Hyperactivity: A Class Phenomenon

Nearly one in every 10 American children will be diagnosed as hyperactive — overwhelmingly in poor areas. A hotly debated statistic: The pharmaceutical lobbies and the attraction of social aid favor quick and easy diagnostics.

Linda Jacobs, 41, is the mother of 10 children, nine of which have been diagnosed with ADHD, or Attention Deficit Hyperactivity Disorder. “They have to take prescriptions or else they’re uncontrollable,” she says. Her youngest, seven years old, takes a methylphenidate pill every morning, a psychotropic medicine recommended to fight the troubles of ADHD. “He takes his pill at 7:30 in the morning, and that keeps him stable for school. At night, you can really see how the pill has stopped working. We’re going to have to up the dosage soon, for sure.” Her nine-year-old daughter takes three different meds a day, including Aripiprazole, an antipsychotic generally prescribed to schizophrenics and also used for ADHD. “She’s so angry,” her mother explains. “The medicines allow her to keep it together most of the time. Without these pills, I have no idea what we would do.” Linda is also worried for one of her oldest: Having reached the age of 16, he no longer wants to take his meds.

“He throws his things”

Nearly one in every 10 American children has been labeled with ADHD, and the number is constantly climbing. Over the last 10 years, the proportion has gone from 7 percent to 9 percent of children, according to a recent study done by the Centers for Disease Control and Prevention, a governmental agency. Among boys alone, 13 percent suffer from ADHD. Most often, it seems to be a disease found among the lower class; the number of children diagnosed and treated for the disorder is higher (by more than 10 percent) among families living beneath or just above the poverty threshold.

These numbers are much higher than what is found in Europe. In France, the prevalence is estimated to be between 3 percent and 5 percent of children, who are also much less medicated. “The first explanation is that the criteria used to define ADHD is much larger in the United States than in Europe,” observes Phillipa Spencer, a young psychologist who works with several children being treated for ADHD in Washington and who has compared the definition of the illness in several different countries. “In the United States, we can judge a behavior — which, in Europe, would be considered an expression of emotion — as hyperactive. Here, we also prefer faster results. For the parents I work with, it’s usually an easy out; we give them a pill, and problem solved.”

For poorer families, treating a child with ADHD is also a way for them to get their hands on an allocation of $700 a month called SSI — Supplemental Security Income — a sum which frequently becomes their sole source of income. “To diagnose your child with ADHD is often a way of avoiding personal responsibility,” observes Gail Avent, the director of the Total Family Care Association, which helps 800 families suffering from psychological illness in the Washington area. “The child becomes a cash machine. In certain places, people know that, in order to get the money, they need to claim their child is sick. It’s not always a bad thing for families that are in need, except for when it involves the systematic medication of children.”

Joan F., the grandmother of a six-year-old boy treated for ADHD, recognizes that the illness brings financial benefits along with it: “For every kid declared to have ADHD, you receive a check of about $700 a month, which is what allows us to live.” In the small courtyard of their dilapidated house, her grandchildren, ages five and six, play. Joan describes the boy, who has been classified as hyperactive: “He really has his own character. Sometimes he’s so frustrated that he’ll throw all of his things in the air. The medicines help calm him down.” Linda, the mother of nine ADHD-diagnosed children, confirms this: “At the moment, I only receive two checks from Social Security for my own illness and the one child who still lives with me. The others are in foster families. But it’s not easy to get money from SSI. Generally, it stops when the kid reaches the age of 16. ADHD is a sickness that is very linked to school: When they don’t go anymore, we’re less concerned about it.”

For Stephen Crystal, a professor at Rutgers University in New Jersey and the author of several studies on the subject, the “overmedication” of American children for attention and hyperactivity troubles is a very real problem. He mentions “enormous differences in treatment from one region to another within the United States. For appendix operations or cancer, we don’t see such high levels of regional variance. For ADHD, these differences suggest that there isn’t a clinical consensus.” According to the latest statistics of the Centers for Disease Control and Prevention, the prevalence of ADHD varies quite a bit: In North Carolina, over 15 percent of children between four and 17 years of age [are affected], while it’s only affecting 6 percent of children in Nevada. In general, the southwestern United States seems to have far fewer cases of this problem.

Very Powerful Intermediaries

Poor children, covered by the public insurance program Medicaid or placed in foster families, are much more likely to be diagnosed as having mental problems, Professor Crystal affirmed. The most worrying, adds the expert, is that the long-term efficacy of these medications prescribed for attention disorders is far from certain: “There is a lot of proof that these medicines can curb the short-term symptoms. But, long-term, we don’t really know what the consequences of these meds are on brain development. What’s more, their negative effects are important, beginning with weight gain.”

If ADHD is so often diagnosed and medicated in the United States, it’s also linked to the lobbying work of the pharmaceutical companies who use very powerful intermediaries. Among them is Children and Adults with Attention Deficit Hyperactivity Disorder, the organization for families with health issues. Located in an outer suburb of Washington, D.C., but close enough to the subway to plead the case to the Capitol, CHADD has 16,000 members, 23 employees and about a thousand volunteers. The organization is in part financed by the pharmaceutical laboratories, and claims that ADHD is “very underestimated.”

“Several studies show this,” explains the director, Ruth Hughes, a psychologist and the mother of a boy who was long ago treated for the disorder. “A lot of children have symptoms of ADHD and are not treated.” Her son, she says willingly, adopted as a baby from India, was so agitated that during the night, his cradle actually bounced against the walls in his room. “When he was seven or eight years old, he started a treatment which at least allowed him to go to school. The medicines soften the symptoms of ADHD which interfere with learning.” Her organization doesn’t push systematic medication, she assures. “There are other possible options: therapy, parental training, educational support, etc.” According to her, resorting to medicines is nonetheless rather effective in “80 percent of cases.”

These last few months still, CHADD had to re-launch its lobbying work to Congress: Looking to cut budgets, the leaders considered getting rid of the financial support given to children diagnosed with ADHD. “We’ve been very active,” the director says. “We went to see the senators armed with all of the studies that show that children with ADHD suffer severe handicaps. Those who decide in Congress assured us that this economic proposition had been pushed aside.”

A Somewhat-Normal School Experience

Generally, psychiatric treatments represent about 30 percent of the budget for Medicaid, the public insurance for the poor. They have powerful defenders. Pharmaceutical laboratories have contributed a lot to the “overmedication” of American children, says Robert Whitaker, the author of an investigative book on the “epidemic” of mental illness in the United States over the past few decades. “The majority of child psychiatrists get paid by pharmaceutical companies, from counselors to experts,” he laments. “These companies, who are trying nonstop to grow their market, exert a huge influence over politicians in Washington.” The result: Motivation to diagnose children [as having] ADHD and thus treat them exists at all levels. “In universities, even the most prestigious, professors have worked for pharmaceutical companies since the 1980s. The phenomenon is particularly serious in psychiatry, where results are always a little subjective, and we can easily twist them. In the schools, to diagnose a child with ADHD is a way to get more public funding. And for families, it’s a way to get your hands on SSI. Children are often finding themselves at the heart of a huge business deal.”

It’s difficult to resist the pressure of medication, especially in the United States, as Cyrille Duperret, a French woman living in Colorado, attests. Her son Nicolas, three years old, had been labeled by his school principal as a “troublemaker.” Parents complained about his agitation and threatened to take their own children out of the private school if little Nicolas continued to disturb the class. The experts who were consulted proposed running some tests to determine if he had ADHD and also put him on Ritalin, one of the most classic treatments. Against all the pressure, his parents refused to medicate him and chose to spend more time with him instead. Today, Nicolas is 15 years old and has a relatively normal school life: “He gets good grades; he’ll get into a good school,” his father is already predicting. “It wasn’t always easy, neither for us nor for the teachers. In elementary school, Nicolas was often in the principal’s office. In middle school, we were often called for behavior problems. But at the school in our neighborhood, there were always teachers and social assistants who recognized the problem, and Nicolas learned how to better behave himself.”

*Editor’s Note: The quotes in this article, accurately translated, could not be verified.