Gooble Gobble, One of Us, ADD, One of Us

I keep hearing that all our children are being diagnosed ADD. Perhaps this comes from our fear of being maligned, diagnosed, and forced to conform to some dystopian, fascist mind control future in the making. Or perhaps it’s fueled by our morbid fascination with subcultures of freaks. Hence, this article’s title, inspired by the classic movie, Freaks, at the point where a beautiful but dastardly woman is horrified to be inducted into the world of circus freaks. And things go downhill from there.

Or, since everyone’s saying it, could it be true? The witch trials were hexed by science. The House on Unamerican Activities went up in indecent smoke. The false memory movement of the ’70′s was sued into oblivion. Maybe it’s time for a kinder, gentler movement. You have ADD and we want to help you.

The problem with this theory may be much like that of all the people that were being sacrificed by demonic cults — there weren’t enough people missing. In a recent study of over 3,000 kids (Froehlich, T.E., Lanphear, B. P., Epstein, J. N., Barbaresi, W. J., Katusic, S. K., Kahn, R. S., 2007), the kids carefully assessed as having ADD came in at 8.7%. Another 3.3% had been diagnosed with ADD, but probably didn’t (or didn’t quite) have it. Is that enough bodies to support the idea that society has turned ADD diagnosis into the latest viral wave of mind control?

Probably not. 8.7% may not be so large when you consider the many ways one can acquire the syndrome. Lead exposure, maternal smoking and other drug use, physical trauma, and genetics are major factors. A childhood disorder that skeptics won’t object to, childhood asthma, has a U.S. prevalence rate of 7.5%. (Centers for Disease Control, 2006)

But we have to ask a different question, because the statistics vary by practice, place, and demographic group. When researchers looked at the actual practice of diagnosing and prescribing, they found that one out of three white elementary-aged boys in southeastern Virginia had been diagnosed with ADD. Statistics like this are don’t show up in nationwide data. (LeFever, G. B., and Arcona, A. P. and Antonuccio, D. O., 2003) The authors point out that the U.S. Drug Enforcement Agency (DEA) statistics suggest that communities may vary in stimulant prescriptions by as much as 100 fold. For now, the DEA may provide our best window into actual prescribing, if the data is accurate enough.

But are there communities that have gone ADD crazy? Are there pockets of faddish overdiagnosis? If not, then there would have to be profound differences in the amount of ADD-causing factors from region to region. Research isn’t supporting a difference great enough to account for the differences found by LeFever’s group.

One more thing. Why, with a consensus reflected in the DSM (which contains widely-accepted diagnostic information) of a 3-5% prevalence rate, am I not saying the 8.7% rate from the Froehlich, et. al., study is suspicious? I will just say that our understanding and measurement of ADD is still fluid for a variety of reasons, and that estimates have varied far more than that. That topic is treated in depth by Nefsky (see references below).

References with Comments

Center for Disease Control. (2006) State of childhood asthma, United States: 1980-2005. Press release.

Froehlich, T.E., Lanphear, B. P., Epstein, J. N., Barbaresi, W. J., Katusic, S. K., Kahn, R. S. (2007) Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Archives of Pediatrics and Adolescent Medicine, 161:857-864

The study data was drawn from The National Health and Nutrition Examination Survey (NHANES), an annual multistage probability sample survey of the non-institutionalized US population.

LeFever, G. B., and Arcona, A. P. and Antonuccio, D. O. (2003) ADHD among American schoolchildren: evidence of overdiagnosis and overuse of medication. The Scientific Review of Mental Health Practice. 2:1.

Nefsky, C., (2004) A conceptual history of attention deficit and hyperactivity disorder. Unpublished paper.

This is a very well-written, detailed, lengthy study funded by the Geza Hetenyi Memorial Studentship for the History of Medicine administered by the University of Ottawa.