Letting Boys Be Boys, Not ADHD Diagnoses

By Brent Dean Robbins Saybrook.edu

Photo by Jorge Royan.

On April 1, The New York Times reported on the startling fact that 11% of children in the United States are now diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). One in five young males of high school age now have the diagnosis. Among children between the ages of 4 and 17, 6.4 million now bear the ADHD label and, no doubt, are medicated for it, most likely with psychostimulants. Since 2007, the ADHD diagnosis has seen a 16% increase, and over the past decade, the increase has been an astonishing 41%.

In a scathing response to this news in the American Spectator, Daniel J. Flynn wrote, “Boyhood isn’t a medical condition to be cured. The God-complex of doctors, on the other hand, could use an injection of humility. Physician, heal thyself.”

In The New York Times, the Letters to the Editor were revealing and powerful.

Carrie Klein of Chapel Hill, N.C. acknowledged the elephant in the room, when she identified the fact that pharmaceutical companies are heavily marketing psychostimulants to children, and the constant expansion of the market of ADHD kids serves the interests of industry.

Dr. Martin A. Silverman, a psychiatrist and former President of the Association for Child Psychologists, observed that the expansion of ADHD diagnosis is perpetuated, in part, due to poor medical practices. “A diagnosis of ADHD is increasingly applied to young people without careful assessment and careful thought,” he wrote. Just because a parent demands or asks for medications for their children, he argued, the doctor should not feel pressured into giving a diagnosis to justify prescription of medications. Yet, this often occurs, and will likely continue to occur.

Rachael Paster Zwiebach, of Queens, correctly observed that ADHD cannot be separated from the context of increasingly dysfunctional school environments. “It’s unreasonable to expect active youngsters to sit for hours on end. When we allow teachers to stop prepping our children for needless tests and return to genuine teaching, and when we allow students to express their creativity—including kinesthetically—these ADHD diagnoses will decrease.”

All of these opinions point to many factors that seem to be contributing to the increase in diagnosis of ADHD: the stigmatization of normal boyish behavior, dysfunctional schools with little opportunities for normal and active childhood activities, lack of adequate parenting, poor medical practice (likely driven by economic forces), and the heavy push of big pharma.

In the upcoming DSM-5, the new diagnostic criteria for ADHD will likely further escalate these problems by loosing the diagnostic criteria and by using criteria that are known to lack acceptable levels of reliability and therefore also validity.

This problem is a microcosm of a larger and sweeping trend in psychiatry in which diagnostic criteria are lowered to expand the market for psychiatric practice and the drug industry. Meanwhile, children and adults who are often responding in normal ways to abnormal environments are unjustifiably stigmatized with psychiatric labels and treated with potentially harmful drugs. This needs to stop.