When the pilot announced that we were making our final approach into Atlanta, I was reading about the shocking increase in ADHD diagnoses among children. That started my head reeling: I was landing in the city that is the poster child for adults cheating (mostly poor) children out of educational opportunities, while I was reading about a man-made epidemic that is drugging (mostly) middle- and upper-middle kids and depriving many of them of opportunities to be–and discover–who they are.
And the longer I thought about it, the more I realized that the two stories are really one, with test score mania being the common element.
Everyone knows about Atlanta, where former superintendent Beverly Hall and 34 other public school employees were just indicted for cheating on 2009 student tests, and face years and years of prison if convicted. They (allegedly) cheated because their jobs and prestige revolved around raising student test scores. More than 34 employees have already admitted guilt. (The report.) Unfortunately, the subsequent debate seems to have devolved into a food fight about testing: “Should we test, or shouldn’t we?” Well, of course we should be testing, but to what end? And with what sort of instruments?
The rise in ADHD diagnoses is “deja vu all over again,” but with a twist. My colleague John Tulenko and I reported this story in 1995 in “ADD: A Dubious Diagnosis?” for PBS. We exposed the greed and venality of CHADD and Ciba-Geigy, then the maker of Ritalin, as well as the naivete of the US Department of Education, which had been snookered by CHADD into endorsing Ritalin.
Our reporting and the subsequent furor slowed down the rush to medicate, but not for long. It’s clearly back, with a vengeance. The New York Times reports that 6.4 million children ages 4-17 had received an ADHD diagnosis at some point, a 16% increase since 2007 and a 53% increase in the past ten years.
Two-thirds of these kids get medicated with Ritalin or Adderall or some other stimulant, which, if nothing else, guarantees that we lead the world in consumption of methylphenidate. (Oh well, I guess it’s good to be NUMBER ONE in something….NOT!)
Roughly one out of every five high school boys is being labelled ADHD, and one out of ten is taking medication.
It’s about to get worse, because the American Psychological Association apparently plans to relax the definition to make it easier to be labelled. Soon, the Times reports, losing your cellphone or losing your focus while doing homework may be enough to get the label. If this behavior ‘impacts’ your life, you could be ADHD. The current wording requires that a behavior ‘cause impairment.’
Even doctors and others whose overly relaxed attitude about ADHD contributed to the explosion in diagnosis are upset by what’s happening now. Dr. Ned Hallowell, who famously once told parents that some stimulants were “safer than aspirin,” said last week, “I regret the analogy.” He told the Times, “That we have kids out there getting these drugs to use as mental steroids–that’s dangerous, and I hate to think that I had a hand in creating that problem.”
ADHD exists, but the epidemics–past and current–are man-made. In the 1990’s it was created largely by greed, abetted by teachers who wanted tightly-controlled classrooms or parents who were looking to explain why their son didn’t seem to be on a track that led to Harvard.
Today? The money trail again leads to Big Pharma, because ADHD medications now amount to $9 billion, up from $4 billion in 2007. It may not come as a surprise to learn that Big Pharma has two feet firmly planted in the federal trough on this– taxpayers are footing the bill for children covered by Medicaid, and their rate of ADHD, the Times reports, turn out to be about one-third higher than the rest of the population. Shocked? Neither am I.
But two veteran educators alerted me to another factor in the current epidemic: test score pressures. Students with ‘special needs’ like ADHD are allowed to take all important exams like the SAT and the ACT untimed, and nobody is the wiser. The admissions committees at Harvard, Amherst, Stanford et cetera are not told that Elizabeth or David had all the time in the world…
That is why, these educators said, some parents don’t mind at all when their children get the ADHD label–and may even seek it out. It is, one said, “a win-win situation, or so parents believe.”
But there’s no free lunch. If the kids take the medication, their bodies change. They’re also learning an unintended lesson: there’s a pill for all their problems. And if they don’t take the pills, they may sell them, because there’s a strong market for the stimulants, which are “uppers” for kids who don’t actually need to be calmed down. James Swanson of Florida International University told the Times that 30% of the pills are sold or passed around. And if it’s all a deception to get them extra time, what sort of ethical lesson have the parents taught their children?
So test scores are the link. Adults cheated in Atlanta (and elsewhere) to raise them. And millions of kids are diagnosed (and perhaps medicated) for the same reason, especially on the all-important tests that determine which colleges admit them.
We cannot and should not ‘ban testing,’ of course. But we need better, deeper, more challenging (and more expensive) assessments.
We also have to stop using test scores as a wedge and weapon against teachers. The central purpose of tests and assessments ought to be to determine what students know, not to evaluate teachers. To that point, I suggest you read Bill Gates’ op-ed in the Washington Post.
Do we realize that we are sacrificing our young on the altar of test scores? Teachers, principals, and superintendents are fired largely on the basis of scores. Parents (and often their kids) want to outscore everyone else on the SAT, the ACT and other gatekeeper tests, and they see the ADHD label and the drugs as the keys.
It’s never enough to curse the darkness, and there are lights to follow. Last night on the NewsHour we profiled a school district, Danville Kentucky, which is trying to change its ways. It wants project-based learning in every classroom, and it wants to be able to help design its own assessments. My colleague John Tulenko is finishing a brilliant piece about what is called ‘deeper learning’ in Portland, Maine. In that piece, he follows a couple of classrooms over a 4-month period. Look for it.
A new report from America Achieves (.pdf) is both a warning shot across the bow and a packet of suggestions for making our schools more competitive and more interesting.
It should get you thinking about pathways toward healthier education, even as it reminds you that ‘school reform’ begins at home; it’s not just an urban poor problem.
But first we have to say ‘No Mas!” to excessive bubble testing and over-diagnosing and medicating our children.
The Merrow Report 
I am responding to your comments about the SAT and ACT and the pressure to get children labeled so they may be able to receive accommodations. How sad is that. Yet, in my view, this, too, could have been predicted back in 2003.
In that year, the SAT and ACT decided to stop ‘flagging’ scores for students who had taken the tests in nonstandardized ways. Most often, this meant that some students with disabilities were allowed extended time–e.g., 50% more time than other students had. The standardization was broken. At the time I wrote about this flawed policy in a story that is still accessible at http://educationnext.org/disabling the sat/
Extended time was and still is a major change in the test, as anyone who has ever taken these timed tests knows. For many, it is the time pressure that makes them so challenging.
Now, of course, one is left to wonder, whether the flawed policy by the SAT and ACT is contributing to the pressures for labeling and diagnosing. How sad is that, all around.
Thank you for your interesting piece.
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I urge everyone to read Miriam’s essay. She is one of the most thoughtful and knowledgeable people around
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Reading this reminds me of the scene at parent teacher meeting in 1983 in Washington DC when Mrs. Butler, Daniel’s 1st Grade teacher, explained to me that she had taught many active little boys just like him and he would be able to sit still long enough to do his work and still love school by the end of the year. We took her prescription rather than the Ritalin recommendation. She was right.
Bill Gates commentary is welcome but it’s a little sad that the man with the money is likely to be listened to more than the educators and researchers who have been saying the same thing for years.
Glad you are focused on the schools and communities that are choosing to rely on multiple forms of assessment.
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Your ADD piece was courageous, excellent, and way ahead of the curve. I tried to contribute to that dialog and it so sad to see that things have only gotten worse despite our efforts.
I think what is overlooked in the Atlanta testing scandal (and other locales) is the absurd complaint that students were adversely affected. Testing is a grossly flawed measurement and children study to retain knowledge just long enough to perform on the test and then quickly forget it afterwards. You can’t simply proclaim: “of course we should have testing” without providing a reasonable defense. Twice you say “of course,” but why is that self-evident? Tradition and convenience are not good answers.
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Fair enough. We need ways of assessing knowledge and skill acquisition. Teachers must play a big part in the development of the assessments. But we need to discuss and debate the skills and knowledge young people need to acquire.
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john merrow says, “…Teachers must play a big part in the development of the assessments. But we need to discuss and debate the skills and knowledge young
people need to acquire.
Yes, after the discussion and debate of what schooling needs to contribute to education, we need to be sure that elementary teachers have that breadth of skills and knowledge themselves. Administrators, too, must come from a background of enriched education, in order to assess, evaluate, diagnose and prescribe.
We’ve lost more than one generation to a narrowed curriculum, and look what we’ve reaped. They are now the adults in the education business. We need to multiply our efforts, back into the children, using the curriculum and teaching methods their bodies and minds deserve.
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Amen….
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John, have you looked into the UK method for student/teacher/school accountability? An independent board comprised of veteran teachers visits the school, observes lessons, looks at student portfolios, talks to parents and students and rates the school. In addition to giving the rating they make specific recommendations for improvement and highlight particular achievements. I don’t think anyone wants there to be zero accountability, but I think there are far more effective and reasonably priced ways to do that.
We usually receive our test results far too late for them to have any meaningful impact on instruction and even then…they are results of a multiple choice test…how much of an impact on instruction can they make. It would be much more helpful to actually have a person observe me and say…”your lesson was engaging but you didn’t have enough ways for advanced students to extend the lesson and demonstrate higher learning” or something similar.
Now the Ofsted inspections are not without criticism but I don’t see why we couldn’t tweak the idea, American style.
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Thanks John.
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Why is it that we provide students “excuses” rather that encourage individualism, courage, and perseverance? We have enabled two generations to abdicate their responsibility for doing the hard work of parenting children, and the children the hard work of self-discipline and self-awareness. We are the #1 nation of excuses!
ADHD and ADD can be blessings (if the conditions actually exist….). Physically active people, with wildly quick, quirky minds are some of the most influential movers of our society. Why didn’t it exist 25 or 30 years ago?? Could it be that children were encouraged to be physically active, and expected to behave – without offering excuses. I believe this is another example of the money to be made while doing irreparable damage to wonderful children. I always encouraged my children and my students to ” nurture your quirks”………That is the spirit of humanity and genius.
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Hello, I just came across your site. I am not an educator, my wife is a veteran H.S. English teacher. I appreciate reading your informed essay. I just wanted to comment with respect to your statement regarding using test scores as weapons against teachers. That’s a feature, not a flaw in the program. It allows the “reformers” to advance their agenda of privatizing education. This in turn has the “benefit” of destroying unions and eliminating solid middle class jobs with good benefits. The effect on the students isn’t even a consideration in this radical agenda to decimate public education.
Hopefully the public is beginning to see this for what is it and turns against this agenda.
Thank you. I plan to visit this site often!
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