Pathologizing for Dollars

The rise of the ADHD diagnosis

January/February 2008

In twenty-seven years as a behavioral pediatrician, I've asked more than 2,500 children, "Why are you here?" when evaluating them for learning or behavior problems. A majority of kids over six years old (I don't usually ask children younger) answered, "I don't know" most of the time.

So I was struck when, in May 2005, I asked a nine-year-old boy named Joey this question and he told me, "Because I can't concentrate or focus. I get distracted." His answer was specific and directed, and I was intrigued.

It was fifteen years ago that a parent first asked me, "Do you test for ADD?", and I remember that I had the same reaction. "How odd," I thought. A parent had never been so direct in asking about a diagnosis. I wondered, where had she gotten the idea to inquire about a test for a specific condition?

Now, looking back, I know. In 1991 the Individuals with Disabilities Education Act (IDEA) was amended to include ADHD as one of the diagnoses that makes a child eligible for special services and accommodations in public school. Once word spread among parents that an ADHD diagnosis opened the door to special help for their children, an "epidemic" of newly diagnosed ADHD spread throughout our country. Now parents "knew" what was ailing their child—or at least they knew the magic words that could make a public school system change the way it dealt with their child.

Doctors, especially psychiatrists, have been changing their view of children's problems…

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