With the rise in the number ADHD diagnoses, fierce controversies have emerged over the mental disorder—how we should classify it, how best to treat it, and even whether it exists at all. We have only recently (within the past century) developed our understanding of how it affects those diagnosed, with the number of papers on “attention deficit” exploding within the past decade. But with the sheer amount of information on ADHD that’s out there, it’s easy for anyone these days to be completely overwhelmed. What do we believe? Who should we believe? Psychologist Stephen P. Hinshaw and Pulitzer Prize-winning journalist Katherine Ellison, authors of ADHD: What Everyone Needs to Know, answered a few questions for us in hopes of debunking some myths about the disorder.
Isn’t ADHD just an excuse for bad parenting, lazy, bratty kids, and pill-poppers?
This is a prevalent myth—and one we spend a lot of time debunking in our book, in interviews, and in our public talks. Despite the skepticism and the stereotypes, substantial research has shown that ADHD is a strongly hereditary neurodevelopmental disorder. The quality of one’s parenting doesn’t create ADHD—although it can influence a child’s development—and children with this condition are not lazy but instead handicapped in their capacity to focus attention and keep still.
It’s not? Well, isn’t it just a plot by pharmaceutical firms that want to sell more stimulants?
Pharmaceutical firms have worked hard to expand awareness of ADHD as they pursue profits in a global market last estimated at $11.5 billion. But they didn’t create the disorder. Moreover, studies have shown that stimulant medications—the most common treatment for ADHD—can be quite helpful for many people with the disorder and are generally safe, when used as prescribed. Our position on medication boils down to this: there is no “magic bullet,” and medication should be used with caution, due to potential side-effects and valid concerns about dependency. But you shouldn’t let Big Pharma’s sometimes remarkably aggressive tactics dissuade you from trying medication, if a doctor says you need it.
But aren’t we all getting a little ADHD because of how much we’re all checking Facebook and Twitter?
Everyone in modern society is facing a new world of devices, social media, and demands for rapidly shifting attention. It’s quite possible that the evolution of technology is moving faster than our brains’ capacity to adapt. Still, it’s important to make a distinction between distraction that can be controlled by turning off your email versus genuine ADHD, which arises from the brain’s inefficient processing of important neurochemicals including dopamine and norepinephrine. While most of us today are facing environmentally-caused problems with distraction, people with ADHD are at a significant disadvantage.
How fast have US rates of ADHD been increasing, and why?
The short answer is: really fast. US rates of ADHD were already high at the turn of the millennium, but since 2003, the numbers of diagnosed children and adolescents have risen by 41%. Today, more than six million youths have received diagnoses, and the fastest-growing segment of the total population with respect to diagnosis and medication treatment is now adults, particularly women.
The current numbers are staggering. For all children aged 4-17, the rate of diagnosis is now one in nine. For those over nine years of age, more than one boy in five has received a diagnosis. Among youth with a current diagnosis, nearly 70% receive medication.
Why are US rates so much higher than anywhere else?
Epidemiological studies show that ADHD is a global phenomenon, with rates of prevalence ranging from five to seven percent, even in such remote places as Brazil’s Amazon River basin. Indeed, diagnosis rates are much lower, for a range of reasons that include simple lack of awareness, cultural differences, and resistance to US-style “medicalization” of behavioral problems. Rates of diagnosis and treatment are now rising, in some cases dramatically, throughout the world, even as they still lag considerably behind US rates. One major factor in this trend is increasing pressures for performance in schools and on the job.
What might be causing some of the high rates in the United States?
One issue that seriously concerns us is the likelihood of over-diagnosis in some parts of the country. The danger of over-diagnosis is heightened by the fact that determining whether someone has ADHD remains a somewhat subjective process, in that, like all mental disorders, there is no blood test or brain scan that can decisively determine it.
“Gold-standard” clinical processes, which include taking thorough medical histories and gathering feedback from family members and teachers, can guard against over-diagnosis, but all too often the diagnosis is made in a cursory visit to a doctor.
What danger might there be of under-diagnosis?
The same quick-and-dirty evaluations that fuel over-diagnosis can also lead to missing ADHD when it truly exists. That is, the clinician who insists that he or she can detect ADHD in a brief clinical observation may overlook the fact that children and adults may act quite differently in a doctor’s office than they do at school or in the workplace. This is equally concerning, because whereas over-diagnosis may lead to over-treatment with medication, under-diagnosis means children who truly need help aren’t getting it.
I keep hearing that ADHD is a “gift.” What does that mean?
Celebrities including the rapper will.i.am and business superstars such as Jet Blue founder David Neeleman have talked about the advantages of having ADHD in terms of creativity and energy, and many ADHD advocates have championed the idea that the condition is a “gift.” We support the idea of ADHD as a kind of neuro-variability that in some contexts, and with the right support, can offer advantages. But do look this gift-horse in the mouth; ADHD can also be a serious liability, and needs to be managed throughout a lifetime. Consider the Olympic swimmer Michael Phelps, who rose to stardom only to be embarrassed by drug and alcohol problems. Longitudinal studies show that people with ADHD on average suffer significantly more problems with addiction, accidents, divorces, and academic and employment setbacks than others. ADHD is serious business.
Is ADHD really more common in boys than girls?
Just like all other childhood neurodevelopmental disorders (e.g., autism, Tourette’s, severe aggression), ADHD truly is more common in boys, at a rate of about two-and-a-half to one. But too many clinicians still don’t seem to understand that ADHD can and does exist in girls. One issue here is that girls—and women—often manifest the problem differently than boys and men. Whereas males may be more hyperactive, females may be more talkative or simply daydreamy. Although girls and women have historically been under-diagnosed, the rates are catching up in recent years, which is a good thing, given that the consequences of the disorder, when untreated, can be serious.
Can adults have ADHD?
Adult rates of ADHD are real and quickly growing. One reason is that as awareness has spread about childhood ADHD, many parents are starting to confront the reasons for their own lifelong and untreated distraction. There is debate about whether children ever “grow out of” their ADHD, or whether some merely learn how to cope so well that it is indistinguishable by adulthood. But the best estimates are that close to 10 million adults—about 4.4% of the population—are impaired to some extent by the disorder. That’s a prevalence rate of about half of the childhood rate.