in finding a new way forward will be getting people to work together.

    I also believe people with ADHD, Asperger’s, dyslexia and other similar neurological differences are very competitive at voicing their views. This can provide difficulties of obtaining collective voices representing all with neurological differences.

    So I certainly agree we need to have a rethink regarding moving forward with ADHD. I also think it’s time to look at things with a wider bandwidth and include dyslexia and other neurological impairments.

    Apologies if I have made any mistakes and using voice recognition software and often don’t notice mistakes with the text to speech facilities I check my work with.

    Looking forward to better understanding in the future.

    Andy founder of Hi2u for people with hidden impairments, at; http://www.hi2u.org

  3. edwould

    The increasing number of diagnoses, I think, partially have to do with long term attention-deficit sufferers discovering a disease that they can fit to formerly unexplained symptoms they’ve had possibly all their lives, more distractions and emotional damage potential caused by chaotic home lives as the result of the continuing slide in the per capita quality of life in the country and globally, and increased interest in being able to fairly compete against others pursuing fewer and fewer resources.

    I’ve had inattentive-type ‘attention deficit’ problems since before age six but the disorder wasn’t named then so I went undiagnosed until my forties. I still don’t know what the real reasons are for the attention deficit. I exhibited autisitic traits in early childhood, have had trouble being responsible to my obligations at times, experienced chronic fatigue, and other symptoms consistent with an attention deficit problem but I can’t say with absolute certainty that I have the disorder because there are so many disorders that produce similar symptoms. Austism is now being investigated as possibly being caused by a parasite. When so many different kinds of diseases exist and so many can produce attention deficit-like symptoms, how can we label anything. If the meds help then what difference does it make if the patient officially has ADD/ADHD. Medicine is supposed to relieve dis-ease, not answer to paranoids who think that people with a particular disease are closet criminals because their symptoms happen to be relieved by a drug that the government-big business complex has had criminalized for profit. A lot of people are just too broke to pay attention nowadays. Nothing is quite so distracting as the sobering realization that you aren’t surviving even when your running as fast as you can. That could be the result of having 7 billion people in the world or the result of a dopamine deficiency manifesting before age 7. Either way, you still need help because your too distracted, depressed, fatigued, or misdirected to pay attention, or your rent. If that’s how it is now, what do you think the kids are seeing in their future.

  4. cleo

    Hi Susan, I love your article. My son who is 8 was diagnosed with General Anxiety at 5 after he was not able to adjust normally in kindergarten. They wanted to put him on Zoloft but we didn’t feel comfortable with it and home schooled him. Then they diagnosed him with ADD and again we would not medicate. He struggles with parts of school but overall we think he is doing well. I feel that if we had medicated him life may make our lives less stressful but I don’t think that would be the best course of action for him in the long run. The main issue I see is that we don’t feel that there are enough peope in the school system that are trained to communicate with kids that have these kind of issues. We realized we just needed to educate ourselves and be our sons best advocate realzing we know and understand his needs best and for now that means no medication.

  5. Susan Hawthorne

    Thank you, Andy, edwould, and cleo, for your feedback and your attention to my blog. I appreciate your very different stories and your valuable perspectives. All best to you!

  6. […] of school and setting them on a course that could be easily corrected with treatment. Some experts believe that the increase in diagnoses leads to several benefits: teachers do not have to deal with noisy […]

Leave a Comment

Your email address will not be published. Required fields are marked *