A study from the University of California at Berkeley just announced that worldwide use of attention-deficit hyperactivity disorder medication has tripled since 1993. After 14 years of media coverage, scientific studies and pharmaceutical P.R., this bulletin hardly seems like anything to write home about, but what's fascinating is how the study is being interpreted. Since the lion's share of ADHD meds are consumed by children and adolescents in the U.S. (a whopping one in 25 kids), some have called the disease an American phenomenon that embraces a psychopharmaceutical solution to unruly and spaced-out kids. This study, researchers say, shows that ADHD doesn't exist only in the U.S., but seems to afflict children worldwide.
Here's a snippet of the press release: "The results temper some key criticisms of ADHD," said Stephen Hinshaw, chairman of UC-Berkeley's Department of Psychology and another coauthor of the study: "A common misconception is that ADHD only exists in the U.S. and that the pharmaceutical firms are getting bigger sales because of the 'creation' of the disorder in the U.S."
But, um, couldn't this study also prove just the opposite? That makers of Ritalin, Concerta and other psychostimulants have upped the ante and are successfully promoting their products outside our borders? Couldn't it be another manifestation of American culture and companies' overweening influence on other countries?
Full disclosure: When I was an 8-year-old, my chatterbox/spaced-out disposition would have made me a perfect candidate for today's ADHD drugs, so I must admit some skepticism when it comes to the entire phenomenon. I was a royal pain in the ass, I'm sure. Hyper in every way. Luckily I had classrooms without chairs and desks and teachers who allowed me to write a poem one moment and cartwheel across the room to deliver it the next. Later, my mother told me my older brother wanted me medicated, though my brother now says it was my doctors who recommended a little chemical therapy. Somehow everyone lived through my antics without pathologizing them and I grew into a happy, strangely unrebellious teenager who trusted her own decision making. I can't be sure I would have found that balance had I used medicine to calm down.
It's not like I don't think the drugs help many kids, or that serious cases of ADHD don't exist. But the rise of a childhood disease that so closely mimics the difficult, downright irritating aspects of many children's personalities still seems vulnerable to overdiagnosis. One 2002 Columbia University study of several hundred children with ADHD, which compared the efficacy of drugs with behavioral intervention, showed that after three months half the families were so happy with the new behavioral techniques that they no longer felt the need to participate in the study. Researchers noted that the children didn't change as much as the parents' attitudes and management strategies.
That the globe is following suit and prescribing stimulants to children at increasing rates seems like mixed news at best. However, the Berkeley researchers concluded that the study's findings "make a strong case for further studies on the long-term benefits of ADHD medications." Nowhere is there a word about long-term side effects or risks associated with ADHD medications, despite the real, if rare, cases of ADHD-drug-related psychiatric troubles and heart failure. But if 4 percent of the globe's children are destined for an ADHD drug, it's worth wondering: Are we discovering a disease or redefining childhood?