You Probably Have ADHD

By Allison McCabe 12/23/13

Deceptive marketing and celebrity endorsements have created an ADHD culture, much to the delight of the pharmaceutical companies.

photo: Shutterstock

I recently took a six question quiz on the website Everyday Health to determine if I have adult ADHD. The quiz was written by “Psychcentral Staff” and included questions such as “When you have a task that requires a lot of thought, how often do you avoid or delay getting started?” And “How often do you feel overly active and compelled to do things, like you were driven by a motor?” I answered honestly, and got this result: “ADHD may be likely.” I have never been diagnosed with ADHD, I am generally focused and calm and no one would ever describe me as hyper. After reading my results, however, I had my doubts. Or maybe I wanted to have my doubts; wouldn’t it be nice to have a condition which would allow me, after receiving the right diagnosis and medication, to miraculously make new friends, get better grades, finish projects, and have among my similarly-diagnosed peers people like Adam Levine, lead singer for Maroon 5?

According to the CDC, childhood diagnoses of ADHD have risen from 600,000 in 1990 to 3.5 million today and 15 percent of high school age kids are diagnosed with ADHD. These numbers represent “a national disaster of dangerous proportions,” according to Dr. Keith Conners, a long time proponent of recognizing and destigmatizing ADHD. Despite the numbers, Dr. Conners says that there is no ADHD epidemic. Instead, “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.” 

Every single major ADHD medication has been in trouble with the FDA for misleading advertising, some more than once.

Pharmaceutical companies have spent the past two decades engaging in aggressive and sneaky marketing that has included diagnosis- and drug-pushing doctors, playing on parents’ fears, and involving schools in the effort to attract, diagnose, and treat kids who suffer (or who appear to suffer) from ADHD. Ads for ADHD medication targeting parents feature headlines such as “Reveal his potential,” and “Thanks for taking out the garbage.” One ad has a hand-drawn picture of a kid and in large, childish writing, states: “Today I got a good mark. And made a new friend. What a great day!” In one particularly manipulative ad, a cheerful mom appears under the headline “I am not a bad mom;” the mom explains that her son’s school was ready to throw him out if his behavior continued. After taking the ADHD medication, however, her son “has become a thousand times better" and she has presumably been exonerated from bad motherhood.

Every single major ADHD medication has been in trouble with the FDA for misleading advertising, some more than once.

ADHD medications are marketed to doctors by psychopharmacology experts such as Dr. Joseph Biederman, a Harvard University child psychiatrist who is a huge proponent of stimulant medication to treat ADHD. Dr. Biederman also believes that the disorder is significantly underdiagnosed, and that failure to medicate will almost certainly cause risks as serious as drug dependence and problems with the law. As an example of Dr. Biederman’s enthusiastic support of stimulant medication for ADHD, in 2006 he told Reuters Health, “If a child is brilliant but is doing just OK in school, that child may need treatment, which would result in their performing brilliantly at school.” According to the marketing efforts aimed at doctors, much of which has been based on findings from Biederman’s research, ADHD drugs will “allow your patients to experience life’s successes every day.” One brochure for Adderall XR contains the remarkable statement that “Amphetamines have been used medically for nearly 70 years. That’s a legacy of safety you can count on.”

A Senate investigation in 2008 found that Dr. Biederman’s research was largely funded by drug companies, including Shire, the manufacturer of many of the leading ADHD medications. He was also paid $1.6 million for speaking and consulting. Dr. Biederman denies that the money had any effect on his research.

The more insidious marketing efforts are the ones that are not obvious. The main advocacy group for people with ADHD is CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder). CHADD was started in 1987 with the goal of bringing more attention to ADHD and its treatment. According to the group’s website, CHADD was founded “in response to the frustration and sense of isolation experienced by parents and their children with ADHD. At that time, one could turn to very few places for support or information. Many people seriously misunderstood ADHD. Many clinicians and educators knew little about the disability, and individuals with ADHD were often mistakenly labeled ‘a behavior problem,’ ‘unmotivated,’ or ‘not intelligent enough.’” CHADD offers advocacy, support, and a CDC-funded clearinghouse for “evidence-based information about ADHD.” They put out a magazine called Attention with articles such as “What’s in a Parent’s ADHD Tool Box?”

Pharmaceutical companies know what they’re doing: in 2012, sales of stimulants reached almost $9 billion, up from $1.7 billion in 2002.

I checked the website's funding, and found no mention of the fact that the group was started with seed money from Ciba-Geigy Pharmaceuticals, the primary manufacturer of ADHD drug Ritalin. Furthermore, the drug company provided funds to create “fact sheets” about treatment, one of which claimed: “Psychostimulant drugs are not addictive.”

CHADD has also lobbied the DEA to loosen government restrictions on stimulants and has worked on an educational video about ADHD with the Department of Education. The 11 main sponsors for CHADD’s 12th annual conference in 2000 were all drug companies. Shire led the pack, and was also revealed to have paid $3 million so that CHADD’s magazine, “Attention” would be delivered to doctors’ offices across the country.

Perhaps the most deceptive—and saddest—marketing efforts are the ones aimed at children.  “What’s Up with Astra?” is a comic book about a girl who has trouble with school and friends because of her inability to focus or stay still. Fortunately, a group of superhero medical experts called “the Medikidz” show up to tell Astra that she has ADHD. They explain how the disorder works in her brain, and introduce her to “Nora and Dopey,” who teach her how she can treat her ADHD.

The Medikidz were created by two pediatricians who were frustrated by the lack of child-friendly resources available to explain medical conditions. In addition to ADHD, the comic books deal with diseases and disorders including brain tumors, cancer, and allergies. According to their website, “Credibility is the cornerstone to the Medikidz offering - professional medical writers and doctors write all the content, which is subsequently peer-reviewed by leading consultants in each respective field. Medikidz also gains the endorsement of established and well-regarded medical institutions, foundations and spokespeople.” 

According to the New York Times investigation, however, credibility may not be such a strong cornerstone for Medikidz, at least in the case of the ADHD comics. Shire paid to have them produced. From the comic: “Medicines may make it easier to pay attention and control your behavior!”

Drug makers also enlist schools to help with their recruitment. Diagnoses are almost too easy when resources such as the American Psychiatric Association include criteria for ADHD such as “makes careless mistakes” or “often has difficulty waiting his or her turn.” The New York Times article describes the case of Andy Perry, a rambunctious child from Mercer Island. Andy’s public school teachers recommended to Andy’s parents that he be evaluated for ADHD and medicated with Ritalin. The school psychologist gave Andy’s mother a pamphlet which included the statement: “Parents should be aware that these medicines do not ‘drug’ or ‘alter’ the brain of the child. They make the child ‘normal.’” Later, Andy’s parents noticed the Ciba-Geigy logo on the back of the pamphlet. The school acknowledged that the pamphlets had been provided to them by representatives from the drug company.

Andy Parry was on Ritalin for three years even though, according to his father, he never had ADHD.“Somebody came up with this idea, which was genius. I definitely felt seduced and enticed. I’d say baited,” Andy’s father told The Times.

Pharmaceutical companies know what they’re doing: in 2012, sales of stimulants reached almost $9 billion, up from $1.7 billion in 2002.

Was the idea to diagnose as many people as possible there from the start? Roger Griggs came up with Adderall in 1994. After buying a small company that produced Obetrol, a weight loss pill, Griggs suspected that the medication might be effective at treating what was then called Attention Deficit Disorder, so he tried to create a new name for the drug that included ADD. He eventually came up with “ADD for All,” which he then shortened to Adderall. “It was meant to be kind of an inclusive thing,” Griggs said.

Adderall immediately became competition for what was, at that time, the predominant ADD treatment, Ritalin. Shire, sensing a business opportunity, bought Griggs’ company for $186 million and then spent millions more to host conferences for doctors and pay physicians to extol the benefits of Adderall.

At one of these meetings, Shire hired Denver psychiatrist Dr. William Dodson to do a presentation on the long acting formula of Adderall, Adderall XR. Dodson encouraged doctors to “educate the patient on the lifelong nature of the disorder and the benefits of lifelong treatment.” Studies show, however, that probably 50 percent of children with ADHD do not suffer from the disorder as adults. Furthermore, there is very little research on how effective or dangerous long-term use of the medication may be.

In other words, an ADHD medication website just diagnosed me with “likely” ADHD.

The New York Times obtained Dodson’s powerpoint presentation from the conference. Among other assertions, the document claimed that stimulants were not “drugs of abuse,” and that the side effects were “generally mild.” It also warned of the dire future that awaits children with ADHD: “job failure or underemployment,” “fatal car wrecks,” “criminal involvement,” “unwanted pregnancy,” and venereal diseases. Dodson did not mention, however, whether the use of stimulants would have any effect on those outcomes.

After creating a virtually self-sustaining childhood ADHD diagnosis and treatment market, drug companies are now targeting adults.

On Bloomberg TV, Shire’s chief executive Angus Russell stated: “The fastest-growing segment of the [ADHD] market now is the new adults who were never diagnosed.” Prescriptions for ADHD medication for adults have tripled since 2007. In 2012, 16 million adult prescriptions were written.  Shire once again saw a money making opportunity early on and took the initiative by rehiring Dr. Dodson in 2004 to write a pamphlet to “help clinicians recognize and diagnose adults with ADHD.” Dr. Dodson put the number of adults with ADHD at 10 percent of the general population, rather than the more widely accepted 3 to 5 percent. The higher percentage was a more accurate measure, according to Dodson, because it included people who had been diagnosed as children. “Once a child has ADHD, he does for life. It doesn’t go away with age.”

Shire followed up its claim of high adult rates of ADHD diagnoses with ads targeted at adults. It ran web ads on sites like MTV, hulu, and youtube. The ads claimed that “adults with ADHD were almost two times as likely to be divorced” and that “ADHD was found in 32 percent of adults with a depressive disorder.” Again, the ads omit any research showing that medication has any effect on these outcomes. In order to remind adults that they have not grown out of their childhood diagnosis, Shire also sponsored the Adam Levine ad in which the singer states: “I remember being the kid with ADHD. Truth is, I still have it.” 

Adults with ADHD have a higher statistical probability of being drug or alcohol addicts than adults without the disorder. According to a 2007 survey, “more than 15 percent of adults with the disorder had abused or were dependent upon alcohol or drugs within the previous year. That’s nearly triple the rate for adults without ADHD.”  Many addicts in recovery do not want to take an amphetamine-based medication, and would rather suffer with their symptoms or look for alternative treatments. Shire, unwilling to lose any potential drug buyers, addresses the concerns of addicts in the adult ADHD booklet by including a quote from one of Dodson’s patients: “If you give me a drink or a drug, I’ll abuse it, but not this medication. I don’t consider it a drug. Drugs get abused. Medication helps people have satisfying lives.”

When ADHD is diagnosed and treated correctly, children and adults can thrive. When it is misdiagnosed, it can lead to children feeling there is something wrong with them and adults looking outside of themselves for a solution to benign problems such as having trouble focusing. With the over-saturation of advertising, quizzes, paid doctors, and cute gimmicks—especially the Shire-sponsored “Roadhd Trip,” a “mobile consumer outreach program” that uses a big rig truck to travel the country providing ADHD screening for adults—how can anyone know if the diagnosis he or she receives is correct or just a result of clever marketing? And since the medication promises to improve your life (while warning that lack of treatment can lead to outcomes such as divorce, drug addiction, and depression), there is little motivation to truly question the diagnosis.

On the self-screening quiz, underneath my diagnosis of “ADHD May Be Likely,” there is an additional helpful message: “people who have answered similarly to you typically qualify for a diagnosis of ADHD or ADD and have sought professional treatment for this disorder.” The website also has video of people “owning” their ADHD and a form to order “Your ADHD Action Guide.” Next to all this information, and clearly delineated in an information box, is the qualifier: “This website was developed by Everyday Health and sponsored by Shire.” In other words, an ADHD medication website just diagnosed me with “likely” ADHD.

Shire and other pharmaceutical companies have created two generations of people dependent on stimulant medication. Their marketing techniques have made it nearly impossible to determine if any of those people were wrongly diagnosed and treated. As a result of all these clever drug pushing strategies, the drug makers have made billions of dollars. By firmly entrenching ADHD diagnoses and amphetamine-based medication in our culture, the pharmaceutical companies have created guaranteed and increasing profits with no end in sight. As a publication put out by the Shire-funded advocacy group CHADD stated, “ADHD: ‘It’s everywhere YOU want to be.'”

Allison McCabe is the Senior Editor of The Fix. Her last feature was on mandatory drug sentencing.

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Allison McCabe is the editor in chief of The Fix. She has written for LA Weekly, Village Voice, Junk: a literary fix, Ramshackle Review, Main Street Journal and others. Follow Allison on Twitter.