ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic

by Alan Schwarz

The groundbreaking account of the widespread misdiagnosis of attention deficit hyperactivity disorder—and how its unchecked growth has made ADHD one of the most controversial conditions in medicine, with serious effects on children, adults, and society. “ADHD Nation should be required reading” (The New York Times Book Review).

More than one in seven American children are diagnosed with ADHD—three times what experts have said is appropriate—meaning that millions of kids are misdiagnosed and taking medications such as Adderall or Concerta for a psychiatric condition they probably do not have. The numbers rise every year. And still, many experts and drug companies deny any cause for concern. In fact, they say that adults and the rest of the world should embrace ADHD and that its medications will transform their lives.

“In this powerful, necessary book, Alan Schwarz exposes the dirty secrets of the growing ADHD epidemic” (Kirkus Reviews, starred review), including how the father of ADHD, Dr. Keith Conners, spent fifty years advocating drugs like Ritalin before realizing his role in what he now calls “a national disaster of dangerous proportions”; a troubled young girl and a studious teenage boy get entangled in the growing ADHD machine and take medications that backfire horribly; and big Pharma egregiously over-promotes the disorder and earns billions from the mishandling of children (and now adults).

While demonstrating that ADHD is real and can be medicated when appropriate, Schwarz sounds a long-overdue alarm and urges America to address this growing national health crisis. “ADHD Nation is a necessary book. Schwarz has done a fine job on a maddening topic, and everyone who’s interested in hyperactivity, attention spans, stimulants, and the current state of American health care should grab a copy” (New York magazine).

Genres: Nonfiction, Adhd, Psychology, Science, Audiobook, Politics, Medical

Audiobook

First published May 10, 2016

Reviews

[Mischenko · Rating 5 out of 5]

I've dealt with ADHD since I was a young child. It seems to run in my family as it’s ‘passed down’ to other family members. I've been skeptical of medications as a treatment and after reading this, I still am.

The book is a real eye-opener. It's amazing to me how many people are taking these meds—not just children, but college students and adults as well. What's even more shocking are the different disorders that they are coming up with now that branch from ADHD like SCT.

I would recommend this to anyone who has an interest or deals with ADHD. We'll written and not too pompous.

5*****

[Esil · Rating 4 out of 5]

I didn't read ADHD Nation for any personal reasons, but I requested a copy from Netgalley because the topic sounded interesting and a recent excellent review in the New York Times nudged me to start reading: http://www.nytimes.com/2016/08/28/boo... Having now read it, I'm somewhat alarmed to see that mine appears to be the first review on GR. This is an excellent balanced review of the history of ADHD diagnosis and treatment. Schwarz is very careful to preface his book -- and to remind readers on many occasions -- that ADHD is real, that it can have truly negative effects on people's lives, and that there is effective treatment for ADHD. However, his book also highlights a growing tendency to over diagnose and over prescribe, and he argues that the economic interests and social forces involved make it really difficult to reverse this trend. I found ADHD Nation to be fascinating, accessible and balanced. I suspect that Schwarz's analysis applies to many other health trends. This book deserves more attention than it seems to have received so far on Goodreads. Thank you to Netgalley and the publisher for giving me access to an advance copy.

[Cathy · Rating 4 out of 5]

The history behind this condition is well explained and the lid gets blown off the big money made by pharmaceutical companies. It balances the pros and cons of taking prescribed 'speed' and tells the stories of individuals who struggle with ADHD and need chemical assistance with a true dopamine deficiency, while exposing the truth behind rampant abuse in the schools of kids who take it for better grades or snort it for recreational use. I was just as surprised as when I learned about the wide use of anabolic steroids commonly abused in schools.

[Yuri Krupenin · Rating 2 out of 5]

В какой-то степени даже опасная книга, затянутая попытка побороть манипуляцию фактами и сенсационализм с помощью манипуляции фактами и сенсационализма же. ADHD — продукт большой фармы, подхваченный медиа и учителями ("у вас ребёнок не успевает систематически, сходите к врачу, пусть амфетаминчика пропишет, что вы за родители такие")? Может быть, но построение книги, затрагивающей заболевание, которым диагностированы 6+ миллионов человек, на анекдате и страшилках (в частности на историях жизни двоих пациентов, которым зависимость от назначенных препаратов сломала жизнь) — не выдерживающий никакой критики подход.

Собственно, до последнего кажется, что автор (уважаемый человек; NYT, Пулитцер) регулярно останавливается в полуслове от того, чтоб заявить, что ADHD как заболевания вероятно вовсе не существует, но за пару глав до эпилога книга делает ощутимый разворот в риторике и предлагает относиться к заболеванию серьёзнее и приводит множество (очень рациональных, тут я не имею никаких претензий) доводов в сторону всего лишь более аккуратной диагностики и более ответственной подготовки медицинкого персонала; выглядит почти как механизм снятия с себя ответственности.

TLDR: книга абсолютно не вызывает доверия в качестве основного источника информации по проблеме, но возможно работает как отправная точка (мне не настолько интересно, чтобы исследовать вопрос дальше).

[Morgan B · Rating 2 out of 5]

Critique: I wanted this to be a thoughtful critique of the relationship between big pharma and inappropriate prescribing of psychostimulants and critiques the way systems of power and oppression make some demographics more and less likely to receive a diagnosis and have access to medication. This book was not that and was light on empiricism and data for the claims made by the author. For example, the author doesn't compare the current diagnosis rate of ADHD with epidemiologic incidence. Schwarz implies that ADHD diagnosis ballooned in the 1990s corresponding with marketing of psychostimulants but does not demonstrate that this change in diagnosis rate is disproportionate to the incidence of ADHD in the US population. Disproportionately high diagnosis would imply inappropriate diagnosis but increases in number of diagnosis may only reflect increased awareness and access to care. Schwartz also criticizes John Ratey (psychiatrist and author of Driven to Distraction) for being "self diagnosed" with ADHD and glamorizing ADHD as a "gift". Pointing out strengths of a neurotype that has historically experienced significant stigma does not negate the experience of ADHD creating a disability in the US social context. The author also points out the spending of pharmaceutical companies on development of psychostimulants without also explaining that many of the newer formations are actually designed to be harder to misuse - for example coatings that cannot be crushed for an immediate euphoric effect or Vyvanse which needs to be metabolized by the liver into an active form making it less appealing for people seeking an immediate effect. I would caution parents seeking more information on ADHD and medication for their child from using this book as their primary learning source in the decision making process.

Strengths: I did appreciate that Scwartz does not deny the reality of ADHD being a condition deserving of treatment and provides suggestions for how to find a professional who will do a through diagnosis. I also appreciated that he cautions parents to assess their own motivations for seeking medication. Undoubtedly there are unscrupulous providers who either don't have the appropriate training or don't have the appropriate desire to thoughtfully diagnose ADHD. This phenomena has especially increased since early 2020 when many prescribing rules were suspended and I agree that the trend is concerning.

[Lil · Rating 4 out of 5]

This is a very compelling read about the history of ADHD and the pharmaceutical industry. Parts of it are really frightening...statistics showing huge percentages of school age kids (1 in 3 boys enrolled in Medicaid in Louisiana!) being medicated in some parts of the country. I have no trouble believing that Big Pharma wants everyone on expensive meds for life. The author does a good job of making the case that ADHD is a real diagnosis but that the increasing prevalence can't be right.

I wish there had been more discussion about the factors of modern education and lifestyle that make inattention and hyperactivity seem to be everywhere.

There are a couple of inaccuracies that keep me from giving this 5 stars. One was an incorrect description of aspirin and stomach bleeding. This may seem petty, but that makes me question what facts could be wrong on things I don't happen to know anything about. The other is that the author attributes ADDitude magazine to CHADD, an ADHD support organization , but their magazine is called Attention. This was easy to figure out (after another reviewer pointed it out) with one quick google search. Makes me wonder what else is inaccurate.

[Jamie Erin · Rating 4 out of 5]

Fascinating and eye-opening history of Attention-Deficit / Hyperactivity Disorder (ADHD). This book explains how the disorder first came to be diagnosed in the 20th century, and how stimulant medications (amphetamines) were first prescribed to children, often with impressive results.

Early in its recognition, researchers and child psychiatrists thought the percentage of children with ADHD would be around two to three. Over the years, however, and as pharmaceutical companies became HEAVILY involved in direct marketing to both physicians and the general public, this number has, in some instances, gone up to 30-plus percent of children in certain school districts.

ADHD Nation examines how the pharmaceutical agenda, when coupled with well-meaning educators, concerned parents, and doctors with insufficient knowledge and time, has resulted in an explosion of ADHD diagnoses. It exposes the reliance of some academically ambitious students on ADHD medications to improve their test scores, and addresses how prescribed stimulants can lead to drug abuse and, in the worst cases, even death. Finally, the book discusses how pharmaceutical companies have encouraged doctors and the public to now embrace "ADULT ADHD," claiming that diagnosis of this newly-recognized disorder can be assumed by simply answering six questions about one's behaviors. The questions are ridiculous, and have surely encouraged many adults to begin taking stimulant medications needlessly.

Currently, the Centers for Disease Control (CDC) puts the rate of ADHD among children at 11 percent, a number that is continually climbing, and that is higher among boys. Bundled into this statistic is the recent push to now identify TODDLERS as having the disorder (per the CDC, nearly 400,000 two- to five-year-olds have already been diagnosed with ADHD as of 2016). Shockingly, doctors are now prescribing stimulant medications to children who are not even potty-trained. These drugs have not been tested on young children, and no one knows how they affect health in the long-term when started at such a critical time of life.

Yes, I know that ADHD is a very real disorder, and that the prescribed medications can make a tremendous impact for some of those whom it impairs. However, lack of unbiased education and training among educators, doctors and parents has resulted in gross over-diagnosis, and over-reliance on potentially addictive chemicals to quell what, in some cases, is truly just kids being kids.

[Joy · Rating 5 out of 5]

As an special educator and a mother of two children who ride the Autism/ADHD line, this book interested me. It is similar to the recent book about Autism, In a Different Key and explores the history of ADHD from its early days of first diagnosis to the present day.

The book spotlights three people: the doctor who first discovered the disorder, a girl who was misdiagnosed with ADHD and a teen who faked ADHD in order to get medication to help him focus in high school. Along the way, other prominent doctors and researchers are discussed who played a role in the history of ADHD. The author spends a lot of time on the influence of pharmaceutical companies who manipulated information about ADHD to turn a profit. From misleading advertisements, first to doctors and then to consumers which downplayed medication's addictiveness and omitted important side effects. They also paid researchers to produce studies on medication, giving the researches and incentive to find in pharma's favor. Also discussed was the very subjective nature of the ADHD diagnosis, which was often diagnosed in as little as 5 minutes by doctors who had very little training on the disorder or its medications.

In the end, Schwarz encourages caution. He definitely believes that ADHD exists but cautions parents that a doctor who will diagnose their child in 5 minutes, is probably not well trained in it. He also says parents should examine themselves to see if they have a bias that would cause them to want to medicate their child, even if the child did not need it. He encourages doctors to seek training so that they are better equipped to properly diagnose ADHD.

This book was easy to understand and is meant for the lay person, not overly technical for doctors and other health professionals. I found it to be very informative.

[Charlene · Rating 3 out of 5]

I really don't even know how many stars to give this book. Some points the author made were great, while other points were terrible. I would have preferred a book that was much more data driven than this.

[Andy · Rating 3 out of 5]

This was quite good in parts. Except for a long weird detour in the middle for a couple of anecdotes on the dangers of ADHD meds, the book generally sticks to looking at studies and the doctors who conduct them, explaining their strengths, weaknesses and biases. The general point is that actual ADHD is much rarer than the number of prescriptions would indicate, and this reveals a number of problems with parents, schools, doctors and Pharma. I think this argument about the medicalization of social problems for profit and convenience is valid.
However, I feel like in a whole book on the topic, that he could have gone into some more detail about solutions. For example, with respect to how to properly diagnose and treat actual ADHD, I don't think he ever mentions individual placebo trials of stimulants; this is when parents and teachers are filling out the rating scales for a few weeks without knowing whether the child is receiving meds. Also, multi-tiered CBT-based school interventions to help kids cope should have gotten attention. Also, better ways of teaching. Etc.

[Takumo-N · Rating 4 out of 5]

Really elocuent and fast history of ADHD overprescription and abuse in the United States. From the early 20th century to basically today. It intertwine personal stories with estadistics and undeniable facts about it. With a sympathetic last chapter giving a little hope for all this to stop. it all boils down to lazy doctors, frustrated parents and teachers, kids dissapointed in themselves, and of course corporate greed. It is analogous with the opioid epidemic, and in a minor way transitioning surgery that is happening right now, let's see how that one sets down in the years to come. The USA indeed has a short memory.

Our culture's handling of the disorder could very well be diagnosed with ADHD itself. From parents to teachers to doctors, we have been to impulsive, jumping at easy labels and even easier medication. We have hyperactively bounced from one definition to the next, scrambling to rationalize the newest ADHD symptom roster that is then swiftly judged insufficient. And the zeal for diagnosis and medicating children, and now adults, had distracted us from the abundantly obvious evidence that ADHD long ago jumped its tracks.

[Dominika · Rating 4 out of 5]

This book is more about the overdiagnosis of ADHD during the 90’s and 00’s. It is not saying that ADHD does not exist nor that medicine should never be prescribed, and I think that’s important to keep in mind because there very much is a movement that shuns psychiatric diagnosis and psychotropic medications.

The main point of this book is that our culture and one-size-fits-all style of schooling have contributed to a pressure that put a lot of kids that don’t need medicine on Adderall and Ritalin. Big Pharma certainly had a role in this as well, from advertising in ladies’ magazines to sponsoring professional workshops for practitioners, and a big chunk of this book is devoted in outlining some of these heinous practices (Lol at Ritalin Man). But its important to note that a lot of children, teenagers, and adults felt the need to take the medicine to improve their performance at work and school, seeing them as the only way to succeed.

It’s also good to see what has been done in response to this (which..isn’t as much as one would hope). It is also interesting to look at this during the opiod epidemic that is happening right now, seeing the parallels, and thinking about how we can prevent these types of things from happening.

I mean, this book clearly has a bias and it is important to keep that first point in mind. A lot of people would look at the broad message, as well as the particular case studies of people who have been addicted to and abused this medication, and take that to mean that all drugs are bad. I honestly don’t even think that advertising these medications are inherently bad, but with the preditory martking and the context of our current healthcare system. But I am interested in population health and hope that this can one day be used to influence policy-making, and this book provides a lot to think about, and I think anyone else who has experience with mental health or epidemics would also find this to be a great read.

[Jason · Rating 4 out of 5]

Occasionally, the book veers uncomfortably close to crackpot conspiracy theory in tone and absolutism, but its central claims--that diagnoses of ADHD in children and adults in the US is more prevalent than any academic model predicts, that amphetamine is being abused throughout the country by people without a proper ADHD diagnosis and that a whole lot of junk science is being employed by ethically-conflicted doctors and funded by drug companies that profit from their conclusions--are persuasive and well supported. Schwarz begins with some necessary caveats. Mainly that ADHD is a real condition and that Adderall, Ritalin, etc. legitimately help those legitimately in need of help. This is not a book about a manufactured condition. It is, however, a book about how motivated reasoning and conflict of interest converge to create a climate of collective mass hysteria.

The issue is, as Schwarz demonstrates, that amphetamine can work on anyone to provide more energy and greater concentration. In this way, it's like steroids that can build muscle and strength regardless of whether or not one has a condition requiring them. This means that the misdiagnosed or just those in need of a competitive edge do see results by abusing ADHD medication. In this light, it's easy to see why so many people take these medications without needing them and still find improvement in the classroom, the boardroom, etc. The problem with this is that maybe medicating the world isn't the greatest idea. Maybe classrooms could be less boring and unengaging. Maybe professional work could be less mundane and tedious. Maybe we could all stop overstimulating ourselves with media and technology and give our brains a break. These aren't Schwarz's conclusions necessarily, but he does an effective job in this book demonstrating the need for thinking about focus, pharmacology, and childrearing differently.

[Casey · Rating 5 out of 5]

With ADHD diagnosis and medication becoming such a prevalent part of our society I think that this book is a must read for all. Schwarz expertly weaves the long history of attention deficit disorder with its undeniable ties to Big Pharma. For the most part, I believe he does a fairly decent job of finding a good middle ground between the die hard Pharma supporters and the ADHD deniers on the opposite side of the spectrum. That being said, some arguments against Big Pharma do come off as more "ranty" than factual (and that is coming from someone with no love lost for the pharmaceutical industry). Overall I think that Schwarz does an excellent job of portraying the mind boggling atrocities that have befallen the ADHD community in recent decades. One of the major aspects of the book that stood out to me (and literally made my jaw drop) was the fact that the projected number of children affected by ADHD is around 5% but that 15% are diagnosed with ADHD by the time they leave high school, which by any standard is astronomically high. Numbers like this, as well as the fact that 10,000 TODDLERS ages 2 and 3 in the United States are currently on medication for ADHD make one question not only the diagnosis and medication process but also the role of pharmaceutical companies in research, advertisement, and medical practice. Clearly these are issues that need to be further investigated and improved up. I would also be very interested to read something for the opposite take of Mr. Schwarz if anyone has any good suggestions!

[Chips O'Toole · Rating 4 out of 5]

A solid read about the history of ADHD and its diagnosis. As an adoptive mother of two boys, one of whom is on Concerta for a legitimate reason, I have long been interested in ADHD medication and how eagerly it is pushed by school administrators. Many have encouraged me to put my younger son on medication as well, never taking his history into account, in order to make him more compliant. As a former high school teacher, I understand their frustration. Public schooling is nothing more than controlled chaos, but THAT is where the problem lies. The system itself is broken, trying to do too much with far too little. THAT is where we must start if we're ever to help kids. Schwarz' book is a great starting place if you're looking to learn more and to foster conversation on this timely (and pressing) topic.

[Alexander Fitzgerald · Rating 5 out of 5]

I found Alan Schwarz's reporting on America's monetization of ADHD to be illuminating, fair, and fascinating.

I was given ADHD meds as a kid. I loved them because they worked like speed for me. While I was always a hyperactive and annoying kid, Adderall simply made me work nonstop and get dangerously paranoid.

As I became older, I realized that first prescription was what got me used to the idea of being altered. I wondered how it was so easy to get a prescription for uppers when I was so young. I had a doctor talk to me for a very short period of time, and then I was on them.

This book provided me with the answers. I also was able to understand how so many good doctors got it wrong.

I felt Mr. Schwarz had a subtle bias against the drug companies throughout the text, but he does a good job of trying to keep it fair.

Highly recommended.

[Liz.dibble · Rating 3 out of 5]

A great history of ADHD and some very interesting points that I do agree with.

What bothered me about this book was the tone. It seemed very dramatic and sensational and less measured and data driven. It was interesting to read it along with other books on the subject to get a more measured, well rounded story.

I do think ADHD is real, I do think children, teens, adults are overly medicated, but I also think medication has it's place and using scare tactics just hurts everyone as they are trying to make decisions for themselves and their children.

Glad I read it, but wouldn't revisit it.

[Desiree Colvin · Rating 5 out of 5]

Important read on the growth of ADHD in the US and the forces that worked together to cause it. Superbly written, well-researched, sensitive, nuanced. Highly recommended for doctos, parents, teachers, and anyone who cares about doing what's right by our children instead of what is easy, expedient, or profitable.

[Linda · Rating 5 out of 5]

Excellent book, clear and cogent writing, interesting facts, personal stories, level-headed analysis, astute observations, malarkey called out as malarkey, praiseworthy behavior rightly praised, and remedies.

Highly recommended.

[Zach · Rating 4 out of 5]

here's hoping Schwarz's book gets into the right hands. ADHD is real. so are the forces trying to cash in on fear(s)

[Janie Lundin-Ledgerwood · Rating 3 out of 5]

For a parent navigating and raising a young child with ADHD, it was helpful to hear how far we've come in understanding and treating the processing disorder. I appreciated the investigation of how parents, doctors, counselors, and big pharma are involved. Particularly, the doctors that have studied and helped many families that struggle with 'what to do' to help their child.

With that said, though the preface Schwarz gives that ADHD is a real disorder to be taken seriously, I was not happy with the tone and how he teeters on extremes. The insinuation that the ADHD epidemic is being caused by drug-abusing teens duping their parents and doctors succumbing to the influence of Big Pharma is outlandish. Based on my experience, its a pretty rigorous process to have your child assessed and diagnosed. It's not as easy as going to the doctor and saying, 'Sally is having trouble concentrating and needs Drug X.' I guess that's just good marketing and how you keep readers interested.

"ADHD is under-diagnosed in most populations. With 40-60% of such children in any given community in the U.S. not being diagnosed or treated." -Russell A. Barley, PHD - Taking Charge of ADHD: The complete, Authoritative Guide for Parents.

What this book did for me was introduce me to the scientists and doctors that are studying the causes and treating the families affected by the disorder. So for that, I'm thankful to be led to their books.

In all, it was worth the read.

[A. Housewife · Rating 4 out of 5]

I was surprised by how dramatically readable this book was. I thought I was going to have to slog through it. It's pretty even-handed, showing the terrible difficulties that ADHD people face and also showing some of the not-frequently-enough-discussed side effects of medication.

Something I had no idea about before reading this book is how much the pharmacy companies and profits drove (and continue to drive) the way ADHD is diagnosed and managed. How they sponsored the research.

The most important points for me:
- ADHD is a murky, subjective diagnosis
- The percentage of the population who is diagnosed with it started at 3% in 1980 and is as high as 15% today (and 20% for boys)
- the medication to cope with it is startlingly effective
- the medication to cope with it works on EVERYBODY, not just people with ADHD, increasing focus and attention and motivation
- the medication has a huge risk of addiction
- the side effects can be awful, and can spiral into what is called a "medication cascade" where psychiatrists keep prescribing other medications to help deal with the side effects, which trigger new side effects, which cause them to prescribe more medication
- CBT was said to not be as effective as medication but it still is somewhat effective and can be an approach for the segment of the population who gets addicted or who can't cope with the side effects
- ADHD medication (ab)use is rampant in competitive high schools and colleges

[Reilly Rockwood · Rating 5 out of 5]

This book deserves more attention! As a psychiatric nurse practitioner, I think this an excellent summary of the history and future direction of ADHD diagnosis and prescribing trends in the US. The author highlights the importance of a thorough, balanced approach to diagnosis and prescription writing, and warns against the dangers of casual assessment. He also reveals big pharma’s alarming tactics for growing their business, and how they profit from rising rates of ADHD diagnoses. I am alarmed by how many adults present to my office after watching tik tok reels or taking brief online surveys of symptoms, then self-diagnose ADHD and request a stimulant prescription. I do think there are valid cases where adults went undiagnosed with ADHD during childhood, and could subsequently benefit from diagnosis and prescription. However, I believe that the rising number of diagnoses and prescriptions written is dramatically influenced by big pharma, marketing efforts, and social media consumption.

[Emiliano Castillo · Rating 4 out of 5]

Este libro contiene mucha información sobre la historia del TDAH (ADHD), la cual es importante para entender cómo se ha desarrollado nuestro entendimiento mediático de este trastorno. Gran parte del libro es dedicado a refutar mitos y propaganda creada por la industria farmacéutica. Donde creo que se queda muy corto es en no sólo definir negativamente qué cosa no es el TDAH, sino afirmar cuál es nuestro conocimiento actual. Al terminar este libro sé mucho sobre qué cosa NO es el TDAH, pero nada sobre qué es realmente. Una oportunidad perdida.

[Jennifer Ingle]

DNF

There’s lots of credible, factual information, yet the overall tone is highly biased. A lot of generalizations about a condition that may be unique for each individual. Since I was just reading for interest, I dropped it about 2/3 of the way through because I got the main takeaways and lost interest.

[Elizabeth Chadsey · Rating 5 out of 5]

so0o0o0o0o good.

[Jon · Rating 5 out of 5]

Frustrating to know how easily treatment decision making can be led astray

[Kerby Elfring · Rating 4 out of 5]

4.5 stars. A well researched and sobering read.

[Colin Murray · Rating 4 out of 5]

Must read about an ongoing epidemic!

[Preston · Rating 3 out of 5]

Kinda wild to hear the story of how everyone is on easily available uppers, and all the events that occurred and incentives that put pressure towards making this reality happen. Listened to the audiobook at 2x as the narration is pretty slow. Mildly interesting.