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ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic, by Alan Schwarz
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A Kirkus Reviews Best Nonfiction Book of the Year The groundbreaking and definitive account of the widespread misdiagnosis of attention deficit hyperactivity disorder—and how its unchecked growth over half a century has made ADHD one of the most controversial conditions in medicine, with serious effects on children, adults, and society.More than 1 in 7 American children get diagnosed with ADHD—three times what experts have said is appropriate—meaning that millions of kids are misdiagnosed and taking medications such as Adderall or Concerta for a psychiatric condition they probably do not have. The numbers rise every year. And still, many experts and drug companies deny any cause for concern. In fact, they say that adults and the rest of the world should embrace ADHD and that its medications will transform their lives. In ADHD Nation, Alan Schwarz examines the roots and the rise of this cultural and medical phenomenon: The father of ADHD, Dr. Keith Conners, spends fifty years advocating drugs like Ritalin before realizing his role in what he now calls “a national disaster of dangerous proportions”; a troubled young girl and a studious teenage boy get entangled in the growing ADHD machine and take medications that backfire horribly; and big Pharma egregiously over-promotes the disorder and earns billions from the mishandling of children (and now adults). While demonstrating that ADHD is real and can be medicated when appropriate, Schwarz sounds a long-overdue alarm and urges America to address this growing national health crisis.
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Product details
Hardcover: 352 pages
Publisher: Scribner; 1 edition (September 6, 2016)
Language: English
ISBN-10: 1501105914
ISBN-13: 978-1501105913
Product Dimensions:
6 x 1.3 x 9 inches
Shipping Weight: 1.2 pounds (View shipping rates and policies)
Average Customer Review:
4.0 out of 5 stars
39 customer reviews
Amazon Best Sellers Rank:
#311,447 in Books (See Top 100 in Books)
I had high hopes for this book. I was convinced on reading a few reviews and knowing something of the author's other work that this book would lead me to understand the history of ADHD, the heavy pushing of drug companies and how we got from there to here in this moment in time. The problem is that for most of this book, there is story after story after story (almost all short) of descriptions of kids and what they and their parents went through. These stories and the running dialog of doctors, drug companies, and court cases makes reading the whole book a challenge, at least for me. How many stories of kids, parents, doctors, drug companies, and court cases does it take to explain all of this? Not this many, trust me. After reading this book I was left with "and the answer is?". No answer came. I can really sum it all up by saying that drugs are a useful tool but with the warning that for many kids (and adults) there can be other tools available. Having said that, the other warning is that ALL drugs have side effects so use them if there is no other way of dealing with a real problem. There's the added complication of that "real problem" and how to tell if there really is a real problem.All kids come with problems - at least all the ones that I have ever known. Life is all about dealing with problems and learning what it takes to be happy. So how does one know when the problem is too big to ignore? That's step one and the book makes that very clear but I knew that without having to read story after story. A good writer (or a good editor) knows how to compile the multitudes of stories into just a few to illustrate the point without having to prove how much background work was done and how many interviews were conducted. Others may find this book just what they needed to help understand all of this. Others will find it way too much of a pretty good thing.
Alan hits the nail on the head with what's happening in America and our kids. As parents of a wonderful ADHD young man, we struggled for years to get our son help. My wife's a wonderfully talented teacher and we worked together to get him the help he needed and thought the medicine was actually helping (it does remove symptoms!) but, in reality it was paint over rust sold to us by the amazingly strong, self-reinforcing ecosystem Schwarz details in his book.Everything I knew to be true about ADHD before I read the book were either in the book or I realized I was wrong after looking at more evidence. I only wish I had this book to read 15 years ago.It's not the medicine isn't good for some, it's that it's not good for the vast majority of kids and it is effectively "Paint over Rust" Only in America will you get a pill first for and ADHD diagnosis, for when you're feeling down or when you can't sleep. Much of America is being run over by our pharmaceutical companies looking to sell you another daily pill prescription rather than help you get fixed.
Overall, I found the book well written, engaging, and easy to read. I found the structure of book, briefly foreshadowing topics found later in the book, kept me interested and wanting to read more. It was easy to understand and not written in overly complication science jargon. Any average reader with average reading ability will be able to understand the book without difficulty. The book also presented its argument in a very logical manner and at least recognized that ADHD is in fact a legitimate diagnosis. For these reasons, I am giving the book two stars instead of one star. Sadly, the book is deeply flawed in several areas. First, I understand the purpose of the book was to expose the alleged over diagnosis of ADHD, however, I think it did not focus enough on the legitimacy of ADHD and the issues untreated and undiagnosed ADHD can cause. I think the book should have been more balanced. The book had a few sentences, saying ADHD is a real diagnosis, can cause severe problems, and people with severe impairment are helped by medication, here and there, but, did not devote enough time to the topic. The book should have spent a couple chapters exploring the importance of an accurate ADHD diagnosis, the problems it can cause, and the benefit of medication. I believe this would have made its argument stronger because it would not have seemed so overtly biased. In short, I was unconvinced the author truly believes in ADHD as a legitimate diagnosis because he never spent more than a couple sentences in the entire 200+ page book discussing that part of the debate (i.e. ADHD is real and can cause severe impairment). If he explored both sides of the debate (ADHD is real and it is over diagnosed) the book would be better balanced and I would be more convinced the author truly believes ADHD is real. Next, I was very disheartened about the focus on the addictive potential of stimulants, especially at drug rehabs (those run by Jamison and when Jamison questioned the use of stimulants for the people who are recovering from other drug addictions in the facility he worked in). Again, this was a very one-sided argument and, to make matters worse, he supported the addictive potential of the drugs by people who were faking ADHD to get the drugs (Richard Fee, Jamison, etc.) or people who were misdiagnosed (Kristen) and never the people with a proper diagnosis and legitimate need for the medication. These people started abusing the drugs and never had a legitimate need for them. I am not saying the drugs do not have addictive potential, but, high addictive potential does not translate or force people to abuse them. There are many factors at work when someone starts abusing drugs, and addictive potential or high addictive potential has very little to do with it. People abuse drugs for a variety of reasons, trauma, escape, family struggles, abuse, self-medication, and a much better predictor of whether people will abuse drugs is their view of drugs and the expectancy effect. This means the people who believe drugs will solve their problems or make them feel fantastic, like Jamison and school, ais much more important than whether the drug has the potential of being addictive. People abuse schedule 4 drugs (modafil, neurotin, ambien) just as much, and maybe more so since those drugs are deemed to have little to no addictive potential, as schedule 2 drugs. Further, most people who take schedule 2 drugs (narcotics and stimulants) with a proper diagnosis and legitimate medical need do not become addicted and do not abuse the medication. This is because these people view the drugs as medication and not a drug with magical properties. There is some research supporting the expectancy effect, self-fulfilling prophecy, and lack of priming (ingestion of a drug does not cause people, even addicts, to use drugs uncontrollably). Further, I believe he was completely unfair to the people who have a dual diagnosis ADHD and substance use disorders. There are numerous double blind placebo controlled studies that demonstrated people with dual diagnosis, ADHD and substance use disorders, can properly take stimulants without worsening the substance abuse. These outcomes were based on self-reports and drug tests. Further, studies have found most people with the dual diagnosis ADHD and addiction take their medication responsibility. Many studies conclude stimulants should not necessarily be avoided with dual diagnosis, ADHD and addiction, and using stimulants in that populations with close monitoring is effective at treating the ADHD without worsening the drug addiction. Again, there are studies that do not support priming (any intake of drugs causes uncontrollable drug use). However, the book implies people with addiction issues should never be given stimulants (especially the way Jamison runs his rehabs and his comments when he was working at the different rehab). Lastly, I think the book is unfairly singling out ADHD without talking about the broader context and problems. The book brings up the very good points most people who are making ADHD diagnoses are not mental health professionals, do not do a thorough and appropriate evaluation, do not do a differential diagnosis to rule out medical conditions, do not collect collateral evidence by talking to family and friends, and the role “big pharma†is playing. The book also makes the very good point these things combined creates misdiagnoses, over diagnoses, and children and now adults taking unnecessary potent medication. The problem is these problems and issues apply to basically every mental health diagnosis and if we looked at each diagnosis separately we would find misdiagnoses, poor evaluations, no differential diagnoses, and non-mental health professionals making mental health diagnoses. I don’t know if ADHD is more over-diagnosed than other mental health conditions are over-diagnosed for the same reasons. However, I do know kids as young as 2 are being diagnosed as bipolar and given Seroquel and other atypical anti-psychotics which are just as dangerous and harmful or more dangerous and harmful than the stimulants. I also know kids in the foster care system are given powerful atypical anti-psychotics at rates much higher than kids not in foster care. The book would have been much better if it talked about the boarder issue of unqualified general family doctors making quick mental health diagnoses, young children taking all sorts of very powerful psychotropic drugs, besides stimulants, the loosening of many DSM disorder criteria, “big pharma†pushing drugs and controlling research and so forth. The issues the book brings up are not unique to ADHD, but, to the medical profession in general. As such, I feel ADHD is being unfairly treated as this book and argument could be made about practically any mental health diagnosis in the DSM or the diagnoses given out from uneducated and unqualified doctors. To emphasize this last point a recent study found that about 13% of kids diagnosed with autism spectrum disorder are misdiagnosed and lose that diagnosis due to more information, maturity, or better assessment. While autism isn't usually treated with drugs, some of the symptoms are, and it is clearly over diagnosed due to the some of the same reasons ADHD is over diagnosed. Clearly this isn't just a problem with ADHD. Now whether autism or ADHD is over diagnosed I have no idea,but it is worth investigating before unfairly singling out ADHD.
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