“Perhaps oddly, ADHD is much more common in some parts of America than in others. The rate of diagnosis in North Carolina, for example, is two-and-a-half times higher than it is in California. One possible explanation, put forward by Stephen Hinshaw and Richard Scheffler in their book, “The ADHD Explosion”, is that much of the marketing budget for Ritalin, the best-known medication for the disorder, was spent on magazine advertising. That matters because more people in the American South than elsewhere subscribe to magazines.”

Read the full Economist article here.

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Oakland Tribune, April 28

Consider noise when reviewing restaurants.

“Recently, this newspaper published an article about Oliveto in Oakland, which had undergone an extensive — and expensive — renovation to lower the noise level. Passionfish in Pacific Grove was mentioned in another article; it was described as a serene dining room with music playing softly in the background where you could actually carry on a conversation.

My husband and I love to eat out, trying different restaurants. Despite sometimes loving the food, we don’t return if the noise is so loud we cannot hear each other speaking unless we shout. We are not alone in our opinion, having asked many friends who agree with us.

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By Paul McCrone

“Most mental health problems are formally identified according to an assessment of clinical symptoms, rather than by taking blood tests, scans, etc. As such, particular care in arriving at a diagnosis is required if these or similar symptoms can to some extent occur in the general population. Such symptoms may of course be influenced by societal factors, which would be less likely with physical health problems and it is probably safe to say that we have now reached a consensus that genes, personal circumstances and the environment each play a part in the manifestation of most psychiatric disorders. Stephen Hinshaw and Richard Scheffler in The ADHD Explosion focus on the contentious issues surrounding this particular condition, particularly those to do with recognition and treatment.

Attention-deficit hyperactivity disorder (ADHD) is clearly a controversial concept and this book does not shy away from the controversy. It is written by a psychologist (Hinshaw) and an economist (Scheffler) – on the face of it very different disciplines, but it can be argued that they are closer than we might think (Rabin, 1998). Although the debate about the existence, nature and treatment of ADHD can polarise people, this book does state as an intention its desire to strike a balance. However, even in the early pages it is apparent that much of the material will be contested. A major theme running through the book is the extent to which ADHD has been noticed because of the education system leading “children … to attend school and perform tasks that human brains and minds never evolved to do, like learning to read”. Whether engaging in formal education flies in the face of evolutionary progress and thereby results in the emergence of attention problems is certainly a hypothesis worthy of testing and a key question is therefore whether this book goes on to achieve that. The book is accessible and nicely presented with a mixture of case studies and empirical data. It does not claim to show whether ADHD is indeed a ‘real’ problem – by default it assumes it is and also suggests that it causes clear personal and societal suffering. There is a hint at the outset that the book will address issues such as whether treatment for ADHD could be rolled out to the wider population in order to enhance well-being. Such an extension of treatment is of course controversial, particularly as the mainstay one is the use of stimulants. There are parallels elsewhere, for example, mindfulness therapy (a brief intervention with roots in Buddhism that is helpful for depression) is used by many without recognised clinical problems. If the main purpose is to prevent full-blown ADHD then that is rather different to attention enhancement for those not at risk, which is more acceptable is open to debate.”

To read more, access Health Economics, Policy and Law / FirstView Article / April 2015, pp 1 – 5

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The sales of ADHD prescription medication are increasing rapidly and are expected to grow by another 13 percent this year alone. According to IBIS World, a new report shows ADHD medication has skyrocketed since 2010, and will continue to grow at an annualized rate of 6 percent per year, bringing in $17.5 billion by the year 2020.

Mother Jones reported on the sharp increase in ADHD prescriptions, claiming that attention deficit hyperactive disorder is a huge business for pharmaceutical companies. And though the spike in medication sales is alarming, it isn’t surprising to certain economic professionals like Richard Scheffler, a coauthor of the book The ADHD Explosion. Schleffer claims the boom in prescriptions is part of a larger global trend, as ADHD symptoms are recognized more and more often around the world. This is especially true of cultures with high expectations of success and academic achievement.
Read more here.

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Listen to Distinguished Professor Richard M. Scheffler and Rebecca Corral discuss the ADHD Explosion throughout the globe and the book that he and his colleague, Stephen Hinshaw, wrote to explain why this has happened.

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By Luke Whelan, editorial fellow at Mother Jones

“Attention deficit hyperactive disorder is big business. That’s the conclusion of a new report, published by the market research firm IBISWorld, which showed that ADHD medication sales have grown 8 percent each year since 2010 and will grow another 13 percent this year to $12.9 billion. Furthermore, it projects this growth will continue over the next five years at an annualized rate of 6 percent, and take in $17.5 billion in the year 2020—making it one of the top psychopharmaceutical categories on the market.

This growth does not surprise Richard Scheffler, professor of health economics and public policy at the University of California-Berkeley and coauthor of the book The ADHD Explosion. It is part of a global trend, he says, as ADHD becomes recognized as a disorder around the world, especially in cultures that put a premium on productivity and high academic achievement. Sales outside the United States—especially in Israel, China, and Saudi Arabia—are increasing twice as fast as in the United States, according to an article he penned in the Wall Street Journal with Stephen Hinshaw, professor of psychology and psychiatry at UC-Berkeley and UC-San Francisco.”

Read more here.

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Reviewed by: Lawrence Diller, Private Practice, Walnut Creek, CA, USA; and the University of California, San Francisco, USA. DOI: 10.1177/1087054714543370

The ADHD Explosion by Stephen Hinshaw and Richard Scheffler is simply the best book in the last 15 years to describe the social phenomenon we call ADHD. Hinshaw and Scheffler have taken a very broad view of the problems of children we diagnose as ADHD and properly relabel the condition a biopsychosocial disorder.

That they should be hailed for such insight is both justifi- able and ironic. Practitioners and the public alike for nearly 30 years have been presented with a deluge of information on ADHD which emphasized its neurological, genetic, and biochemical etiologies. Much of this information was based on drug industry–supported research and promoted by their advertising.

Hinshaw and Scheffler are now clearly stating that psy- chosocial factors play a major role in either the formation or presentation of what we are calling ADHD in America. This takes courage. The authors correctly say “Emphasizing the biological was as misleading as suggesting it (ADHD) is a social construct” (p. 11).

But it is also ironic because some of us over two decades have maintained a vigil for the importance of emotions, family, neighborhood, and culture (Diller, 1998).

The ADHD Explosion does not neglect the individual or the benefits of diagnosis and treatment of ADHD even as it addresses the very important broader associated societal issues. Each chapter opens with a short clinical vignette that then is connected with the larger themes the chapter addresses. They repeatedly acknowledge the pain, suffering, and real costs of an untreated or unrecognized disorder.

Chapter Five (“What a Difference a State Makes”) is pivotal and provocative. In it, Hinshaw and Scheffler take on the wide variations in diagnosis and treatment that exist within the United States. North Carolina is noted to have diagnosis rate of 15.5% for children (ages 4-17) whereas California’s is only 6%. (Note that boys in North Carolina have an ADHD diagnosis rate of 30%! [Visser et al., 2014]). Clearly there is something else going on with American ADHD diagnosis and treatment besides genes and syn- apses. It is to authors’ credit that they finally acknowledge, in a mainstream academic book, what has been obvious for years—psychosocial factors matter in ADHD.

Hinshaw and Scheffler look at four broad factors to account for this wide variation in diagnosis and treatment. The authors consider demographics, health care factors, cul- tural values, and teacher accountability laws. Looking at the United States, the pattern of ADHD diagnosis and treatment (except for Vermont and Massachusetts) seems to conform to a Red State/Blue State pattern (associated with political and social values) with the Red States having the highest rates of ADHD diagnosis and stimulant medication treatment.

The authors contend that their analysis leads them to believe the first three factors are not as important as teacher accountability laws (e.g., schools and teachers are assessed by the performance of their students in statewide exams). They believe the earlier the state adopted such accountabil- ity laws (before the “No Child Left Behind” law made teacher accountability a federal statute) the higher the rates of ADHD diagnosis and medication treatment.

It is too bad Hinshaw and Scheffler chose to present this intriguing theory in book form where there is no peer review. I, for one, was not dissuaded by their relatively brief discussion on the importance of cultural values. But I could understand their reluctance to conclude that decreased tol- erance for talent and temperamental diversity (especially in minority populations) might better explain why the American South and Midwest had much higher rates of stimulant use in children compared with those growing up in the Western and most of the Atlantic coast states.

Still, it is refreshing and encouraging to simply have a discussion of these questions finally raised by mainstream experts in the field. I do have some other questions or chal- lenges. The authors suggest that the national cost of ADHD is US$100 billion a year just for the care of children with the diagnosis. This figure assumes that the diagnosis is accurate. Given that ADHD rates approach 30% in boys in some states, one might conclude that the US$100 billion is the cost of addressing children’s externalizing problems in general in the United States.

Hinshaw and Scheffler are to be congratulated for includ- ing a good discussion of the ethics and values surrounding a correct and incorrect diagnosis of ADHD and its treat- ment. But the discussion left out the critical issue of “fairness” when it comes to potential enhancement versus treatment and the offers of accommodations and services based on diagnosis.

Increasingly, the public feels that students who may or may not have ADHD are receiving accommodations (extra time on tests) and medication (which improves short-term performance for anyone who takes stimulant medication) placing them at an advantage over undiagnosed students. Similarly, the use of medication (legal and illegal) at the high school and college level is creating a situation similar to one faced by athletes of “free will under pressure”—when one group is allowed to take performance enhancing drugs, it puts pressure on those not taking the drug to consider it.

In their chapter on Direct to Consumer (DTC) advertis- ing, the authors weigh the pros and cons of DTC advertising and decide to remain neutral overall. In their discussion, they do not mention that the United States is a signatory to the 1972 amendment to the Single Convention on Narcotic Drugs Treaty (United Nations, 1972) which prohibits adver- tising to end users of potentially abusable drugs. However, the Drug Enforcement Administration (DEA) decided in the late 1990s that the government would be unlikely to prevail in court against the drug companies in the current atmo- sphere of first amendment rights of free speech for corpora- tions. Therefore, the DEA never challenged the introduction of DTC advertising for prescription stimulants.

In their last chapter, Hinshaw and Scheffler make predic- tions about the current ADHD “epidemic” and suggestions for addressing the over- and mis-diagnosis problems. They predict on the short term that the incidence of reported diag- nosis of ADHD will continue to rise with a leveling off by 2020. They note with concern that rising rates of ADHD inherently delegitimize the potentially serious nature of the condition for those with more impacting symptoms.

Their suggestions for the future directions are excellent, thoughtful, and moral but do not sufficiently recognize the “money” factor stated in the title of the book. Hinshaw and Scheffler are to be applauded for their overall effort. But in the end their views and hopes reflect the best of the aca- demic/ivory tower perspective. Those of us on the front- lines of ADHD diagnosis and treatment are more cynical about change, as long as the overall structure and finances of mental health care delivery remain the same in this country.

References

Diller, L. (1998). Running on ritalin: A physician reflects on children, society and performance in a pill. New York, NY: Bantam Books.

United Nations. (1972). Single convention on narcotic drugs, 1961 (As amended by the 1972 Protocol amending the Single Convention on Narcotic Drugs, 1961). Retrieved from http:// www.unodc.org/pdf/convention_1961_en.pdf

Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., . . .Blumberg, S. J. (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. Journal of the American Academy of Child & Adolescent Psychiatry, 53, 34-46.

The post Journal of Attention Disorder reviews ADHD Explosion appeared first on The ADHD Explosion.

By Marty Nemco Ph.D.

Attention Deficit Hyperactivity Disorder (ADHD) is among our most controversial disorders. Is it really a disorder or a function of schools’ inadequate response to active kids’ needs? Is the increase in prescribing stimulant drugs for ADHD mainly because it’s helpful or because drug companies are pushing it?

Stephen Hinshaw is an authoritative voice on ADHD.  He’s Professor of Psychology at the University of California, Berkeley, Vice-Chair of Psychology, Department of Psychiatry at the University of California, San Francisco and co-author with Richard Scheffler of The ADHD Explosion: Myths, Medication, Money, and Today’s Push for Performance.

Read interview here.

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By Lawrence Diller

The ADHD Explosion: Myths, Medication, Money  and Today’s Push for Performance by Stephen Hinshaw and Richard Scheffler (Oxford, New York, 2014) is the most recent best survey of the ADHD/medication “scene” to be published recently.  The authors truly see ADHD as a neurological isse but defined with different contexts as problems.  They bring full circle back to the academic mainstream thinking of ADHD as a biopsychosocial disorder (something I stated quite clearly sixteen years ago in Running on Ritalin).  It would have been nice to received a little bit of credit but that takes nothing away from the importance of this book as an up to date exploration of the ADHD phenomenon in America today.

Read more here.

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Are we at war with ADHD? David McMillian talks with co-author Richard Scheffler about his book “The ADHD Explosion – Myths, Medication, Money and Today’s Push for Performance.” Together they explore how the recents changes in the health care sector and the push for excellence in standardized tests resulted in a rise of ADHD diagnosis in children and adolescents.

Listen more here.

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