School Testing and the Rising Rate of ADHD

A new book finds a startling connection

Read the Interview: http://www.nbcnews.com/health/kids-health/could-school-testing-be-driving-adhd-n55661

Is the increased demand for performance behind the increased diagnoses of ADHD? Two University of California professors have released a book this month titled, “The ADHD Explosion.” They call it a “reality check” for parents, providers, educators and politicians.

The Berkeley professors, Dr. Stephen Hinshaw and Dr. Richard Scheffler, are noted researchers on ADHD. Their research tells them that federal policy issues may be behind the recent explosion in cases of ADHD.

“When you look at that [national testing policy], you get the
closest thing there is to a smoking gun,” says Dr.Scheffler.

The Journal of the American Medical Association (JAMA) Pediatrics, found that rates of ADHD in California have jumped by 24% since 2001. Additionally, the Center for Disease Control (CDC) reports increases from 7.8 percent in 2003 to
9.5 percent in 2007 and to 11 percent in 2011— a rate of 5 percent a year.

It looks for all the world like a growing epidemic. But ADHD wasn’t even something people noticed until recently,” says Hinshaw.

“It started about the same time in history that we made kids go to school,” Hinshaw told NBC News in an interview.

Then come the 1990s, and a crisis of falling test scores. “What happened is that a number of states began to pass accountability laws,” Hinshaw said.

Hinshaw and Scheffler examined the correlation between diagnoses of ADHD and maps of states that had passed accountability laws.

According to NBC News, by the turn of the century, 30 states had passed accountability laws. They tended to be Republican-leaning states in the South, such as North Carolina. In 2007, 15.6 percent of all children in North Carolina had been diagnosed with ADHD at some point, including nearly one in three teenage boys.

Two things happening together don’t prove a correlation. Is it coincidence? Hinshaw and Scheffler were persuaded to look further.

AN NBC News article reports that the professors then examined date related to the No Child Left Behind federal policy enacted in 2002. It was one of the first official acts of President George W. Bush after he took office.NCLB required standardized testing to show if schools were, in fact, educating students. A truly salient aspect of NCLB was that it held teachers and principals directly responsible for the results and removed federal and state bureaucrats who mandate curriculum and educational policy.

According to the NBC News article:

“Now what happens is a natural experiment,” says Hinshaw. The other states raced to write accountability laws, requiring schools to show they are actually educating children.

“When you incentivize test scores above all else, there is probably pressure to get kids diagnosed with ADHD.”

Hinshaw and Scheffler compared ADHD rates in the 30 states that had been requiring testing with the 20 states that had to play catchup.

Rates of ADHD diagnoses soared.

“Children ages 8 to 13, living in low-income homes and in states without previous consequential accountability laws, went from a 10 percent to a 15.3 percent rate of ADHD diagnoses once No Child Left Behind started,” they wrote. That’s a 53 percent increase over four years.

California’s current rate, post-testing? It’s 7.3 percent. North
Carolina’s rate actually fell slightly, to 14.4 percent in 2011.

“When you incentivize test scores above all else, there is probably pressure to get kids diagnosed with ADHD,” Hinshaw said. “We know from our own research that medication not only makes you less fidgety but also can bump up your test scores.”

That would be the benign interpretation, that testing has
encouraged parents to get their kids in to see specialists for
much-needed medical care. But there’s also a more sinister
possibility and one that Hinshaw and Scheffler say is at work in
some states.

“If you can identify the children with ADHD, you can take them out of the pool that measures how schools are doing,” says Scheffler.

He says some districts — he won’t say where — do seem to have been doing so. State school officials and the federal Department of Education did not respond when contacted by NBC News.

No Child Left Behind ties federal funding to test scores, Scheffler points out.“You can see the incentive for schools to get kids diagnosed with ADHD,” he says.

Either way, Scheffler and Hinshaw say the increase in ADHD cases is real, and it’s not just affecting kids. Recent studies show adult diagnoses are on the rise, too.

“Although often ridiculed, ADHD represents a genuine medical
condition that robs people of major life chances,” they write in the book.

“You can see the incentive for schools to get kids diagnosed with ADHD.”

Scheffler doesn’t see the increase in adult ADHD diagnoses as
surprising. “This has nothing to do with the schools. This has to do with global competition and performance,” he says. People are under pressure to perform better at work.

And news about adult ADHD in turn sends more people to their doctors, and diagnoses spike even more, Hinshaw adds. “Here are we are in 2014 with evidence that medications can benefit. Adult ADHD clinics spring up,” he says.

“That’s not necessarily a bad thing,” says Hinshaw.

What is bad is if ADHD is not being diagnosed with the proper care, Hinshaw says. A 10-minute pediatrician visit is not adequate for an ADHD diagnosis and certainly not as the basis for writing a prescription for a powerful stimulant, such as Ritalin or Adderall, to treat it.

“Many pediatricians are not trained in the emotional disorders of childhood, or not reimbursed for the time it takes,” Hinshaw said.

“It is easy to pull out prescription pad at the end of a visit.”

He calls the book a “reality check” and says parents, providers, educators and politicians should take note, and make sure the right kids are being diagnosed, and helped, properly.

 

Training the ADHD Brain

For years, we at Play Attention, have trained thousands and thousands of people to better pay attention, learn the cognitive skills they need to succeed, and change their behavior. Our results have spoken clearly for us since 1994. Now science is catching up.

Two recent distinct studies validate the brain’s ability to change. While a vast plethora of research confirms these studies’ findings, they are noteworthy. The first study demonstrates the efficacy of skill training, and the second demonstrates how teaching skills rewires the living brain.

The first study, published in the August 25 Journal of the American Medical Association, was performed by researchers from Massachusetts General Hospital (MGH). They utilized cognitive behavioral therapy as a direct intervention for ADHD adults. Cognitive therapy teaches skills for managing life challenges.

The researchers at  MGH found that while medications were the first line of treatment, many patients still persist with underlying symptoms.  While previous studies on cognitive behavioral therapy for ADHD were small and short term, the researchers at MGH claim their study to be the first to conduct full-scale randomized, controlled trial of the efficiency of an individually-delivered, non-medication treatment of ADHD among adults.

“Medications are very effective in ‘turning down the volume’ on ADHD symptoms, but they do not teach people skills,” commented Steven Safren, PhD, ABPP, director of Behavioral Medicine in the MGH Department of Psychiatry, who led the study. “This study shows that a skills-based approach can help patients learn how to cope with their attention problems and better manage this significant and impairing disorder.”

“Sessions were designed specifically to meet the needs of ADHD patients and included things like starting and maintaining calendar and task list systems, breaking large tasks into manageable steps, and shaping tasks to be as long as your attention span will permit,” commented Safren, an associate professor of Psychology in the Harvard Medical School Department of Psychiatry. “The treatment is half like taking a course and half like being in traditional psychotherapy.”

Like Play Attention has been doing since 1994, the researchers provided training sessions mainly that included skills training in filtering of distractions, organization, problem solving, and planning.

Safren’s group receiving cognitive and behavioral training demonstrated advanced control of their symptoms over their control group.  This benefit had persisted when measured three and nine months after the training.

The second study, published in The Journal of Neuroscience (August 25, 2010, 30 34 11493-11500 doi 10.1523 JNEUROSCI.1550-10.2010), examined the brains of rats when they learned to control their impulses.  The researchers documented synaptic changes in the medial prefrontal cortex. They concluded that the rat’s brains rewired themselves to produce the impulse controls necessary to be successful in the tasks the scientists had established for them.

Other past studies have confirmed that the brain will rewire to make changes for skills, impulse control, organization, etc. We’re glad that science is catching up to an learning process that we’ve done at Play Attention for sixteen years now.  That’s beyond cutting edge; it’s leading the way for others.