They are skyrocketing because all of the incentives align to push them upwards: more money for providers & pharma, more status for individuals (like the endless number of people who include 'ADHD' in their self-description, as if that's a meaningful detail for others), and more activity for counselors, researchers, educators, etc.
The only factors that might limit this trend are self-respect and self-discipline. Some people might not want to advertise their diagnoses to others in order to gain status, and some people might decide that they can manage their problems on their own, without engaging with a vast mental health bureaucracy that is, in the aggregate, undeniably making things far worse. But these qualities are rare (because they're difficult to maintain) and it's much easier to simply seek the privilege and accommodations and pharmaceutical benefits of a diagnosis. Why would someone NOT want to be diagnosed with ADHD? That's the real question. A diagnosis (any diagnosis) should be (socially) negative; it indicates some dysfunction or abnormality. It's a problem that must be identified and addressed. But our culture is involved in a project of trying to reward dysfunctions (at least the fashionable ones - autism, ADHD, DID, etc.; I notice that NO ONE ever advertises their NPD or schizophrenia diagnosis) and of trying to pretend that there IS no such thing as abnormality.
The biggest problem is that we're relentlessly self-absorbed. If rising ADHD diagnoses make people feel better about themselves and let them access new tools and adopt coveted labels then they will continue to rise... until they become unfashionable or unprofitable, at which time they will plummet. Welcome to modern mental health treatment.
Thanks for commenting, James. I find the conversation around status and "fashionable diagnoses" an interesting one, and I'm still forming up my thinking around this.
I was diagnosed a long time ago, after a very involved psych assessment involving two practitioners and a TOVA (which measures how well you can pay attention comparative to an established average) and I was pretty upset about it. Because it meant a natural limit to what I could reasonably expect to achieve on my own compared to others (at least, this was how I initially took it). Since this time, my thinking has evolved - it's an extremely helpful framework to have if you use it to understand that standard advice on functioning well probably won't work well for you. It's a creative invitation to take *more* responsibility for your life, but in ways that will work for your brain.
But I'm also haunted by how negative it would have been for me if I'd stopped at (for example) "Ah, being on time is hard because of my brain" and closed the book. Psychiatric diagnosis is a complex and often inexact endeavour that raises serious questions (https://paintingwithlightning.substack.com/p/lies-damned-lies-and-the-dsm) but used as a starting point for understanding a treatment path it's incredibly useful. The problem is, it should be the first step - not the end of the story.
"The biggest problem is that we're relentlessly self-absorbed" you will get no argument from me on this one, and I won't comment on the difficulties with the mental helth industry at present or this will reply will end up longer than the post.
I can appreciate that the world is heavily edited. Human bodies edited, faux perfect lives sold to us as achievable life goals.
But the idea that an explosion in ADHD diagnoses might be because we are being sold lifestyles that aren’t real, is a thin line to tread, especially when written by a person themselves diagnosed with ADHD!
The line that “diagnosis is not an exact science,” suggests a potential bias leaning towards many new cases being misdiagnosed? Again, that’s a potentially precarious place to be in! It suggests your diagnosis was spot on and has helped you — but others may just be a case of feeling like they need 10 different side hustles and a spotless house.
I can imagine many people diagnosed with ADHD feeling threatened with a seeming explosion of cases. It might threaten the validity of the condition.
And while you might have a worthy point here for some new cases, I think there are plenty of other areas to take into account too, and then there’s the suggestion that cases really aren’t exploding at all — we are just getting better at diagnosis.
So that would be a tremendous thing, that now there is the help for these people. I’m 50, and have diagnosed myself as being on the ADHD spectrum just this year. It’s a relief because I’ve never fitted in, and I’ve had all these quirky idiosyncrasies and stumbling blocks and suddenly there’s a really decent explanation.
Interestingly, according to one study, diagnoses were around two times higher in the most deprived areas. I wonder what correlations might be drawn from that, whether diet, poor sleep, and environmental factors, might be at play. Etc. There is also a strong genetic component.
So whilst it’s possible that some people think they have ADHD simply because they don’t fit in to an unreal version of the world sold to us by the media and online, it’s still possible there are other factors at play too!
Might there be potential correlations with a rise in various vaccines, too? And could Covid brain fog contribute to a rise in ADHD-like symptoms? Etc. I’d be asking questions like these, too!
Thanks for sharing your thoughts Sarah, I can appreciate it's a delicate subject and perhaps I haven't fully done justice to stressing (1) the difference between receiving a diagnosis via a trained professional vs self-ID, while holding in mind how inaccessible official diagnosis can be, and (2) that I see this as a contributing factor to people searching for an "answer" as to why they are having so much difficulty managing "the stuff of life", the answer for which may or may not be ADHD.
We are absolutely getting better at diagnosis. There are many people as-yet undiagnosed. I appreciate that I come to this from a certain position which may seem unfair (ADHD is true for me but not for thee). I do not believe this to be the case, I don't get to say what the truth of another person's life is. There are also, as you say, likely many contributing factors - environmental, genetic, epigenetic.
What I am attempting to do here is name a phenomenon I notice in my practice whereby people's expectations of what is "normal" to manage is unreasonable, but they are certain that this is pathological, and link this to why it is useful (where possible) to seek diagnosis through an experienced professional. This way, differential diagnoses such as cPTSD (which can look very, very similar to ADHD) are considered because the treatment/management pathway is very different.
Thank you Skye! 😊 That’s a terrific reply. I totally appreciate that what is considered “normal” these days can be vastly skewed and unrealistic in the first place. And that getting a diagnosis from an experienced professional is key. Have a lovely weekend. 😊🦋
You're very welcome Sarah! I appreciate your thoughts and that you have taken the time to articulate them clearly, my thinking around this is ongoing. Have a lovely weekend too.
I can’t keep up with all of my subscriptions! I must have a diagnosable condition, since I imagine that nobody else would oversubscribe. Substack thought I would like this Substack. Holly MathNerd restacked this piece. As a result there may be an influx of other subscribers. I hope so. I thought I had a good grasp on the extent to which my world is curated by others, but it turns out I have been naive. Thank you.
Diagnosable condition or not, thanks so much for stopping by and sharing your thoughts Jackson. I’m very grateful for the readers and thoughtful discussion that have come via this piece.
One of the very real issues is the horrible case of gifted and ADHD. Kids like this drive most teachers nuts. I know. This was my son. He was bored, he was smart, and he didn’t always fit in. In second grade, an angry teacher threw a sixth grade math worksheet at him with a sneering, “So do this then.” WHich, of course, he did. It took a long time to determine that he was also ADHD.
There are also parents who seek a diagnosis so that the kid gets extra time and other bits of bonuses.
It’s a mess.
On bodies - it was only a few years ago that I finally realized that the photos of younger women that I only knew slightly (children of family members mostly) actually didn’t look the way they did in real life. Just posting a photo of themselves at a party, or on a trip, or having dinner required that they use various filters. It’s terrible , particularly for girls just starting to notice how they look.
Oh absolutely, the school system has no idea what to do with children like your son, and because they're smart kids people also tend to expect corresponding socio/emotional maturity from them. The "extra time" thing drives me mad because it isn't even helpful to ADHD kids ... a two-minute break to move around every 10 minutes is *far* more effective than an extra hour tacked on. It is a mess, indeed.
The photos/bodies distorting thing is so shocking in terms of the implications for the brain and how it comes to recognise normality, how you come to understand what you really look like. Even being able to take 30 photos easily and choose the best one is a huge change between generations...
Just one thought on your lack of "skinny-ness": Almost all photos, except a few done by professional photographers, add 20 pounds to the body. That's one reason why fashion models look almost anorexic when seen in person. A skilled photographer by the use of various lenses and adjusting the distance from the subject can eliminate most of that look; the rest can be done by retouching.
And maybe one more: living a significant number of decades gives one the ability to ignore a lot of the unpleasant stuff, and get away with it.
Ok, I was being flip when I posted this earlier. I have to say that ADHD has never been a problem for me, although I do have some signs of obsessive/compulsive behavior. That said, my experience tells me, and I have been writing about this on and off for a year, that a big part of our problem is what I call a lack of grounding...not in the sense of walking barefoot in the grass or at the beach, but rather experiencing real life, in nature; you might say life in the raw. I lived on a dairy farm from age 3 to 15, and you don't get much more real than that. Even rode out a tropical storm 150 miles inland.
After 24 and a half years into this century, the world we're living in now is nothing like the 20th century, for a number of reasons, some well established, some still to be discovered. And much of it comes from the unreality of the digital world. It's no wonder so many are now being diagnosed with ADHD: most don't have any stable ground to hang on to.
I could say it's that things are changing faster than we humans are able to evolve; I'd rather say that we were created for living in a real, physical world, and being more or less forced to live in unreality is going to cause problems for some more sensitive souls, and eventually for all of us who are left standing.
I will say that about ten years ago, after I had been retired a few years, I looked around at what appeared to be heading our way and thought, momentarily, that if I were 55, I would probably slit my wrists. Obviously, I didn't and I wouldn't, but the thought did occur to me. I applaud all those awake young persons who persist during these tough times, and not only that, push back against the onslaught.
Now in my late 70s, I have survived a bout with covid, a heart attack and atrial flutter. I'm no longer young, but I'm not old yet. For some reason, God is keeping me here for a while longer. My maternal grandmother was born in 1900, worked hard most of her life and finally left for home at age 96 when her body finally wore out. I suppose I'm following in her tracks.
Hi John, I appreciate these thoughts because they go where I would have liked to meander in this piece, and also because I haven't quite been around long enough to look back on change the way you have. The lack of being "in real life" instead of apes in an arcade (to paraphrase a post I came across a while back but can't find to link to).
I often imagine moving somewhere up the coast where everyone has their own tractor and a big apple tree in the garden, after a few days in that environment it's like waking up from a dream and remembering how I'm meant to be living. But individual escape fantasies can't change where we find ourselves as a species.
An interesting point too about photography, that makes sense and is another element of how images aren't reality (whether it's that a camera adds 20lbs or that retouching changes the shape of a body in unreal ways, even if the aim is sometimes to reproduce reality more faithfully).
Oh, this hits a little hard. My son is one of the youngest in his grade. Always bright, but struggled so much in school and was recently diagnosed with ADHD at 16. We put him in his year because he was smart and even in kindergarten was bored and wanted to go to school. He's never been emotionally at the same level as his peers, but intellectually we thought it was better for him to be in the higher grade. I had some friends who kept their kids back a year - which was advantageous to them academically but I always thought it was a little bit like cheating to make them do better than their peers, and that it was making the difference between the youngest and oldest in a grade more like 18 months than the 12 months it's supposed to be. In the end my kid probably would have done better being kept back.
I particularly liked your comment: "We used to remember that the camera changes things. That the observer alters the outcome." One of the things I talk about is "othering" oneself, so I was fascinated to see how this played out in your experience.
They are skyrocketing because all of the incentives align to push them upwards: more money for providers & pharma, more status for individuals (like the endless number of people who include 'ADHD' in their self-description, as if that's a meaningful detail for others), and more activity for counselors, researchers, educators, etc.
The only factors that might limit this trend are self-respect and self-discipline. Some people might not want to advertise their diagnoses to others in order to gain status, and some people might decide that they can manage their problems on their own, without engaging with a vast mental health bureaucracy that is, in the aggregate, undeniably making things far worse. But these qualities are rare (because they're difficult to maintain) and it's much easier to simply seek the privilege and accommodations and pharmaceutical benefits of a diagnosis. Why would someone NOT want to be diagnosed with ADHD? That's the real question. A diagnosis (any diagnosis) should be (socially) negative; it indicates some dysfunction or abnormality. It's a problem that must be identified and addressed. But our culture is involved in a project of trying to reward dysfunctions (at least the fashionable ones - autism, ADHD, DID, etc.; I notice that NO ONE ever advertises their NPD or schizophrenia diagnosis) and of trying to pretend that there IS no such thing as abnormality.
The biggest problem is that we're relentlessly self-absorbed. If rising ADHD diagnoses make people feel better about themselves and let them access new tools and adopt coveted labels then they will continue to rise... until they become unfashionable or unprofitable, at which time they will plummet. Welcome to modern mental health treatment.
https://jmpolemic.substack.com/p/rule-1-you-are-responsible
Thanks for commenting, James. I find the conversation around status and "fashionable diagnoses" an interesting one, and I'm still forming up my thinking around this.
I was diagnosed a long time ago, after a very involved psych assessment involving two practitioners and a TOVA (which measures how well you can pay attention comparative to an established average) and I was pretty upset about it. Because it meant a natural limit to what I could reasonably expect to achieve on my own compared to others (at least, this was how I initially took it). Since this time, my thinking has evolved - it's an extremely helpful framework to have if you use it to understand that standard advice on functioning well probably won't work well for you. It's a creative invitation to take *more* responsibility for your life, but in ways that will work for your brain.
But I'm also haunted by how negative it would have been for me if I'd stopped at (for example) "Ah, being on time is hard because of my brain" and closed the book. Psychiatric diagnosis is a complex and often inexact endeavour that raises serious questions (https://paintingwithlightning.substack.com/p/lies-damned-lies-and-the-dsm) but used as a starting point for understanding a treatment path it's incredibly useful. The problem is, it should be the first step - not the end of the story.
"The biggest problem is that we're relentlessly self-absorbed" you will get no argument from me on this one, and I won't comment on the difficulties with the mental helth industry at present or this will reply will end up longer than the post.
I enjoy your writing style! It’s very good. 😊
I can appreciate that the world is heavily edited. Human bodies edited, faux perfect lives sold to us as achievable life goals.
But the idea that an explosion in ADHD diagnoses might be because we are being sold lifestyles that aren’t real, is a thin line to tread, especially when written by a person themselves diagnosed with ADHD!
The line that “diagnosis is not an exact science,” suggests a potential bias leaning towards many new cases being misdiagnosed? Again, that’s a potentially precarious place to be in! It suggests your diagnosis was spot on and has helped you — but others may just be a case of feeling like they need 10 different side hustles and a spotless house.
I can imagine many people diagnosed with ADHD feeling threatened with a seeming explosion of cases. It might threaten the validity of the condition.
And while you might have a worthy point here for some new cases, I think there are plenty of other areas to take into account too, and then there’s the suggestion that cases really aren’t exploding at all — we are just getting better at diagnosis.
So that would be a tremendous thing, that now there is the help for these people. I’m 50, and have diagnosed myself as being on the ADHD spectrum just this year. It’s a relief because I’ve never fitted in, and I’ve had all these quirky idiosyncrasies and stumbling blocks and suddenly there’s a really decent explanation.
Interestingly, according to one study, diagnoses were around two times higher in the most deprived areas. I wonder what correlations might be drawn from that, whether diet, poor sleep, and environmental factors, might be at play. Etc. There is also a strong genetic component.
So whilst it’s possible that some people think they have ADHD simply because they don’t fit in to an unreal version of the world sold to us by the media and online, it’s still possible there are other factors at play too!
Might there be potential correlations with a rise in various vaccines, too? And could Covid brain fog contribute to a rise in ADHD-like symptoms? Etc. I’d be asking questions like these, too!
Thanks for sharing your thoughts Sarah, I can appreciate it's a delicate subject and perhaps I haven't fully done justice to stressing (1) the difference between receiving a diagnosis via a trained professional vs self-ID, while holding in mind how inaccessible official diagnosis can be, and (2) that I see this as a contributing factor to people searching for an "answer" as to why they are having so much difficulty managing "the stuff of life", the answer for which may or may not be ADHD.
We are absolutely getting better at diagnosis. There are many people as-yet undiagnosed. I appreciate that I come to this from a certain position which may seem unfair (ADHD is true for me but not for thee). I do not believe this to be the case, I don't get to say what the truth of another person's life is. There are also, as you say, likely many contributing factors - environmental, genetic, epigenetic.
What I am attempting to do here is name a phenomenon I notice in my practice whereby people's expectations of what is "normal" to manage is unreasonable, but they are certain that this is pathological, and link this to why it is useful (where possible) to seek diagnosis through an experienced professional. This way, differential diagnoses such as cPTSD (which can look very, very similar to ADHD) are considered because the treatment/management pathway is very different.
Thank you Skye! 😊 That’s a terrific reply. I totally appreciate that what is considered “normal” these days can be vastly skewed and unrealistic in the first place. And that getting a diagnosis from an experienced professional is key. Have a lovely weekend. 😊🦋
You're very welcome Sarah! I appreciate your thoughts and that you have taken the time to articulate them clearly, my thinking around this is ongoing. Have a lovely weekend too.
I can’t keep up with all of my subscriptions! I must have a diagnosable condition, since I imagine that nobody else would oversubscribe. Substack thought I would like this Substack. Holly MathNerd restacked this piece. As a result there may be an influx of other subscribers. I hope so. I thought I had a good grasp on the extent to which my world is curated by others, but it turns out I have been naive. Thank you.
Diagnosable condition or not, thanks so much for stopping by and sharing your thoughts Jackson. I’m very grateful for the readers and thoughtful discussion that have come via this piece.
One of the very real issues is the horrible case of gifted and ADHD. Kids like this drive most teachers nuts. I know. This was my son. He was bored, he was smart, and he didn’t always fit in. In second grade, an angry teacher threw a sixth grade math worksheet at him with a sneering, “So do this then.” WHich, of course, he did. It took a long time to determine that he was also ADHD.
There are also parents who seek a diagnosis so that the kid gets extra time and other bits of bonuses.
It’s a mess.
On bodies - it was only a few years ago that I finally realized that the photos of younger women that I only knew slightly (children of family members mostly) actually didn’t look the way they did in real life. Just posting a photo of themselves at a party, or on a trip, or having dinner required that they use various filters. It’s terrible , particularly for girls just starting to notice how they look.
Oh absolutely, the school system has no idea what to do with children like your son, and because they're smart kids people also tend to expect corresponding socio/emotional maturity from them. The "extra time" thing drives me mad because it isn't even helpful to ADHD kids ... a two-minute break to move around every 10 minutes is *far* more effective than an extra hour tacked on. It is a mess, indeed.
The photos/bodies distorting thing is so shocking in terms of the implications for the brain and how it comes to recognise normality, how you come to understand what you really look like. Even being able to take 30 photos easily and choose the best one is a huge change between generations...
Just one thought on your lack of "skinny-ness": Almost all photos, except a few done by professional photographers, add 20 pounds to the body. That's one reason why fashion models look almost anorexic when seen in person. A skilled photographer by the use of various lenses and adjusting the distance from the subject can eliminate most of that look; the rest can be done by retouching.
And maybe one more: living a significant number of decades gives one the ability to ignore a lot of the unpleasant stuff, and get away with it.
Ok, I was being flip when I posted this earlier. I have to say that ADHD has never been a problem for me, although I do have some signs of obsessive/compulsive behavior. That said, my experience tells me, and I have been writing about this on and off for a year, that a big part of our problem is what I call a lack of grounding...not in the sense of walking barefoot in the grass or at the beach, but rather experiencing real life, in nature; you might say life in the raw. I lived on a dairy farm from age 3 to 15, and you don't get much more real than that. Even rode out a tropical storm 150 miles inland.
After 24 and a half years into this century, the world we're living in now is nothing like the 20th century, for a number of reasons, some well established, some still to be discovered. And much of it comes from the unreality of the digital world. It's no wonder so many are now being diagnosed with ADHD: most don't have any stable ground to hang on to.
I could say it's that things are changing faster than we humans are able to evolve; I'd rather say that we were created for living in a real, physical world, and being more or less forced to live in unreality is going to cause problems for some more sensitive souls, and eventually for all of us who are left standing.
I will say that about ten years ago, after I had been retired a few years, I looked around at what appeared to be heading our way and thought, momentarily, that if I were 55, I would probably slit my wrists. Obviously, I didn't and I wouldn't, but the thought did occur to me. I applaud all those awake young persons who persist during these tough times, and not only that, push back against the onslaught.
Now in my late 70s, I have survived a bout with covid, a heart attack and atrial flutter. I'm no longer young, but I'm not old yet. For some reason, God is keeping me here for a while longer. My maternal grandmother was born in 1900, worked hard most of her life and finally left for home at age 96 when her body finally wore out. I suppose I'm following in her tracks.
Hi John, I appreciate these thoughts because they go where I would have liked to meander in this piece, and also because I haven't quite been around long enough to look back on change the way you have. The lack of being "in real life" instead of apes in an arcade (to paraphrase a post I came across a while back but can't find to link to).
I often imagine moving somewhere up the coast where everyone has their own tractor and a big apple tree in the garden, after a few days in that environment it's like waking up from a dream and remembering how I'm meant to be living. But individual escape fantasies can't change where we find ourselves as a species.
An interesting point too about photography, that makes sense and is another element of how images aren't reality (whether it's that a camera adds 20lbs or that retouching changes the shape of a body in unreal ways, even if the aim is sometimes to reproduce reality more faithfully).
I need to read this more carefully but for now I would just like to say that the thumbnail is a riot
Memes are love, memes are life.
Oh, this hits a little hard. My son is one of the youngest in his grade. Always bright, but struggled so much in school and was recently diagnosed with ADHD at 16. We put him in his year because he was smart and even in kindergarten was bored and wanted to go to school. He's never been emotionally at the same level as his peers, but intellectually we thought it was better for him to be in the higher grade. I had some friends who kept their kids back a year - which was advantageous to them academically but I always thought it was a little bit like cheating to make them do better than their peers, and that it was making the difference between the youngest and oldest in a grade more like 18 months than the 12 months it's supposed to be. In the end my kid probably would have done better being kept back.
Terrific piece. I can identify with so much of this. I have written about my own experience with ADD here:
https://douglasmcclenaghan.substack.com/p/it-just-dont-add-up
I particularly liked your comment: "We used to remember that the camera changes things. That the observer alters the outcome." One of the things I talk about is "othering" oneself, so I was fascinated to see how this played out in your experience.