Kids today live in a quietly demanding world. They get to enjoy the tremendous benefits of the Information Age and yet have to step up to the increased burden of school and later employment that no longer rewards strength as much and demands greater concentration and focus. To succeed in this new environment, parents and their doctors have turned to medication in record numbers for their children. Whether this will succeed or result in a new wave of drug-addicted young Americans remains to be seen.
As healthcare coverage has expanded, so has affordable access to medicines for children. Along with this expansion of coverage has come a staggering expansion of Attention Deficit Hyperactivity Disorder (ADHD) diagnoses – from just 3-5 percent to nearly 15 percent in the past two decades, according to Psychology Today.
I believe there are two major factors at play here. The first is the access we have to more mental health resources leading to a jump in diagnoses, and the diagnosis has been growing faster in black households, which had previously reported lower levels of the condition. The other is the incredible, mounting pressure being placed on kids today with the added stress on educational performance, repeated testing, and competition for college.
Generally, it is boys who suffer with ADHD, especially in ways that can impact their performance in school. The 2016 National Survey of Children’s Health reported that 9.4 per cent of US kids have had a diagnosis of ADHD and this is now as high as 13.6 per cent of kids age 12 to 17. Of those with a current diagnosis and under age seven, nearly two-thirds are on medication, according to the survey, and to a lesser extent these kids receive therapy alone or therapy along with the medication. About one in five are diagnosed but receive no treatment.
Although the diagnosis has been rising with girls, it is boys who are more than twice as likely to have the condition. This means that when it comes to boys the numbers are about one in five teens. Part of the reason may be that it manifests itself typically in girls in harder to detect ways, but the inability of boys to focus and succeed is at the core of why most of those today getting college degrees today are women, and women are also the majority of students at medical and law schools. This condition is at the heart of why boys are having more trouble in school in this new age.
This surge in diagnosis and medication is big business. According to the CDC, the number of American kids that are taking ADHD medications has jumped from 7.8 to 11 percent for youth ages four to seventeen. The market for these drugs is also surging—a report from IBISWorld puts the ADHD drug market at $17.5 billion by 2020. The money in medications is certainly a factor. It’s a market that will only continue to grow.
When we think about kids on meds, zip codes in California suburbs and on the Upper East Side in New York immediately come to mind — kids attending elite private schools, and many of those kids are medicated today. But it’s the children of poorer Americans that are being put on medication at accelerating rates. Between 1998 and 2013, among children in America living in poverty, there has been a 73 percent rise in ADHD diagnoses, compared with 35 percent increase among kids above the poverty line.
Much of what has happened here is the result of the law of unintended consequences. As we broadened health care coverage, more families could afford mental health care and could get these kids on medicines. But the jury is out on whether this significant increase in child medicating is going to produce a more stable, better-educated generation — or is going to result in a new set of social problems among drug-dependent kids when they grow up. As a country, we are suffering from a deadly opioid crisis. As more kids with meds come out of adolescence we need to make sure they are not easy prey for opioids, as their early medication use may make them.
One area where the kids-on-meds trend has improved American lives is in the fight to legitimize and destigmatize mental health. Having an open mind toward antidepressants means the feelings of isolation that mark a lot of mental illness can dissipate. This will hopefully only continue to increase – taking a pill at lunchtime at school going unnoticed by classmates, who likely will be taking medication too. Lessened shame around addressing mental health issues, particularly around insecure and vulnerable teens, could also mean benefits like empathy and (very optimistically) fewer incidents of bullying.
Americans have faith in medication — so much so that large numbers of American parents are willing to medicate their kids as early as age two and in some sense, these medications supply needed relief to parents often at wit’s end. This under-the-radar trend requires thorough monitoring and tracking long past childhood because its capacity for societal good and harm is enormous given the rising diagnoses and an unprecedented number of kids on meds whose long-term effects are largely unknown.
This op-ed is adapted from Mark Penn’s new book, Microtrends Squared, out March 20, 2018 with Simon & Schuster.