“ADHD Nation should be required reading … Schwarz is sounding an alarm for a fire that looks nowhere near abating.”
The New York Times Book Review (Read)
“The most important book of the year for anyone who cares about children.”
John Merrow, former PBS Education Correspondent (Read)
“Chilling … In this powerful, necessary book, Schwarz exposes the dirty secrets of the growing ADHD epidemic.”
Kirkus Reviews (Read)
“[A] sweeping critique… The calm, incisive side of Schwarz’s investigative style dominates.”
Publishers Weekly (Read)
“Devastating and very necessary … I beg you to read this candid, fact-packed and even-handed study.”
Daily Mail (UK)
“Brimming with intelligence and insight … Those with the disorder will hear a voice of compassion. And those who may be misdiagnosed, a clarion note of caution.”
Jerome Groopman, MD, Harvard Medical School; Staff Writer, The New Yorker
At its core, A.D.H.D. Nation is a story – not just of the disorder itself, which has evolved over more than 50 (some would say 200) years, but of children, doctors and drug companies who have led us to the point where 15 percent of American youngsters get diagnosed with it. The main characters are Dr. Keith Conners, often considered the father of A.D.H.D., and two children, Jamison Monroe and Kristin Parber, who got caught up in the growing A.D.H.D. machine.
CHAPTER 1: FIDGETY PHIL’S ARITHMETIC PILLS
A look at the earliest days of concern about attention deficits in children, from the 1700s to today, with an emphasis on Charles Bradley’s discovery in the late 1930s that Benzedrine, an amphetamine for adults and ancestor of Adderall, calmed hyperactive children and made them more interested in schoolwork.
CHAPTER 2: DR. CONNERS
Meet Dr. Keith Conners, a Utah-born Rhodes Scholar turned young child psychologist, as he finds a new medication from Switzerland — Ritalin — improves children’s behavior. He publishes many high-profile scientific papers through the 1960s on how the pills treat hyperactivity — what was then called “Minimal Brain Dysfunction”.
CHAPTER 3: FROM M.B.D. TO A.D.D.
In 1970, the first national controversy over the use of Ritalin in children erupts when news that thousands of children in Omaha are being put on the drug leads to a fiery Congressional hearing. Dr. Conners ignores the debate and continues to diagnose and prescribe Ritalin for M.B.D., which in 1980 is rebranded “Attention Deficit Disorder.”
CHAPTER 4: COLLISION COURSE
As diagnoses of A.D.D. rise to 3 to 4 percent of American children, Ritalin explodes into an American phenomenon, featured on the covers of national magazines, debated on television talk shows, and subjected to high-profile lawsuits. The U.S. National Institute of Mental Health holds a summit on the matter and winds up only confusing parents more.
CHAPTER 5: KRISTIN
Meet Kristin Parber, a third-grader in suburban Philadelphia who is overactive and having trouble concentrating. Her parents and teachers, who through the 1990s have been bombarded by messaging that this means she has what is now called “Attention Deficit Hyperactivity Disorder,” get her put on Ritalin. The adults around Kristin believe it helps; she isn’t so sure.
CHAPTER 6: JAMISON
Meet Jamison Monroe, a freshman at a prestigious Houston-area prep school who sees his grades slip and wants to focus and study harder. He tries one of his friends’ Ritalin pills and likes them so much that he fakes A.D.H.D. to his parents and doctor to get a regular prescription.
CHAPTERS 7-18: Coming soon
NOTE: This is only a partial bibliography. Interested researchers can e-mail Alan Schwarz for any other citations.
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Whitaker, Robert, and Lisa Cosgrove. Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform. New York: Palgrave Macmillan, 2015. LINK
PERIODICAL AND WEB ARTICLES
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———. “Report Says Medication Use Is Rising for Adults With Attention Disorder.” NYT, Mar. 12, 2014, A16. http://www.nytimes.com/2014/03/12/us/report-says-medication-use-is-rising-for-adults-with-attention-disorder.html.
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———. “Thousands of Toddlers Are Medicated for A.D.H.D., Report Finds, Raising Worries.” NYT, May 17, 2014, A11.
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Do you have A.D.H.D.? Do you have any family or personal connection to it?
I do not have A.D.H.D., and, as far as I know, have never been suspected of it. A few young relatives were diagnosed 10 to 20 years ago, and from what I’m told have benefited from medication. My attraction to the subject was purely journalistic.
You spent almost five years writing about brain injuries in sports –what brought you to A.D.H.D.?
In mid-2011, having written about 120 articles on concussions for the Times, I was pretty burned out and wanted a change. I chose the Education department because I had heard that some high school kids in my native Westchester County were feeling such academic pressure that they would snort Adderall before the S.A.T.’s. I was horrified — and, because I have my own memories of academic pressure from the 1980s, wanted to find out what was going on. It turned out that Adderall misuse among teenagers was far worse than anyone — grownups, not kids — wanted to admit. My first article for the Times on the subject in June 2012 was not really about A.D.H.D. or Adderall, but about the pressure some kids face to exploit the system.
I thought it would be a single story. But the more I researched the subject I found so many parallels to my concussion work. There was a significant health risk flying under the radar. Those in the industry (football, psychiatry) reacted by either minimizing or outright denying any problem at all. Dubious scientific research was generated, misinterpreted and mishandled by adults who darned well should have known better. And kids were paying the price.
Has anyone you know had problems with abusing Adderall?
No one I am aware of. Of course I met scores of people during my four years of research, but if any friend or family member abused A.D.H.D. medications I have never known about it.
I will say this — my father told me recently that in the 1940s, when he was about 11 years old and overweight, his parents put him on Benzedrine as a diet aid. He liked it. Not because it kept him trim, but because it kept him awake a few extra hours — for listening to baseball games on a radio stashed under his pillow.
Why does the book not use Kristin Parber’s real name?
Kristin is very candid with her story, and in fact has discussed it publicly in the past to help other dealing with problems like hers, but respected that her family might be less open about it than she is. She also did not want people to blame her parents for her struggles — they were merely doing what others told them was best for her. Some people might choose to figure out her real name, but including the family name in the book was not necessary.
Have you ever tried Adderall or other A.D.H.D. medications?
No. I’m not into psychoactive substances much, including alcohol, and don’t have any particular desire to experiment with any. That being said, I’m a high-performing guy who can barely function without coffee, and would certainly welcome something that would provide instant energy and focus. I’ll bet I would love it. All the more reason not to try it.
They say “When in doubt, take it out” — so even though these tidbits and sections would interest many readers, the material didn’t make the final cut. But I saved it to present here and will try to add new material occasionally.
THE REAL FIDGETY PHIL
Chapter 1 of A.D.H.D. Nation introduces “Fidgety Phil,” a fictional little boy featured in Heinrich Hoffmann’s 1845 illustrated book about quirky children. Because Phil drove his parents crazy by wriggling and giggling at dinner and leaning back in his chair, many A.D.H.D advocates and historians have diagnosed Phil with attention deficit and cited him as proof that the disorder has been recognized for almost two centuries. This is preposterous, of course, but it turns out that there really was a Fidgety Phil — Phil Collins, a major league baseball player who was actually a pretty decent pitcher for the (you can’t make this stuff up) Philadelphia Phillies from 1929 to 1935. Collins earned the nickname because he would pull on his uniform pants and cap between pitches; whether he did this because of nerves or to distract hitters has been lost to history.
C.H.A.D.D. AND SHIRE
Expecting Children and Adults with Attention Deficit Disorder, A.D.H.D.’s primary support and advocacy group, to forego pharmaceutical funding is simply unrealistic in today’s world. But the organization must be wary of how it is used to further some benefactors’ objectives. In 2013, a Shire executive admitted to me that his company’s support of C.H.A.D.D. was not necessarily charitable, but “a marketing expense,” as he put it. He continued: “We do support broadly what they are trying to do in the marketplace,” before realizing what he’d just said. “Maybe in society is a better way to say it.”
The Multimodal Treatment of Children in A.D.H.D. study, published in 1999 to great industry and media fanfare, was probably the most pivotal moment in the disorder’s history — the researchers trumpeted the results as proving medication as the best treatment for A.D.H.D., even though behavioral therapy fared reasonably well given the study’s parameters and should have been presented as a viable approach for families to consider. But one of the study’s authors, Dr. William Pelham, was horrified at this irresponsibility and said so. “The results have been widely, prematurely, and inaccurately described as indicating that medication alone is sufficient to treat A.D.H.D.,” he wrote in the newsletter Clinical Psychiatry. Keith Conners had his misgivings, too, but was more subtle in sharing his concerns. Because few of the study’s 19 behavioral-therapy categories actually showed statistically significant differences — as he put it, the method “almost guaranteed no real result” — Dr. Conners did his own analysis, merging the 19 categories into one to see what happened. This method put behavioral therapy in a much better light. Conners’s 2001 paper received little attention then or since.