Today is the day.  The day of your most important exam.  It's critical you get a B or higher on the test or else your GPA will drop and you'll lose your scholarship. Fortunately, you've studied for weeks and are fully prepared.  What you're not prepared for is the person sitting beside you and the constant tapping of their foot.  You can't comprehend a single question because all your mind can register is your peer's foot.  Suddenly, your professor tells the class to stop because time is up and turn in the tests, and you've only completed half of the exam.  This is an example of what every test day is like for someone who struggles with ADHD.

ADHD (Attention Deficit Hyperactivity Disorder) is the second most diagnosed childhood disease, next to asthma.  New information about the disorder has recently been published and people are becoming more educated and aware of ADHD everyday.  This is great news for those who have felt alone in their struggle through school and/or the workplace.  On the other side, the heightened awareness has lead to dramatic increases in ADHD diagnoses and stimulant prescriptions.  In a recent article written by Sanford Newmark for Psychiatry Advisor,  Sanford describes the different ways societal pressures are contributing to the increasing diagnoses of ADHD.  He starts by highlighting the dramatic increase in diagnoses stating that "In 2011, the CDC reported that the prevalence of attention-deficit/hyperactivity disorder in children ages 4 to 17 years was 11%, with 6.4 million children diagnosed with ADHD and 4.2 million taking psychostimulants" (CDC 1).

While stimulants can be extremely beneficial for some, there is no information or research being conducted on the long term effects of these medications.  This is because they are so new and bring in great wealth for the pharmaceutical industry.  It's unsafe for so many children, some being as young as 2 and 3, to be labeled ADHD and prescribed stimulants known for having an addictive nature similar to that of cocaine.  

As well as the little knowledge on ADHD prescriptions, there is no uniform test used to diagnose ADHD.  This leaves the final diagnosis decision up to a physician based on what a patient or patient's parent and/or teacher has said and the physician's own observations.  This is an issue because it makes getting a diagnosis and prescription extremely easy for just about anyone.  For the child with a parent who is addicted to prescription pills, for the energetic child whose parent(s) is too tired by the end of the workday to play with them, or the child who lacks discipline in the home, it is extremely easy for the parent to say their child is "hyperactive" and needs medication.  For this reason, a uniform diagnostic test and stricter guidelines need to be created for diagnosing ADHD.

The physician creates their conclusion through use of the most recently published DSM (Diagnostic and Statistical Manual of Mental Disorders) or other certified diagnostic manual.  The DSM lists criteria that a child must meet in order to be diagnosed with ADHD.  The problem with the DSM is that with each version, more criterion are added.  While this may seem like the result of research discoveries and studies, I believe it is society and its expectations for behavior which deem what behavior is acceptable and unacceptable for a "normal" child.  The expectations for children in America are set high and for some, possibly due to their home life or brain developmental process, may be unattainable.

The process for getting an ADHD diagnosis and a prescription for a stimulant is fairly simple due to the lack of diagnosis credibility and surplus of profit stimulant prescriptions bring in.  There are some tests available that increase the accuracy of diagnosing ADHD, but these tests are not 100% accurate, are expensive, and few practices have them available to patients.  Most physicians and specialists use a recent version of the DSM to ask the patient and guardian questions about how the patient struggles with ADHD in their day-to-day life.  If the patient meets at least 6 of the 9 criterion then they can be diagnosed with ADHD.  Another popular way to diagnose ADHD is through a survey-like test given by a physician or specialist.  Both the patient and parent answer statements by rating them on a scale of 1-5 on how often it applies to the patient's life.  The total score of the statements tells the physician how hyperactive, impulsive, and/or distracted the patient is.  Both tests are very similar and have the same problem: patients and/or guardians can exaggerate the truth to receive diagnosis.  Insert information collected from interviews here.  Since methylphenidate is known for its addictive nature, it is common for college students or parents who struggle with addiction to attempt to get a diagnosis and prescription for themselves or their child.  Because stimulants have brought in millions of dollars to the drug industry and there is no information as to if the long term effects of them could be dangerous, physicians/specialists do not question or second guess what the patient/guardian is telling them and are quick to write a prescription.  Our culture in America is fast paced and efficient, so writing a prescription that quickly puts money into the prescriber's pocket and solves the patient's problems seems like the best option.

Since America has become centralized around speed and efficiency, we apply those mechanisms to our community too.  We push our children to grow up faster than the last generation.  Unlike now, students enrolled in kindergarten 10-15 years ago weren't expected to be able to read and comprehend what they read.  The academic pressures on students are increasingly unachievable for some.  The area in which a child grows up can affect how much is expected of them.  For example, those in and around wealthier areas, such as Silicon Valley, where there's more pressure to get into a good college, one-third of children are prescribed stimulants for ADHD.  20 years ago a college degree wasn't necessary to get a decent job.  Today, a college degree won't guarantee you a job at all.  Areas of our nation that emphasize and prioritize academic success put stresses on students to do well throughout grade school and to be accepted into a good college.  If a student is talented in a non-academic way, such as sports or music, they're looked down upon and in some cases not allowed to play for their school team or band.  In areas where Medicaid is the primary health care, so lower income areas, ADHD prevalence is 33% higher than in the general population.  Reasons for this may include parent/teacher needs to control the behavior of children receiving little to no discipline at home (Newmark 1).  Another academically-centered issue impacting ADHD diagnoses may include educational policies.  The states which adopted "No Child Left Behind" saw the largest increases in the diagnosis of ADHD (Newmark 1).

We continue to put stress on our kids to do well academically, but we expect our kids to sit still and be quiet for 7-8 hours a day, 5 days a week; this is next to impossible for someone with ADHD.  If one child is out of line, it can cause a whole group of children to follow.  That one child, or the bad apple, may have ADHD, but because they can cause a whole group of children to follow their lead, the whole group may be seen as ADHD and referred to a doctor by the teacher for diagnosis.  The bad apple may not even have ADHD.  In this case, it's likely the child is not getting appropriate parenting and discipline at home.  If a child isn't getting the same or more discipline at home from a parent, how can they be expected to respect the discipline they receive from any other adult at school?  The child is seen as hyperactive by the teacher.  Once the child goes home, it is likely their parent has been at work all day and is exhausted.  The child, who has been around their peers all day, wants someone to play with them at home too.  The exhausted parent is too tired to tend to their child.  The child is seen as hyperactive by the parent.  Now that both the teacher and the parent see the child as hyperactive, the child must be ADHD, but they're not; the child is simply lacking discipline and structure in their day-to-day life.  Because it is more common today for both parents to have jobs and less common for one to stay home and tend to the child, this scenario is fairly common.

While some may say everyone has a little ADHD in them, it is those who truly struggle with daily tasks that need treatment.  Studies have shown that stricter guidelines and uniform testing prove more accurate diagnoses.  If there is so much proof and accuracy in these studies, why have no changes in the diagnostic process occurred?  It is because of the amount of profit brought in by stimulant prescriptions.  With no information on whether or not these stimulants are harmful in the long-run, there is no hesitancy to write a prescription.  So many children are brought in by their parents for a "quick-fix."  These overworked parents can't contain their children's energy and need something to make their job as a parent easier.  Teachers refer children for ADHD testing to make their job as a teacher easier.  It's all about making life easier and more structural.  For this to occur, our children need to be cooperative and successful.  The academic pressures our children feel are heavy.  With the expectations to make honor roll, be captain of the soccer team, and be vice president of a voluntary club, we push the importance of a resume from the start of their school career.  If the child fails at one aspect of our expectations, they feel as if they've failed at everything and that the failure will follow them through life.  With the economy lacking jobs, it adds more pressure for a child to get into the best college and graduate with a respected degree in hopes of competing with others for a decent job.  While it is important to find the happy-medium between free-time and discipline as a parent, it's important we don't look for the quickest fix if a child acts out of line a few times.  In conclusion, I leave this with a question: is the label of disordered worth a lifetime of excuses?
