The ADHD Epidemic: Smart Drugs and the Control of Bodies and Minds

(Photo: Erich Ferdinand)(Photo: Erich Ferdinand; Edited: LW / TO)

This is an excerpt from Scripted Bodies: Corporate Power, Smart Technologies, and the Undoing of Public Education (Routledge 2016)

Attention Deficit Hyperactivity Disorder (ADHD), which has seen massive recent increases in diagnosis since 2000, is defined as a difficulty in paying attention, restlessness, and hyperactivity. By 2010, nearly one in three US children age 2-17 had been diagnosed as suffering ADHD, and by 2012, diagnoses of ADHD had risen 66% in the prior decade. Ballooning rates of diagnosis for ADHD have been met with unprecedented levels of medical prescriptions principally for the amphetamine pharmaceutical drugs Adderall and Ritalin. By 2011 11% of all US children 4-17 were diagnosed with ADHD and 6.1% were taking ADHD drugs and an estimated 8% to 35% of university students in the US using cognitive stimulants. Boys are diagnosed at nearly three times the rate as girls. About 80% of those children diagnosed with ADHD are using these medications. Children below the poverty line are diagnosed at higher rates especially poor toddlers.

Some scientific literature claims ADHD results from underdevelopment of parts of the brain responsible for executive function, that is, the parts of the brain responsible for self-control. Doctors and psychologists use the US-based psychological diagnosis manual DSM-IV to diagnose ADHD 3-4 times more frequently than their European counterparts do with the ICD-10. Spectacular increases in diagnosis and radically disparate rates of diagnosis lend empirical weight to cultural theories of ADHD that suggest the disorder is principally a social construct rather than a biologically-based medical pathology.

The public discourse on both ADHD and the overprescription of medical solutions to it have seldom exceeded narrow questions about the individual health side effects of putting kids on uppers and the “fairness” of using performance enhancing drugs in educational competition. What is taken for granted in corporate media coverage is a system of test-oriented high stakes educational competition that filters into capitalist competition. The promise of using cognitive enhancing drugs is presented as the promise of a greater capacity to study and perform on tests, to consequently advance educationally to higher and more elite levels of schooling, and ultimately to cash educational advancement in for employment and luxury consumption of goods and services. The consumption of the drugs begins a chain of knowledge consumption that ends with rarified commodity consumption. More recent news coverage of the over-prescription of Ritalin and Adderall such as the coverage in The New York Times has emphasized psychological side effects such as psychosis, withdrawal, and depression. There is more at stake in drugging kids for educational and ultimately economic competition than physical health and psychological health. The use of pharmacological technologies for educational competition participates in a broader contestation over what constitutes valuable knowledge, intelligence, and political agency.

A student is restless in class, bored by lessons, and finds paying attention and sitting still excruciating. In an era of neoliberal educational restructuring, youth are expected to display corporeal discipline, docility, and a willingness to endure lessons that are increasingly standardized, scripted, and removed from individual and social meaning. The student in the instrumentalized, hyper-rationalized, and vocational era of neoliberal education is required to become a disciplined consumer of commodified knowledge. Proper self-discipline in the name of producing “college and career readiness” increasingly brings together the imperative for students to use the tools of bodily control to be entrepreneurial “subjects of capacity.” That is, proper attention is demanded of students to display test based performance outcomes that allow the student to compete for shrinking access to the world of work, income, and commodity consumption.

(Image: Routledge)(Image: Routledge) Smart Drugs and the Pursuit of Profit

The steady expansion of ADHD diagnosis and cognitive stimulant prescription has been driven by the profit-seeking educational projects of the pharmaceutical industry. The US-based industry targets parents, teachers, and doctors with drug advertisements and educational materials that encourage diagnosis and prescription. These educative projects have succeeded. In 2010, Americans spent $7 billion on ADHD drugs. By 2015 the amount spent had risen to $12.9 billion.

The radical rise in ADHD diagnoses by two thirds over the first decade of the millennium coincided with the implementation of the federal No Child Left Behind law that centered on high stakes standardized testing. The “high stakes” part of the high stakes testing puts economic sanctions on low test scores and rewards high test scores. As Maggie Koerth-Baker has observed, “…[W]hen a state passed laws punishing or rewarding schools for their standardized –test scores, A.D.H.D. diagnoses in that state would increase not long afterward. Nationwide, the rates of ADHD diagnosis increased by 22 percent in the first four years after No Child Left Behind was implemented.” Studies that break down ADHD diagnosis by state confirm that the states with the greatest financial penalties under No Child Left Behind are also the states with the greatest rates of diagnosis, especially for youth below the poverty line.

Based in an industrial efficiency model of knowledge transmission, high stakes standardized tests undermined the historical efforts of the Elementary and Secondary Education Act to use federal funds progressively to support schools and districts in poverty. Instead, high stakes testing punishes schools with low tests scores and rewards schools with high scores, thereby exacerbating educational resource inequality by affirming the connection between the wealth of classes and the cultural capital that the tests affirm or punish. In the era of neoliberal “accountability,” “smart drugs” are used as a tool to raise test scores for teachers subject to value added assessment whose job security and income is now linked to test scores. Likewise, in schools and districts in need of financial support and with low, stagnant, or declining test scores, smart drugs offer a means to game the regressive federal system.

The neoliberal imperatives for testing, scripted lessons, and direct instruction for “higher outputs” have created institutional conditions and financial rewards and punishments so that ADHD symptoms of restlessness, inattentiveness, and hyperactivity have become more prevalent, numerous, and more likely to be identified. That is, the new culture of control in schools is inseparable from the trend for the radical rise in the medical pathologization of students. Reasonable individual responses (like restlessness) to repressive institutional conditions – like disassociation from the environment, extreme boredom, and inability to find relevance in the assignment — become the basis for the identification of disease and the prescription of drugs. Moreover, the medical pathologizing of students is interwoven with neoliberal ideology in education in which knowledge, learning, and intelligence are understood through the register of economic competition, social mobility, and opportunity. Koerth-Baker writes, “From parents’ and teachers’ perspectives, the diagnosis is considered a success if the medication improves kids’ ability to perform on tests and calms them down enough so that they’re not a distraction to others.” As well, the high stakes testing and drugging of students facilitates the expansion of the multi-billion dollar test and textbook publishing industry and creates profits for the medico-pharmaceutical industry.

Smart Drugs Against Critical Pedagogy

The nexus between pharmaceutical control of kids’ attention and the steady expansion of standardized testing and standardization of curriculum transforms the social and individual value of knowledge while also undermining critical pedagogies and efforts to develop in students a critical consciousness for engaged social intervention. While the Every Student Succeeds Act of 2015 allows states to reduce the number of standardized tests promoted under No Child Left Behind, it maintains the requirement for standardized testing, ties state funding for teacher and leader preparation to student test scores, and comes following the federally promoted installation of a massive state-based infrastructure in testing and standardization.

Smart drugs promise intelligence, but, in fact, by being promoted in conjunction with standardized testing and the standardization of curriculum, they foster ways of thinking that devalue some of the most crucial questions of knowledge and curriculum. It is crucial to emphasize that cognitive enhancers are tools. I am criticizing the use of these tools in school as compensatory for an approach to schooling that devalues thinking and abstracts knowledge from the self and society. That is, smart drugs are used to promote efficacious consumption of knowledge in place of questions that ought to be interwoven with the process of schooling such as: What values and assumptions undergird claims to truth? What are the social positions, class and cultural interests represented by knowledge and the kinds of questions that are asked? The dominant educational reforms share the same framing assumptions about knowledge as the smart drug trend.

The Common Core State Standards, the recently revised and consolidated teacher certification standards CAEP, and the new system to assess student teachers in colleges of education EdTPA (owned by educational publishing giant Pearson NCS) share crucial elements that accord with the anti-critical trends of the high stakes standardized test era and the use of smart drugs. The standards for the Every Student Succeeds Act, the Common Core State Standards, the teacher certification standards in CAEP, and the revised guidelines for student teaching under EdTPA do not encourage the comprehension of knowledge in relation to the subjective experiences, contexts, identity positions, and social conditions of students. They also do not foster forms of teaching and learning that facilitate comprehension of how subjective experience is produced by objective structures, systems, institutions, and realities in the world. They also do not encourage a critical approach to learning in which knowledge is comprehended in terms of its social conditions of production or the social conditions for acts of interpretation. They also do not treat knowledge in terms of its possibilities for facilitating political agency to reconstruct subjective experience and to engage and transform objective realities.

Smart drugs used in conjunction with repressive pedagogies like scripted lessons, grit and other forms of resurgent behaviorism, have a political implication that is diametrically opposed to that of critical pedagogy. Critical pedagogy addresses experiences which are meaningful to students and helps them to comprehend those meaningful experiences in terms of the broader forces and struggles that produce those experiences. Smart drugs are being overprescribed in order to work on the body to allow the mind to endure or even enjoy the focus on that which is meaningless so that students can study for standardized tests and their decontextualized content. This corporate dream of replacing thought with stimulation is the same dream of ending contemplative thought that animates the positivist school reforms of standardized testing, scripted lessons and the rest. Contemplative thought, the work of interpretation, cedes to the memorization and accumulation of decontextualized facts. In contemporary positivist school reforms such as standardized testing, the meanings behind the facts, the selection and value of truth claims are determined elsewhere by the ones who know, the experts, the test makers who sit in the offices of large corporations such as Educational Testing Services and Pearson NCS. Thought resides there, with them. The practice of drugging children for test preparation undermines intelligence, the work of interpretation and judgment of the meanings of texts and claims to truth.

Critical pedagogies ideally begin with meaningful student experience and educative contexts to foster interpretation of how broader social forces produce these contexts and meaningful experiences. Such interpretation ideally forms the basis for social intervention. While critical pedagogies aim to expand understanding of the production of both knowledge and subjective experience, prescriptive methodologies and positivist forms of schooling aim to decontextualize knowledge and reduce comprehension of experience to the individual. The contemporary discourse and use of smart drugs contributes to conceptions of the self, the social, and the school that are at odds with public and critical forms of schooling and life.