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1 - The ADHD Epidemic
Attention-deficit hyperactivity disorder (ADHD) is a phenomenon of the late twentieth century. At no point in history have such large numbers of children thought to be diseased on the basis of what some might call unruly behavior. Yet in the past two decades, ADHD has become one of the most commonly diagnosed disorders of childhood in the United States. Controversy surrounds the precise numbers of children currently diagnosed with ADHD. Since U.S. doctors are not required to report their diagnoses to a central database, figures are extrapolated from surveys of smaller populations and from records on the production of Ritalin, the treatment most often prescribed for ADHD. The National Institutes of Health reported in 1999 that ADHD affected 3 to 5 percent of all school-age children in the United States, while Joseph Biederman, an influential ADHD researcher from Harvard Medical School, has suggested that as many as 10 percent is a more realistic approximation. Despite the lack of agreement, one thing is certain: The numbers are continuing to grow.
Records kept by the U.S. Drug Enforcement Agency on the production of Ritalin show a steady annual output of 1,700 kilograms of Ritalin through the 1980s, fluctuating only slightly each year. Beginning in the early 1990s, however, Ritalin production rose sharply - with a record production of 13,824 kilograms in 1997, 90 percent of which was consumed in the United States. This dramatic 700 percent increase led pediatrician Barry Diller to conclude that, since 1990, the number of adults and children diagnosed with ADHD in the United States alone has risen from about 900,000 to almost 5 million. It is clear that ADHD has become a public health concern of epidemic proportions.
The History of ADHD
The emergence of ADHD represents the medicalization of what have typically been considered normal childhood behaviors. What one ADHD expert calls the "holy trinity" of symptoms - poor self-control (impulsivity), poor attention (distractibility), and excessive activity (hyperactivity) - describes behaviors that seem to characterize all children at some point or another. So when did these behaviors become an illness?
Author and ADHD critic Thomas Armstrong has likened the evolution of ADHD to the "errant wanderings of a pinball through the mazes of an arcade machine." Its history is not that of a mysterious disease unmasked by a researcher; instead, ADHD has gone through multiple categorizations and manifestations. In fact, over the decades the disorder has gone through at least twenty-five name changes. There has also been debate over how to diagnose ADHD, with much controversy over exactly how many symptoms a child must exhibit to warrant the diagnosis. Currently a child must have six symptoms in two categories of behavioral signs to be considered to have ADHD. Some researchers have suggested that just five symptoms would be a better counter, but other researchers protest that