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Whether it’s unfiltered TikTok influencers or formal public awareness campaigns, it’s been hard to miss the growing media coverage of ADHD, or attention deficit hyperactivity disorder.
People with this condition tend to be distractible, forgetful and impulsive, and may also have high energy levels. Often treated with stimulant medication that eases symptoms, it was once thought to mainly affect children, especially boys, but is now also recognised in adults, male and female.
There are a wide range of views about ADHD. To many parents of affected children, it is a condition that is going under-recognised and needs better resourcing. NHS waiting times for assessment can be over two years.
But to sceptics, like Lincoln psychiatrist Dr Sami Timimi, ADHD is a prime example of “overmedicalisation“. This is the idea that modern medicine gives unnecessary labels to people who just have more quirky personalities, who then end up taking life-long psychoactive drugs.
US health chief, Robert F Kennedy (RFK), recently called for an inquiry into the rising numbers of children taking ADHD meds over the past few decades, as part of his Make America Healthy Again campaign.
So, where does the truth lie? What is it like to find out you have ADHD as an adult? And what are the possible explanations for the rise in cases?
ADHD is in the news this week because of a press conference held about a study into whether cases really are on the up. Their results have been published in the Journal of Affective Disorders.
Against expectations, they found there has been no increase in the number of cases in the US, Canada and Sweden between 2020 and 2024.
That lack of a recent rise made some headlines but a previous study found that ADHD diagnoses increased in the UK from 2000 to 2018. By 2018, the highest rates were in boys aged 10 to 16 – 3.5 per cent had been diagnosed and 2.4 per cent were on medication. Back in 2000, those numbers were 1.4 per cent and 0.6 per cent.
“It seems likely that clinical diagnosis rates in the UK continue to increase – but we need research to see exactly the size of this,” said Professor Phillip Shaw, director of the King’s Maudsley Partnership for Children and Young People in London.
Story of an adult diagnosis
The UK study found that, while teenage boys have the highest rate of ADHD overall, the biggest relative increase in medication use in the past two decades was in adults. The stimulant medicines don’t just help schoolchildren but can also help adults focus in work and everyday life.
Caroline Williams, for instance, was diagnosed with ADHD two years ago, at 48. “I’d suspected for a long time, but at the time, it wasn’t a thing in adults, and it certainly wasn’t a thing in adult women,” she said.
“Everyone goes to the supermarket and forgets what’s on the list, but I can go to the supermarket with a list, cross things off the list and come back and still not have a key ingredient.
“You spend all the time backtracking, correcting yourself and giving yourself a hard time.”
Caroline Williams was formally diagnosed with ADHD at 48After a six-month-wait, Williams was assessed through an NHS pathway, which confirmed her suspicions, and the doctor suggested she try the standard ADHD medication. At first she tried using it only when needed but has found herself more productive when taking it daily.
Without the medicine, Williams would find herself unable to start on the day’s to-do list. “You can know logically that these things on the top are most important, and you should do them first. But in my mind, they’re all at the top jostling for position, and there’s no way of knowing where to start.
“It can be so overwhelming, I just don’t do anything and I end up completely paralysed. For me, the medication has been the best way to get through that.
The growing numbers of people diagnosed with ADHD might seem alarming, but it is less so if we consider that the diagnosis rate of 3.5 per cent in teenage boys is still probably an underestimate, said Professor Shaw.
Other studies that have tried to find how common it really is – by giving the same behavioural tests to large numbers of children, whether diagnosed or not – suggest that true figure is about 5 per cent of children.
For years there has been rising awareness about ADHD, and less stigma, among both parents and teachers. This could contribute to families being more keen to get a diagnosis, and medication if necessary.
So the current long waiting lists for assessments, for both children and adults, may just reflect more people coming forward. “The most likely explanation is simply that we’re playing catch-up,” said Professor Shaw.
Broader definition
Another possibility is that doctors have become more liable to diagnose people with ADHD than they used to be.
Like most conditions affecting mental health, there is no blood test or brain scan that can give a definitive diagnosis of ADHD. Instead, doctors go through checklists to see if people’s symptoms reach a certain level of severity based on what’s usual for their age, but this can be subjective.
And genetic research in recent years has shown that ADHD is not a single discrete condition – that you either have or you don’t – but represents one end of a spectrum of behaviours involving impulsivity and inattention, said Professor Edmund Sonuga-Barke, a developmental psychologist at King’s College London.
“It means that the margin between ADHD and non-ADHD becomes more arbitrary, more subjective,” he said.
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“It does offer a potential explanation for why ADHD diagnostic rates – compared to, say, rates of high blood pressure – may be particularly influenceable by societal changes driving more diagnosis,” he said.
Cultural differences between doctors in different countries could explain why diagnosis rates vary so much globally.
In the latest research, the rate for under-18s in Sweden was 3.2 per cent, while in the US it was 10 per cent, making it more understandable why RFK wants to investigate.
It may also explain why ADHD isn’t necessarily a lifelong condition. In fact, recent research found that of children who had been diagnosed, within five years, a quarter were no longer classed as having it, while in another quarter, the diagnosis came and went.
A common belief is that the rise of fast-paced social media content like TikTok videos are shortening attention spans and contributing to the rise of ADHD.
“There’s a great degree of interest in the possibility that the constant dividing of attention and multitasking online is creating the distracted generation,” said Professor Shaw.
But while some studies have found correlations between more social media use and ADHD-like symptoms, that doesn’t prove that the former is causing the latter, he said.
“We don’t know if social media is driving some symptoms of inattention, or is it that kids who are a bit distractible are the ones who are going online and multitasking,” he said. “What’s the chicken, what’s the egg?”
Lockdown disruption
While there are clearly long-term trends going on, it would seem foolish to ignore the potential impact of the biggest societal upheaval of the last few years – the Covid pandemic. “Kids had a marked disruption to their learning environment for about two or three years,” said Professor Shaw.
But the latest study did not find evidence that diagnosis rates had changed markedly over the pandemic years in Sweden, Canada and the US.
“There was some evidence for fluctuations across Covid, that bounced back to expected rates prior to the pandemic, but those fluctuations were not statistically significant, so that suggests that it hasn’t had a particular impact,” said Dr Alex Martin, a psychologist at King’s College London.
But all the experts called for more research to find out how ADHD rates have been changing in the UK in recent years. “Our study has shown significant gaps in the tracking of ADHD prevalence, resulting in a frustratingly unclear picture,” said Dr Martin.
There could be multiple reasons why ADHD diagnosis rates are rising and it may take a lot more research to get to the bottom of it. Some think it is a cause for concern, but I’m going to give the last word to Caroline Williams.
She said her diagnosis was “validation that I wasn’t just making this stuff up and I wasn’t just lazy. There was something actually making it more difficult for me than it necessarily should be. This has made a huge difference to my life.”
The ban on disposable vapes that came in last week was meant to reduce teenage vaping and cut down on litter and pollution in one stroke.
But manufacturers have already designed vapes that get around the new law, because while technically reusable, they look like disposables and are priced just as cheaply.
I’ve watched
Wes Anderson’s new black comedy, The Phoenician Scheme, is, by parts, moving, exciting and surreal, but always entertaining. I didn’t quite manage to follow all of the complicated plot – about a crazy plan to make huge profits by building transport infrastructure in a desert – but it didn’t matter one bit.
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