The reasons behind the rapid rise in diagnosis rates
Any visitor to North Carolina and California will know that the two states have their differences. The former is a typically “red state”; California is staunchly “blue.” Each has certain geographic, ethnic and cultural peculiarities, different demographic makeup, family income levels, and more. Yet perhaps the most surprising divide, one many wouldn’t expect, is that North Carolina appears to be a hotbed for attention deficit hyperactivity disorder, or ADHD—especially when compared to California. A child who lived in North Carolina instead of California in 2007, according to U.S. academics Stephen Hinshaw and Richard Scheffler, was 2½ times more likely to be diagnosed.
In their forthcoming book The ADHD Explosion, Hinshaw and Scheffler—a psychologist and health economist, respectively, at the University of California at Berkeley—examine the causes behind the startling and rapid rise in diagnosis rates of ADHD, a neurobehavioural disorder that has somehow become epidemic. In the U.S., more than one in 10 kids has been diagnosed; more than 3.5 million are taking drugs to curb symptoms, from lack of focus to hyperactivity. While ADHD typically hits middle-class boys the hardest, rates among other groups are steadily rising, including girls, adults and minorities. Kids are being tested and diagnosed as young as preschool. In North Carolina, as many as 30 per cent of teenage boys are diagnosed. Scheffler says, “It’s getting scary.”
According to psychologist Enrico Gnaulati, who is based in Pasadena, Calif., ADHD is now “as prevalent as the common cold.” Various factors seem to be driving up the numbers, factors that extend from home to school to the doctor’s office and beyond. “So many kids have trouble these days,” says long-time ADHD researcher L. Alan Sroufe, professor emeritus at the University of Wisconsin at Madison. “I doubt it’s a change in our genetic pool. Something else is going on.”
A closer look at the case of North Carolina and California may be instructive. According to Hinshaw and Scheffler, North Carolinian kids between the ages of four and 17 had an ADHD diagnosis rate of 16 per cent in 2007. In California, it was just over six per cent. Kids with a diagnosis in North Carolina also faced a 50 per cent higher probability they’d get medication. After exhaustively exploring demographics, health care policies, cultural values and other possible factors, they landed on school policy as what Scheffler calls “the closest thing to a silver bullet.”