Over the past few years, an increasing number of adults are getting ADHD diagnoses. Some seek out diagnosis and treatment for themselves after helping a child through the process. Others start to wonder about the possibility after seeing themselves reflected in stories shared on social media. In many cases, an official diagnosis comes as a relief after years of feeling like they just couldn’t keep up, no matter how hard they tried. It offers an explanation for this struggle and opens the door to pharmacological help.
In 2022, 11.4% of children ages 3-17 had an ADHD diagnosis, according to the Centers for Disease Control and Prevention. This represents 7 million children, with an increase of 1 million since 2016.
This means that more than 1 in 10 people will struggle with ADHD at some point in their lives. If ADHD is so common, does it really make sense anymore to call it a disorder (a stance some experts support)? Or could it be a part of normal human variation?
While most of us will find at least some of our own behaviors reflected in the diagnostic criteria for ADHD — who among us doesn’t get distracted or try to avoid a difficult, tedious task? — this doesn’t mean the struggles of folks who do have a diagnosis aren’t real.
What’s behind the surge in diagnoses
There are “many contributing factors” leading to the spike in attention-deficit/hyperactivity disorder diagnoses in recent years, Dr. Ralph Lewis, a professor of psychiatry at the University of Toronto, told HuffPost. These include: the spread of information on social media and online; pharmaceutical marketing interests; changes to diagnostic criteria; increased attentional demands on both students and workers; the way the pandemic brought struggles with attention to a head for many people; the availability of school and workplace accommodations; and the destigmatization of mental health issues, Lewis explained.
It’s a confluence of an increased awareness of what the symptoms are and changes to our modern lifestyle that are bringing these symptoms to light.
In recent years, the people most frequently getting diagnosed are adults, and many of them are women whose symptoms may have been overlooked when they were younger because they did not fit the stereotypical profile of a boy who cannot sit still during class.
While increasing awareness, in part due to people talking about their experiences with ADHD on social media, has led to less stigmatization of the condition, this phenomenon also has its downside. One study published in 2022 analyzed popular TikTok videos about ADHD and found that 52% of the videos, most of which were not created by healthcare providers, qualified as “misleading.”
It all comes down to executive function
The term “executive function” refers to the way that people are able to “set goals, plan and get things done,” according to Understood.org, an organization that advocates for people with learning and thinking differences, such as ADHD and dyslexia. Executive function is what allows you to break a big task into smaller components and decide in which order to tackle them. On the other hand, if you’re left paralyzed and unable to approach a task because you can’t figure out where to begin, faltering executive function may be your problem.
As challenges to executive function increase over the years, either in school or in a changing workplace, a person may find that they are no longer able to manage these challengeson their own, explained Sharon Saline, a psychologist who specializes in treating people with ADHD.
“There’s a lot of distractions in our lives,” Saline told HuffPost, noting that our digitally connected lives stretch executive functioning to its limit.
“We all have executive functioning strengths and challenges,” she continued. “For people with ADHD, those challenges are more numerous and more intense than they are for people who don’t have ADHD, and … those challenges are really impeding their ability to live their lives in ways that express who they are, their interests, [and] to manage the tasks of daily living effectively.”
An ADHD diagnosis is about having certain symptoms and also about the degree to which these symptoms impact a person’s life.
Saline said that she believes the categories of mild, moderate and severe ADHD can be useful when gauging the intensity or disruptiveness of a patient’s symptoms. “People who have severe ADHD really struggle with the tasks of daily functioning and fulfilling responsibilities, paying bills on time [and] remembering appointments,” she said. They may also struggle with emotional dysregulation, Saline noted.
Lewis suggested thinking about the distribution of executive functioning skills on a bell curve — “the graph that defines most human traits” — both behavioral and physical, from IQ to height to blood pressure.
“We’re thinking about the entire population of humans, wherein some folks have a long attention span and quite strong executive function, and some have a short attention span or relatively weaker executive function,” he said. “Most folks are in between the bulge of the bell curve.”
People who have ADHD, Lewis said, would represent about 10% of the population — those with the most difficulties around executive function. In a classroom of 30 students, you would expect about three of them to fall into this range, for example.
When someone receives a diagnosis of ADHD, that has to do with where we draw that line, Lewis explained. (He did note in a small number of cases that ADHD is caused by a genetic disorder, however.) It also means there are others right next to that line on both sides.
“Once you reconceptualize any disorder on a continuum, you will always run into this problem of the boundary cases, and it’s a broad swath of that curve, that gray, fuzzy boundary zone. Is a diagnosis warranted or not?” he said.
This is where a clinician’s judgment comes into play, and it also explains how a person might fall on different sides of the line depending on which grade they’re in, how their classroom is set up or what line of work they go into.
Although he treats patients who have ADHD, Lewis explained that he has come to view it as more of a disadvantage than a disorder. He also thinks of medication, which for ADHD usually means a stimulant, as a performance enhancer.
It’s “helping that person to be less disadvantaged, more focused, more within the average range like their peers for those hours when they’re needing to perform a very focused task, sitting in class or doing homework, or a focused type of work in your occupation,” he said.
However, Saline pointed out that a provider’s reasons for prescribing medication will be different from one patient to the next. For instance, she noted that some children with autism who do not meet the full criteria for ADHD nevertheless respond well to medication, and that the same can be true for some patients who have experienced trauma.
We can alter environments to better support a range of executive function abilities
We can think of ADHD as a disadvantage in our attention-demanding society in the way that being short might be a disadvantage in a world designed for tall people, Lewis explained. Those of us on the lower end of the height curve would need some sort of support, like shoe boosters, to help us accommodate for our disadvantage, in the same way that people with ADHD use stimulant medication to help them navigate the world as it’s set up now.
“We have created an environment that favors people with high executive function and disadvantages people with low executive function in many, if not most, occupations and school environments,” Lewis said, noting that our Paleolithic ancestors may have benefited from being low executive functioning in a way that made them “novelty-seeking hunters.”
There is another option, of course. Knowing that a good number of people are struggling, we could redesign the world to accommodate a wider range of executive functioning capabilities.
Because we all rely on executive function, Saline said that “executive functioning skills need to be taught right along academic skills” for the benefit of every student.
Students can learn to work through the instinct to procrastinate by breaking a task down into smaller steps, for example. They can also be explicitly taught how to organize and prioritize.
“These are all things that are worth teaching all kinds of learners,” Saline said.
“The last executive functioning skill to develop is metacognition,” she added, which is a type of self-awareness. This can encompass things like teaching kids to think before they speak, and also encouraging awareness of themselves as thinkers and learners.
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For example, Saline said that educators can help kids understand things like, “What happens when I lose focus? What leads me to lose focus? How do I come back to my task? Do I like to do something easy first and warm up, and then take the hard task? Or do I like to get the hard thing out of the way and then maybe do something that’s medium and then finish with something easy when I’m tired?” Learning the answers to these questions can help kids gain the kind of executive function skills they need to successfully tackle a night’s homework load, a big social studies project, and, eventually, a load of college courses.
Sometimes, teachers will feel that there isn’t time to insert this kind of learning when they are required to get through so much curriculum. But Saline believes that teaching executive function skills lays the foundation for everything else.
“Ideally we want kids to be more self-reliant,” she said, adding that these skills “are good for anybody, but they’re essential — they’re lifesavers for people with ADHD. It’s a matter of degree.”