Attention Deficit Hyperactivity Disorder (ADHD)

 

Patients Waiting to See the Doctor, with Figures representing Their Fears
Rosemary Carson (b. 1962)
Photo Credit: Wellcome Collection  [CC BY]

Why does everyone suddenly seem to have ADHD? It's a question that many of us working in mental health have been asking each other recently. Just a decade or so ago I rarely saw anyone in clinic with attention deficit hyperactivity disorder; now I see at least one case a day. It's bewildering. Have all these people simply been undiagnosed for years? Is it a medical fad? No one knows.

ADHD used to be mainly diagnosed in children, but more and more people are now getting a diagnosis in adulthood. These adult patients tend to assume that they have had the disorder since childhood but what they don't grasp, is that even the existence of childhood ADHD as a condition is up for debate.

Research suggests that far from being under-diagnosed in children, ADHD is wildly over-diagnosed. - and this is dangerous... It's easier to whack a label on a child - to medicalise their behaviour - than to confront parents with the idea they might be in part to blame for the way their offspring behave.

There are also concerns that the mainstay of ADHD treatment - powerful stimulant medications such as methylphenidate - can have serious side effects. The evidence is not clear that this medication is truly effective and that the majority of of trials into the use of of methylphenidate have been deemed by Cochrane (a body that evaluates research) as being "at high risk of bias." This isn't surprising seeing as half of the trials were funded by the pharmaceutical industry...

Some 15 years ago the diagnosis du jour was  bipolar. Thanks to a slew of celebrities claiming to have it, suddenly many more were self-diagnosing. Plain old depression was boring. Now bipolar is out, ADHD is in, with the added benefit that the medication used to treat it is much more fun than bipolar meds. ADHD medication such as Ritalin has a street value as a stimulant. One patient once said to me: "It's like cocaine but better."

There are great incentives for parents to get an ADHD diagnosis for their child. The highest rates of children diagnosed with mental health conditions - including ADHD - are in affluent areas. This is most likely because middle-class mums know well that diagnosis secures a child additional time in exams...

The question about ADHD feed into the big question in mental health at the moment: to what extent are we medicalising normal everyday issues, difficulties and problems? And to what extent are we recasting ordinary human variation as pathology...

(Max Pemberton, consultant psychiatrist, The Times, 2025)

Health fashion then. Diagnosis creep and over-treatment? And one may also want to know why the rate of special needs children in the education sector has increased so dramatically over the last decade too. Both have been a boon for private doctors and psychologists who can charge hundreds of pounds to those who are asking for a diagnosis. How about that the rates of attention and behaviour difficulties in children and young adults have increased hugely in line with the rise of technology? For many, less Ritalin, better parenting and less screen time?

Below, an article and comment on the same issue four years ago.

... My own perception of ADHD (Attention Deficit Hyperactivity Disorder) was gleaned entirely from popular culture and the stereotypes it perpetuates.

Though I know now the obstacles it presents are obvious in every area of my life, nothing I saw gave me any inkling that I might have it.

The Dreamer
Annie Louisa Swynnerton (1844-1933)
Photo Credit: Manchester Art Gallery [CC BY-NC-ND]

I'm a girl, I'm a daydreamer rather than a disruptor. I did not underachieve at school and I always considered my lateness, chaos or limitations personal failures rather than caused by a neurological disorder.

I felt the impact on my self-esteem, but it was hardly something to see a shrink about. And, yes, I am talkative and have never been able to sit still. And I am very sensitive, impatient and impulsive. And I can't tell stories in order and I interrupt people and I can't focus and I can't  start tasks and I can't finish tasks and I can't go to supermarkets or restaurants or follow instructions or a recipe without feeling overwhelmed. And I can't relax - ever. But that's just my problem, isn't it?

Well, no, actually, and had any of these symptoms been explained to me, or had ADHD been displayed in functioning people on TV instead of being used as shorthand for "disorganised" or "stupid", or a lazy way to paint a character as deviant, perhaps it wouldn't have taken me until the age of 27 to seek treatment and start lifting the fog. When I did, it was YouTube vlogs that helped me learn to manage it.

(Sarah Carson, The i, 2020) 

The trouble is that plenty of people who exhibit your behaviour traits, or symptoms do not have ADHD. Like dyslexia there are many children who have reading difficulties who do not have dyslexia. 

One of the difficulties with ADHD is drawing the line at where normal levels of inattention, hyperactivity and impulsive behaviour end and significant levels requiring intervention begin.