Human Exceptionalism

Put All Boys on Ritalin?

The headline is hyperbole, for all you literalists out there–and you know who you are.  But I think Jacob Sullum is right that we seem to be in danger of medicating “boyhood.”  From the Reason article, “Pediatrician Group Seeks to Boost ADHD Diagnosis:”

This week the American Academy of Pediatrics (AAP) began recommending that “any child 4 through 18 who has school or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity” be evaluated for attention deficit hyperactivity disorder (ADHD). Previously the AAP’s guidelines applied only to kids between 6 and 12. An ADHD diagnosis is considered confirmed if a patient meets the criteria in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, which lists characteristics that are very common in children but tries to narrow the label’s reach by requiring that the “symptoms” last for at least six months “to a degree that is maladaptive and inconsistent with developmental level.” It looks like that caveat has been somewhat successful, since far less than 100 percent of American 4-to-17-year-olds have been diagnosed with ADHD—only about 10 percent, according to the National Survey of Children’s Health. One in 10 is still a pretty impressive number, of course, and the AAP’s new guidelines can be expected to boost it further.

That used to be what fathers and tough school counselors were for, but I look back to a golden age that never was.  Today, kids experience broken homes, a toxic culture, and other environmental issues–including, I think, a desire to modify the expression of masculinity to a more passive model–that can lead to medicalizing what used to be considered disciplinary and socialization issues.

Sullum notes that the rates of diagnosing ADHD have more than doubled, and the prescription of stimulants like Ritalin too.  Moreover, he notes, that a teenager so diagnosed often go straight to prescriptions instead of behavioral approaches:

Confusingly, the AAP urges doctors to “carefully weigh the risks of drug therapy at an early [prepubescent] age with those associated with delayed diagnosis and treatment” even though “evidence for use of stimulants in this age group is particularly strong.” By contrast, doctors should go straight to speed for adolescents, even though “the evidence in this age group is not as strong as in the younger patients.”

Sullum says that the ADHD is an example of psychiatrists “creating diseases by defining them.”  I don’t know about that, but there is cause for concern when a study claims 38% of Europeans have a mental illness.

Back to boys, I tend to believe that at least some children do need these medicines. But not as many as are actually prescribed them.  Moreover, it does seem to me that what was once considered normal boyhood has been turned, at least in some cases, into a pathology.


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