ADHD Nation

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

LIST PRICE $13.99
About The Book

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).

Reading Group Guide
This reading group guide for ADHD Nation includes an introduction, discussion questions, and ideas for enhancing your book club. The suggested questions are intended to help your reading group find new and interesting angles and topics for your discussion. We hope that these ideas will enrich your conversation and increase your enjoyment of the book.

Introduction

In ADHD Nation, former Pulitzer Prize–nominated New York Times reporter Alan Schwarz offers an authoritative account of the explosion of ADHD diagnoses and the overmedication of children and adults, with consequences few understand. Based on more than 1,000 interviews with doctors, parents, children, pharmaceutical executives, teachers, and researchers, ADHD Nation sounds an alarm and makes the case for society to wake up and address this national health crisis.

Topics and Questions for Discussion

1. The opening of ADHD Nation reads, “Attention deficit hyperactivity disorder is real. Don’t let anyone tell you otherwise.” Why do you think so many people don’t consider ADHD a true disorder? What impact does this skepticism have on afflicted patients’ ability to seek help?

2. In the introduction, Schwarz describes ADHD Nation as a “we book.” He writes, “It’s the story of how we, as a society, have allowed what could be a legitimate medical condition to become diluted beyond recognition, and beneficial medication to become a serious drug problem.” Why do you think he frames the book this way? What is the significance of “we” instead of “they?” How important it is to consider society as a whole instead of just the pharmaceutical industry?

3. How does knowing ADHD’s history affect your understanding of ADHD? Does its evolution give you confidence or discomfort?

4. Dr. C. Keith Conners could be considered the father of ADHD because he discovered and helped popularize the benefits of Ritalin for treating hyperactivity. He says he now has serious regrets about how ADHD has been handled. Why do think he feels this way? How would you feel if you were in his shoes?

5. The symptom questionnaire Conners developed to help doctors consider ADHD diagnoses measured “not necessarily a child’s behavior, but outsiders’ impression of it—their tolerance for it.” What is the danger with such a subjective scale? Could Conners have predicted how others’ used it?

6. Teachers and schools have been greatly involved in diagnosing children with ADHD. Why did some pressure parents to put their children on Ritalin? How has the teacher’s role in ADHD diagnoses changed over time? Do you think involving teachers in children’s medical care is ever suitable?

7. What was the point of renaming minimal brain dysfunction (MBD) attention deficit disorder (ADD)? What did it accomplish? What did it fail to accomplish? Can you think of any other disorders that have been rebranded in a similar fashion?

8. Stephen Colbert once called the ADHD explosion “Meducation” and joked it was shocking that there are children in American who haven’t been diagnosed. Similarly, the Onion sardonically profiled a four-year-old girl stricken with “Youthful Tendency Disorder.” What is the impact of this kind of satire when used to talk about a medical disorder? How large a role did US media play in the advancement of ADHD and Ritalin? How do media influence consumer perception of new drugs today?

9. What was your reaction when, on page 68, a panel of the field’s top experts failed to simply describe a typical child with ADHD? Do you think doctors today can provide this description? How would you describe the typical child with ADHD?

10. Does modern culture have a quick-fix, just-take-the-pill ethos? What other factors contribute?

11. The CDC reports that the rate of ADHD diagnoses among boys nationwide is 20 percent, but can be up to 30 percent or higher in southern states such as Mississippi, South Carolina, Louisiana, and Arkansas. Why do you think the rate is so much higher there? Why do you think the rate is generally higher for boys than it is for girls?

12. Schwarz frames the book around the narratives of two casualties of the ADHD epidemic: a seven-year-old girl who was mistakenly diagnosed and medicated, and a fourteen-year-old boy under tremendous academic pressure who faked having ADHD to get an Adderall prescription. What is your reaction to those stories? Do individual case studies help our understanding of larger trends?

13. ADHD drugs were among the first that drug companies directly marketed to consumers. What was the effect of this strategy? How did their aggressive and misleading advertising shape the ADHD epidemic? Does this type of advertising work for other disorders or drugs?

14. Recently, pharmaceutical companies have taken to marketing their drugs to adults—from working professionals to the elderly—who think they might have ADHD. Discuss the implications.

Enhance your Book Club

1. Most people know at least one person diagnosed with ADHD or taking ADHD medication. Share your personal stories and conceptions of ADHD as a disorder. Discuss similarities and differences.

2. Have the ways in which society views ADHD changed? How do you think our perceptions will continue to change in the future?

3. Near the end of the book, Schwarz reports there is a new disorder being formulated by several ADHD figures: sluggish cognitive tempo (SCT). Discuss how recognition of that concept might impact American culture and medicine.
About The Author
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Alan Schwarz is a former Pulitzer Prize–nominated investigative reporter for The New York Times whose acclaimed series of more than one hundred articles exposed the seriousness of concussions in the NFL and led to safety reforms for young athletes nationwide. His work was profiled in The New Yorker and honored with a George Polk Award, the Associated Press Sports Editors Award for Project Reporting (three times), and the 2013 Excellence in Statistical Reporting Award from the American Statistical Association. He and his family live in New York City.

Raves and Reviews

"An illuminating exploration of ADHD, brimming with intelligence and insight. Schwarz reveals the powerful cultural and economic forces fueling its widespread diagnosis and drug treatment. Those with the disorder will hear a voice of compassion. And those who may be misdiagnosed, a clarion note of caution."
—Jerome Groopman, M.D., Professor of Medicine, Harvard Medical School, staff writer, New Yorker

ADHD Nation is a true rarity – a book that confronts an important subject with the authority of an expert, makes its case with the urgency of a red alert, and moves at the pace of a thriller."
—Daniel Okrent, New York Times bestselling author of Last Call

"In this powerful, necessary book, Schwarz exposes the dirty secrets of the growing ADHD epidemic."
Kirkus Reviews (starred review)

"ADHD Nation should be required reading for those who seek to understand how a field that once aimed to ameliorate the behavioral problems of children in a broad therapeutic context abdicated its mission to the stockholders of corporations like Shire and Lilly. Schwarz is sounding an alarm for a fire that looks nowhere near abating."
The New York Times Book Review

"This eye-opening book should be a hit with drug-industry skeptics and worried parents who want to read a well-reported, definitive guide to this misunderstood and overly medicated disorder."
Booklist

"Mr. Schwarz’s disciplined focus gives his book clarity and even utility."
The Wall Street Journal

"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

"A dazzling piece of journalism, based on extensive research and an enormous number of interviews...an outstanding exposé."
New Republic

"[Schwarz's] nimble investigation interweaves the narratives of pharmaceutical companies with those of child psychologist Keith Conners, who led ADHD's 'Manhattan Project', and young people grappling with the medical fallout. An intriguing sidelight is the misuse of ADHD drugs as performance enhancers."
Nature

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