The ADHD and Stimulant Epidemic in America

U.S.A: United Stimulant Addicts

By Zachary Estrada April 4, 2018

Attention deficit hyperactivity disorder, commonly known as ADHD, is the most

commonly diagnosed and researched mental disorder among children in the United States today1.

“ADHD is a neurodevelopmental disorder currently characterized as a persistent pattern of

hyperactivity and impulsivity that interferes with development or functioning”2. An estimated

9.5% of children aged 5-17 years old have been diagnosed with ADHD in the United States3. While

it is estimated that 4.4 percent of adults aged 18-44 years old have ADHD in the United States4. 45

The majority of both children and adults diagnosed with ADHD in American are

prescribed medication in order to treat symptoms. Among medication used to treat ADHD,

stimulants such as Adderall and Ritalin are most commonly prescribed to reduce the severity of

symptoms associated with the disorder. In the United States, 69.3% of children currently

diagnosed with ADHD are taking medication

for treatment5. Meanwhile, 2% of adults in the

United States are prescribed stimulant

medication for ADHD which is nearly half of

all adults estimated to simply have ADHD in

America6. Stimulant medications such as

Adderall and Ritalin are chemically labeled as

an amphetamine and methylphenidate, respectively.
Both are labeled as schedule II drugs with high potential
Medication Use Among Children Currently
Diagnose with ADHD. NSCH, 2011.
https://www.nimh.nih.gov/health/statistics/at
tention-deficit-hyperactivity-disorder-
adhd.shtml

for abuse and have a high risk of leading to severe psychological and physiological dependence

according to the Drug Enforcement Administration7 (DEA). However, due to their medical use

1 The ADHD and Stimulant Epidemic in America

to treat ADHD among children and adults it is assumed that Adderall and Ritalin enhance the

cognitive functioning of the brain making someone smarter, more successful, and more focused.

This perspective of Adderall and Ritalin often held by many college students and adults without

a prescription for the drug resulted in a dramatic increase of illicit stimulant abuse among adults

aged 18-25 years old8 .

Over the last decade the diagnosis of both children and adults have been climbing

steadily at epidemic rates9. Amongst children ages 5-17 years old, the rate of diagnosis increased

from 7.0% in 1997-1999 to 10.2% in 2012-201410. A positive correlation is evident between the

continual increase of ADHD diagnosis in America and the increase of stimulant medication

prescriptions and stimulant abuse amongst young adults at similar rates. The continual increases

among these categories at epidemic rates has raised some immense concern for the mental health

of Americans as well as the concern for the long-term effects of stimulant medication including

the addiction and abuse of the drug used by children and adults prescribed it as well as those not

prescribed it. If left alone, the current epidemic of ADHD diagnosis that started the abuse and

addiction of stimulants could lead to increasing long lasting health complications among children

and young adults in America.

Overdiagnosis of Children With ADHD

As the number of ADHD diagnoses among children climbs steadily each year it is

necessary to look at the epidemiology of the disorder to critically evaluate the current practices

of diagnosing ADHD among children in the United States. In doing so it was clear that numerous

factors involved with the diagnostic process of ADHD among children used predominantly by

certified clinicians have either lead to or been the direct cause of the epidemic rise of ADHD

among children in America.

2 The ADHD and Stimulant Epidemic in America

 A study from the National Survey of Children’s Health in which data collected from

parent reports was utilized to reveal an increasing trend in prevalence of ADHD among children

in the United States. From the 2003 to 2011 the prevalence of ADHD among children ever-

diagnosed with the illness increased 42 percent from 7.8 percent to 11 percent respectively11.

While overlapping with that time from 1997-2006 the diagnosis of ADHD increased 3 percent

per year12. This epidemic-like increase in the number of childhood ADHD diagnoses in America

for over a decade is a result of numerous factors stemming from the lack of standardization when

it comes to clinically diagnosing ADHD.

Being that “epidemiological studies can only approximate clinical diagnostic processes”,

Trends in Prevalence of Children Ever-Diagnosed with ADHD(https://www.nimh.nih.gov/health/statistics/attention-deficit-

hyperactivity-disorder-adhd.shtml)

the epidemiological study of ADHD required that there be a definitive case of the disorder13. As

there is a severe lack of experimental research defining a “core” trait or commonly shared deficit

exhibited by a person believed to have ADHD or like symptoms, further understanding of the

3 The ADHD and Stimulant Epidemic in America

disorder through epidemiological studies cannot be progressed14. While there is still no singular

shared deficit or core trait of children diagnosed with ADHD, there are three overarching

categories that define ADHD in which symptoms a child exhibits fall under. Symptoms

including messy and carelessly performed schoolwork; difficulties sitting still; excessive talking;

impatience; frequently interrupting and intruding on others; and blurting answers out before the

question is finished are all categorized by either hyperactivity, impulsiveness or inattention15.

The ambiguous language consistent with the criteria presented by the American Psychological

Association leaves definitions of the symptoms, such as behaviors that constitute a person’s

talking as “excessive”, in the air to be subject to multiple interpretations of clinicians, patients,

parents, and teachers involved in process of evaluating a child with ADHD16. In fact, parent

teacher reports hold tremendous value to clinicians when they are evaluating a patient as they are

able to best tell when symptoms are exhibited in excess compared to other children of the same

age and cognitive level17. Teachers especially hold the most influence on a child’s diagnosis of

ADHD as they have increased understanding of “good” developmental behavior18. Nonetheless,

parent teacher reports serve no purpose in standardizing the process of ADHD as the DSM-IV

lacks instructions on how to analyze and compile the subjective reports in order to come up with

a diagnosis19.

Consequently, lack of standardized diagnostic methods has created a diverse group of

children diagnose with ADHD that share a variety of symptoms20. Among the symptoms

commonly associated with ADHD prevalence in children many are shared with other mental

disorders21. While there is almost no concrete way for researchers to identify the over diagnosis

or mis diagnosis of ADHD due to the lack of standardized diagnostic method, they can only infer

that the commonality of ADHD symptoms with other disorders likely inflated the prevalence

4 The ADHD and Stimulant Epidemic in America

rates recorded by other epidemiological studies22. Thus, explaining the varying rates of diagnosis

among children in the United States by multiple sources during one year. For example: ADHD

prevalence recorded by steadily increasing number of diagnoses of childhood ADHD each year

can be attributed to the fact that symptoms associated with other mental disorders such as the

prevalence of anxiety disorders in people are often mistaken for or seen as symptoms of ADHD

resulting in a misdiagnosis or overdiagnosis of the disorder among children calling into question

the overall mental health of children in the United States.

Limited Understanding of ADHD in Adults

What was previously acknowledged for decades as a childhood disorder, thought only to

regress insurmountably in adolescence, ADHD in adults has become increasingly prevalent in

America over the past decade (source). Longitudinal studies have proven the symptoms of

ADHD from childhood to carry on into adolescence and adulthood23.

There’s an estimated 4.4 percent of adults who have ADHD in the United States

according to the National Comorbidity Survey Replication. 24 From when research first proved

the prevalence of ADHD symptoms in adults they were diagnose and treated the same way

children were25. The DSM-IV at the time was the American Psychological Association’s

handbook for mental disorders which in order for a child or adult to be diagnosed with ADHD

required that they exhibit at least six symptoms, have hyperactivity/impulsiveness or inattentive

symptoms prior to 7 years of age, impairment in two or more settings and clinically significant

impairment in social; academic or occupational environments. 26 These criteria set forth by the

APA for the diagnosis of ADHD in both children and adults lead to an even further issue as the

diagnosis of ADHD in adulthood is unreliable and controversial among experts.27

5 The ADHD and Stimulant Epidemic in America

 While it is commonly understood that ADHD symptoms change over time and at the

time of ADHD diagnosis in adults had the same symptom requirements for a diagnosis of ADHD

in children. The American Psychological Association eventually realized that there was a need

for a change of ADHD diagnosis requirements to resemble the changing of symptoms over time

with their update requirements in the DSM-V for the diagnosis of adult ADHD. However, 15

years prior to the publishing of the DSM-V in 2013 a researcher to proposed the concept of age

norming, so that people of older ages would not have to exhibit the same criteria that children

would have to in order to get diagnosed.28

Although age norming was seemingly the most logical way to level out the playing field

between children and adults making adults and older people exhibit less symptoms in order to

be diagnosed, “the dilemma of how to define and conceptualize ADHD in teenagers and adults

and how to develop developmentally sensitive diagnostic criteria remains an important

issue.”29 Age norming would also make it easier for adults and teenagers to get diagnosed with

ADHD and be prescribed treatment for it with stimulant medication in turn making the chances

of dependability, addiction, or abuse of stimulant medication higher.

Illicit Use of Stimulants Among Young Adults

In 2006, the U.S. Food and Drug Administration investigated the cardiovascular and

psychiatric risks associated with the use of attention deficit hyperactivity disorder (ADHD)

medication, or stimulants30. During the time the FDA was investigating medical risks associated

with ADHD medicine, there were four and one-half million children aged 5-17 years old

diagnosed with ADHD31. By 2007, $2.3 billion had been spent on prescription medication used

to treat ADHD, particularly stimulants.32

6 The ADHD and Stimulant Epidemic in America

 During this time the diagnosis of ADHD among children in the United States was

increasing approximately 3 percent per year, subsequently meaning that there would be more

kids being prescribed stimulant medication.33 In fact, this is not the only time stimulants

increased in sales. From 1990, Adderall and other ADHD medication sales have increased by

400 percent.34 For drugs like Adderall that work as an amphetamine stimulant by enhancing

concentration, focus, increasing dopamine and norepinephrine in the brain there are many

purposes the drug is illicitly used for as it enhances focus with a feeling of brain-overstimulation.

While the use of Adderall without a prescription is illegal, about 25 percent of college students

still admit to taking it to study.35

Similar feelings of euphoria and brain stimulation occur with the use of Ritalin, a

methylphenidate, which also increases the amount of dopamine in the brain by blocking the

reuptake sites.36 According to a study of the brain activity comparing the potency of cocaine to

that of Ritalin as stimulants and transport inhibitors, a 0.5mg/kg dose of Ritalin blocked up to 70

percent of dopamine transporters whereas cocaine only blocked up 50 percent.37 This study is not

only startling because daily millions of children are being given a drug that is a more potent

transport inhibitor than cocaine but also because Ritalin has been classified as a weak stimulant

for nearly forty years.38

Often times young adults and college students, even an entire society can be oblivious to

the negative effects of the drugs as they are being led to believe that stimulants “are harmless

study aids” or pills that simply help a person focus more and fidget less. These negative medical

effects are what the Johns Hopkins Bloomberg School of Public Health study of Adderall use

and misuse from 2006 to 2011 saw, the non-medical use of Adderall went up 67 percent and

emergency room visits went up 156 percent.39 Given that 60 percent of those who use stimulants

7 The ADHD and Stimulant Epidemic in America

illegally fall under the age range of 18-25 years old, it is clear to see that there is an epidemic

occurring among young adults and college students in America. All over the country college

students and young adults are developing an addiction to being able to focus more, feel better,

stay up later, and have more energy to do things.

As most illicit users of Adderall or Ritalin progress and become more addicted, they may

go to their doctor on campus and manipulate the weaknesses and flaws that plague the process of

diagnosing ADHD, especially amongst young adults. More research needs to be conducted, in

order to identify and define a case for ADHD in order to prevent a flawed system in which

clinicians enable stimulant addicts and abusers to continue by legitimately diagnosing them and

writing them a prescription. The discovery of a definitive ADHD case or identification of a

deficiency that is shared amongst all of those who it is prevalent in would also solve the problem

of over-diagnosis among children and adults saving many from having to undergo treatment with

prescription medication that has unknown long-term effects on their body. However, in order to

do this clinicians and researchers would have to re-evaluate all cases of ADHD that have ever

been diagnosed and determine which cases exhibit symptoms of a generic mental disorder or

simply just a behavioral reaction and which symptoms constitute ADHD.

8 The ADHD and Stimulant Epidemic in America

Endnotes

1
Stolzer, J. M. (2007). “The ADHD epidemic in America.” Ethical Human Psychology and Psychiatry, 9(2), 109-116.
Retrieved from http://ezaccess.libraries.psu.edu/login?url=https://search-proquest-
com.ezaccess.libraries.psu.edu/docview/205051644?accountid=13158
2
American Psychiatric Association. (2000). “Diagnostic and statistical manual of mental disorders: DSM-IV-TR.”
Washington, DC: Author.

3. Pastor, Patricia N. “QuickStats: Percentage of Children and Adolescents Aged 5–17 Years with Diagnosed
Attention-Deficit/Hyperactivity Disorder (ADHD), by Race and Hispanic Ethnicity — National Health Interview
Survey, United States, 1997–2014,” Morbidity and Mortality Weekly Report (MMWR) 64(33)(2015):925–925.

4
Kessler, R. C., et al.’ “The prevalence and effects of adult attention deficit/hyperactivity disorder on work
performance in a nationally representative sample of workers.” Journal of Occupational and Environmental
Medicine (47)(2005): 565-572, available at: https://www.ncbi.nlm.nih.gov/pubmed/16585449/
5
Visner, SN., “Trends in the parent-report of health care provider-diagnosed and medicated attention
deficit/hyperactivity disorder: United States, 2003-2011.”J Am. Acad Adolesc Psychiatry 53(1)(2014):34-46,
available at: https://www.ncbi.nlm.nih.gov/pubmed/24342384/
6
Medco. (2011). “America's State of Mind”, http://apps.who.int/medicinedocs/en/d/Js19032en/
7
U.S.C.A., “Schedules of Controlled Substances” § 812
8
Lian-Yu Chen, et al., “Adderall Misuse Rising Among Young Adults” Johns Hopkins Bloomberg School of Public
Health (2016) available at: https://www.jhsph.edu/news/news-releases/2016/adderall-misuse-rising-among-
young-adults.html
9
Abramowitz, Ann J., et al. “The Epidemiology of Attention Deficit Hyperactivity Disorder (ADHD): A Public Health
View, ”Mental Retardation and Developmental Research Reviews (8) (2002): 162, available at:
https://s3.amazonaws.com/academia.edu.documents/45857128/The_epidemiology_of_attention-
deficithyp20160522-20073-
m5nmpa.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1522857163&Signature=uSTA5kc6getu96qXK
HCCqKxGkxY%3D&response-content-disposition=inline%3B%20filename%3DThe_epidemiology_of_attention-
deficit_hy.pdf

10
Pastor, Pastor N. et al. “Association between diagnosed ADHD and selected characteristics among children aged
4–17 years: United States, 2011–2013.” NCHS data brief, no 201. (2015). Hyattsville, MD: National Center for
Health Statistics.
11
Visser SN, et al., “Trends in the parent-report of health care provider-diagnosed and medicated attention-
deficit/hyperactivity disorder: United States, 2003-2011.” J Am Acad Child Adolesc Psychiatry. Jan;53(1)(2014):34-
46.e2.
12
Clarke, Juanne N., “Magazine Portrayal of attention deficit/hyperactivity disorder (ADD/ADHD): A post modern
epidemic in a post-trust society” Health Risk and Society (13)(2011): 623, accessible at:
http://sk8es4mc2l.search.serialssolutions.com/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-
8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajourna
l&rft.genre=article&rft.atitle=Magazine+portrayal+of+attention+deficit%2Fhyperactivity+disorder+%28ADD%2FAD
HD%29%3A+A+post-modern+epidemic+in+a+post-

9 The ADHD and Stimulant Epidemic in America

trust+society&rft.jtitle=HEALTH+RISK+%26+SOCIETY&rft.au=Clarke%2C+JN&rft.date=2011&rft.pub=ROUTLEDGE+J
OURNALS%2C+TAYLOR+%26+FRANCIS+LTD&rft.issn=1369-8575&rft.eissn=1469-8331&rft.volume=13&rft.issue=7-
8&rft.spage=621&rft.epage=636&rft_id=info:doi/10.1080%2F13698575.2011.624178&rft.externalDBID=n%2Fa&rf
t.externalDocID=000299643300002&paramdict=en-US

13
Abramowitz, Ann J., et al. “The Epidemiology of Attention Deficit Hyperactivity Disorder (ADHD): A Public Health
View, ”Mental Retardation and Developmental Research Reviews (8) (2002): 164, available at:
https://s3.amazonaws.com/academia.edu.documents/45857128/The_epidemiology_of_attention-
deficithyp20160522-20073-
m5nmpa.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1522857163&Signature=uSTA5kc6getu96qXK
HCCqKxGkxY%3D&response-content-disposition=inline%3B%20filename%3DThe_epidemiology_of_attention-
deficit_hy.pdf
14
Ibid.
15
American Psychiatric Association. “Diagnostic and statistical manual of mental disorders: DSM-IV-TRf”(4)(2000).

Washington, DC: Author.

16
Rogalin, Mathilda Tassiniri, “Consequences of the ‘Attention Deficit/Hyperactivity Disorder’ (ADHD) diagnosis. An
Investigation With Medical Professionals,” Psychological Studies (60)(2015): 41-49
17
Abramowitz, Ann J., et al. “The Epidemiology of Attention Deficit Hyperactivity Disorder (ADHD): A Public Health
View, ”Mental Retardation and Developmental Research Reviews (8) (2002): 164, available at:
https://s3.amazonaws.com/academia.edu.documents/45857128/The_epidemiology_of_attention-
deficithyp20160522-20073-
m5nmpa.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1522857163&Signature=uSTA5kc6getu96qXK
HCCqKxGkxY%3D&response-content-disposition=inline%3B%20filename%3DThe_epidemiology_of_attention-
deficit_hy.pdf Cantwell, DP. “Attention deficit disorder: a review of the past 10 years.” J Am Acad Child Adolesc
Psychiatry (35)(1996):978–987.
18
Barkley RA. “Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment.” Second Edition.
(1998) New York: Guilford.
19
Abramowitz, et al. “The Epidemiology of Attention Deficit Hyperactivity Disorder (ADHD): A Public Health View,
”Mental Retardation and Developmental Research Reviews (8) (2002): 164
20
Denckla MB, “Commentary: the myth of ADHD.” J Child Neurol (7)(1992):458–461, available at:
http://journals.sagepub.com/doi/10.1177/088307389200700424

21
American Psychiatric Association. “Attention deficit and disruptive behavior disorders.” Washington DC:
American Psychiatric Association Press (4) (1994):78–85. Zametkin AJ, Ernst M, “Problems in the management of
attention-deficit-hyperactivity disorder.” N Engl J Med (340)(1999):40–46, available at:
http://www.nejm.org/doi/full/10.1056/NEJM199901073400107

22
Abramowitz, et al. “The Epidemiology of Attention Deficit Hyperactivity Disorder (ADHD): A Public Health View,”
Mental Retardation and Developmental Research Reviews (8) (2002): 165
23
Shaffer, D., “Attention deficit hyperactivity disorder in adults.” Am J Psychiatry (151)(1994):633– 638, available
at https://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.151.5.633?url_ver=Z39.88-
2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed

24
Kessler, R. C., et al.’ “The prevalence and effects of adult attention deficit/hyperactivity disorder on work
performance in a nationally representative sample of workers.” Journal of Occupational and Environmental
Medicine (47)(2005): 565-572, available at: https://www.ncbi.nlm.nih.gov/pubmed/16585449/

25
Mayes, R. et al., “Medicating children: ADHD and pediatric mental health.” Harvard University Press (2009),
available at: http://journals.sagepub.com/doi/pdf/10.1177/1087054709338843

10 The ADHD and Stimulant Epidemic in America

26
American Psychiatric Association. “Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text
Revision. Washington, DC: American Psychiatric Association 2004.

27
Riccio, C. A., et al., “Attention deficit hyperactivity disorder: Manifestation in adulthood.“ Archives of Clinical
Neuropsychology, (20)(2005): 249-269, available at: https://academic.oup.com/acn/article/20/2/249/2735
Faraone, S. V.,et al., “Assessing symptoms of attention deficit hyperactivity disorder in children and adults: Which
is more valid?” Journal of Consulting and Clinical Psychology(68)(2000): 830-842, available at:
http://psycnet.apa.org/record/2000-02835-009

28
Barkley, RA., “Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment, Second Edition.”
New York: Guilford (1998): 628, available at: http://www.jaacap.com/article/S0890-8567(09)62904-X/pdf

29
Abramowitz, et al. “The Epidemiology of Attention Deficit Hyperactivity Disorder (ADHD): A Public Health View,
”Mental Retardation and Developmental Research Reviews (8) (2002): 165

30
Lian-Yu Chen, et al., “Adderall Misuse Rising Among Young Adults” Johns Hopkins Bloomberg School of Public
Health (2016)
31
32
Sonni, A., “Statistical Brief: Attention-Deficit Hyperactivity Disorder (ADHD) in Children, Ages 5–17: Use and
Expenditures.” Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality; (2009).
33
Clarke, “Magazine Portrayal of attention deficit/hyperactivity disorder (ADD/ADHD): A post modern epidemic in a
post-trust society” Health Risk and Society (13)(2011): 623

34
Pavision, James, “The Case for Human Ingenuity: How Adderall Has Sullied The Game” Washburn L.J. (48)(2008-
2009): 181, available at: http://contentdm.washburnlaw.edu/cdm/ref/collection/wlj/id/5849

35
Ibid. at 175
36
Vastag, Brian, “Pay Attention: Ritalin Acts Much Like Cocaine” JAMA 286(8)(2001): 905-906, available at:
https://jamanetwork.com/journals/jama/fullarticle/194125

37
Ibid.
38
Ibid.
39
Lian-Yu Chen, et al., “Adderall Misuse Rising Among Young Adults” Johns Hopkins Bloomberg School of Public
Health (2016).

11 The ADHD and Stimulant Epidemic in America