We are turning childhood into an illness

The statistics tell us that our children are getting sicker and sicker. Attention deficit hyperactivity disorder (ADHD) has more than tripled in just 20 years: It is now diagnosed in 11 percent of all kids, and in an astounding 20 percent of teenage boys. Autism is also on a rapid rise.  The latest reported rate suggests that it occurs in one in every 68 kids — 20 years ago it was less than one in every 500. Thankfully, childhood bipolar disorder has recently lost a good deal of its faddish luster, but for a while it enjoyed a bizarre 40-fold increase in popularity.

Don’t believe the statistics: They are wildly exaggerated. Our kids are no sicker now than they have always been, it’s just that they are too often mislabeled for behaviors that used to be considered part of normal variation. We are turning childhood into an illness.

The surest proof of misplaced diagnostic exuberance comes directly from the classroom. Research shows that the youngest kids in class are much more likely than the oldest to be diagnosed as having ADHD, and to receive stimulant treatment. It is shameful that simple immaturity due to being younger is now mislabeled as mental illness and mistreated with a pill.

A diagnosis of ADHD is useful only for those kids who have an early onset of very severe and persistent symptoms displayed in a wide variety of family, school, and social contexts. Children who are properly diagnosed after a careful evaluation and a period of watchful waiting usually benefit from the treatment and extra school attention.

But the two thirds or more of active kids who have been mislabeled with ADHD suffer unnecessary stigma, reduced expectations, and harmful drug side effects. We need to do a better job of protecting our children from such widespread careless diagnosis and reckless treatment.

One crucial step would be to tame the drug companies that have benefited from overselling the ADHD ill in order to push their stimulant pills. Pharmaceutical companies have used its formidable lobbying might to gain the unprecedented right to advertise directly to consumers — aiming directly at parents and teachers. The only other developed country on Earth that allows direct-to-consumer advertising is New Zealand.

Massive and cleverly misleading marketing has transformed the stimulant drug market from a minor player to a $10-billion-a-year cash cow. This is great for executives and shareholders but bad for the kids who are mislabeled and mistreated.

Wouldn’t it be a much better world if most of this misspent and wasted money were instead budgeted toward better schools? We should be able to manage the more active kids with educational tools rather than subjecting them to fake medical diagnoses.

What makes more sense: Promiscuous use of pills or smaller class sizes and more facilities for physical activity that allow kids to blow off steam?

Our country is spending far too much on unnecessary and often iatrogenically harmful medical care and far too little on education. It is completely irrational to shortchange our schools and then spend a bundle on misguided medical treatment for normally active kids who don’t do well in a stressed school environment.

A first step would be to follow the lead of the rest of the developed world and end all drug company advertising. We shouldn’t fall for the sales pitch that the problems in our schools should be treated by medicating our kids.

Instead, let’s diagnosis and treat our classrooms and playgrounds, not overdiagnose and overtreat our children.

Allen Frances is a psychiatrist and professor emeritus, Duke University.  He blogs at the Huffington Post.

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  • Jennifer Jonsson

    I’m glad childhood bipolar disorder is no longer the “diagnosis of the week,” but I’m bipolar and I had clear symptoms from about age four (and maybe before). The idea of a child being bipolar was unheard of in the 1970s, but “hyperactivity” wasn’t and I spent a lot of my youth being medicated for the wrong thing. (Put a manic kid on stimulants–oh yeah, that’s a good idea.) My fault or my parents’ fault that the meds didn’t work, never the fault of the meds themselves.

    This condition has been like a tornado in my life, repeatedly showing up and wreaking havoc with relationships, jobs and everything else I value. Again, I can see how overdiagnosis is a real problem but I hope clinicians don’t abandon childhood bipolar disorder entirely. If I’d gotten effective treatment when I was young, my life would have been a lot easier.

  • http://www.affordablehealthclinics.com Robert J Tilley MD

    I agree wholeheartedly about overtreatment of inattentiveness. I have two other thoughts.
    1. Inattentiveness is a symptom, not a disease. All too often we confuse the two, especially in mental health. There are many causes for inattentiveness – physical, mental and social. The article identifies simple immaturity as one potential “cause” of inattentiveness. Not all inattentiveness is ADD.
    2. I question whether inattentiveness is increasingly a product of our environnment. My father once said that as a young adult he had one number to remember – the number of his house. Now we are bombarded with usernames, passwords, twitter feeds, facebook, apps, online activities and on and on. Our jobs are the same, with technology interrupting and eventually dominating our day to day activities. We physicians can certainly attest to this. It almost takes a degree in computer engineering just to understand all of the options to open a bank account. I wonder whether we simply have an increasing segment of our population that are simply not capable of managing all this comples multitasking which then manifests as “inattentiveness”.

  • VoxLogos

    … you do realise that people on the autistic spectrum cannot be medicated for it, nor do they want to be, because it’s a neurological variance and a key part of their identity, right?
    So yes, moving away from throwing pills at any medical problem in the case of that particular mental ‘disorder’ would be a good idea.
    (That said, comorbidity with other conditions which CAN be helped with medication can be relatively high with some that are autistic, so that aspect of their health being medicated can be presented as an option.)

    But yes, as you pointed out, there is a heavy stigma towards mental health conditions in general.
    Much of it is ignorance about the nature of.. well, just about anything.
    (The average layperson knows next to nothing about any mental disorder, & what they do know often involves misinformation or an extremely simplistic and exaggerated view.)

    Also, on the previous note about medication and the autistic spectrum, that is why ‘Autism Speaks’ is universally hated by individuals that are themselves autistic.
    They push for a ‘cure’ (when the alleged afflicted often don’t want “fixed” ; they want support and respect), they sympathise with and excuse parents that consider killing themselves or their child (in front of said child in some instances), & not ONE member of their leadership is autistic themselves.

    I would agree with the article that there is a wide range of natural variation.
    Whilst some fall far enough out (& exhibit other conditions which exacerbate the issues) that they need more serious support, the “mild” instances can still benefit from a diagnoses IF it means they have access to support that enables them to cope and maintain independence or near to it.
    That applies to ADHD/autism in particular since it’s not so much that either group is (necessarily) incapable but that they may need support in certain areas or adjustments to accommodate their particular quirks.
    If those are in place, individuals from either group can often excel.

    Apologies for the lengthy spiel, & I ultimately do agree with your post, but the comment about not moving away from the medical model was ever so slightly too close to the idea that everything should be medicated.
    I think modern medicine is at risk of forgetting the ‘patient care’ side of things amongst the tide of pharmaceutical solutions.