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ADHD was not invented to disadvantage Black children and increase pharmaceutical sales
If Your Time is short
- ADHD stands for attention-deficit/hyperactivity disorder. In a viral video, clinical psychologist and advocate Umar Johnson claims the American Psychiatric Association added the "H" in ADHD so pharmaceutical companies could sell more medicine and make more money. But that's untrue. Children were being prescribed a stimulant to treat attention disorders even before the term attention-deficit disorder, or ADD, was coined in 1980.
- Studies that evaluated racial disparities in ADHD diagnoses found that Black children were less — not more — likely to get diagnosed with ADHD compared with white children displaying similar behavior.
- There is evidence that ADHD is being overdiagnosed among the entire population of children. But misdiagnoses occur because of a lack of trained professionals, a researcher said.
A video clip circulating on Facebook claims attention-deficit/hyperactivity disorder was fabricated to disadvantage Black boys.
"ADHD does not exist. Neither does the learning disability," said Umar Johnson, a sociopolitical activist, in the video, which was filmed in 2017.
A 14-second clip from Johnson's interview was shared on Reels and sums up the discussion with this claim: "ADHD does not exist." The video was flagged as part of Facebook’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Facebook.)
But the Diagnostic and Statistical Manual of Mental Disorders says attention-deficit/hyperactivity disorder does exist. The DSM is the American Psychiatric Association handbook medical professionals rely on for mental diagnoses.
People diagnosed with ADHD "show a persistent pattern of inattention and/or hyperactivity — impulsivity that interferes with functioning or development," according to the Centers for Disease Control and Prevention.
Johnson’s broader argument asserts that ADHD is overdiagnosed in Black boys so that large pharmaceutical companies can profit from the sale of ADHD drugs. Johnson has a doctorate in clinical psychology, is a certified school psychologist and wrote a book on ADHD and special education.
"Simply diagnosing a Black boy with ADD did not result in a prescription. The drug companies were losing money. Wall Street was not getting paid, so they forced the American Psychiatric Association to add the H — attention-deficit/hyperactivity disorder," Johnson said in the video.
That's not true, said Dr. Eugene Arnold, a psychiatry and behavioral health professor at Ohio State University who studies drug development and alternative treatments for ADHD.
Benjamin Lahey, professor of public health sciences at the University of Chicago who researches ADHD, agreed with Arnold.
"There's nothing about the diagnostic criteria that rules out medication," Lahey said.
Lahey was part of the child disorders workgroup for the fourth DSM, which was published in 1994 and defined ADHD and its list of symptoms. Lahey considers himself "the person most involved" because he ran the fourth DSM’s field trials.
"It was all about the data on symptoms and impairment to the children's lives, never about coming up with some kind of bogus disorder that would sell more medications," Lahey said.
Johnson did not respond to email requests for comment.
Johnson's now-circulating ADHD claims originate from a 2017 interview with Houston radio station KQBT-FM 93.7, aka The Beat, in which he asked Black parents to refrain from getting their children evaluated for ADHD.
Skepticism about the validity of inattention as a disorder has been around for generations.
Let's break Johnson’s claims into four parts: the history of ADHD, Big Pharma's influence on the ADHD criteria, racial disparities in diagnoses and why the disorder is still controversial.
The earliest documentation of an inattention disorder similar to modern-day ADHD traces back to 1798, when a Scottish physician, Alexander Crichton, published "An Inquiry Into the Nature and Origin of Mental Derangement," one of the first English textbooks on psychiatry. Crichton characterized "the incapacity of attending with a necessary degree of constancy to any one object" as a mental disease that can be identified in childhood.
It wasn't until 1902 that the "scientific starting point of the history of ADHD" came along, according to a study published in the National Library of Medicine. A British pediatrician described a "lack of moral control" using some similar patterns seen in people with ADHD, including a desire for instant gratification and impulsivity.
In 1932, two German physicians reported on children with increased motor restlessness and an inability to stay still. They called it a hyperkinetic disease of infancy, and it was the first recorded instance of what’s now called ADHD. The characteristics defining this hyperkinetic disease — inattention, impulsivity and hyperactivity — are the same as ADHD’s three main symptoms.
In 1937, U.S. physician Charles Bradley reported on the first positive effect of stimulant medication in children. Bradley wasn't looking to resolve children’s troubles with focus, but to find a drug to help them with emotional distress, journalist Alan Schwarz wrote in his 2016 book, "ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic."
Bradley tested the drug Benzedrine on 30 children and noted "the remarkably improved school performance of approximately half," in his 1937 study published in the American Journal of Psychiatry.
During the 1930s, ’40s and ’50s, research on mental illnesses or behavioral disorders in children was often categorized as "minimal brain dysfunction." It was theorized that children who displayed behavioral abnormalities may have had minimal brain damage, although this characterization was later criticized as too speculative.
The term "hyperkinetic impulse disorder" was coined in 1957, because research was showing "you couldn't always demonstrate damage," said Arnold, the psychiatry researcher from Ohio State University.
To treat the new, ambiguous hyperkinetic impulse disorder, U.S. physicians Charles Bradley and Leon Eisenberg conducted a 1963 study on how "disturbed children" reacted to Ritalin. They found the drug did ease their symptoms.
U.S. use of Ritalin increased after the American Psychiatric Association validated its hyperkinetic dysfunction definition. Drug companies started marketing Ritalin to parents as a way to get children to behave. In 1970, The Washington Post published an article reporting that 5% to 10% of children in a Nebraska elementary school system were taking drugs to control their hyperactivity as part of a "behavior modification program."
Following a movement led by Dr. Virginia Douglas, the APA renamed the disorder "attention deficit disorder (ADD) (with or without hyperactivity)" in the third DSM handbook, published in 1980.
In 1987, the APA published a revised edition that eliminated the two subtypes and renamed ADD as "attention-deficit/hyperactivity disorder (ADHD).
"That was just a mistake," Lahey said of eliminating the subtypes. "It was a very different group of people who had access to much less data. It was not a data-based decision that was, I think, sensible for them to make."
Backed by Lahey's field research, the fourth DSM handbook, published in 1994, reinstated the subtypes and introduced three categorizations: "a predominantly inattentive type, a predominantly hyperactive-impulsive type, and a combined type with symptoms of both dimensions."
Lahey said that's why there's now a slash in the name: attention-deficit/hyperactivity disorder, "which means you can have either high levels of attention or high levels of hyperactivity, or both."
The most recent handbook for mental disorders recognizes ADHD in both hyperactive people and inattentive people. People who show hyperactivity/impulsivity symptoms often talk excessively, fidget and exhibit restlessness, the handbook states. People who show inattention symptoms often lose things, have poor organizational skills, are forgetful and make careless mistakes.
ADHD is not a one-size-fits-all diagnosis. People who exhibit high levels of ADHD behavior are more likely to have serious, even fatal, accidental injuries. They are also more likely to develop depression and become suicidal compared with other children, Lahey said.
"There's a range of how well kids pay attention and inhibit their impulses and regulate their motor behavior," Lahey said, "and the ones that are most unregulated are going to have problems because of it."
It's true that ADHD medication, such as Adderall or Ritalin, are made by pharmaceutical companies that profit from drug sales.
Industry researcher IBIS World estimates that the U.S. ADHD medication manufacturing industry is worth $9.7 billion in 2022. With ADHD diagnoses surveyed to be rising, demand is high. The Food and Drug Administration recently reported an ADHD-medication shortage.
The APA has been criticized for its relationship with the pharmaceutical industry. Of the 170 researchers who worked on the fourth DSM published in 1994, 95 of them had a financial relationship with a drug maker from 1989 to 2004, a 2006 study found.
The APA's guidelines allow psychiatrists to take money from pharmaceutical companies, and the 2010 Physician Payments Sunshine Act requires hospitals and individual physicians to disclose any financial relationship with the industry.
And those relationships still exist. The biopharmaceutical company that makes Adderall, Shire LLC, spent more than $42 million in research payments to hospitals and individuals, according to a federal government database.
But the idea that the APA bent to pharmaceutical company influence when creating the diagnostics for ADHD is nonsense, Lahey said.
"I can tell you — that from all the hundreds of hours I spent with people, other psychologists and psychiatrists who were involved in developing the criteria — that there was never a hint of creating or having an interest in creating a diagnostic category that was not valid in order to sell more medication," Lahey said. "It was all about the data."
We were unable to find any evidence concretely showing that drug companies pressured the APA's criteria despite financial involvement.
Johnson claims there is a "deliberate misdiagnosing of Black boys" for ADHD. But multiple studies show that Black children have not been disproportionately diagnosed for ADHD compared with white children.
In 2016, the CDC estimated that 6.1 million U.S. children — 9.4% of all U.S. children — have been diagnosed with ADHD. Of those diagnosed children, 62% were taking medication for ADHD, a CDC survey showed.
But Black children in the U.S. were 70% less likely to be diagnosed with ADHD compared with white children, according to a 2014 Association for Child and Adolescent Mental Health study.
Black children have higher risks for ADHD than others, according to a 2021 Brown University study, while a 2013 National Library of Medicine study found that white children are more likely to get diagnosed with ADHD compared with their peers of other races.
"The literature points to the fact that there's a whole access issue, and being able to get in to have a proper ADHD evaluation is lower in Black and Latino or Hispanic families," said Jeni Johnstone, assistant professor of psychiatry at Oregon Health and Science University's Center for ADHD Research.
Johnstone, who researches racial differences in diagnoses and treatment, attributed the diagnosis decline to cultural differences, varying parenting styles, costs, waitlists and language barriers.
The three experts PolitiFact spoke with — Johnstone, Lahey and Arnold — said there was no evidence pointing to a deliberate misdiagnosis of ADHD in Black male children. We found no other specific evidence proving this in our own review of studies about ADHD.
Increasing evidence suggests ADHD is being overdiagnosed, regardless of race.
Johnson says this is because the pharmaceutical companies are pushing their drugs on the APA, but Lahey said it’s because physicians aren't trained on how to properly diagnose ADHD.
"They're trained to be physicians, and they're very good at diagnosing strep throat versus COVID," Lahey said, "But they're not trained to be psychiatrists."
Many ADHD symptoms overlap with other mental illnesses. For example, children who are having trouble focusing in school may be diagnosed with ADHD when they are actually showing signs of post-traumatic stress or anxiety, Johnstone said.
Besides a lack of proper training, Lahey said some medical professionals will shortcut the "rigorous methods that we used in the DSM for field trials" because it's time-consuming and costly, which could lead to over- or underdiagnoses.
"There's just a lot of messiness in the application of the DSM criteria," Lahey said. "But does ADHD exist? Yes. That pattern of behavior causes real problems for kids, and it should not be ignored."
The claim that "ADHD does not exist" is not accurate.
Johnson’s underlying argument about the justification for medication and disproportionate diagnoses of ADHD in Black children do not give his takeaway more credibility, either.
Research shows and psychiatrists told PolitiFact that ADHD is a real mental disorder with a recorded history that dates back to 1798. While misdiagnoses do occur, research shows that Black children are often underdiagnosed compared to white children with similar behavior patterns.
We rate Johnson's claim False.
93.7 The Beat, Dr. Umar Johnson discusses Tariq Nasheed beef & defines "Cooning," Jan. 4, 2018
Interview with Dr. Eugene Arnold, a professor of psychiatry and behavioral health at Ohio State University, July 8, 2022
Interview with Jeni Johnstone, an assistant professor of psychiatry at Oregon Health & Science University's Center for ADHD Research, July 8, 2022
Interview with Benjamin Lahey, professor of public health sciences at the University of Chicago, July 7, 2022
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The Conversation, Ritalin at 75: what does the future hold?, Sept. 18, 2019
The Guardian, TikTok trends or the pandemic? What’s behind the rise in ADHD diagnoses, June 2, 2022
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Schwarz, Alan. "ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic" (P. 293). Scribner. Kindle Edition.
IBIS World, The market size, measured by revenue, of the ADHD Medication Manufacturing industry is $9.7bn in 2022, Oct. 29, 2022
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ADDitude, ADHD Symptoms Unmasked by the Pandemic: Diagnoses Spike Among Adults, Children, July 9, 2022
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