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Many of those who treat ADHD see the recognition of the problem as a humane breakthrough: finally we will stop blaming kids for behavior they cannot control. But some are worried that the disorder is being embraced with too much gusto. "A lot of people are jumping on the bandwagon," complains psychologist Mark Stein, director of a special ADHD clinic at the University of Chicago. "Parents are putting pressure on health professionals to make the diagnosis." The allure of ADHD is that it is "a label of forgiveness," says Robert Reid, an assistant professor in the department of special education at the University of Nebraska in Lincoln. "The kid's problems are not his parents' fault, not the teacher's fault, not the kid's fault. It's better to say this kid has ADHD than to say this kid drives everybody up the wall." For adults, the diagnosis may provide an excuse for personal or professional failures, observes Richard Bromfield, a psychologist at Harvard Medical School. "Some people like to say, 'The biological devil made me do it.' "
A DISORDER WITH A PAST
Other than the name itself, there is nothing new about this suddenly ubiquitous disorder. The world has always had its share of obstreperous kids, and it has generally treated them as behavior problems rather than patients. Most of the world still does so: European nations like France and England report one-tenth the U.S. rate of ADHD. In Japan the disorder has barely been studied.
The medical record on ADHD is said to have begun in 1902, when British pediatrician George Still published an account of 20 children in his practice who were "passionate," defiant, spiteful and lacking "inhibitory volition." Still made the then radical suggestion that bad parenting was not to blame; instead he suspected a subtle brain injury. This theory gained greater credence in the years following the 1917-18 epidemic of viral encephalitis, when doctors observed that the infection left some children with impaired attention, memory and control over their impulses. In the 1940s and '50s, the same constellation of symptoms was called minimal brain damage and, later, minimal brain dysfunction. In 1937 a Rhode Island pediatrician reported that giving stimulants called amphetamines to children with these symptoms had the unexpected effect of calming them down. By the mid-1970s, Ritalin had become the most prescribed drug for what was eventually termed, in 1987, attention deficit hyperactivity disorder.
Nobody fully understands how Ritalin and other stimulants work, nor do doctors have a very precise picture of the physiology of ADHD. Researchers generally suspect a defect in the frontal lobes of the brain, which regulate behavior. This region is rich in the neurotransmitters dopamine and norepinephrine, which are influenced by drugs like Ritalin. But the lack of a more specific explanation has led some psychologists to question whether ADHD is truly a disorder at all or merely a set of characteristics that tend to cluster together. Just because something responds to a drug doesn't mean it is a sickness.