You Might Not Have ADHD. You Might Just Be Tired.

Will we ever solve the mystery surrounding the symptoms and diagnosis of ADD/ADHD?

The New York Times recently fanned the flames of the controversy over whether many cases of ADD, and even ADHD, are actually cases of sleep deprivation. Every time this idea hits big media, the same reactions happen: Other media picks it up, overgeneralizes and twists it; camps are formed, and people go to (verbal) war.

I saw one HuffPo item that called ADHD a mental illness, which seems more of a brutal word choice than semantics should allow, and the author accused parents of hoping for the diagnosis so that their child might get “homework medicine.” I saw a piece that called parents of ADD and ADHD-labeled children “lazy” and put them down as poor parents who simply can’t control their kids. I saw many, many pieces blame the phenomenon of high rates of diagnosis on our cultural’s favorite topic, hobby, tool and scapegoat: technology, in all its forms.

I don’t know that much about ADD and ADHD. I know I have a dear friend whose son and husband have been diagnosed, and whose daughter has a more controllable, less severe case of ADHD. To reach those diagnoses, her family members took tests, the children were observed at school by a clinician, the childrens’ teachers filled out questionnaires that went directly to the doctor so that the teachers could answer without any fear of blowback from the parents.

ADD and ADHD is a real issue; it’s estimated that three percent to five percent of Americans aged 12-17 have it. Yet a report by the Centers for Disease Control tells us 6.4 million American children have been diagnosed with ADHD. One out of every five high-school boys have been diagnosed with the disorder.

The issue couldn’t be more complicated. We’re applying science to a condition that cannot be clinically proven. The symptoms are inattention, hyperactivity, impulsivity, distraction, fidgeting, losing things, daydreaming, talking nonstop, touching everything in sight, having trouble sitting still during dinner, being constantly in motion, impatience, interrupting conversations, showing emotions, acting without regard for consequences, and difficulty waiting your turn. Sounds like a middle-school cafeteria. (Or maybe even the Dunkin’ Donuts on 20th and Chestnut.)

Where does the line between “disorder” and personality meet and cross over? What’s “normal?”

Things are going to get more complicated before they become easier. Criteria for the proper diagnosis of ADHD, to be released next month in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, have been changed specifically to allow more adolescents and adults to qualify for a diagnosis.

We’re at an all-time high of 11 percent of all school-aged children in America being diagnosed as ADD/ADHD, depressed or suffering from severe anxiety. Are we smarter and more savvy at catching conditions early on? Sales of stimulants to treat ADHD have more than doubled to $9 billion in 2012 from $4 billion in 2007. The fastest-growing market for antidepressants is pre-schoolers.

A friend’s son went away to Penn State, and when he came home for Christmas break, he told her that he’d been taking his roommate’s Ritalin and it made him better able to focus. He asked her if she could take him to his pediatrician or just call and get a prescription for him. When my friend started to explain that wasn’t how it worked, that diagnosis of ADD or ADHD was a process, he was flabbergasted: All three suitemates had scripts, as well as other kids on his floor, and everyone shared pills all the time. He wanted to have his own script so he wouldn’t have to pay his friends for individual pills. Numbers show seven percent of college students report using prescription stimulants for cognitive performance; that number grows to 25 percent at elite universities.

About a month after my husband died, I was having trouble sleeping. I went to my GP and she asked me if I was depressed. When I answered that I damn well better be, she suggested Wellbutrin. I also smoked, then, and she said we’d have a “two-fer.” I did not like the idea, but I wanted to sleep, and I did want to stop smoking.

Two weeks in to taking the drug, I was standing outside the Kenneth Cole on Walnut Street, screaming into my phone, and I had this strange experience of being able to see myself, marching on the street, talking too loud, never quite sure of what I was doing or what I should do next. Even in my grieving state, my hyper-kinetic personality went into overdrive on the Wellbutrin. I felt (and often looked) like the Tasmanian devil, whirling about, wild-eyed.

Growing up, my teachers called my “Chatty Kathy.” My father still loves to tell people I “came out talking.” I can’t help but wonder if, had I been raised in the ’90s instead of the ’70s, I would have been labeled ADHD. And what would be different about me now if I had?

I don’t know the answer: Kids who aren’t diagnosed until later are often found to self-medicate, and often suffer from academic failure and low self esteem. Ned Hallowell has been the talking head on ADD, and arguably one of the leading experts. But all the new CDC data, and news reports of young people abusing stimulants, has left him reassessing his role.

He has concern for the undiagnosed right alongside acknowledgment that the diagnosis is “being handed out too freely.” For years, Hallowell’s much-quoted opinion on Adderall and other stimulants was that they were “safer than aspirin.”

Last month he said, “I regret the analogy … I won’t be saying that again.”