How The Sausage Gets Made

Except That Sausage is Delicious, and These Drugs Are Really Bad

Welcome new readers! Last week, I wrote about how the governing authorities in pediatrics pressure doctors to drug daydreamers. Today, I would like to pull back the curtain a little further and show you all precisely how easy it is for your children to get drugged for life.

How is the life-altering diagnosis of ADHD made? As loosely as possible. There is no brain scan or blood test. In the early days (see here for more on the tragic story of the inventor of ADHD), dedicated specialists would spend hours observing a child. Today, the American Academy of Pediatrics deems such resource-intensive measures unnecessary. Nine out of ten children with ADHD are now diagnosed using behavioral rating scales filled out in a few minutes by parents and teachers and reviewed by general pediatricians like me in between visits for ear infections and sore throats. If you want to understand how stimulant prescriptions have become a multi-billion-dollar industry, these checklists are a great place to start.

There are at least two glaring problems with the rating scales. The first is their ignorance of sex differences. In their guideline, the AAP explains that “[b]oys are more than twice as likely as girls to receive a diagnosis of ADHD, possibly because hyperactive behaviors, which are easily observable and potentially disruptive, are seen more frequently in boys.” But wait: if boys tend to be more hyperactive than girls, they should not get diagnosed using identical questionnaires. Think of it this way: if cats and dogs were held to the same standard of barking frequency to meet Pet Barking Disorder, there would be hardly a mutt on earth that escaped the clutches of Big Furry Pharma. Yet in truth it should not take more than a solitary woof to consider institutionalizing a calico, whereas a bevy of barking could be a lazy afternoon for the average airedale; you can’t judge them on the same scale. If a group is more prone to certain behaviors, that must be factored into diagnosis. Even as the experts acknowledge boys are more hyperactive than girls, they madly persist in grading them on sex-neutral rating scales. Men may be from Mars, but the ADHD industry insists on judging them by the standards of Venus.

The second problem cuts to the heart of the questionnaires. Take a closer look. There are nine total items on the famous Vanderbilt form used to diagnose children with a hyperactivity disorder. A five year old boy needs to meet, in the eyes of just one teacher and one parent, the highly technical, objective determination of ‘often’ (in stark scientific contrast to ‘occasionally’) on just six of these items to be diagnosed with ADHD:

1. Fidgets with hands or feet or squirms in seat

2. Leaves seat in classroom or in other situations in which remaining seated is expected

3. Runs about or climbs excessively in situations in which remaining seated is expected

4. Has difficulty playing or engaging in leisure activities quietly

5. Is “on the go” or often acts as if “driven by a motor”

6. Talks excessively

7. Blurts out answers before questions have been completed

8. Has difficulty waiting in line

9. Interrupts or intrudes on others (eg, butts into conversations/games)

Of these nine items – which, to remind you, have led to the drugging of millions upon millions of children – notice how many are outright repetitions. Is it even possible, in keeping with the physical laws of the universe, to run about in situations in which remaining seated is expected and yet not leave your seat? Is running around the classroom, wildly waving your chair above your head, a loophole that qualifies? These obvious restatements of identical behavior wouldn’t be such a big deal, except that, considering it only takes six items to qualify as mentally ill, a little effort at variety would have been nice.

ADHD’s ugly diagnostic secret: the famed questionnaires are nothing but an exercise in list-making via thesaurus. I have heard skeptics compare the checklists to a quiz in Cosmopolitan; this is an insult to the magazine. Compare with a real Cosmo quiz helping readers find out if they’re truly in love. One question that does not appear: are you in love? This would be a violation of quizzing 101. You don’t put the characteristic you’re testing for alongside examples of what it’s like to have that characteristic. Yet, on the Vanderbilt, there it is: “Talks excessively.” It is not simply that having trouble playing quietly, interrupting people, blurting out answers, and talking excessively are all ways of saying the same thing. It is that the first three of those are examples of a subjective personality type described by the fourth. Similarly, the subjective judgment “acts as if driven by a motor” is right there alongside examples of acting as if you’re driven by a motor. The whole nine item questionnaire could be simplified to read as follows:

1. Do they move too much?

2. Do they talk too much?

I suspect that having only those two questions would have had the awkward effect of making the whole diagnostic exercise all the more obviously a put-up job, but at least it would be honest. As is, the Vanderbilt made the embarrassing choice to disregard decades of American quiz-making expertise. At least when a Cosmo quiz goes wrong, nobody ends up on brain-altering pharmaceuticals.

And that’s it, that’s how a kid gets diagnosed with a mental illness. A short questionnaire that doesn’t hold up to a moment’s reflection – and, presto, a lifetime supply of mind-altering stimulants are yours.

I share this behind-the-scenes look to hopefully help demystify the process. Don’t let the white coats and medical school jargon intimidate you – this is as clear a con job as ever there was. Don’t let your child be their next mark.

Thank you for reading and have a wonderful rest of your week! For those who’ve had enough of the ADHD topic, don’t worry, I’m stepping down from my soapbox for now, keep an eye out for something very different in the weeks to come.