Medicating Children: ADHD and Pediatric Mental Health

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Why and how did ADHD become the most commonly diagnosed mental disorder among children and adolescents, as well as one of the most controversial? Stimulant medication had been used to treat excessively hyperactive children since the 1950s. And the behaviors that today might lead to an ADHD diagnosis had been observed since the early 1930s as "organic drivenness," and then by various other names throughout the decades. Rick Mayes and his coauthors argue that a unique alignment of social and economic trends and incentives converged in the early 1990s with greater scientific knowledge to make ADHD the most prevalent pediatric mental disorder. New movements advocating for the rights of children and the disabled and a massive increase in Medicaid spending on psychotropic drugs all contributed to the dramatic spike in ADHD diagnoses and stimulant use. Medicating Children is unique in that it integrates analyses of the clinical, political, historical, educational, social, economic, and legal aspects of ADHD and stimulant pharmacotherapy. Thus, it will be invaluable to educators, clinicians, parents, and policymakers, all of whom are trying to determine what is in the best interest of millions of children.

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Editorial Reviews

New England Journal of Medicine

This book reminds us that a vast array of social and political factors will affect decisions regarding the medicating of children. Medications might be approved by the FDA, but many years of public debate will probably be required before the use of these medications is considered acceptable.
— Joseph J. Jankowski

Leon Eisenberg
In this thoughtful and critical book, Mayes and colleagues provide answers where there is evidence for them and makes it clear why some questions cannot be answered with what we know today. Parents, teachers, and doctors will be the wiser for reading it.
C. Keith Conners
Rick Mayes and colleagues have made a brilliant, scholarly, and unique contribution to the literature on ADHD. In a critical but balanced approach, the authors fill the gaps in understanding left by narrow and one-sided debates. A must-read for anyone interested in ADHD.
Stephen P. Hinshaw
Without pulling any punches, the authors take on the many diverging opinions about attention deficits and hyperactivity in today's world, skillfully blending perspectives from science, clinical practice, and policy, helping readers sort out fact from fiction in the overly heated media coverage. Analyzing a real condition, but one steeped in the loaded crossfire between big pharma, media frenzy, biology vs. culture, and the very nature of childhood itself, Medicating Children is a beacon of reason.
Judith L. Rapoport
At last, a balanced and comprehensive account of the history, science, treatment and controversy of ADHD. Medicating Children is scholarly but very readable. This unique book will be my first reading recommendation to anyone interested in ADHD.
Ronald T. Brown
There are likely more journal articles and books on the topic of ADHD than there are children with the disorder, but this work indeed is a rare find. Thoughtful, comprehensive, and carefully referenced, this seminal work manages to weave an important tapestry of mental health services practice in this nation, public policy, and the unique challenges in providing mental health care to children and adolescents.
Deborah Stone
Start with one of the most intriguing socio-medical puzzles of our time: Why the explosion in prescription stimulants for children at a time when we're supposedly fighting a war on substance abuse? Add a hefty dose of intellectual curiosity and mix with three well-tempered analytical minds. Pour into elegant narrative prose. Voilà! A broad-ranging, comprehensive, and wise interpretation of mental health, politics, policy, and scientific culture. And like all good works of art, this one reveals the world in a grain of sand.
Edward Hallowell
Medicating Children is superb, a tour de force. If you want the most balanced, informed, and sane view on the use of medication in children who have ADHD, read this book.
Howard Markel
Mayes, Bagwell and Erkulwater have both written a brilliant book and performed a great public service. Medicating Children should be required reading for anyone wishing to understand the complex and complicating legal, medical, historical, economic, and political frameworks of attention deficit disorder in the United States. This measured, thoughtful, and elegantly written volume is a scholarly tour de force.
Steven Mintz
With clarity and compassionate insight, this remarkable book explains why ADHD becomes the most commonly diagnosed psychological disorder in children, and how millions of children came to be treated with stimulants. But Medicating Children does something more: It brilliantly describes a paradigm shift in thinking about mental disorders—from a psychodynamic to a biological view—and details the converging factors—including shifts in disability law, welfare policy, and research funding—that opened the door to the greatly expanded use of psychotropic drugs to treat not only ADHD, but childhood depression and other mental disorders in the young as well.
New England Journal of Medicine - Joseph J. Jankowski
This book reminds us that a vast array of social and political factors will affect decisions regarding the medicating of children. Medications might be approved by the FDA, but many years of public debate will probably be required before the use of these medications is considered acceptable.
New England Journal of Medicine
Medicating Children is an account of the past 100 years of the diagnosis and treatment of attention deficit-hyperactivity disorder (ADHD). The three authors come from different fields: Rick Mayes is a public policy analyst specializing in health care policy and mental health; Catherine Bagwell is a clinical psychologist who works with children who have ADHD; and Jennifer Erkulwater is a political scientist whose research focuses on disability, education, and social welfare policy.

Beginning with George Frederick Still's description of the hyperactive child in 1902 and continuing into the present, there has been controversy regarding the clinical features of ADHD and the efficacy of its treatment. Before 1902, it was felt that children who would now receive diagnoses of ADHD merely required training or discipline. In 1937, the amphetamine Benzedrine was found, accidentally, to be helpful in the treatment of "hyperactive" children, but it was allowed for use only in children who were hospitalized or in severe straits. In 1955, a new stimulant called methylphenidate (Ritalin), which was similar to Benzedrine, was developed and marketed as having fewer side effects and less potential for abuse than other stimulants. Stimulants were approved in 1961 by the Food and Drug Administration (FDA) for use in children with behavioral problems - 24 years after they were first reported to be effective by clinicians.

Over the next 10 years, many groups debated the use of psychoactive stimulants in children. By 1976, committees had been appointed in numerous states to investigate the use of stimulants in children. Nine states instituted guidelines and legal controls, and three states banned research on these compounds in children. Nevertheless, the number of children in the United States who were receiving stimulant medication rose to 600,000, a fourfold increase between 1970 and 1978. In the 1990s, increased eligibility for Supplemental Security Income and Medicaid increased the number of children who were able to have prescriptions for stimulants filled. Between 1991 and 2001, Medicaid spending on psychotropic medications grew tenfold, from $0.6 billion to $6.7 billion.

In 1980, attention deficit disorder (ADD) was included as a diagnostic category in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). This diagnosis received further specificity in 1994 in the fourth edition of the DSM (DSM-IV), the edition that is still in use today. With the evolution of ADHD as a diagnosis, stimulant medication became the first psychotropic medication targeted to treatment of a specific diagnosis in children. As a result of the increase in the number of children taking methylphenidate, a backlash against medicating children took place in the mid-1990s. Many asked whether ADHD was a valid medical disorder, whether any psychotropic medications (stimulants included) had any efficacy, whether they could be administered safely at any dose, and whether these medications were overused.

This book reminds us that a vast array of social and political factors will affect decisions regarding the medicating of children. Medications might be approved by the FDA, but many years of public debate will probably be required before the use of these medications is considered acceptable.

Joseph J. Jankowski, M.D.
Tufts University School of Medicine
Boston, MA 02111
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Product Details

  • ISBN-13: 9780674031630
  • Publisher: Harvard University Press
  • Publication date: 1/31/2009
  • Pages: 360
  • Sales rank: 1,070,713
  • Product dimensions: 6.10 (w) x 9.40 (h) x 1.20 (d)

Meet the Author

Rick Mayes is Associate Professor of Public Policy at the University of Richmond.

Catherine Bagwell is Professor of Psychology at Colgate University.

Jennifer Erkulwater is Associate Professor of Political Science at the University of Richmond.

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Table of Contents

  • Acknowledgments
  • 1. Introduction
  • 2. An Introduction to ADHD
  • 3. A Survey of the Evolution of ADHD and Pediatric Stimulant Use, 1900–1980
  • 4. The Transformation of Mental Disorders in the 1980s: The DSM-III, Managed Care, and “Cosmetic Psychopharmacology”
  • 5. ADHD and the Politics of Children’s Disability Policy
  • 6. The Backlash against ADHD and Stimulants
  • 7. Current Questions about Stimulant Treatment for ADHD
  • 8. Conclusion
  • Notes
  • Selected Bibliography
  • Index

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Sort by: Showing 1 Customer Reviews
  • Posted August 14, 2009

    more from this reviewer

    A Balanced Book on ADHD and Stimulants

    Benjamin J. Lovett, Ph.D., is an assistant professor of psychology at Elmira College, where he teaches classes on a variety of topics in applied psychology and his research focuses on the conceptual and psychometric foundations of psychoeducational assessment and psychiatric diagnosis.

    The vast literature on Attention-Deficit/Hyperactivity Disorder (ADHD) can be classified into three categories. In the first category we find most of the literature, which treats ADHD as a well-established medical condition whose validity is not in any doubt. Almost all of the scientific research on ADHD fits into this category, and most of the popular books on ADHD do as well. In a second, smaller category we find wholesale attacks on the concept of ADHD, which is described variously as a myth, a social construction, or the product of a conspiracy by drug manufacturers. There is occasional scholarly work in this vein, but most of the literature in the second category consists of books meant for a general audience. Finally, in what is by far the smallest category, we find literature that takes a position in the middle. The few authors in this last category understand that people with ADHD diagnoses often have very real cognitive and behavioral problems that make life difficult, but these authors also understand that determining who merits a formal diagnosis of ADHD is an extremely difficult process, misdiagnoses are common, and society plays a large role in deciding what behavior is abnormal and should be treated. In short, these authors admit that the issue of ADHD is complicated. Medicating Children is a contribution to this third category, and that alone is enough to celebrate its arrival.

    Taking the via media in the ADHD debate is difficult to do well. It is easy enough to say that things are complicated, but exploring those complications in detail and emerging with convincing conclusions is the bolder task that Rick Mayes and his colleagues set out to complete. The result is an interesting hodgepodge of chapters, mostly historical in nature, and each focusing on a few central questions. The first full chapter is a review of the clinical literature on ADHD: its symptoms, epidemiology, causes, and treatment options. Mental health professionals may be familiar with this information, but given the book's broader audience, it is useful background for the remainder of the book. This chapter is also emblematic of the book's neutral tone and approach: research is reviewed clearly without the injection of opinion, and when extant findings are controversial or insufficient to draw conclusions, this is noted as well.

    I was impressed by the range of scholarship that the authors considered throughout the book, and the endnotes and bibliography (over 100 pages, together) are as useful as the text itself. More generally, the volume fills a unique spot in the ADHD literature, providing a detailed historical account of the controversy over ADHD and medication treatment options for it. The writing is clear and accessible, and I would recommend it to general readers who would like to understand the ADHD controversy. The book's balanced tone comes from its unwillingness to take a side, rather than its crafting of an insightful and novel interpretation of the issue. Still, it is a valuable addition to the category of "balanced" books about ADHD and should be required reading for any researchers in the field.

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