Educators’ Role in A.D.H.D. Misdiagnoses

My View

While spending four years examining the rampant mishandling of Attention Deficit Hyperactivity Disorder in children, first for The New York Times and then for a more wide-ranging book, A.D.H.D. Nation, I suspected our education system would be held responsible for what one of A.D.H.D.’s founders has declared “a national epidemic of dangerous proportions.”

You’ve all heard it: Teachers just want to drug disruptive children into obedience, either to calm their classrooms or raise the test scores used for performance accountability. They pressure parents into getting their kids diagnosed. School districts rely on prescription medication to replace expensive support staff, allowing class sizes to swell and operating budgets to balance.

But this doesn’t add up. We must heed the shreds of reality in each of those statements, but educators are better cast not as scapegoats for the past, but as drivers of future reform.

CDC Documentation

What does add up, to heights now grotesque, are the numbers. According to the U.S. Centers for Disease Control and Prevention, 15 percent of America’s children get diagnosed with A.D.H.D. by the time they leave high school. About 14 percent of 3rd-grade boys, one in seven, already have been diagnosed — with most of them put on serious medications like Adderall or Concerta. This is the nationwide picture. Some communities, particularly in the South, have close to 30 or 40 percent of children being told they have this serious, often life-lasting, brain disorder.

These rates are clearly unjustified — and raise the question of just whom these diagnoses are actually for, the children or the grownups around them.

After studying the 100-year rise of the A.D.H.D. phenomenon, surveying all the forces and factions behind this shameful situation, I see responsibility resting mostly with three groups: doctors who blithely diagnose kids and prescribe medication, researchers who have enriched themselves by publishing specious studies, and drug companies that have pushed their products on doctors and parents well beyond conscionable bounds.

Educators’ Part

The role of educators has been less direct. Particularly in the 1980s and ’90s, teachers and other school staff did coerce many families into getting their children diagnosed and medicated, sometimes in the best interests of the child but other times in the best interests of the teacher and school.

This well-substantiated fact, however unpalatable, led to state laws that continue to forbid school officials other than licensed health providers to even utter “A.D.H.D.” or “Adderall” to a parent. But it still happens a lot, just more subtly. (Many teachers say the magic question is now, “Have you had Billy evaluated?”) To suggest that no teacher is human enough to prefer class-distracting Kristin to calm down and stop impeding state-test prep lies somewhere between quixotic and insulting.

But when Simon & Schuster proposed that my book’s subtitle — ultimately Children, Doctors, Big Pharma and the Making of an American Epidemic — include the word “Teachers,” I refused. Given all the other evidence, it’s just not fair, let alone constructive.

Economic Forces

So what are school systems to do? Sadly, this would mean reversing the economic choices that bedeviled superintendents and school boards already have made.

Cutting recess and physical education has denied an increasing number of students, many of them boys, from their natural need to burn off physical energy, leaving that energy to burst out elsewhere and be mistaken for clinical A.D.H.D. (My 5th-grader’s once-a-week gym period is generally spent, I kid you not, cup-stacking.) Stuffing 30-plus students into classrooms is to deny the three or four who have particular trouble focusing the individual attention they need, attention they might have received from an extra aide had that luxury not been eliminated in the last round of budget cuts. And judging educators more and more by test scores only tempts some to raise those scores through diagnoses and medication.

One doctor in Georgia told me that he prescribes Adderall to kids not because they have A.D.H.D., but to compensate for subpar schools and services. He explained: “We’ve decided that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

To consider that statement is to be ready to help.