A SYMPOSIUM ON ATTENTION DEFICIT HYPERACTIVITY DISORDER The Changing Social Reality of ADHD

Attention Deficit Hyperactivity Disorder (ADHD) has become a hallmark disorder of American society, especially among children. The Center for Disease Control estimates seven percent of the school-age population has the disorder and numerous studies have shown that the number of children, adolescents and now adults who are treated with medication for the disorder continues to increase. It has been the most common psychiatric diagnosis among children for several decades. The widely-used medication treatment, Ritalin, has become synonymous with the disorder (although now there are more than a dozen different medications used). Until the last decade this had been a mostly American phenomenon, with European and other countries diagnosing and treating a fraction of the numbers treated in the United States, but in recent years the diagnosis has migrated to other countries, although still at much lower rates. Rick Mayes, Catherine Bagwell and Jennifer Erkulwater give us a thorough and thoughtful social and historical account about the emergence and expansion of the ADHD diagnosis and treatment. Their detailed history of the disorder is fascinating and well-researched, presenting a provocative analysis of the impact of policy changes on ADHD. The roots of ADHD are in the chance discovery in the 1930s of a misnamed ‘‘paradoxical effect’’ of stimulant medications that could reduce hyperactive and restless behavior in children, but the treatment did not become well-known until the approval of Ritalin for use with children in the 1960s. During this period we see a series of names for a disorder that Ritalin and similar medications were deemed to treat: organic drivenness, minimal brain dysfunction, hyperkinesis, hyperactive syndrome and ADHD. All of these assumed but did not demonstrate some kind of underlying biophysiological disorder. An important conceptual shift occurred when focus on the disorder shifted from disruptive behavior to attention difficulties. Reframing the problem from largely hyperactive behavior to include inability to sustain attention was a significant definitional change that widened the net of children who could be diagnosed and treated for ADHD. It also altered the gender balance, because the symptom array now included girls who spaced out as well as boys who acted up. While the number of children diagnosed grew steadily during the 1970s and 1980s, expanding to include adolescents, it was in Medicating Children: ADHD and Pediatric Mental Health, by Rick Mayes, Catherine Bagwell, and Jennifer Erkulwater. Cambridge, MA: Harvard University Press, 2009. 352pp. $39.95 cloth. ISBN: 9780674031630.