A major story in the New York Times over the weekend offers a riveting look at pharmaceutical advertising and other spending to promote ADHD medication to parents, teachers and doctors. The ads are shameless and they do, indeed, suggest that stimulant meds are good for everything from improving lackluster grades to getting kids to take the garbage out. Alan Schwarz, who’s made a specialty of reporting on abuse of ADHD meds in the Times, has done a good job exposing the pharma money being funneled to doctors and advocacy groups to push the medication.

Schwarz links these ads and payoffs to the steep rise in prescriptions for ADHD medication over the last decade and more. What he doesn’t do is offer any evidence that these marketing efforts are the major, or even a major, factor in the increase.

Proving the impact of marketing campaigns is notoriously difficult to do, especially when there are other factors that could be driving the increase. In this case, there are hugely important changes in our economy and educational system that make school failure much more serious in the 21st century than it was in the 20th.

If parents are quicker to worry about their kids struggling in school—and to seek help—than they used to be, it seems less likely to be the result of magazine ads for Adderall than awareness that there are no longer good jobs for kids who don’t get a good education. They’re more worried about kids succeeding in school because the stakes are higher than ever.

If teachers are quicker to blow the whistle on kids who are disruptive or falling behind in their classrooms—and to suggest that parents get help—it seems to me less likely to be because they’ve drunk the pharma kool-aid than because schools now lose their funding if not enough kids pass standardized tests. As Dr. Stephen Hinshaw has documented, some states have much higher rates of diagnosis and medication for ADHD than others, and the highest are those that were early adopters of laws, now in effect all across the country, that base school funding on student test scores. Every child who fails is now a problem for the school, too.

Of course we suspect it’s true that some kids who are getting diagnosed with ADHD don’t have the disorder—if they’re struggling, it may be from anxiety or trauma or lack of sleep or that they just aren’t mature enough to manage current expectations for kids in elementary school, as one pediatrician suggests in the comments of the story. What we don’t buy is that large numbers of children are being medicated for problems that aren’t real—that are invented by drug companies or by overweening parents. Such an assumption does a real disservice to the majority of parents who go to their pediatrician seeking help because they’ve hit a dead end. And as long as we place the blame on a Good Housekeeping ad we continue to ignore whatever real problems these kids are facing.

The other group that always gets lost in the conversation about the overdiagnosis of ADHD is the many children who really do have the disorder. For kids who do have ADHD, medication can be a lifeline, giving them an opportunity to flourish and a chance for extremely stressed families to recover. For those families, popular skepticism of both the diagnosis and the medication just adds to their challenges. I give the last word to another commenter on the Times story:

Like everything else, ADHD can be exploited and it is. This is unfortunate for those who have struggled for years to overcome the “there’s no such thing” barrier and receive the help they need. Now we have the other extreme—ADHD turning up everywhere and in the end, another reason to dismiss those with a real, life-impairing disorder.