Diagnoses of attention deficit hyperactivity disorder (ADHD) have surged globally, rising as much as tenfold in some countries. The disorder has become a cultural and economic phenomenon — but it may not be a medical one, according to one scientist who studies the sociology of health and illness.
“Exporting American-based diagnoses like ADHD is really exporting American behavioral norms under the guise of medicine,” Peter Conrad, professor of sociology at Brandeis University, told The Huffington Post. “With millions more kids (and adults) likely to be diagnosed with and treated for ADHD in the next decades we see the export of American behavioral norms worldwide. This may be more insidious than the globalization of American fast food or pop music, in that it comes in the name of proper mental health and behavior.”
In a paper published in the journal Social Science and Medicine, Conrad and colleague Meredith Bergey investigated the growth of ADHD diagnoses in five countries where ADHD diagnosis and treatment rates increased dramatically — the United Kingdom, Germany, France, Italy and Brazil.
In Germany, for instance, prescription ADHD drugs increased from 10 million daily doses in 1998 to 53 million in 2008. In the UK, stimulant-treatment for ADHD increased from under 200,000 prescriptions in 1991 to 1.58 million in 1995, according to data cited in the paper. These rates mirror the United States, where ADHD diagnoses have risen by almost 25 percent in a decade.
Currently in the U.S., some 11 percent of children and 4.4 percent of adults now have a diagnosis. While some data suggests that ADHD is more common in the United States than in other countries, research points to an increasing global prevalence of ADHD diagnoses as well as an increase in consumption of ADHD medication.
Conrad and Bergey argue that while ADHD has been medicalized in the U.S. since the 1960s, other countries have been slower to medicalize the condition. It wasn’t until the 1990s, he said, that ADHD diagnosis and treatment migrated from North America to be increasingly applied internationally.
While much of the rise of ADHD can be attributed to improvements in recognition, acceptance and treatment of the disorder, some in the medical community have expressed concerns about over-diagnosis.
“We need to ensure balance,” Thomas Frieden, M.D., director of the Centers for Disease Control and Prevention told the New York Times last year. “The right medications for ADHD, given to the right people, can make a huge difference. Unfortunately, misuse appears to be growing at an alarming rate.”
Conrad and Bergey pointed to five trends — what Conrad refers to as the “how” of the globalization of ADHD — that may have influenced the exponential rise in diagnoses and treatment globally.
For one, drug companies are increasing their lobbying efforts overseas.
“The multinational pharmaceutical industry, which has been promoting ADHD and stimulant treatments in the United States for decades, now is looking for larger markets as the U.S. market has become increasingly saturated,” Conrad said. “I don’t mean that in any evil sense, but that’s just what the drug companies do.”
Secondly, Western psychiatry increasingly has a biological focus, which looks at biological rather than psychodynamic causes for various psychological problems. We’ve come to view ADHD more as a chemical problem in the brain that should be treated using stimulants, he explained, rather than considering potential psychological causes and behavioral treatment interventions, such as psychotherapy. Another factor is that other countries have adopted the standards of the American Diagnostic and Statistical Manual (DSM). In the DSM-5, the requirements for ADHD were made broader, allowing more people to be diagnosed.
The third fact is that ADHD advocacy groups (sometimes funded by drug companies) have become more common and more visible to the public in the U.S. and abroad. These groups often promote pharmaceutical treatments, Conrad noted.
And lastly, ADHD information and self-diagnosis tools are easily accessible on the Internet. While online self-tests are generally meant to be used for screening purposes only, Conrad said that they are often used as “do it yourself” diagnostic tools.
Of course, the data shouldn’t be taken as conclusive evidence of the global rise of ADHD, and doesn’t prove that American influence has caused an international impact. The data is theoretically driven, and only looks at five countries which were specifically selected based on their known increase in ADHD rates. There may be other explanations for the increasing rather of diagnosis and treatment in these countries.
Still, the research does underscore the importance of being aware of the potential risks of overdiagnosis.
“We’re defining more and more kids as having some kind of psychiatric disorder,” Conrad told The Huffington Post. “And while they may have some kind of difference, a difference isn’t necessarily a disease or a disorder.”
Clinical psychologist Lara Honos-Webb, Ph.D., agrees that ADHD diagnoses are being thrown around too loosely, and she thinks that the public should be concerned. In addition to the influence of pharmaceutical companies, Honos-Webb attributes the phenomenon to “sloppy diagnosis and changes to DSM.”
“In principle, looking to a brain disorder to explain attention deficits should be the last possible explanation,” Honos-Webb said in an email to The Huffington Post. “Let’s take for example a 6-year-old boy — developmentally, you would expect rowdy behavior and difficulty with attention. Almost all kids have some of the symptoms of ADHD — some of the time. The key point of diagnosis is to rule out alternative explanations and to determine that an impairment in functioning exists.”