Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-28T01:56:56.494Z Has data issue: false hasContentIssue false

Medicating Kids: Pediatric Mental Health Policy and the Tipping Point for ADHD and Stimulants

Published online by Cambridge University Press:  27 April 2009

Extract

Attention Deficit Hyperactivity Disorder (adhd) holds the distinction of being both the most extensively studied pediatric mental disorder and one of the most controversial. This is partly due to the fact that it is also the most commonly diagnosed mental disorder among minors. Currently, almost 8 percent of youth from the ages of four to seventen have a diagnosis of ADHD, and slightly more than 4 percent both have the diagnosis and are taking medication for the disorder. In other words, on average one in every ten to fifteen children in the United States has been diagnosed with the disorder and one in every twenty to twenty-five uses a stimulant medication—often Ritalin, Adderall, or Concertaas treatment. The biggest increase in youth diagnosed with ADHD and prescribed a stimulant drug occurred during the early 1990s, when the prevalence of physician visits for stimulant pharmacotherapy increased fivefold. This unprecedented increase in U.S. children using psychotropic medication triggered an intense public debate.

Type
Articles
Copyright
Copyright © The Pennsylvania State University, University Park, PA. 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. Wolraich, M., “Attention Deficit Hyperactivity Disorder: The Most Studied and Yet the Most Controversial Diagnosis,” Mental Retardation and Developmental Disabilities Research Reviews 5 (1999): 1631683.0.CO;2-T>CrossRefGoogle Scholar.

2. Williams, J., Klinepeter, K., Palmes, G., Pulley, A., and Foy, F., “Diagnosis and Treatment of Behavioral Health Disorders in Pediatric Practice,” Pediatrics 114 (09 2004): 601606CrossRefGoogle ScholarPubMed.

3. Visser, S., Lesesne, C., and Perou, R., “National Estimates and Factors Associated with Medication Treatment for Childhood Attention-Deficit/Hyperactivity Disorder,” Pediatrics 119 (02 2007, suppl.): S99S106Google Scholar; Centers for Disease Control and Prevention, “Mental Health in the United States: Prevalence of Diagnosis and Medication Treatment for Attention-Deficit/Hyperactivity Disorder,” MMWR. Morbidity and Mortality Weekly Report 54 (2 09 2005): 842847Google Scholar.

4. Rappley, M., “Attention-Deficit Hyperactivity Disorder,” New England Journal of Medicine 352 (13 01 2005): 165173Google Scholar; Zuvekas, S., Vitiello, B., and Norquist, G., “Recent Trends in Stimulant Medication Use among U.S. Children,” American Journal of Psychiatry 163 (05 2006): 579585Google Scholar.

5. Bhatara, V., Feil, M., Hoagwood, K., Vitiello, B., and Zima, B., “National Trends in Concomitant Psychotropic Medication with Stimulants in Pediatric Visits: Practice versus Knowledge,” Journal of Attention Disorders 7 (05 2004): 217226Google Scholar; Robison, L., Sclar, D., and Skaer, T., “Datapoints: Trends in ADHD and Stimulant Use among Adults, 1995–2002,” Psychiatric Services 56 (12 2005): 1497Google Scholar; Thomas, C., Conrad, P., Casler, R., and Goodman, E., “Trends in the Use of Psychotropic Medications among Adolescents, 1994 to 2001,” Psychiatric Services 57 (01 2006): 6369Google Scholar; Olfson, M., Gameroff, M., Marcus, S., and Jensen, P., “National Trends in the Treatment of Attention Deficit Hyperactivity Disorder,” American Journal of Psychiatry 160 (06 2003): 10711077Google Scholar.

6. Eberstadt, M., “Why Ritalin Rules,” Policy Review 94 (0405 1999): 2444Google Scholar.

7. Chiarello, R. and Cole, J., “The Use of Stimulants in General Psychiatry: A Reconsideration,” Archives of General Psychiatry 44 (03 1987): 286295CrossRefGoogle Scholar.

8. Bradley, C., “The Behavior of Children Receiving Benzedrine,” American Journal of Psychiatry 94 (11 1937): 577578CrossRefGoogle Scholar.

9. Barkley, R., Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (New York, 1990), 338Google Scholar.

10. Maynard, R., “Omaha Pupils Given ‘Behavior Drugs,’” Washington Post, 29 06 1970, 1Google Scholar.

11. Swanson, J., Lerner, M., and Williams, L., “More Frequent Diagnosis of Attention-Deficit Hyperactivity Disorder,” New England Journal of Medicine 333 (5 10 1995): 944CrossRefGoogle ScholarPubMed.

12. Schneider, H. and Eisenberg, D., “Who Receives a Diagnosis of Attention-Deficit/Hyperactivity Disorder in the United States Elementary School Population?Pediatrics 117 (04 2006): 601609Google Scholar; Spencer, T., Biederman, J., and Mick, E., “Attention-Deficit/Hyperactivity Disorder: Diagnosis, Lifespan, Comorbidities, and Neurobiology,” Ambulatory Pediatrics 7 (0102 2007): 7381Google Scholar; Zuvekas, Vitiello, and Norquist, “Recent Trends in Stimulant Medication among U.S. Children,” 579–85.

13. Scotch, R., “Politics and Policy in the History of the Disability Rights Movement,” Milbank Quarterly 67 (1989): 380400Google Scholar; Sommer, R., “Family Advocacy and the Mental Health System: The Recent Rise of the Alliance for the Mentally Ill,” Psychiatric Quarterly 61 (Fall 1990): 205221Google Scholar; Tomes, N., “The Patient as a Policy Factor: A Historical Case Study of the Consumer/Survivor Movement in Mental Health,” Health Affairs 25 (0506 2006): 720729Google Scholar; McLean, A., “Empowerment and the Psychiatric Consumer/Ex-Patient Movement in the United States: Contradictions, Crisis and Change,” Social Science & Medicine 40 (04 1995): 10531071Google Scholar; Hatfield, A., “The National Alliance for the Mentally Ill: A Decade Later,” Community Mental Health Journal 27 (04 1991): 95103Google Scholar; Minow, M. and Weissbourd, R., “Social Movements for Children,” Daedalus 122 (Winter 1993): 129Google Scholar; Pfeiffer, D., “Overview of the Disability Movement: History, Legislative Record, and Political Implications,” Policy Studies Journal 21 (12 1993): 724734Google Scholar.

14. Perrin, J., Kuhlthau, K., McLaughlin, T., Ettner, S., and Gortmaker, S., “Changing Patterns of Conditions among Children Receiving Supplemental Security Income Disability Benefits,” Archives of Pediatric & Adolescent Medicine 153 (01 1999): 8084Google Scholar; Reid, R., Maag, J., and Vasa, S., “Attention Deficit Hyperactivity Disorder as a Disability Category: A Critique,” Exceptional Children 60 (12 1993–January 1994): 198214Google Scholar.

15. Bayer, R. and Spitzer, R., “Neurosis, Psychodynamics, and DSM-III,” Archives of General Psychiatry 42 (02 1985): 188CrossRefGoogle ScholarPubMed.

16. See Michels, R. and Marzuk, P., “Progress in Psychiatry,” New England Journal of Medicine 329 (19 08, 26 August 1993): 552560, 628–38CrossRefGoogle Scholar.

17. See Mayes, R. and Horwitz, A., “DSM-III and the Revolution in the Classification of Mental Illness,” Journal of the History of the Behavioral Sciences 41 (Summer 2005): 249267CrossRefGoogle ScholarPubMed.

18. See Brown, P., “Diagnostic Conflict and Contradiction in Psychiatry,” Journal of Health and Social Behavior 28 (03 1987): 3750CrossRefGoogle Scholar.

19. See Goodwin, D. and Guze, S., Psychiatric Diagnosis, 5th ed. (New York, 1996)Google Scholar.

20. See Rogler, L., “Making Sense of Historical Changes in the Diagnostic and Statistical Manual of Mental Disorders: Five Propositions,” Journal of Health and Social Behavior 39 (03 1997): 920CrossRefGoogle Scholar.

21. See Frank, R. and Glied, S., Better but Not Well: Mental Health Policy in the U.S. Since 1950 (Baltimore, 2006)Google ScholarPubMed.

22. See Frances, A., Pincus, H., Widiger, T., Davis, W., and First, M., “DSM-IV: Work in Progress,” American Journal of Psychiatry 147 (11 1990): 14391448Google ScholarPubMed.

23. See Horwitz, A., Creating Mental Illness (Chicago, 1992)Google Scholar; Greenberg, G., “Manufacturing Depression: A Journey into the Economy of Melancholy,” Harpers, 05 2007, 3546Google Scholar.

24. See Silk, J., Nath, S., Siegel, L., and Kendall, P., “Conceptualizing Mental Disorders in Children: Where Have We Been and Where Are We Going?Development and Psychopathology 12 (2000): 713735CrossRefGoogle ScholarPubMed.

25. See Hamm, N., “The Politics of Empiricism: Research Recommendations of the Joint Commission on Mental Health in Children,” American Psychologist 29 (01 1974): 913Google Scholar; Taylor, W., “Developmental Theory: Unsolved Problem for Child Psychiatry,” American Journal of Orthopsychiatry 41 (07 1971): 557565Google Scholar; Goodrich, W., “Changes in Child Psychiatry Training Required by Developmental-Adaptive Theory,” Journal of Nervous and Mental Disease 154 (03 1972): 213220Google Scholar; Ramey, C., “Children and Public Policy: A Role for Psychologists,” American Psychologist 29 (01 1974): 1418Google Scholar; Dusek, J., “Implications of Development Theory for Child Mental Health,” American Psychologist 29 (01 1974): 1924Google Scholar; Segal, J. and Yahraes, H., “Protecting Children's Mental Health,” Children Today 7 (0910 1978): 2325Google Scholar; Wright, L., “Health Care Psychology: Prospects for the Well-Being of Children,” American Psychologist 34 (10 1979): 10011006Google Scholar; Marks, A. and Cohen, M., “Health Screening and Assessment of Adolescents,” Pediatric Annals 7 (09 1978): 596604Google Scholar; Laufer, M., “Which Adolescents Must Be Helped and by Whom?Journal of Adolescence 3 (12 1980): 265272Google Scholar; Marks, A., “Aspects of Biosocial Screening and Health Maintenance in Adolescents,” Pediatric Clinics of North America 27 (02 1980): 153161Google Scholar.

26. See Kopp, C. and Krakow, J., “The Developmentalist and the Study of Biological Risk: A View of the Past with an Eye to the Future,” Child Development 54 (10 1983): 10861108CrossRefGoogle Scholar.

27. See Weiss, N., “Mother, the Invention of Necessity: Dr. Benjamin Spock's Baby and Child Care,” American Quarterly 29 (1977): 519546CrossRefGoogle Scholar.

28. See Rosenbaum, S. and Wise, P., “Crossing the Medicaid-Private Insurance Divide: The Case of EPSDT,” Health Affairs 26 (0304 2007): 382393Google Scholar; Foltz, A., “The Development of Ambiguous Federal Policy: Early and Periodic Screening, Diagnosis, and Treatment (EPSDT),” Milbank Memorial Fund Quarterly 53 (Winter 1975): 3564Google Scholar.

29. Sec. 1905(a)(4)(B), added by sec. 302(a), P.L. 90–248

30. See Irwin, P. and Conroy-Hughes, R., “EPSDT Impact on Health Status,” Health Care Financing Review 2 (Spring 1981): 2539Google ScholarPubMed.

31. PL 94–142.

32. See Richmond, J., “Disadvantaged Children: What Have They Compelled Us to Learn?Yale Journal of Biology & Medicine 43 (12 1970): 127144Google Scholar.

33. Silk, Nath, Siegel, and Kendall, “Conceptualizing Mental Disorders in Children: Where Have We Been and Where Are We Going?” 720.

34. See Shear, L., “From Competition to Complementarity: Legal Issues and Their Clinical Implications in Custody,” Child and Adolescent Psychiatric Clinics of North America 7 (04 1998): viviii, 311–34Google ScholarPubMed;

35. See Blau, F., “Trends in the Well-Being of American Women, 1970–1995,” Journal of Economic Literature 36 (03 1998): 112165Google Scholar.

36. See Kendall, J., Leo, M., Perrin, N., and Hatton, D., “Modeling adhd Child and Family Relationships,” Western Journal of Nursing Research 27 (2005): 500518Google Scholar; Morgan, J., Robinson, D., and Aldridge, J., “Parenting Stress and Externalizing Child Behavior,” Child & Family Social Work 7 (08 2002): 219225Google Scholar.

37. See Kitagawa, E., “New Life-Styles: Marriage Patterns, Living Arrangements, and Fertility Outside of Marriage,” The Annals of the American Academy of Political and Social Science 453 (1981): 127Google Scholar; Thornton, A. and Freedman, D., “The Changing American Family,” Population Bulletin 38 (10 1983): 144Google Scholar.

38. See Weiner, B., “An Overview of Child Custody Laws,” Hospital & Community Psychiatry 36 (08 1985): 838843Google ScholarPubMed.

39. See Kelly, J., “Children's Adjustment in Conflicted Marriage and Divorce: A Decade Review of Research,” Journal of the American Academy of Child & Adolescent Psychiatry 39 (08 2000): 963973CrossRefGoogle ScholarPubMed.

40. See Doan, R. and Petti, T., “Clinical and Demographic Characteristics of Child and Adolescent Partial Hospital Patients,” Journal of the American Academy of Child & Adolescent Psychiatry 28 (01 1989): 6669Google Scholar; Wallen, J. and Pincus, H., “Care of Children with Psychiatric Disorders at Community Hospitals,” Hospital & Community Psychiatry 39 (02 1988): 167172Google Scholar; Pottick, K., McAlpine, D., and Andelman, R., “Changing Patterns of Psychiatric Inpatient Care for Children and Adolescents in General Hospitals, 1988–1995,” American Journal of Psychiatry 157 (08 2000): 12671273Google Scholar; Case, B., Olfson, M., Marcus, S., and Siegel, C., “Trends in the Inpatient Mental Health Treatment of Children and Adolescents in U.S. Community Hospitals between 1990 and 2000,” Archives of General Psychiatry 64 (01 2007): 8996Google Scholar.

41. See Olfson, M. and Klerman, G., “Trends in the Prescription of Psychotropic Medications: The Role of Physician Specialty,” Medical Care 31 (1993): 559564Google Scholar; Safer, D. and Krager, J., “A Survey of Medication Treatment for Hyperactive/Inattentive Students,” Journal of the American Medical Association 260 (21 10 1988): 22562258Google Scholar.

42. See Safer, D. and Krager, J., “Effect of a Media Blitz and a Threatened Lawsuit on Stimulant Treatment,” Journal of the American Medical Association 268 (26 08 1992): 10041007Google Scholar; Williams, L., “Parents and Doctors Fear Growing Misuse of Drug Used to Treat Hyperactive Kids,” Wall Street Journal, 15 01 1988, 1Google Scholar; Moss, D., “Ritalin under Fire,” ABA Journal 74 (1 11 1988): 19Google Scholar.

43. See Rissmiller, D. and Rissmiller, J., “Evolution of the Antipsychiatry Movement into Mental Health Consumerism,” Psychiatric Services 57 (06 2006): 863866CrossRefGoogle ScholarPubMed.

44. See Ouellette, E., “Legal Issues in the Treatment of Children with Attention Deficit Disorder,” Journal of Child Neurology 6 (1991, suppl.): 569575Google Scholar; Welke, R., “Litigation Involving Ritalin and the Hyperactive Child,” Detroit College Law Review (Spring 1999): 125176Google Scholar.

45. McBurnett, K., Lahey, B., and Pfiffner, L., “Diagnosis of Attention Deficit Disorders in DSM-IV: Scientific Basis and Implications for Education,” Exceptional Children 60 (1011 1993): 109CrossRefGoogle Scholar.

46. Ibid., 109–10: “The syndrome of ADD without hyperactivity was not included in DSM-III-R. A separate category of undifferentiated attention Deficit disorder (UADD) was placed at the end of the child disorders section. UADD had no diagnostic criteria and was described as applicable to ADD not specified by the ADHD criteria, including attention Deficits unaccompanied by significant hyperactivity. The result was that UADD became an ill-defined, heterogeneous category; and research into ADD without hyperactivity was not stimulated.”

47. See Lahey, B., Loeber, R., Stouthammer-Loeber, M., Christ, M., Green, S.. Russo, M., Frick, P., and Dulcan, M., “Comparison of DSM-III and DSM-III-R Diagnoses for Prepubertal Children: Changes in Prevalence and Validity,” Journal of the American Academy of Child and Adolescent Psychiatry 29 (07 1990): 620626CrossRefGoogle ScholarPubMed.

48. See Diller, L., Running on Ritalin (New York, 1999), 130131Google Scholar.

49. See Rojas, N. and Chan, E., “Old and New Controversies in the Alternative Treatment of Attention-Deficit Hyperactivity Disorder,” Mental Retardation and Developmental Disabilities Research Reviews 11 (2005): 116130CrossRefGoogle ScholarPubMed.

50. See Swanson, Lerner, and Williams, “More Frequent Diagnosis of Attention Deficit-Hyperactivity Disorder,” 994; Diller, Running on Ritalin, 146–50; U.S. General Accounting Office, “Social Security: Rapid Rise in Children on SSI Disability Rolls Follows New Regulations,” GAO/HEHS-94–225 (Washington, D.C., 09 1994)Google Scholar.

51. See Zito, J., Safer, D., dosReis, S., Magder, L., Gardner, J., and Zarin, D., “Psychotherapeutic Medication Patterns for Youths with Attention-Deficit/Hyperactivity Disorder,” Archives of Pediatrics & Adolescent Medicine 153 (12 1999): 12571265CrossRefGoogle ScholarPubMed; Pincus, Tanielian, Marcus, Olfson, Zarin, Thompson, and Zito, “Prescribing Trends in Psychotropic Medications: Primary Care, Psychiatry, and Other Medical Specialties,” 526–31.

52. See Newacheck, P. and Taylor, W., “Childhood Chronic Illness: Prevalence, Severity, and Impact,” American Journal of Public Health 82 (1992): 364371CrossRefGoogle ScholarPubMed.

53. See Kelleher, K., Childs, G., Wasserman, R., McInemy, T., Nutting, P., and Gardner, W., “Insurance Status and Recognition of Psychosocial Problems: A Report from PROS and ASPN,” Archives of Pediatric & Adolescent Medicine 151 (1998): 11091115Google Scholar; Kelleher, K. and Wolraich, M., “Diagnosing Psychosocial Problems,” Pediatrics 97 (1996): 899901Google Scholar; Kelleher, K. and Scholle, S., “Children with Chronic Medical Conditions II: Managed Care Opportunities and Threats,” Ambulatory Child Health 1 (1995): 139146Google Scholar; Kelleher, K., Scholle, S., Feldman, H., and Nace, D., “A Fork in the Road: Decision Time for Behavioral Pediatrics,” Journal of Developmental Behavioral Pediatrics 20 (1999): 181186Google Scholar.

54. See Hoagwood, K., Kelleher, K., Feil, M., and Comer, D., “Treatment Services for Children with ADHD: A National Perspective,” Journal of the American Academy of Child & Adolescent Psychiatry 39 (02 2000): 198206CrossRefGoogle ScholarPubMed.

55. See Cantwell, “Attention Deficit Disorder: A Review of the Past 10 Years,” 982–85.

56. Kelleher, K., McInerny, T., Gardner, W., Childs, G., and Wasserman, R., “Increasing Identification of Psychosocial Problems: 1979–1996,” Pediatrics 105 (06 2000): 1313CrossRefGoogle ScholarPubMed.

57. See Liu, C., Robin, A., Brenner, S., and Eastman, J., “Social Acceptability of Methylphenidate and Behavior Modification for Treating Attention Deficit Hyperactivity Disorder,” Pediatrics 88 (09 1991): 560565Google ScholarPubMed.

58. Kolata, G., “Researchers Say Brain Abnormality May Help to Explain Hyperactivity,” New York Times, 15 11 1990, B18Google Scholar.

59. Ibid.

60. Zametkin, A., Nordahl, T., Gross, M., King, A., Semple, W., Rumsey, J., Hamburger, S., and Cohen, R., “Cerebra Glucose Metabolism in Adults with Hyperactivity of Childhood Onset,” New England Journal of Medicine 323 (15 11 1990): 13611366CrossRefGoogle Scholar.

61. Zametkin, A. and Liebenauer, L. et al. , “Brain Metabolism in Teenagers with Attention-Deficit Hyperactivity Disorder,” Archives of General Psychiatry 50 (1993): 333340Google Scholar; Ernst, M. and Liebenauer, L. et al. , “Reduced Brain Metabolism in Hyperactive Girls,” Journal of the American Academy of Child and Adolescent Psychiatry 33 (1994): 858868Google Scholar; Ernst, M. and Cohen, R. et al. , “Cerebral Glucose Metabolism in Adolescent Girls with Attention-Deficit/Hyperactivity Disorder,” Journal of the Academy of Child and Adolescent Psychiatry 36 (1997): 13991406Google Scholar.

62. Perrin, J., Kuhlthau, K., McLaughlin, T., Ettner, S., and Gortmaker, S., “Changing Patterns of Conditions among Children Receiving Supplemental Security Income Disability Benefits,” Archives of Pediatrics & Adolescent Medicine 153 (01 1999): 8084CrossRefGoogle ScholarPubMed.

63. Reid, R., Maag, J., and Vasa, S., “Attention Deficit Hyperactivity Disorder as a Disability Category: A Critique,” Exceptional Children 60 (1201 1993): 198214CrossRefGoogle Scholar.

64. Dubay, L. and Kenney, G., “The Effects of Medicaid Expansions on Insurance Coverage of Children,” The Future of Children 6 (Spring 1996): 152161Google Scholar; Kronebusch, K., “Medicaid for Children: Federal Mandates, Welfare Reform, and Policy Backsliding,” Health Affairs 20 (0102 2001): 97111Google Scholar.

65. Cuellar, A. and Markowitz, S., “Medicaid Policy Changes in Mental Health Care and Their Effect on Mental Health Outcomes,” Health Economics, Policy & Law 2 (2007): 2328CrossRefGoogle ScholarPubMed.

66. Tomes, N., “The Patient as a Policy Factor: A Historical Case Study of the Consumer/Survivor Movement in Mental Health,” Health Affairs 25 (0506 2006): 720729CrossRefGoogle ScholarPubMed.

67. Perrin, J., “Health Services Research for Children with Disabilities,” Milbank Quarterly 80 (2002): 303324CrossRefGoogle ScholarPubMed.

68. Safer, D. and Krager, J., “The Increased Rate of Stimulant Treatment for Hyperactive/Inattentive Students in Secondary Schools,” Pediatrics 94 (10 1994): 462464Google ScholarPubMed.

69. Shapiro, No Pity, 142–83; Chamberlain, “Psychiatric Survivors,” 4.

70. U.S. Senate, Committee on Labor and Public Welfare, Subcommittee on the Handicapped, “Education for All Handicapped Children, 1973–1974,” Hearings, 93rd Cong., 1st sess., 7 May 1973, 341.

71. See the accounts of this episode in Swanson, J., McBurnett, K., Christian, D. L., and Wigall, T., “Stimulant Medications and the Treatment of Children with ADHD,” in Ollendick, T. and Prinz, R., eds., Advances in Clinical Child Psychology (New York, 1995), 288290Google Scholar, and Diller, L., Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill (New York, 1998), 149150Google Scholar.

72. Ibid.

73. Ibid.

74. Congress added the listing for “developmental delay” in 1997. It applies only to children ages 3 through 9 and for ages 6 through 9 is optional for states to implement.

75. 20 U.S.C. 1401(a)(1), and 34 C.F.R. 300.5. Traumatic brain injury was added to the list in 1990.

76. See 34 C.F.R. 300.8(c)(9).

77. U.S. House, Subcommittee on Select Education, Hearings on the Reauthorization, 352–55.

78. Reid, R., Maag, J., and Vasa, S., “Attention Deficit Hyperactivity Disorder as a Disability Category: A Critique,” Exceptional Children 60, no. 3 (12 1992–January 1993): 198215, online document from Expanded AcademicCrossRefGoogle Scholar.

79. U.S. House Subcommittee on Select Education, Hearings on the Reauthorization of the EHA Discretionary Programs, 60, 78, 99. See also Council for Exceptional Children, The ADD Controversy: What Did CEC Say?Exceptional Children 60, no. 2 (1011 1993): 181182CrossRefGoogle Scholar.

80. Ibid.

81. Aleman, S., Special Education for Children with Attention Deficit Disorders: Current Issues, Washington, D.C.: Congressional Research Service, 1991Google Scholar; Danielson, L., Henderson, K., and Schiller, E., “Education Policy—Educating Children with Attention Deficit Hyperactivity Disorder,” in Jenson, P. and Cooper, J., eds., Attention Deficit Hyperactivity Disorder: State of the Science, Best Practices (Kingston, N.J., 2002), 2632Google Scholar.

82. Appling, R., Jones, N., The Individuals with Disabilities Education Act (IDEA): Overview of Major Provisions, Congressional Research Service Report for Congress, 11 01 2002, 8Google Scholar.

83. Diller, Running on Ritalin, 150.

84. Davila, R., Williams, M., and MacDonald, J., Clarification of Policy to Address the Needs of Children with Attention Deficit Disorders within General and/or Special Education, Washington, D.C., 09 16, 1991Google Scholar.

85. 34 C.F.R. 104.3(j)(1).

86. See Ozawa, M. and Hong, B., “SSI for Children with Mental Disorders: Backgrounds and a Study of Participation,” Children and Youth Services Review 21 (06 1999): 437462CrossRefGoogle Scholar.

87. Mashaw, J., Perrin, J., and Reno, V., eds., Restructuring the SSI Disability Program for Children and Adolescents (Washington, D.C., 1996)Google Scholar.

88. Erkulwater, Disability Rights and the American Social Safety Net, 132.

89. Ibid.

90. Zebley v. Bowen, Appeal from the U.S. District Court of the Eastern District of Pennsylvania, Civil Action No. 83–3314, to the U.S. Court of Appeals for the Third Circuit, amicus brief by the Mental Health Law Project on behalf of the American Academy of Child and Adolescent Psychiatry et al., 1988, 9–10, copy in authors' files. (The Mental Health Law Project was renamed the Bazelon Center for Mental Health in 1990).

91. Ibid.

92. Sullivan v. Zebley, 493 U.S. 521 (1990).

93. For an overview of the SSA's process for evaluating childhood disability before and after Zebley, see Erkulwater, Disability Rights and the American Social Safety Net, 172–93.

94. Ibid.

95. Ibid.

96. B. Eigen, executive program policy Officer in the Office of Disability, interview with author, Baltimore, 6 September 2000, quoted in ibid., 185–86.

97. Ibid.

98. Mashaw, Perrin, and Reno, eds., Restructuring the SSI Disability Program, 27–29.

99. U.S. General Accounting Office, Social Security: New Functional Assessments for Children Raise Eligibility Questions, GAO/HEHS-95–66, 1995, fig. 1, P9–10Google Scholar.

100. Erkulwater, Disability Rights and the American Social Safety Net, 172–93.

101. U.S. General Accounting Office, Supplemental Security Income: Recent Growth in the Rolls Raises Fundamental Program Concerns, GAO/T-HEHS-95–67, 01 27, 1995, 3Google Scholar.

102. GAO, New Functional Assessments, 9–10.

103. Perrin, J., Kuhlthau, K., MacLaughlin, T., Ettner, S., and Gortmaker, S., “Changing Patterns of Conditions among Children Receiving Supplemental Security Income Disability Benefits,” Archives of Pediatric and Adolescent Medicine 153 (1999): 8084CrossRefGoogle ScholarPubMed.

104. See Currie, J and Gruber, J., “Health Insurance Eligibility, Utilization of Medical Care, and Child Health,” Quarterly Journal of Economics 111 (05 1996): 431466CrossRefGoogle Scholar.

105. See Dubay, L. and Kenney, G., “The Effects of Medicaid Expansions on Insurance Coverage of Children,” Special Education for Children with Disabilities 6 (Spring 1996): 152561Google ScholarPubMed.

106. Erkulwater, Disability Rights and the American Social Safety Net, 158–59.

107. Morgan, D., “Medicaid Costs Balloon into a Fiscal ‘Time Bomb,’” Washington Post, 30 01 1994, A1Google Scholar; Lombardi, R., “The Evaluation of Children's Impairments in Determining Disability under the Supplemental Security Income Program,” Fordham Law Review 57 (1989): 1107Google Scholar.

108. Ullman, F., Hill, I., and Almeida, R., “CHIP: A Look at Emerging State Programs,” New Federalism: Issues and Options for States, Urban Institute, Series A, No. A-35, 09 1999Google Scholar.

109. Cuellar, A. and Markowitz, S., “Medicaid Policy Changes in Mental Health Care and Their Effect on Mental Health Outcomes,” Health Economics, Policy, and Law 2 (2007): 23CrossRefGoogle ScholarPubMed.

110. Ibid., 27.

111. Zito, J., Safer, D., doesReis, S., Gardner, J., Magder, L., and Soeken, K. et al. , “Psychotropic Practice Patterns for Youth,” Archives of Pediatrics & Adolescent Medicine 157 (01 2003): 1725CrossRefGoogle ScholarPubMed.

112. See Sax, L. and Kautz, K., “Who First Suggests the Diagnosis of Attention-Deficit/Hyperactivity Disorder?Annals of Family Medicine 1 (0910 2003): 171174CrossRefGoogle Scholar.

113. See DuPaul, G., Stoner, G., adhd in Schools: Assessment and Intervention Strategies (New York, 2003)Google Scholar; Stein, M., Marx, N., Beard, J., Lerner, M., Levin, B., and Glascoe, F. et al. , “ADHD: The Diagnostic Process from Different Perspectives,” Journal of Developmental and Behavioral Pediatrics 25 (02 2004): 5358Google Scholar; Biederman, J., Faraone, S., Monuteaux, M., and Grossbard, J., “How Informative Are Parent Reports of Attention-Deficit/Hyperactivity Disorder Symptoms for Assessing Outcome in Clinical Trials of Long-Acting Treatments? A Pooled Analysis of Parents' and Teachers' Reports,” Pediatrics 113 (06 2004): 16671671Google Scholar; Biederman, J., Gao, H., Rogers, A., and Spencer, T., “Comparison of Parent and Teacher Reports of Attention-Deficit/Hyperactivity Disorder Symptoms from Two Placebo-Controlled Studies of Atomoxetine in Children,” Biological Psychiatry 60 (15 11 2006): 11061110Google Scholar.

114. Havey, J., Olson, J., McCormick, C., and Cates, G., “Teachers' Perceptions of the Incidence and Management of Attention-Deficit Hyperactivity Disorder,” Applied Neuropsychology 12 (2005): 120127CrossRefGoogle ScholarPubMed.

115. See Hinshaw, S. and Cicchetti, D., “Stigma and Mental Disorder: Conceptions of Illness, Public Attitudes, Personal Disclosure, and Social Policy,” Development and Psychopathology 12 (2000): 555598Google Scholar; Diller, L., “The Run on Ritalin: Attention Deficit Disorder and Stimulant Treatment in the 1990s,” Hastings Center Report 26 (0304 1996): 1218Google Scholar.

116. See Conrad, P. and Potter, D., “From Hyperactive Children to ADHD Adults: Observations on the Expansion of Medical Categories,” Social Problems 47 (2000): 559582CrossRefGoogle Scholar.

117. Cowley, G., “The Promise of Prozac,” Newsweek, 26 03 1990Google Scholar.

118. See Mintz, S., Huck's Raft: A History of American Childhood (Cambridge, Mass., 2004)Google Scholar.

119. E-mail exchange with Jerry Rushton, director of the Pediatrics Residency Program, Indiana University School of Medicine, 6 November 2007.

120. Diller, “The Run on Ritalin,” 17.

121. See Timimi, S., “adhd Is Best Understood as a Cultural Construct,” British Journal of Psychiatry 184 (2004): 89Google Scholar; Conrad, P., “The Shifting Engines of Medicalization,” Journal of Health and Social Behavior 46 (03 2005): 314Google Scholar; Conrad, P. and Leiter, V., “Medicalizatoin, Markets, and Consumers,” Journal of Health and Social Behavior 45 (2004): 158176Google Scholar.

122. See Hinshaw, S. and Cicchetti, D., “Stigma and Mental Disorders: Conceptions of Illness, Public Attitudes, Personal Disclosure, and Social Policy,” Development and Psychopathology 12 (2000): 574CrossRefGoogle ScholarPubMed.

123. See Bussing, R., Schoenberg, N., and Perwien, A., “Knowledge and Information about ADHD: Evidence of Cultural Differences among African-American and White Parents,” Social Science & Medicine 46 (04 1998): 919928Google Scholar; McLeod, J., Fettes, D., Jensen, P., Pescosolido, B., and Martin, J., “Public Knowledge, Beliefs, and Treatment Preferences Concerning Attention-Deficit Hyperactivity Disorder,” Psychiatric Services 58 (05 2007): 626631Google Scholar.

124. Good, B., “Studying Mental Illness in Context: Local, Global, or Universal?Ethos 25 (1997): 231CrossRefGoogle Scholar.

125. See Breggin, P., Talking Back to Ritalin (New York, 2001)Google Scholar.

126. For more on the inherent subjectivity and clinical uncertainty in diagnosing and treating mental disorders, see Luhrmann, T., Of Two Minds: The Growing Disorder in American Psychiatry (New York, 2001)Google Scholar.

127. See Power, T., Costigan, T., Leff, S., Eiraldi, R., and Landau, S., “Assessing adhd Across Settings: Contributions of Behavioral Assessment to Categorical Decision-Making,” Journal of Clinical Child Psychology 30 (09 2001): 399412CrossRefGoogle ScholarPubMed.

128. See Singh, I., “A Framework for Understanding Trends in ADHD Diagnosis and Stimulant Drug Treatment: School and Schooling as a Case Study,” BioSocieties 1 (2006): 439452CrossRefGoogle Scholar.