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“Look, the kid can’t stay still for a second. He took the book we gave him, leafed through briefly and left it on the table. He turned on the TV, but didn’t pay attention to it. Then he immediately grabbed his cell phone and started swiping left, right, up and down, as if his mind were somewhere else… Google search it… Did you find anything? “Attention-deficit” huh? Yes, that’s what he has. I’m sure of it.”
Some variation of this scene is playing out more and more in people’s homes. Attention-Deficit/Hyperactivity Disorder (ADHD) is to blame, and the disorder has become a recurring subject in the media and in psychiatric consultations. In the United States, one study with a sample size of almost 190,000 children between 4 and 17 years old, born between 1997 and 2016, showed the estimated prevalence of diagnosed ADHD in U.S. children and adolescents increased from 6.1% in 1997-1998 to 10.2% in 2015-2016.
The phenomenon is happening elsewhere as well. In the United Kingdom, research by experts at University College London, using data from more than 7 million individuals between 2000 and 2018, revealed that almost 35,900 had been identified with the disorder and that the largest increase in the rate of diagnoses was among male children between 6 and 9 years old (from 300 cases per 100,000 children, to 700), as well as among young people from 18 to 29 (from just 3 cases per 100,000, to 50). In Spain, the trend is similar: According to the Multidisciplinary Working Group on Mental Health in Childhood and Adolescence, the pandemic led to a notable increase in mental health disorders among minors. Particularly, in the number of those affected by ADHD: Diagnoses have gone from 2.5% to 7%.
Such an “explosion” of diagnoses leads one to wonder whether it may, in fact, be rooted in doctors being too complacent and simply affirming parents’ assessments of their children, while, paradoxically, there are actual cases that go undiagnosed due to doctors’ lack of preparedness or lack of time during medical appointments to properly assess the child.
Your diagnosis, in minutes
Dr. Stephen P. Hinshaw, professor of psychology at the University of California-Berkeley and former president of the Society for Clinical Child and Adolescent Psychology, has documented the “precipitous rise” in diagnosis rates in children and adolescents across the United States between 2004-2018, numbers “that perhaps have begun to stabilize.”
Dr. Hinshaw tells Aceprensa that “direct-to-consumer drug advertising, school policies incentivizing getting better grades on exams, and ‘quick and hasty’ doctor visits of just a few minutes” without the patient’s medical records, third-party observations or tests, etc. are among the reasons behind the reported rise in cases.
Could the same thing be happening with ADHD as with diagnoses of gender dysphoria in several countries, where, rather than evaluating the patient in depth, the practice has consisted of not challenging their opinion or that of their relatives? “I don’t know enough about gender dysphoria to comment knowledgeably; It’s a complex issue,” he tells Aceprensa. “Doctors are finally recognizing previously ignored and stigmatized conditions, but in the absence of thorough evaluations, there may be a ‘confirmation bias’ to make unsubstantiated diagnoses.”
The expert also tells Aceprensa that ADHD diagnosis rates in American adults, previously low, have skyrocketed in the last decade. “Part of this is explained by recognition of the fact that ADHD can and does exist in adults, but it is also related to TikTok and other websites where [the person concerned] can do a simple self-assessment, get a ‘certified’ ADHD diagnosis and, in some cases, even get medications online shipped to them.”
TikTok to the rescue!
“I haven’t been diagnosed with it, but I definitely have it.” Talia Belowich, columnist for The Michigan Daily, has already heard that statement in several informal conversations in which the topic of ADHD has come up. In an article titled “The Epidemic of Self-diagnosing,” the writer takes note of the growing tendency to address mental illnesses on social networks by people who are not familiar with the matter, but who proclaim with utmost confidence that they suffer from ADHD, obtaining validation from millions of other users who accept – with a “like”, “I care” or “it makes me sad” – their descriptions of what having the disorder is like.
More than half of the videos about ADHD on TikTok contribute to misinformation about the condition
To offer an idea of the magnitude of the phenomenon, Belowich mentions that TikTok videos of the type “signs you have ADHD” had 72.8 million views as of June – by October 31, they reached 96 million views. One video, titled “Things I Didn’t Know Were Signs of ADHD,” in which a smiling young woman films herself walking over objects on the floor instead of picking them up, opening a cabinet door without later closing it and binge eating ice cream, has countless comments, mostly validating the creator and themselves: “Very true”; “That’s me”; “I finally understand why I do these things,” etc.
If this type of TikTok guru video’s “credibility” is added to people’s sympathy for and inclination to imitate celebrities who have been diagnosed with ADHD – like athlete Simone Biles, singer Justin Timberlake, Paris Hilton, “Barbie,” director Greta Gerwig, etc. – the temptation to self-diagnose or seek a medical evaluation that confirms they have the disorder may increase. It doesn’t matter that more than half of the videos about ADHD on the social platform are misinformation rubbish (52%, to be more exact, according to a recent Canadian study): it will always be easier – and more popular – to hold onto the simplistic characterizations of anything, although the result is to paint ADHD as a cool fad and not a real condition.
A disorder, some symptoms, and an effective treatment
But ADHD is not some myth, an invention of our times where it’s almost cool to say you suffer from some real or imagined mental health problem. We cannot automatically say that every restless child or adolescent has ADHD, but the condition does exist.
The ICD-11 – published by the WHO – defines it as a disorder identifiable from a “persistent pattern (at least 6 months) of inattention and/or hyperactivity-impulsivity that has a direct negative impact on academic, occupational or social functioning;” inattention and impulsivity that go beyond the expected age limits and level of intellectual functioning of the individual.
Lack of attention, in a case of ADHD, refers to difficulty with organization and focusing on tasks without a high level of stimulation, while hyperactivity or impulsivity is evidenced in “excessive motor activity and difficulties in remaining still” in situations where it is necessary (such as at school or in work activities). It should be added that, when it comes to specific individuals, ADHD can translate into predominantly distracted behavior, or mostly hyperactive-impulsive behavior, or a combination of the two.
With treatment, symptoms remit completely towards young adulthood in 30% of patients
To confirm the presence of the disorder, experts point out that the symptoms must be influencing the person’s life “to a notably maladaptive degree.” The website of the ADHD Europe association, which encompasses the associations of ADHD patients on the continent, lists among the most recurrent problems experienced by people with ADHD difficulty in establishing friendships and maintaining them, poor academic performance, a lower aptitude for living independently, job instability, etc.
Fortunately, there are therapies that offer good results. Dr. Azucena Díez, director of the Child and Adolescent Psychiatry Unit at the Clínica Universidad de Navarra, explains to Aceprensa that an effective treatment combines pharmacological and psychoeducational elements. “The prefrontal lobes, responsible for organizing a person’s activity, are precisely the ones that set us apart in our behavior compared to that of animals,” and in cases of ADHD “it’s as if they’re asleep; They’re low performing. The medication (methylphenidate and lisdexamfetamine) activates these areas, which helps them better manage themselves.”
To what extent can a condition with a neurobiological origin like ADHD be cured? “In 30% of patients, the symptoms remit completely towards young adulthood,” she adds, “and about half continue to present them. Some decide to continue with treatment into adulthood, and others do not. But, yes: in some cases, with the help of appropriate treatment, the symptoms subside.”
A lack of formation
According to Dr. Díez, in addition to the overdiagnosis of the disorder, attention to underdiagnosis is important: “There are still many children and adolescents who suffer from the symptoms and repercussions of ADHD, and families don’t look into their behavior because they figure it’s just the way the child is.” And then there is misdiagnosis: where any child who moves or doesn’t pay attention has ADHD, which can sometimes be confused with anxiety. “Children with anxiety move a lot.”
Perhaps there is a lack of preparedness. In Spain, the Child and Adolescent Psychiatry specialization was recognized for the first time in 2022, Diez tells us, meaning that many professionals who evaluate minors are not specialized in that area.
“They are adult specialists, or pediatricians with very basic training on the issue,” she says. And the field of Clinical Child Psychology is not yet recognized; there are very few psychologists. So, it is common in primary care for a doctor to listen to parents and say: ‘Well, if you’re seeing these symptoms, then your child must have the disorder,’ and medication is prescribed. The average time to make a proper ADHD diagnosis – because the diagnosis is clinical; there is no evidence to establish it – is approximately an hour and a half to two hours. And not all doctors have that amount of time.”
Dr. Juncal Sevilla, an adult psychiatrist, agrees that many ADHD cases go undiagnosed. An expert in ADHD, she is aware that it can overlap with other conditions and cause confusion. “And I am one of the psychiatrists who diagnose and treat the disorder; Imagine those who don’t even believe ADHD exists, or who resist diagnosing it.”
In Spain, there is still a knowledge gap when it comes to the disorder, according to Sevilla. “On a medical level, when it comes to certain neuroscience issues, the country is far behind, compared to, for example, England, which was a pioneer in the diagnosis and treatment of ADHD.”
“There is a lot of training needed,” she adds. Currently, symptoms are being validated via social spheres. And the problem is that those already in the field of medicine don’t want to continue their formation. Young people do, but older people don’t even want to hear about it since the treatment is an amphetamine. It’s that absurd.”
Conclusion: Between those who are unfamiliar with the disorder and those who practically preach on it, between those who responsibly diagnosis it and those who choose to ignore it altogether, ADHD is still a black hole, without any clear signage around it. And any restless child or self-diagnosing TikToker can fall into it.
Translated from Spanish by Lucia K. Maher