How America Became an ADHD Nation

America appears to be in the middle of an attention deficit epidemic—but is it really? In his new book ADHD Nation, Alan Schwarz points out that,

“At the current rate, in 2017, half a million American children will be taken to their doctors and be newly diagnosed with attention deficit hyperactivity disorder. Many of them will receive thoughtful and reasonable evaluations and benefit from medication. Another sizeable number will be seen by casual clinicians who either bypass the child’s real problems or give in to his frustrated parents and teachers. Some of the adolescents will be faking ADHD just to get Adderall for themselves or others.”

Attention deficit hyperactivity disorder (ADHD) was first included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1987 and has been “increasingly diagnosed over recent decades,” writes Casey Schwartz in the New York Times.


In the fifth edition (DSM-5), the American Psychiatric Association states that “in most cultures” about five percent of children have ADHD.


The U.S. seems to have a different culture. “Fifteen percent of youngsters in the United States—three times the consensus estimate—are getting diagnosed with ADHD,” writes Alan Schwarz in ADHD Nation. “In southern states such as Mississippi, South Carolina, and Arkansas, it’s 30 percent of all boys, almost one in three.”


According to the Centers for Disease Control and Prevention as of 2011, “approximately 11 percent of children 4-17 years of age (6.4 million) have been diagnosed with ADHD.”


From these statistics, Schwarz concludes that “ADHD has become, by far, the most misdiagnosed condition in American medicine.” Unfortunately, the careless over-prescription has also led to widespread abuse. Adolescents can easily research the symptoms of ADHD on the internet, there’s even a wikiHow page entitled “How to Get an Adderall Prescription.” Armed with a catalog of fake symptoms, they can then try to obtain a prescription. But not only dishonest patients or lazy doctors are to blame.


In 2013, Schwarz reported that “the rise of ADHD diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult ADHD, which could become even more profitable.”


A 2013 study revealed that by year four, more than 60 percent of college students will have been offered prescription stimulants for nonmedical use. A survey released in 2014 by the Partnership for Drug-Free Kids suggests the misuse of prescription stimulants is becoming normalized among current college students and other young adults.


The predominant motive is studying. Casey Schwartz first took Adderall when she was a sophomore at Brown University, “lamenting to a friend the impossibility of her plight: a five-page paper due the next afternoon on a book I had only just begun reading.” The friend had a solution for Casey. “Do you want an Adderall?” she asked.


Soon, Casey started to depend on the pills. “Through my Adderall years, I lived a paradox, believing that the drug was indispensable to my very survival while also knowing that it was nothing short of toxic, poisonous to art, love and life.”


Millennials are the first generation of Americans who have been routinely prescribed stimulants during childhood and adolescence and who have gone on to abuse those stimulants in high school and college. Now they are starting to join the workforce and quitting the drugs can be difficult.


Despite pursuing an ambitious recruiting campaign, the U.S. Secret Service has been turning down job applications of promising candidates because they had abused Adderall, or other prescription drugs. Problematic prescription drug histories are emerging with troubling frequency, officials said.


Amphetamine use in the workplace is a tricky issue. There are now approximately five million stimulant prescriptions for adults in the United States and it is hard to tell how many are legitimate ADHD cases and how many are not.


In his book, Alan Schwarz describes a case in which “it took an entire six minutes for the doctor to diagnose her adult patient with ADHD, and to recommend some of the most addictive substances known to medicine.”


And addictive they are. Although Adderall is a Schedule II controlled substance, which carries a high risk for addiction or abuse, non-medical and illegal use has increased dramatically. A 2016 study found that non-medical use of Adderall by adults between 2006-2011 had gone up by over 67 percent and emergency department visits involving the medication had gone up by almost 156 percent in the same period.


Taking too much Adderall can cause dependence. Abruptly stopping the medication can cause depression, fatigue and sleep problems. It is especially dangerous to mix Adderall and similar substances with alcohol.


“Occupying a uniquely bizarre place in American culture, let alone medicine, ADHD has become the brain disorder some choose to fake,” writes Alan Schwarz in ADHD Nation. “Because Adderall, Concerta, and other drugs can instantly boost any person’s motivation and focus, whether for terms papers or tax returns, the pills move from medicine to performance-enhancing drugs, steroids for the brain.”