ADHD: The Money Trail

In this country, we spend over twenty billion dollars a year drugging children for something called “Attention Deficit Hyperactivity Disorder,” or ADHD. For that kind of outlay, we could pay the mid-career salaries of an extra 365,000 teachers, or 827,000 teachers’ aides.

This may seem like a preposterous misallocation of resources, but the situation is not likely to change until we confront an interlocking network of players who have a vested interest in promoting the medical model of “ADHD.” Let’s take a look at some of these players now, shall we?

A child looks shocked to receive an overflowing handful of pills

The Key Opinion Leader

Probably no man alive has done more to promote the diagnosis and drugging of children for ADHD – and its bastard offspring, pediatric bipolar disorder –­ than Joseph Biederman.

Dr. Biederman is Chief of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at the Massachusetts General Hospital and Professor of Psychiatry at Harvard Medical School. Once, while being deposed in a lawsuit, he gave his rank at Harvard as “Full Professor.” Asked if there was anything above that, he replied “God.”

In 2002, Dr. Biederman and his colleague Steven Faraone authored the annual report of the Johnson and Johnson Center for Pediatric Psychopathology at Mass General, which discussed plans to study children diagnosed with conduct disorder and comorbid affective disorder: “Further validation of this group will alert physicians to the existence of a large group of children who might benefit from treatment with RISPERDAL.” At the time, J&J was the owner of Janssen, which in turn owned the patent rights to Risperdal. This drug is commonly prescribed to children and adults for bipolar disorder, which in turn is often diagnosed after taking stimulant drugs prescribed for ADHD.

A June 2007 article in the Boston Globe noted that Dr. Biederman had taken payments from fifteen different drug companies, and served as a paid speaker or adviser to seven of them, including Janssen, along with Eli Lilly, the maker of Zyprexa, another drug commonly prescribed for bipolar disorder. In the same article, Jerrold Rosenbaum, Chief of Psychiatry at Mass General, absolved Biederman of any blame: “For Joe, it is his idea and mission that drive him, not the fees.”

In June of 2008, the New York Times revealed that Dr. Biederman had earned $1.6 million in consulting fees from J&J and other drugmakers but did not report much of this income to Harvard. Two of Biederman’s associates, Thomas Spencer and Timothy Wilens, had also taken over $1 million each in drug company payments.

In addition, the article revealed that in 2000, Dr. Biederman had received a grant from the National Institutes of Health to study the effect of the drug Strattera in children. That same year, he had received over $14,000 in payments from Eli Lilly, the maker of Strattera. At the time, Harvard rules forbade researchers from conducting clinical trials of any drug if they had received more than $10,000 from the drug’s manufacturer.

In an email statement, Biederman declared: “My interests are solely in the advancement of medical treatment through rigorous research and study.”

Meanwhile Dr. Spencer offered these words in his own exculpation:

I am deeply committed to helping children with ADHD and other similar disorders find treatments that can help improve their lives… It was my sincere belief that I was at all times complying with the relevant policies and procedures as to outside income.

Mass General sent out a missive to its physicians, expressing profound sympathy for Dr. Biederman and his colleagues Spencer and Wilens: “We know this is an incredibly painful time for these doctors and their families, and our hearts go out to them.”

The following January, Marcia Angell, author of The Truth About the Drug Companies,  offered this devastating assessment of Dr. Biederman in an article in the New York Review of Books:

Thanks largely to him, children as young as two years old are now being diagnosed with bipolar disorder and treated with a cocktail of powerful drugs, many of which were not approved by the Food and Drug Administration (FDA) for that purpose and none of which were approved for children below ten years of age.

The same article offered this devastating critique of modern medicine:

It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgement of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of the New England Journal of Medicine.

In July of 2011, Mass General announced sanctions against Dr. Biederman, along with Drs. Spencer and Wilens, for violating disclosure rules. All three men were required to undergo unspecified “training,” to refrain from all industry-sponsored outside activities for one year, to obtain permission from Harvard and Mass General before engaging in such activities for two years after that, and to face unspecified delays in being considered for promotion and advancement.

In a joint statement, all three men declared “We always believed that we were complying on good faith with the institutional policies and that our mistakes were honest ones.”

Two years later, the United States Department of Justice announced that J&J had been ordered to pay $2.2 billion to resolve criminal and civil claims of illegal marketing of its drugs, including Risperdal. In January of 2018, the Philadelphia Court of Common Pleas found the company liable for eight billion dollars in punitive damages after a young man grew breasts after taking the drug.

None of this seems to have slowed Dr. Biederman down. In 2014 the news and information service Thomson Reuters named Biederman as one of the World’s Most Influential Scientific Minds. The website for Mass General boasts of his 800 scientific articles, 650 abstracts, and seventy book chapters. He was ranked second-highest producer of high-impact papers in child psychiatry and highest in total citations to his papers on ADHD.

The website also demurely notes that “Dr. Biederman’s work is supported by multiple federal and pharmaceutical industry grants.”

The Story of Strattera

The evidence base for FDA approval of the new drugs and new drug indications touted by key opinion leaders is for the most part manufactured and controlled by the drug companies who have a fiduciary duty to their stockholders to sell as many drugs as possible. The results are predictable and well-documented: exaggeration of benefits and downplaying or outright concealment of harms.

Consider the case of Eli Lilly’s blockbuster drug Strattera. This drug was initially developed by Lilly as a treatment for incontinence and major depression. However, only one small study, on ten patients diagnosed with major depression, was ever published. All of these patients were given chloral hydrate, a sedative, in addition to Strattera. Three of the ten dropped out of the study, and while the remaining ones did exhibit some improvement in depressive symptoms, further research into using the drug as a treatment for depression was shelved.

Strattera was approved by the FDA for treatment of ADHD in children and adults in November of 2002, and released on to the market the following January. Strattera was the first new chemical entity okayed for the treatment of ADHD since the approval in 1975 of Pemoline (that drug was taken off the market in 2005 after being linked to cases of liver damage). Amphetamine and Ritalin had already been on the market for decades, and grave concerns had been raised about the potential of these drugs for addiction and abuse. By contrast, Strattera was touted as a “non-stimulant” remedy for ADHD.

The month before Strattera was released on to the market, no less a luminary than Dr. Biederman himself, along with several of colleagues, published a paper proclaiming the need for this new drug:

There are significant limitations to treatment with psychostimulants, which are not effective or well tolerated in approximately 30% of school-age children with ADHD. Adverse effects such as insomnia, decreased appetite, and irritability may lead to discontinuation or dosage limitations. The lack of adequate full-day treatment often results in recurrence of impairing symptoms at home and in the community. In addition, psychostimulants bear the additional burden of being controlled substances, resulting in concerns about abuse and diversion. For these reasons, there remains a need for safe, effective, and nonstimulant alternatives for the treatment of ADHD in children and adults.

The research was funded by Eli Lilly and Company. Seventeen of the authors of the paper had served as paid consultants or investigators for Lilly, and five more were employees and shareholders. Not surprisingly, the study concluded that Strattera was indeed a safe and effective nonstimulant remedy for ADHD.

A 2009 book chapter by David Cohen and two of his colleagues noted that at the time Strattera was released, there were a total of eleven published Phase II and Phase III studies on the drug, all of them funded by Lilly, and many of the authors of these studies were Lilly employees. In other words, prescribers consulting the scientific literature would be able to find what Lilly wanted them to know about Strattera, and no more than that.

However, shortly after the drug was released, the FDA published on its website many of the documents submitted by Lilly for its New Drug Application for Strattera. These documents contained some interesting revelations. Dr. Cohen and his co-authors note that while the eleven published ADHD studies reported the rate of serious adverse events as 0.7 percent, the FDA documents show a 2.1 percent rate of serious adverse events for ADHD studies and a whopping 7.1 percent for the discontinued incontinence and major depression studies.

In September of 2004, a letter to the editor of Pediatrics reported that of 153 consecutive patients treated for ADHD with Strattera, fifty-one, or one out of three, exhibited extreme irritability, aggression, mania, or hypomania. The authors seemed at a loss as to why so many of these children reacted badly, although as a possible explanation they suggested “incompletely treated ADHD with its attendant impulsivity.”

Almost exactly a year later, the FDA issued a black-box warning (the strongest sanction short of removing a drug from the market) for increased risk of suicidal thinking in children and adolescents taking Strattera.

Martin Whitely is a former state legislator in Western Australia and a research fellow at the John Curtin Institute of Public Policy. In his 2021 book Overprescribing Madness, he recounted some of the adverse event reports for Strattera submitted to the Adverse Drug Reactions Committee:

  • A seven-year-old girl who experienced abdominal pain, nausea, migraine headaches, shooting pains, white spots in her visual field, and academic regression along with fecal and urinary incontinence
  • A seven-year-old boy who experienced suicidal ideation, mood changes, extreme aggression, and self-harm
  • An eight-year-old boy who banged his head against the wall and said he wanted to kill himself
  • A nine-year-old boy who became emotionally withdrawn and exhibited abnormal behavior, drooping eyelids, and strange facial expressions
  • A nine-year-old boy who exhibited extreme mood swings, anger, violent outbursts, banged his head against the wall, and said he wanted to kill himself
  • A nine-year-old boy who experienced suicidal ideation, aggression, and self-harm, and drew pictures of himself hanging from a tree
  • A ten-year-old boy who experienced violent outbursts and suicidal thoughts and threatened suicide
  • A ten-year-old boy who experienced nausea, depression, aggressive behavior, and suicidal thoughts
  • A ten-year-old boy who experienced psychotic symptoms and began talking about killing himself
  • A ten-year-old boy who experienced auditory and visual hallucinations, including voices in his head commanding him to murder his sister
  • An eleven-year-old boy who experienced a psychotic episode
  • An eleven-year-old boy who experienced headaches, stomach cramps, muscle rigidity, and poor concentration, and attempted suicide
  • An eleven-year-old boy who became extremely agitated and talked about wanting to die
  • An eleven-year-old boy who became depressed and suicidal
  • A twelve-year-old girl who experienced anorexia, weight loss, fidgeting, anger outbursts, and ripped out her own fingernails and toenails
  • A twelve-year-old boy who experienced strong suicidal ideation and expressed a desire to hang himself
  • A thirteen-year-old boy who experienced hostility, aggression, and chest pains
  • A thirteen-year-old boy who became angry, withdrawn, socially isolated, impulsive, moody, exhibited physical and verbal aggression to his family, and experienced suicidal ideation
  • A thirteen-year-old boy who experienced agitation, suicidal ideation, and threatened to harm his classmates
  • A fourteen-year-old girl who experienced suicidal ideation and cut herself with scissors, knives, and razors
  • A fifteen-year-old girl who experienced suicidal ideation and began cutting herself to an extent that was described as “life-threatening”

In 2012, the Therapeutic Goods Administration (the Australian equivalent of the FDA) responded to these distressing reports with alacrity, by ceasing to make individual adverse events reports available to the public.

While Strattera may not have benefitted every child who took it, it certainly has been a boon to Eli Lilly’s bottom line. Within six months of its release, over one million prescriptions were written for the drug, and market share rose from zero to 12.3 percent. For the year 2016, the drug’s last year on-patent, total sales were $535 million in the United States and $854 million worldwide.

The Ghost Writer

The pharmaceutical industry relies on the services of medical writers in order to spin the results of their studies to make their products look as good as possible. These professionals are known colloquially as “ghost writers.”

In August of 2011, an essay appeared in PLoS Medicine by one self-described “ghost writer,” Linda Logdberg. Having earned a PhD in neuroanatomy, Dr. Logdberg found herself unable to secure a tenure-track faculty position, and she decided to seek employment as a medical writer instead.

Initially, Dr. Logdberg enjoyed the job. As a mother of young children she appreciated the flexibility of working at home, the work was interesting, she genuinely believed she was helping people, and the money was good – “really good,” she remembers:

Traveling, eating in high-end restaurants, wearing fashionable clothes, and rushing to meet important deadlines – what’s not to like?

As it turned out, there was a great deal not to like. Initially, the companies she worked for were small stand-alone firms, owned and run by actual scientists. But these companies went out of business and she found herself working for giant corporations owned by large advertising agencies, having to answer to superiors who had no background in science. While working for one such firm, she was ordered to write a paper extolling the virtues of a new extended-release formula of an ADHD drug.

There already were several competing products on the market, and the drugmaker needed some way of distinguishing its product from the others. This nostrum had a duration of action intermediate between those of short-acting and long-acting ADHD drugs.

Living in an ADHD household, Dr. Logdberg did not think this was a great idea. She could not see the value of a drug whose effects would wear off right around suppertime, a time when tempers flared and arguments were often at their worst.

Dr. Logdberg asked for permission to speak to the notional author of the paper. Her boss sneered “Just write it.”

Dr. Logdberg got out of the business, and went to work as a teacher for the Fernbank Science Center, giving presentations to kids ranging in age from Kindergarten through Grade Twelve. Almost all the staff members there had PhD’s or at least Master’s degrees in science. Fernbank is a program of the Dekalb County School District, which serves a student population that is eighty-nine percent minority.

When I asked her how she found the students, she replied without hesitation: “I loved them. They were great. They were fun to teach. They liked learning, and I liked teaching them.”

“It’s a wonderful model,” she says of the Fernbank project. “On a typical day, I could go out and present ‘Everybody smells’ to kindergartners, and teach them about the sense of smell, and then I could go do three STD classes in the Middle School.”

Dr. Logdberg indicated that she is not anti-med. “I believe in medication if it is given intelligently – like any drug.” But when I asked her if her time as a public schoolteacher gave her any insight into the problem of ADHD, she did not hesitate before replying:

Schoolteachers should be prohibited from having any input whatsoever into ADHD diagnoses. They have no training or background or interest in psychology. Their solution for the hyperactive kids was to turn the desk to face the wall and have the child miss recess.

They would ask these teachers to fill out these checklists. So they would fill out the check sheet, and the parent would take the kid to the pediatrician – a person completely unskilled in diagnosing any kind of emotional ailment. That’s like going to a gynecologist for a heart disease.

I do get that it’s hard to be with forty kids in one classroom – and there was not much space. And there was a lot of belief then that if you take too much time out of the day to deal with things like sports, or recess, it will take time away from learning, and then the kids won’t score well on the standardized tests.

Direct-to-Consumer Advertising

The media profits handsomely from direct-to-consumer advertising of prescription drugs. Between 1998 and 2006, annual spending on direct-to-consumer ads rose from $1.3 billion to $5.4 billion. This is potentially a lucrative area for the drugmakers as well – every dollar spent on direct-to-consumer advertising is believed to generate six dollars in sales.

Let’s consider the case of Adderall XR, the extended-release version of Adderall, which was released in 2002, the same year that the patent expired on original-formula Adderall. A 2013 article in the New York Times by reporter Alan Schwarz and an accompanying video examined a number of print advertisements for ADHD drugs, including Adderall XR.

One of these ads depicted a young boy toting a soccer ball under one arm and an armful of books under the other, while the caption exhorted parents to “reveal his potential.” The message is obvious: Adderall XR isn’t changing your child, just “revealing” his better self – scholarly, athletic, well-rounded. The photograph of the child is superimposed upon an image of nerve cells, implying that something awfully important and science-y is going on.

Another featured a lad being enthusiastically embraced by his mother. The boy holds a worksheet bearing the notation “B+” in bright red ink, while the caption exclaims “Finally! Schoolwork that matches his intelligence!”

A third showed a youngster frolicking with his mother, both of them sporting smiles as wide as the Grand Canyon, while the accompanying captions read:

David’s mother is learning a whole new language

I’m proud of you

Do you want to have your friends over on Saturday?

Let’s play a game

Thanks for taking out the garbage

A pill to make your kid take out the garbage? Seriously? Is that what parents want? It’s a measure of how beleagured some parents feel these days that the answer is probably Yes.

The overall message of these ads is clear: these drugs will improve every aspect of your child’s life, including grades, extracurricular activities, peer relations, and family life. In fact, there is no credible evidence that any of these drugs leads to any meaningful long-term benefits to kids (vide infra).

Schwarz’s NYT article also noted that nearly every major ADHD drug – Adderall, Concerta, Focalin, Vyvanse, Intuniv, and Strattera – had been touted in ads which resulted in its manufacturer being cited by the FDA for false or misleading advertising, some of them multiple times. But the FDA’s efforts in this area may be akin to trying to hold back the wind with a fishnet. For the fiscal year 2009, the FDA had only fifty-nine employees charged with reviewing over 70,000 advertisements submitted to the agency by the drug companies.

Whether these ads have helped parents become better-informed consumers of Shire’s patent medicines is an open question, but they certainly don’t seem to have diminished that company’s income stream. Between 2002 and 2008 (the last full year Adderall XR remained on-patent), sales receipts for Shire’s blockbuster drug skyrocketed from less than $2 billion to over $8 billion. By the time the patent expired on Adderall XR, Shire’s new blockbuster-to-be, Vyvanse, had already been released.

Anyone who takes the time to scrutinize news accounts can see how time and again the mainstream media have spurned their role as watchdogs to serve as cheerleaders for the latest discovery “proving” the biological basis of ADHD – even though none of these claims has ever held up. Could this lack of serious scrutiny be due to their dependence on drug company largesse to stay in business in a time of falling ad revenues?

A Perverse Set of Incentives

It’s not just doctors, drug companies, and the news media who have profited from skyrocketing rates of diagnosis and drugging for ADHD. The law has created a perverse set of incentives for parents and children which favor the ADHD label.

The key piece of legislation which brought this about was the Individuals with Disabilities Education Act (IDEA) of 1990, which mandates special services for children with disabilities. Under the provisions of that act, a child thought to be disabled is entitled to an evaluation and, if deemed necessary, access to special educational services according to an Individualized Education Plan (IEP) tailored to meet the needs of that child.

Originally ADHD was not a covered disability under IDEA, although children so labeled might have been deemed eligible for special services according to any of several other categories covered in the act, such as “other health impairment,” “serious emotional disturbance,” or “specific learning disability.” But in September of 1991, the United States Department of Education issued a “Policy Clarification Memorandum” which specifically included ADHD in the list of covered disabilities.

Now children “disabled” by ADHD could be eligible for any of a variety of special privileges, including reduced class size, one-on-one tutorials, classroom aides and note-takers, tape recorders, and the use of “high-interest” materials. (Why does a student need a psychiatric diagnosis in order to be provided with “high-interest” materials? Shouldn’t they all be getting that?) No wonder that enrollment in special education programs skyrocketed in the years following the Policy Clarification Memorandum.

Any child – with or without the ADHD label – could probably benefit from any or all of the perks that come with that label. As psychiatrist Lawrence Diller (who is by no means anti-med) points out in his book Running on Ritalin, this process has cascading effects. The more money schools spend on special education, the less they have to spend on all of the other students, resulting in overcrowded classrooms, stressed-out teachers, etc. These are precisely the sorts of problems which are guaranteed to push marginal students over the edge into failure – resulting in more students being diagnosed as “ADHD” or “learning disabled,” more resources devoted to special education, and so on.

So just how much are we spending to provide extra services to children with the ADHD label? Here’s the astonishing answer: nobody knows. A 2015 report prepared by the Education Commission of the States stated:

As hard as it may be to believe, there is little information about how much funding school districts in the U.S. are expending on the education of students with disabilities. Most states don’t require districts to report their special education expenditures, and those states that do require reporting from districts tend not to require that they provide detailed financial information.

The report goes on to note that the most recent attempt to tally up the total dates all the way back to the school year 1999-2000, and found that per-pupil spending for general education students was $6,556, while for special education that figure was $12,474 – almost twice as much. (In fairness, it should be pointed out that the $12,474 figure is for all special education students, not just the ones labeled “ADHD.”)

There’s more. Families of children labeled ADHD may also be eligible for Supplemental Security Income (SSI) payments. Just two years after the SSI law was changed in 1990 by adding ADHD to the list of eligible diagnoses, the number of new enrollees with the ADHD label increased more than five-fold.

In addition, students labeled disabled may also be shielded from the consequences of their own misbehavior. Under IDEA, a school could not suspend a “disabled” student for more than ten days, for any reason. Moreover, the courts had ruled that repeated suspensions could be interpreted as evidence of a pattern of discrimination directed at the child. The burden of proof was placed on the school to demonstrate that a student’s anti-social behavior was not the result of his “handicap.”

In 1997, Congress amended this obviously unworkable rule to allow an emergency forty-five-day suspension of any student for possessing a gun, or bringing drugs to school. The irony of this latter proviso apparently was lost on these Solons.

How has this worked out for us? An August 1997 article in the New Republic titled “Defining Disability Down” told the tale of Michael F., a ninth-grader who was earning A’s in his honors courses. He also found time to play in his high school band, had written a book, and had successfully completed his bar mitzvah training – all the while battling the scourges of “attention-deficit disorder, language-based specific learning disabilities, neuro-motor dysfunction, and tactile sensitivity.” Fortunately, Michael enjoyed the saving graces of an IEP which afforded him special tutoring; extra time on homework, assignments, and tests; permission to stand up, stretch, and/or walk around in class; permission to chew gum or hard candy “to help him concentrate and focus”; access to transcripts of lectures, outlines, and notes; as well as a tape recorder and a laptop computer (this was before such devices became ubiquitous).

But Michael’s parents became dissatisfied with the miserly provisions of their son’s IEP and demanded more. After their boy received a grade of 65 on his Honors Geometry midterm exam, they excoriated school officials for numerous procedural failings, including neglecting to pursue a math reevaluation of their son, and demanded extended summer tutoring for him in that subject.

More recently, in September of 2009 a federal judge ordered Williamson County Schools in Tennessee to pay for legal fees incurred by the family of Chase Kildgore in their three-year legal battle with the school district. Young Chase was diagnosed with ADHD in May of 2003, prior to entering the seventh grade. School officials decided the boy was not eligible for special education services but devised an education plan for him, allowing him extra time on homework and tests, organizational help, and “incentives” for completing assignments.

Things got complicated when Chase got into a fight at school. After meeting with the boy’s doctor, father, teachers, and counselors, school officials determined the fight was not caused by his ADHD (how such a thing is determined was not explained) and suspended him for twenty days. The punishment was later dropped to ten days of in-school suspension.

Chase’s father demanded that the fight be expunged from the boy’s disciplinary record, and also that the school district provide his son with three hours a week of tutoring. After an administrative law judge ruled in his favor, the district appealed the ruling to District Court but lost and was ordered to pay the family’s lawyers $135,859. An article in the Tennessean reported that two more lawsuits were pending against Williamson County Schools, and also that 3,776 children, or thirteen percent of the total student population, were enrolled in special education programs in the school district, at an annual cost of $36.5 million. By then Chase had moved on, and was enrolled as a student at the University of Tennessee.

While IDEA mandates that children labeled “special needs” are entitled to a free “appropriate” public education in the “least restrictive setting,” there is no such mandate for children who are not so labeled, and whose parents are faced with the choice of accepting whatever is on offer at the local public school system or nothing at all. And acquiring such a label for one’s child is a process that can require time, energy, knowledge and money – requirements guaranteed to stack the deck against the poor and uneducated. It’s no wonder the probability of a diagnosis of ADHD correlates positively with income and negatively with racial minority status.

Moreover, many wealthy educated parents no longer see special education as a stigma or a trap, and are willing to spend five- and six-figure sums on legal fees to obtain the special treatment for their children that goes with the disability label. A December 2007 article in the New York Times noted that the previous year, the city of New York spent $57 million to provide private education for children so labeled. The city was deluged with so many lawsuits it assembled a unit of ten lawyers to fight these cases, presumably including the one filed by former Viacom CEO Tom Freston, who demanded the city pay for private education for his “learning-disabled” son.

The year before this, Freston had been fired by Viacom, with a $100.8 million golden parachute to cushion his fall from grace.

In her book We’ve Got Issues, author Judith Warner details the struggle of one mother, a former government employee who quit her job in order to have more time to lobby to have her child labeled with ADHD and “sensory integration issues.” She finally succeeded and was able to enroll him in private school, at the taxpayers’ expense, where the boy thrived. The mother asked rhetorically, “How do parents who aren’t educated and obnoxious get anything done for their kids?”

How indeed?

Students with the ADHD label may also be eligible for extra time taking the Scholastic Aptitude Test (SAT) as well. A 2019 article in the Vanderbilt Law Review subtitled “Affirmative Action for the Elites?” noted some astonishing findings:

In prosperous regions such as Beverly Hills and La Jolla, nearly 10 percent of students taking the SATs received extra time; by contrast, of the 1,439 students taking the SATs in inner-city regions including Roosevelt, Garfield, and Inglewood, not a single one received any accommodations.

142 high schools in America – 43 private schools and 99 public – are responsible for 24 percent of all accommodated test takers, though they comprise considerably less than 1 percent of the nation’s high schools.

In one school, an incredible 46 percent of all students taking the SATs received accommodations.

(Again, it should be noted these figures refer to students labeled with any kind of “learning disability” – not just ADHD.)

The perks don’t stop after graduating from secondary school. Students with the ADHD label may be eligible for extra time to take the Law School Admission Test (LSAT) and even the Medical College Admission Test (MCAT). Unfortunately, no one has yet figured out a way to give all these ADHD-afflicted aspiring docs extra time after they begin the practice of medicine and then find themselves facing a patient who presents to the emergency room with, say, a traumatic brain injury or a cardiac arrest.

Patient Advocacy

As the number of children diagnosed with ADHD soared, so did the membership rolls of Children and Adults with Attention-Deficit Hyperactivity Disorder (CHADD). Founded in 1987, CHADD is far and away the largest “patient advocacy organization” for children and adults with ADHD. According to their 2018 annual report:

CHADD improves the lives of people affected by ADHD by providing support, training, education, and advocacy for millions of children and adults in the United States living with ADHD, their families, educators, and healthcare professionals.

Early in its history, CHADD became embroiled in a controversy when the organization petitioned congress to have Ritalin declassified as a Schedule II drug with a high potential for abuse and addiction. The petition stated that Ritalin is “a beneficial and relatively benign medication which assists millions of children daily” and is not “dangerous and addictive.” What the petition did not mention was that CHADD had received nearly $900,000 in contributions from Ciba-Geigy, the manufacturer of Ritalin.

This inconvenient truth was brought to light by the PBS news magazine The Merrow Report. In a 1995 op-ed piece in the New York Times, reporter John Merrow quoted Ciba-Geigy’s director of public information as saying that CHADD is “essentially a conduit for us,” adding “We’re getting big information out there.” The same article quoted Dr. Harvey Parker, one of the co-founders of CHADD, who described the organization as “absolutely independent,” adding that they recommend Ritalin “because it works, plain and simple,” and that the group did not use any Ciba-Geigy money to lobby for the loosening of restrictions on Ritalin.

Since that episode CHADD has grown into an organization with an annual budget of $2.5 million a year. How much of that comes from the drug companies is not easy to find out – the group’s website coquettishly notes that “We rely on many sources of funding to support the activities of the organization,” but a comprehensive list of those sources is not provided.

Nevertheless, a dash through that website is instructive. A fact sheet titled “About ADHD” informs readers that “Without identification and proper treatment, ADHD may have serious consequences, including school failure, family stress and disruption, depression, problems with relationships, substance abuse, delinquency, accidental injuries, and job failure.” Which of these bad outcomes is reduced by “identification and proper treatment” is never mentioned.

Also, note the author’s choice of words: family stress and disruption are consequences of ADHD – not the causes of the complaints that fall under that diagnostic label. This formulation may make the parents of troubled children feel better about themselves temporarily, but it also exempts the rest of us from having to do something about crowded underfunded schools and other social problems that may be contributing to these children’s distress.

Another fact sheet tells us that “Medication is recognized by the scientific community as the primary treatment to reduce the symptoms of ADHD.” As evidence for this pronouncement, the paper cites the MTA Study fourteen-month follow-up – ignoring the eight-year follow-up which found no benefit from medication for any of twenty-four outcome variables. The “fact sheet” cites other sources from as recently as 2013, so it seems unlikely that the author could have missed the MTA eight-year follow-up, which was published in 2009.

The organization’s “Public Policy Agenda for Children and Adolescents” states that “CHADD supports the fact that researchers have an obligation to disclose their sources of funding of their research…” This is an admirable sentiment, but the reader may be forgiven for wondering why the group apparently does not apply this principle to themselves.

Finally, the website boasts of an “ADHD Centers Directory,” which provides “contact information for clinics which have specific experience and expertise in diagnosing and treating ADHD…” One of these fonts of expertise is Tufts Medical Center, where two-year-old Rebecca Riley was diagnosed with ADHD and prescribed clonidine. At the age of three she was diagnosed with bipolar disorder and prescribed Eli Lilly’s blockbuster drug Zyprexa and then Seroquel in addition to the clonidine. At the age of four she died, a direct result of the drugs she had been prescribed.

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Editor’s Note: This piece is an edited excerpt from the author’s new book, Obedience Pills: ADHD and the Medicalization of Childhood.

ADHD: The Money Trail