The Disturbing Link Between ADHD and Conservative Education Reform
Photo Credit: By Policy Exchange [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
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There has been a lot of public agonizing lately about the steep rise in diagnoses of ADHD over the last two decades. There is growing, and justifiable, worry that a lot of kids are being put on stimulant medications who don’t need them.
What there hasn’t been is a plausible theory about what’s driving this explosion of diagnoses — 40 percent over the last decade and more than 50 percent over 25 years. The CDC now estimates that 12 percent of school age kids, and as many as 20 percent of teenage boys have been diagnosed with ADHD.
Blame has been directed at parents, for being so poor at discipline that they reach for a pill to make unruly kids settle down. Teachers are blamed for being so inept at maintaining order that they want students medicated into submission. Psychiatrists are blamed for being the pawns of drug companies peddling ADHD meds. But blaming doesn’t explain it. It’s not credible that an increase of this magnitude comes from individual parents, teachers and doctors suddenly pathologizing ordinary child and adolescent behavior. In my experience, most parents are quite reluctant to put their kids on psychotropic medication unless they’re in serious distress.
Now comes a book that, finally, offers a data-based analysis that could begin to account for an increase on this scale. “ The ADHD Explosion,“ by Stephen Hinshaw and Richard Scheffler, considers all kinds of factors that may contribute to the surge, from diagnosis by undertrained and harried pediatricians to pharmaceutical advertising. But the eye-opening insight from Hinshaw, a clinical psychologist, and Schleffler, a health economist, who are colleagues at University of California, Berkeley, is the correlation between educational policies and the prevalence of ADHD diagnoses.
Using Centers for Disease Control surveys, Hinshaw and Sheffler found that when rates of ADHD diagnoses are broken down by state, it turns out that there are dramatic discrepancies. Based on the most recent survey, from 2011, a child in Kentucky is three times as likely to be diagnosed with ADHD as a child in Nevada. And a child in Louisiana is five times as likely to take medication for ADHD as a child in Nevada.
And these states aren’t just outliers. The five states that have the highest rate of diagnoses — Kentucky, Arkansas, Louisiana, Indiana and North Carolina — are all over 10 percent of school age children. The five states with the lowest percent diagnosed — Nevada, New Jersey, Colorado, Utah and California — are all under 5 percent. The disparity is even greater for kids prescribed ADHD medication. The same five states are at the top of the list, all of them with over 8 percent of kids getting medication. The states at the bottom of the list for medication — Nevada, Hawaii, California, Alaska and New Jersey — are all under 3.1 percent.
The authors set out to look for factors that could account for those sharp discrepancies.
“We thought it might have to do with the supply of providers — how many pediatricians or child psychiatrists in a given region — or the ways states supplement Medicaid,” explains Hinshaw. “It might have to do with advertising. But it doesn’t take a genius to figure out that most kids first get noticed for ADHD in a classroom setting. So we wondered, are there policies about schooling that might be relevant?”
What the team found was that high rates of ADHD diagnoses correlated closely with state laws that penalize schools when students fail. Nationally, this approach to education was enacted into law in 2001 with No Child Left Behind, which makes funding contingent on the number of students who pass standardized tests. In more recent years, similar testing-based strategies have been championed by education reformers such as Michelle Rhee. But many states passed these accountability laws as early as the 1980s, and within a few years of passage, ADHD diagnoses started going up in those states, the authors found, especially for kids near the poverty line.