In 1845, the German physician Heinrich Hoffmann penned a jaunty verse to his son. Entitled The Story of the Fidgety Philip, Hoffmann’s poem perfectly encapsulated parental frustration with children who, for whatever reason, are unable to regulate their behaviour in accordance with adult expectations. “Let me see if he is able/To sit still for once at a table,” Hoffmann begins his ditty, only to recognise that Philip is an incurable wriggler and incapable of being, as he puts it, “a little gentleman”.
Hoffmann could not have imagined that, 150 years later, Philip’s fidgets would become a cardinal sign of Attention Deficit Hyperactivity Disorder (ADHD), resulting in the needless medicalisation of millions of American teenagers.
Formerly known as “hyperkinetic impulse disorder”, “minimal brain dysfunction”, and attention deficit disorder, the American Psychiatric Association finally settled on ADHD in 1987. But as early as 1970, intolerance of disruptive classroom behaviour, coupled with growing parental anxiety about their children’s school performance, had led to a steady increase in demand for Ritalin, the first ADHD wonder drug. The result today is that 15% of children in the US have been diagnosed with ADHD, while in some southern school districts the rate for boys is as high as 30%. And this for a condition that scientific studies suggest affects no more than 5% of children.
In ADHD Nation, the New York Times journalist Alan Schwarz aims to make sense of this disturbing medical and cultural phenomenon by speaking to the psychiatrists who pushed the diagnosis of ADHD, and the parents and children who bought into it – oblivious to the fact that Ritalin and copycat medications such as Adderall were addictive and could trigger dangerous side-effects, including hallucinations and psychosis.
In keeping with a story that began as a newspaper exposé, Schwarz reserves most of his scorn for the pharmaceutical companies and their paid-for scientific experts, who touted the benefits of treatment drugs while downplaying or ignoring evidence that might have given parents pause for thought. In so doing he provides a valuable corrective to those ads promising that Ritalin can make “the problem child become lovable again”.
However, while calling ADHD “by far the most misdiagnosed condition in American medicine” and acknowledging that the “disorder” is purely functional (there is, as yet, no objective blood test or CAT scan to identify the disorder), Schwarz rejects any idea that ADHD is a construct of our anxious, post-capitalist times. “ADHD is real,” reads his opening sentence. “Don’t let anyone tell you otherwise.” The result is to foreclose what could be a more sophisticated analysis.
The limitations of Schwarz’s approach are most evident in his sympathetic portrayal of Carmen Keith Conners, the former Rhodes scholar who was the first to study the effects of Ritalin on children with ADHD, and founded the ADHD programme at Duke University, North Carolina. While other experts are as good as accused of being shills for Big Pharma, Schwarz presents Conners as a naive, ivory tower academic who genuinely believes his studies can make a difference to “legitimate” sufferers. This despite the fact that Conners is just as happy to accept paid gigs to speak at drug conferences, and lend his name to diagnostic questionnaires which, marketed to incompetent psychiatrists and family doctors, are easily “gamed” by students desperate to obtain Ritalin to boost their performance.
It was only towards the end of his career, in 1998, that Conners realised the damage wrought in his name, calling ADHD a “national disaster of dangerous proportions”. But by then, no one – except Schwarz and the worst-affected patients, two of whom we meet in the book – was listening.
Schwarz seems to think there is still time to return the ADHD genie to the bottle. But now that fidgety Philip is doing a high-pressure job in Wall Street, demand for what in a previous era were known as “pep pills” only looks set to rocket. As Conners himself realised when he tried Ritalin, and liked the effects so much he swore he’d never take it again, ADHD is simply the fall guy; the real problem are the drugs and regulatory systems that allow the vulnerable easy access to them.
ADHD Nation is published by Little Brown (£14.99). Click here to buy it for £12.29
