The ADHD Explosion: Myths, Medication, Money, and Today's Push for Performance

618 Pages·2014·2.68 MB·English

by  Stephen P. Hinshaw

The ADHD Explosion
The ADHD Explosion
Myths, Medication, Money, and Today’s Push for
Performance
STEPHEN P. HINSHAW
RICHARD M. SCHEFFLER
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© Stephen P. Hinshaw and Richard M. Scheffler 2014
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Library of Congress Cataloging-in-Publication Data
Hinshaw, Stephen P.
The ADHD explosion : myths, medication, money, and today’s push for
performance/
Stephen P. Hinshaw, Richard M. Scheffler.
pages cm
Includes bibliographical references and index.
ISBN 978–0–19–979055–5
1. Attention-deficit hyperactivity disorder—Treatment—Finance. I. Scheffler,
Richard M. II. Title.
RJ506.H9H57 2014
616.85′8900835—dc23
2013028792
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
To Kelly, Jeff, John, and Evan To Meg and Zach
Contents
Foreword by David Mechanic
Acknowledgments
Introduction
The Reality of ADHD
Essential Issues
Rising Rates of Diagnosis and Expanding Treatment
ADHD: A Top 10 List
ONE The TNT Fueling the Explosion: Origins and Costs of ADHD
Jose: “Immaturity that Might Last a Lifetime”
From Then to Now
Money: The Costs of ADHD
TWO The Nature and Causes of ADHD: Where Biology Meets Culture
Becky: “Lost Opportunities”
A Continuum, Not a Category?
Symptoms, Problems, and Impairments: What Is ADHD?
ADHD Across the Years
Impairments
Models and Causes
Putting It All Together
THREE Diagnosing and Treating ADHD: Do It Right or Pay the Price
Tommy: “Problems Everywhere”
Performing the Evaluation
Treatments for ADHD and Evidence for Their Effects
FOUR The Upward Spiral of ADHD Medications: Enhanced Performance or
Potential for Abuse?
Ralph: “Miracle Cure”
Skyrocketing ADHD Medications
Stimulants and the Brain: Main Effects and Side Effects
Reducing Problems or Enhancing Skills?
Diversion and Neuroenhancement: Stimulants for Everyone?
FIVE What a Difference a State Makes: How Educational Policy Determines
Diagnosis and Treatment
Jessie: “A New Home”
A Tale of Two States
Schools and School Policies Matter
Other Laws Regarding Schools and ADHD
SIX The Cost of ADHD: It’s the Economy, Stupid
Frank: “Will It Always Be This Way?”
Ever-Increasing Cost Escalation
Benefits of the Spending
Conclusion
SEVEN ADHD and the Media: What’s Being Said and What’s Being Sold?
What Does the Public See and Hear?
Advertisements and the Selling of ADHD Medications
EIGHT ADHD Around the World
International Recognition and Diagnosis
Treatment and Services for ADHD Around the World
Differences Across Cultures and Nations: A Bird’s-Eye View
Economic Development and ADHD
NINE Beyond White, Middle-Class Boys—Plus the Stigma of ADHD
Young Children
Adults
Girls, Women, and Minorities
Stigma: Is ADHD Still a Source of Shame?
TEN The Future of ADHD: Predictions, Confusions, and Conclusions
Weighing and Weighting the Evidence
Predicting the Future
Back to School
What Can Be Done? The Bottom Line
Notes
References
Index
Foreword
ADHD is the most common childhood behavioral health problem leading to
medical and behavioral health interventions. In fact, one in nine children and
adolescents in the United States has received a diagnosis (including nearly one
boy in six), and medication treatment is initiated for the vast majority of them.
As with autism, its numbers have skyrocketed in recent years. ADHD
medications are the number one medicine used worldwide for behavioral
problems in youth.
Impressive evidence exists that children who exhibit ADHD behavior patterns
suffer many difficulties in school and community adjustment, struggling to keep
up academically. They also have disproportionate rates of later problems, from
car accidents to substance abuse and divorce. Moreover, problems of
hyperactivity, impulsivity, and inability to concentrate that become evident in
school and home settings commonly persist in later life, compounding
difficulties in successful adjustment. Because these behaviors often first become
problematic when children face increased school expectations and demands,
requirements for attention and concentration, and expectations of discipline and
conformity, some critics see the problem as one of regimented and
unimaginative schools that are too rigid to accommodate the varied needs of
children.
Thus, ADHD is commonly viewed as a contested behavior, not a true
disorder, serving the interests of schools in their need to maintain order, the
pharmaceutical industry that seeks to sell as many drugs as possible, or the
varying professions and clinicians who build their practices around treatment of
these children. Although there is some truth to such claims, they present an
incomplete and distorted story that often trivializes the pain, disruptions, and
frustrations caused by this behavioral syndrome, underestimating the large
personal and social costs for the children, their families, schools, and
communities. They also ignore the field’s increasing neurobehavioral
understanding and the effectiveness of some treatments.
This book brings together an unusual collaboration between an outstanding
clinical investigator of ADHD and other behavioral disorders (as well as mental
illness stigma) with a distinguished health economist who has specialized over
his career in the economics of mental disorders. Thus, this book is unique in its