A New Age of ADHD

Along the sides of Abby Doan’s (12) in-class notes are caterpillars — doodled caterpillars, that is. There are other drawings too: some hearts, some cats. They can’t hear the voice of Doan’s teacher. But then, neither can Doan. 

“I can’t listen to lectures,” Doan said. “I always draw when teachers are talking because if I try to only listen to somebody talking, I’ll just zone out.”

Doan was diagnosed with Attention-Deficit/Hyperactivity Disorder, a neuro-developmental condition that involves attention difficulty, impulsivity and hyperactivity. She is one of the estimated 9.8% of U.S. children aged 4-17 who have been diagnosed with ADHD, according to Center for Disease Control and Prevention data from 2016-2019. 

Clearly, ADHD is a prevalent disorder. But the number of ADHD diagnoses has been increasing in recent years too. According to the same CDC data, the prevalence of ADHD in children rose from 6% in the 1990s to almost 10% in 2016. The number of adults diagnosed with ADHD has also increased. 

But exactly why this rise has occurred is less clear; there is not one simple answer. Instead, there are a plethora of factors — many of which are intertwined, some of which are debated — that could have played a role.

It seems, though, that a significant one is the expanding awareness of ADHD.

“A lot of people have more information about what ADHD is, so people are seeking out more treatments,” Dr. Esther Samadi, a local psychiatrist, said. “Before, people weren’t aware that they had it.”

Heightened awareness of the condition also helps deconstruct stigmas, leading to more individuals seeking a diagnosis. 

“I think there’s certainly less shame over it,” Dr. Lori Rappaport, a local clinical psychologist, said. “I think people are recognizing that it’s not a behavioral issue — it’s how your brain is wired.”

Along with these transformations, changes have occurred to the medical diagnosis itself in recent years.

The Diagnostic and Statistical Manual of Mental Disorders is the professional guide to definitively diagnosing mental disorders. The fifth and newest edition, published in 2013, raised the age of symptom onset from seven to 12 years old, meaning a child who exhibited symptoms before they were 12 could be diagnosed. It also removed the requirement for symptoms to cause impairment and allowed for Autism Spectrum Disorder to coexist with ADHD — all of which broadened the group of children eligible for an ADHD diagnosis. 

According to Samadi, it is extremely “important to get a proper assessment.” The symptoms of ADHD, however, can overlap with those of other conditions, making misdiagnosis something to consider as a contributing factor to the rise. 

“Oftentimes if you go to a pediatrician, they will give you a questionnaire of 20 questions, and if you meet whatever their criteria is, that may be indicative of ADHD, but it’s not enough to diagnose someone because a lot of things overlap,” Rappaport said. “ADHD symptoms can also be the same symptoms caused by anxiety or depression, executive function or autism.”

Another worry, which could be an element of the rise, is overdiagnosis. There is no clear consensus on this by experts, though some recent research found evidence of it. 

“I do think maybe there’s a slight overdiagnosis at times,” Samadi said. “I think because of the hyper-competitive nature of the academic world right now, there’s much more of a push for being diagnosed with these things … Because of that, everybody wants an advantage.”

An alternate explanation for overdiagnosis could be misinformation spread on social media, which has made it so “a lot of people don’t understand what ADHD is really like,” according to Doan. 

“They tend to see it as this small little quirk, but it’s actually something that is really life-halting,” Doan said.

However, for Doan, and potentially for many other girls struggling with attention or hyperactivity, these “life-halting” effects may have gone unchecked longer than necessary.

According to the CDC, girls are underdiagnosed with ADHD compared to boys, the latter being three times more likely to receive an ADHD diagnosis. A further explanation for the surge is that experts are more informed about how girls specifically exhibit ADHD. 

“Who’s the more obvious patient: the kid who’s bouncing off the wall, a troublemaker, or a really quiet girl in the back [of the classroom] who maybe doesn’t have a behavioral problem, but she’s totally zoned out?” Samadi said. 

Similarly, recognition of how ADHD manifests in adults has been a large contribution to the rise. 

That in mind, experts seem to have numerous potential explanations for the uptick in ADHD diagnoses. Yet one angle has not been considered: does the increase in diagnoses actually reflect a rise in symptoms or incidents of ADHD? One of the most common ideas is that stimulating technology, especially social media, is leading to more cases of ADHD, though this is also contested.

“I think we live in a world where we’re bombarded with information,” TPHS AP Psychology teacher Lynn Leahy said. “I think all of that trains our brain to constantly look for distractions.”

Though some studies have linked social media usage to ADHD symptoms, Rappaport said “you can’t cause [ADHD] and you can’t catch it.” 

“If you take those [distractions] away, people who don’t have that neurological underlying issue don’t have the ADHD issue,” Rappaport said. 

Albeit social media might not cause ADHD, it makes “attentional issues for people who are genetically predisposed to ADHD get worse,” according to Samadi. 

Ultimately, regardless of exactly why ADHD diagnoses have increased, Rappaport said support systems for those with ADHD, like Section 504 plans and Independent Education Programs that provide accommodations, can be “behind.” 

“Often what the school will say when we try to get [a 504 or IEP] for, let’s say, a high school student who’s a straight-A student but super anxious and dealing with depression is, ‘You’re doing fine. You have to be failing to get [support],’” Rappaport said. “We’re not helping because what we’re reinforcing is that ADHD is something related to intelligence. When we perpetuate those myths … we’re invalidating them.” 

At TPHS, 7% of the student population has a 504 and 9% has an IEP, according to Assistant Principal Robert Shockney. Shockney declined to specify how many of these accommodations are related to ADHD. 

Doan herself has an IEP that she’s used,  particularly for homework because she can turn things in late. The caterpillars, the hearts, the cats continue to dot the page, but a sense of support is also there. 

Whether the evident rise in ADHD diagnoses is rooted in misdiagnosis or overdiagnosis, deconstructed stigmas, even our culture — perhaps the most significant element is simply awareness, not only as a cause of the increase but as an approach to treating and handling ADHD in the future.