Is ADHD a Pretext for Selling Speed?

New York Times
reporter Alan Schwarz, who for the last year or two has been

wondering what’s up with all the speed kids are taking these
days, has a
long article in Sunday’s paper on “The Selling of
Attention Deficit Disorder.” Unfortunately, Schwarz barely mentions
the American Psychiatric Association (APA), the organization that
identified ADD, later relabeled “attention deficit hyperactivity
disorder” (ADHD), as a disease that can be treated with
prescription stimulants such as Adderall, Ritalin, and Vyvanse.
Instead he focuses on the companies that make those stimulants,
which he accuses of encouraging “overdiagnosis” to maximize
sales.

Schwarz surely is right that companies such as Shire, which
sells Adderall, and Ciba-Geigy, which makes Ritalin, have a
financial interest in pushing as broad a definition of ADHD as
possible. But none of this would be possible without the APA’s
blessing, and Schwarz pays scant attention to the problem of saying
whether someone does or does not have a disease for which there is
no objective test. Here is the sole reference to the APA in his
5,300-word story:

Like most psychiatric conditions, A.D.H.D. has no definitive
test, and most experts in the field agree that its symptoms are
open to interpretation by patients, parents and doctors.
The American Psychiatric Association, which receives
significant financing from drug companies, has gradually loosened
the official criteria for the disorder to include common childhood
behavior like “makes careless mistakes” or “often has difficulty
waiting his or her turn.”

ADHD, like every other condition listed in the APA’s
Diagnostic and Statistical Manual of Mental Disorders, is
whatever the current edition of the DSM says it is.
Since the official definition is broad and “open to
interpretation,” it is hard to know what Schwarz means by
“overdiagnosis.” Here is his best stab at explaining:

Few dispute that classic A.D.H.D., historically estimated to
affect 5 percent of children, is a legitimate disability that
impedes success at school, work and personal life. Medication often
assuages the severe impulsiveness and inability to concentrate,
allowing a person’s underlying drive and intelligence to
emerge.

But even some of the field’s longtime advocates say the zeal to
find and treat every A.D.H.D. child has led to too many people with
scant symptoms receiving the diagnosis and medication. 

Evidently Schwarz accepts the legitimacy of Classic ADHD while
turning up his nose at New ADHD. But since neither purported
disease can be objectively verified, it is not clear on what basis
Schwarz prefers the narrower definition. It seems to me that
Schwarz, who started his career as a sports reporter, is making a
moral judgment about when it is acceptable to use
performance-enhancing drugs: If you have a “legitimate disability,”
it’s OK, but not if you are merely
trying to turn a B+ into an A. He dresses up this moral
judgment in the language of medical science, but it remains a moral
judgment, and a questionable one at that.

As Schwarz concedes, stimulants help many people, adults as well
as children, pay attention and perform better in school and at
work. The relevant question is not, as Schwarz seems to think,
whether all of these people “really” have ADHD (whatever that
means) but whether the benefits of stimulants outweigh their risks.
Schwarz tries mightily to magnify those risks:

Psychiatric breakdown and suicidal thoughts are the most rare
and extreme results of stimulant addiction, but those horror
stories are far outnumbered by people who, seeking to study or work
longer hours, cannot sleep for days, lose their appetite or
hallucinate. More can simply become habituated to the pills and
feel they cannot cope without them.

Notice how Schwarz mixes “rare and extreme…horror stories”
with a common, often welcome effect of stimulants, implying that
users experience suicidal thoughts, insomnia lasting for days, and
hallucinations (presumably due to the aforementioned sleep
deprivation) about as often as appetite suppression. His final
warning—that people may “become habituated to the pills and feel
they cannot cope without them”—is little more than negative spin on
a situation he elsewhere describes as taking a “medication” to
compensate for a “disability.” Schwarz’s most laughable attempt to
scare people away from stimulants is his grave warning that “these
drugs are classified by the government among the most
abusable substances in medicine.” Yes, and according to the
government, marijuana is
even more dangerous.

I don’t mean to imply that prescription stimulants—or their
illegal counterparts, many of which, impurities aside, are
chemically very similar or identical (e.g., Desoxyn vs.
black-market meth)—carry no hazards at all. But the risks are the
same whether or not consumption of the drug has been blessed by a
doctor’s prescripton, and whether or not Alan Schwarz thinks that
prescription should have been written. People should be free to
weigh the risks for themselves, without having to obtain the
magical piece of paper that transforms crime into medicine.