If someone were to say that the number of cancer cases were rising in an exponential fashion, it would draw serious attention to the issue. Scientists across the globe would be studying the cause of the sudden rise and looking for solutions. That said, why is it that the exponentially rising number of ADHD cases in America is being so overlooked?  As of 2014, 6.4 million children were diagnosed with ADHD, a 42% increase in the previous eight years (Holland and Riley, 2014).  This striking surge has been written off countless times by drug companies and doctors who claim that the rate is due to an increase in knowledge of the disorder. To blindly follow this school of thought would be to completely ignore the bias of the drug companies who profit from the rise and the doctors who diagnose the disorder. Upon further investigation, the increasing rate of ADHD in America is due largely to misdiagnosis. The confounded causes of these misdiagnoses are a changing system of education, push from drug manufacturers and, most importantly, the subjective diagnostic process. Without the subjectivity of the diagnostic process, which is commonplace for the diagnosis of many mental health disorders, none of the previously listed matters could have any significant effect on the rising frequency of ADHD diagnosis.

Firstly, it is important to acknowledge the consequences of the vast amount of ADHD misdiagnoses. Most commonly, children who are diagnosed with ADHD are prescribed amphetamines and methylphenidates such as Ritalin, Adderall, and Vyvanse. These drugs are stimulants, meaning that they increase body activity and hyperawareness (Rettner, 2013). Children with ADHD have shown positive results while using these medications because they help to improve focus and settle hyperactivity. However, these drugs have serious long term effects, particularly on those have been wrongfully diagnosed with the disorder. In addition to increased risk of heart attack and stroke, misdiagnosed children are at higher risk for other problems while taking the drugs such as mood disorders and aggressive behavior (Rettner, 2013). What is worse yet, doctors are prescribing these drugs at an even younger age than they were before. As of 2015, over 10,000 children between the ages of 2 and 3 have been prescribed some form of ADHD medication and, due to the rates of misdiagnoses in the country, we can deduct that many of these drugs are prescribed to perfectly healthy toddlers (Lane, 2015).  American children are being started on highly addictive drugs before they are even able to read, causing them to develop a tolerance as the years go on. As these children age, they will be forced to continually increase their dosage and, subsequently, increase the side effects of the medication. To make matters worse, these young kids are already at the highest risk for many of the more serious side effects of these stimulants. For these reasons, the rapidly increasing amount ADHD cases needs to be addressed. However, the issue is not currently being addressed because, the players who are contributing to the growing counts of the disorder also stand to benefit from them.

Our school systems are, in part, to blame for the climbing numbers. It seems that as every generation enters into school age, they are struck with exceedingly difficult tasks that were not put upon the generation before them. Children are given more homework and expected to take more tests as time goes on. As such, the rates of ADHD in America are climbing alongside the rates of standardized testing (Robinson, 2010). However, this may have less to do with the actual testing and more to do with the legislation surrounding it. In 2001 President Bush passed the No Child Left Behind Act that allocated funding to schools based on their standardized test scores. Under this legislation, which was adopted by the states at different rates, children with ADHD are excluded from the reported standardized test data (Koreth-Baker, 2013). So, while this sort of legislation was instated with the intention of helping the most hard-to-reach students, it actually incentivized teachers to report this to parents as a problem with the student, rather than with them. Parents then take the children to doctors, who are quick to diagnose the children as ADHD, because they are falling behind in school. With these children excluded from the data, schools are able to report higher scores and therefore receive more funding. Not coincidentally, some of the first states to adopt such a policy are also the states that have some of the largest instances of ADHD in the country. For instance, the state of North Carolina, one of the first to adopt the policy, has a rate of 15.6% of 4-17 year olds diagnosed with ADHD (Koreth-Baker, 2013). This is significant considering California, one of the last to adopt the policy, has a rate of 6.2% diagnosed with the disorder. These discrepancies are not the only alarming numbers surrounding this change in legislation, though. The New York Times Reports, “Nationwide, the rates of A.D.H.D. diagnosis increased by 22% in the first four years after No Child Left Behind was implemented” (Koreth-Baker, 2013). The No Child Left Behind Act, and other similar state legislation, have been contributing significantly to the rising rates of ADHD. This is because of the prioritizing of standardized test scores in America and increased pressure on teachers to produce good results.

However, it is more than just legislation in our schools that contributes to the climbing proportions of ADHD cases. Teacher to parent testimonial is often all it takes for an ADHD diagnosis and is typically skewed by outside factors. In a study done by Michigan State University in 2010, researchers looked at the relative ages of children in school. The study showed that the youngest kids in the class, those with birthdays closest to the school’s cut-off date, were 60% more likely to be diagnosed with ADHD than their older classmates. This blatant discrepancy is due to the maturity of the students compared to one another. Essentially, children who are younger are more likely to get distracted and act hyper than the older students. When teachers see the difference in the behavior of the students, they relay to the parents that the children show signs of ADHD and this leads to misdiagnosis (Elder, 2010). This study proves that teacher testimonial, although given with good intentions, is a very unreliable source when it comes to ADHD diagnoses. Unfortunately, these testimonials are so trusted by parents and health professionals that it can be the sole reason for why children are prescribed the harmful medication.

Though it is clear that the school systems play a key role in the ADHD epidemic, they are not the only power players who stand to benefit from it. Drug manufacturers worldwide profit from the considerable amount of American children who are diagnosed with ADHD. In fact, American methylphenidate prescriptions make up between 80 and 90 percent of all production (Stolzer, 2007). Because of this, it would make sense for these manufacturers to target their key demographic of American children and their parents. Pharmaceutical companies have done just that. The firms secured America’s spot as the number one buyer of ADHD medication through the following process according to Alan Schwarz, writer of ADHD Nation:

[Pharmaceutical companies] corralled all the top researchers and doctors in the field and paid them five, six, even seven-figures apiece to conduct studies all written in the same key: ADHD is more widespread and dangerous than anyone knows, the drugs work wonderfully and with almost no side effects, and that if you don't diagnose and medicate a child, he or she will be doomed to academic and social failure, crash their car, get venereal disease and more.

In this quote from Schwarz’s interview for Scientific American, he explains one way that drug companies have led to increased diagnoses of ADHD. Although the research was not completely unfounded, the reports were greatly exaggerated in order to skew the results to benefit the drug companies. With the publication of ‘credible’ scientific studies that popularized the disorder, doctors, parents, and teachers were even more likely to attribute normal childhood characteristics to ADHD. Additionally, doctors and parents were more open to the idea of prescribing medication to children because the drugs supposedly had no side effects. The subjectivity of the diagnostic process allowed the proclamations to contribute to the growing epidemic and as far as the doctors were concerned, the increasing rates of ADHD as a result of these studies only further proved them right.

Drug companies also play a more indirect role in contributing to the ADHD epidemic. In addition to skewing academic studies in their favor, the company’s excessive advertising for their pharmaceuticals contribute to the rising numbers. The ads can be seen in parenting magazines, doctor’s offices, medical journals, and television/radio commercials. The widespread advertisement campaign works so hard to pacify parental conscience of giving children psychotropic drugs that it causes unnecessary worry for normal child behaviors. Any inattention or hyperactivity by children could be mistaken as ADHD by parents because the company’s work to normalize the disorder (Stolzer, 2005). The role of these businesses in the normalizing of the disorder, the research into the disorder, and the funding of the doctors that diagnose the disorder creates a large conflict of interest. These firms have are not concerned with the best interest of the patients, but rather the best interest of their own bank accounts. Best said by Stolzer, “the American consumer should be the beneficiary of authentic and scientifically validated research—not the pawn of an economic partnership” (Stolzer, 2005). In order to prevent this relationship from further adding to the epidemic, laws need to be implemented to stop these companies from perpetuating a dangerous monopoly.

Lastly, and most importantly, none of these factors could have any significant effect on the ascending numbers if the diagnostic process was more definite and less subjective. The ability of school systems and drug companies to have any effect on the number of misdiagnoses stems from the subjectivity of the diagnostic process. If the tests were not subjective, then the children and parents that are sent to the doctor, that wrongfully believe they have ADHD, would not receive a diagnosis. A definitive test, like a blood test or CAT scan, would diminish the effect that these outside factors have the epidemic. Moreover, a biologically rooted test is a feasible form of diagnosis for ADHD because the disorder has been shown to have genetic origins. Michigan State University conducted a study on fraternal and identical twins that compared the likelihood that both of the identical twins would have the disorder to the likelihood that both fraternal twins would have it. Because identical twins share almost 100 percent of the same genes and fraternal twins only share about 50 percent, when more of the identical twins showed symptoms of ADHD it showed scientists that the disorder is likely genetic (Koreth-Baker, 2013). Additionally, “the brains of people with ADHD are different. They're short on receptors for the neurotransmitter dopamine, and their brain volume looks to be slightly smaller” (Lunau, 2014). As such, the diagnostic process should be equally genetic related. It is not enough to ask a child whether or not they have trouble focusing at school or to ask a parent if their child plays louder than other children (Stolzer, 2007). Unfortunately, a biologically determined diagnosis has not been developed. This is most likely due to the interest of the drug companies who fund most ADHD studies and benefit from subjective diagnosis.

However, this subjectivity is not uncommon among diagnostic processes for neurological disorders. Many other neurological disorders such as bipolar, schizophrenia, and depression also lack a biological test for diagnosis. This means that disorders that have overlapping symptoms, like those of ADHD and bipolar are likely to be confused for one another. This kind of confusion can result in children who are addicted to medication that does not even benefit them in the long term. This kind of problem can cause serious problems for the child later in life with the combination of a dependency on a drug that is not meant to treat their disorder, aggression caused by being on unwarranted stimulants for a long period of time, and lost time in treating the disorder they are actually suffering from (Rettner, 2013). Furthermore, other neurological disorders are not the only things that mimic the symptoms of ADHD. Extremely gifted children are likely to be wrongfully diagnosed with ADHD as well. Children who are this gifted often times have problems focusing in school and often fidget in their seats due to lack of stimulation and boredom from the curriculum (Webb, 2005). These symptoms directly match those listed among the symptoms for ADHD. In summary, the diagnostic process includes such a broad list of symptoms that many outside factors can mimic ADHD.

However, it is important to address that these diagnoses do not always result in the prescription of psychotropic drugs and therefore the over-diagnosis problem is not quite so harmful. While this is the typical treatment recommended by doctors, only about 70% of those diagnosed with the disorder are undergoing treatment for it (Walkup, 2014). The cause of this discrepancy is two-fold. On one hand, some of those not undergoing treatment are possibly choosing not to do so because of financial reasons. According to ABC News, ADHD is most commonly diagnosed in children of low-income families (Conley, 2011). Because of this, many children are not on the medication because they simply cannot afford it. The second reason for this discrepancy is due to the existence of diet based treatment for ADHD. In a study conducted by European Child & Adolescent Psychiatry, food based treatment for ADHD patients was effective in minimizing their hyperactivity and inattentive behaviors (Walkup, 2014). This kind of natural alternative to normal medication is less harmful to the children and part of the reason why not all ADHD patients are undergoing drug-based treatment. However, a majority of children who are diagnosed with ADHD are, indeed, undergoing treatment. So, to say that the ADHD epidemic is not a problem because not all of the diagnoses result in treatment, would be to overestimate the actual amount of diagnoses that this applies to.

The ADHD epidemic in America is a severely unreported issue that leads to unnecessary medicating of hundreds of thousands of children every year and although not all of these children are immediately put on medication, a majority are. Additionally, there is little to no evidence to support that this spate of ADHD cases is due to increased knowledge of the disorder. In fact, it is unclear whether there even is increased knowledge of the disorder due to the role that pharmaceutical companies play in research for the disorder. There is great evidence, however, that the recent outbreak of ADHD cases in America is due to the subjective diagnostic process. This evidence is supported by the fact that many outside factors have had an effect on the numbers of misdiagnosis, which would not be possible without the subjectivity of the process. If the process was biologically or genetically determined, none of the previously listed outside factors would have any significant effect on the rates of the disorder. There is no amount of legislation, rigor in school, faulty studies, or advertisements that could cause the rate of ADHD to rise as significantly as it has. The only way to fix this ever-worsening problem would be to fix the diagnostic process all together. There must be more money allocated to finding a biological determiner for ADHD and creating a test that can identify it. However, this solution is far from being accomplished, so as of now, all there is to do is to acknowledge it.
