Overdiagnosis is not a problem, but misdiagnosis may be as people are driven into the private sector by long waits, and sadly, missed diagnoses remain common —Tamsin Ford
Experts are warning that far from being over-diagnosed, people with ADHD are waiting too long for assessment, support and treatment.
Isn’t it strange how we discovered a lot more stars after inventing telescopes?
Obviously there was an unrelated increase in stars born at that exact time.
I have an ADHD diagnosis, and I do think this is 60% just being better at diagnosing it, but I do also believe ADHD is sort of on the rise.
There is an incredible book called Scattered Minds by Gabor Maté, which is the significant book on ADHD in the same way that The Body Keeps the Score is for trauma, which delves into the potential ADHD causes beyond it being hereditary.
Of course modern dopamine-consumerist culture is part of the problem, but it largely makes ADHD symptoms obvious, and various unmet attention needs in early childhood are significantly more linked to developing ADHD, not to fault the parent or other caregiver who may not have the availability or ability to provide that attention due to modern societal demands. It’s been some years since I read it but I really remember one part clearly; it’s basically impossible to test nature Vs nurture in separated-at-birth twins because the act of separating twins at birth spikes the likelihood of having ADHD so much.
But honestly I think the largest contributor to increased ADHD cases is not that we’re better at diagnosing it, it’s that modern society increasingly warrants its diagnoses. 12000 years ago ADHD traits weren’t a disorder, as much as having different physical strength or height to your peers isn’t. Modern capitalist society demands an efficiency of its workforce and ADHD is an inherently inefficient trait, and therefore suddenly warrants treatment.
Don’t get me wrong, medication is incredible, and has turned days I’ve barely been able to get out of bed into productive days, but that’s still valuing being productive.
I’ve always liked the left-handedness analogy, but I am definitely stealing the stars one as well. It’s very pithy.
This is actually the most apt analogy for the whole “sudden increase in diagnosis” bullshit line that anti-vaxxers and anti-science people continually vomit out.
A culture where people believe ignoring your mental health issues makes you more strong, more independent, more of a role model… They think people have been fine for generations, and all of a sudden “fine” people are now being diagnosed with all kinds of problems.
I can understand their logic when I first understand their mistakes.
I’m in no way an anti-vaxxer or anti-science (I’m a researcher myself). I still think it can be justified to look closely at the large increase in, and volume of, various mental disorders. First of all: There’s no doubt that a lot more people are being diagnosed due to better diagnosis tools.
However, a major difference between psychological and somatic illness is that the divide between sick and healthy is (typically) a lot sharper in the latter case. Either you have an injury or infection, or you don’t, and we can measure that. In the case of e.g. depression or ADHD, there’s a much wider gray zone from e.g. “healthy person having a bad day” to “clinically depressed”.
The point I’m getting at is this: When a certain percentage of the population is diagnosed with a disorder, you have to ask whether we’ve started diagnosing ordinary human existence as a disease. Alternatively, you have to start looking at a systematic level for why an enormous portion of the population has a certain disorder. Where that limit should be is an open question, but I would argue that when something like 10-20 % of the population has a specific disorder, we’re no longer just looking at individual cases of disease but rather at (a) the possibility that the criteria for diagnosis are two wide, so we’re catching “healthy” people with it, or (b) we have a society-level problem (e.g. an epidemic).
I know of areas with ADHD-rates around 20 %. For a somatic illness, we would never let that kind of infection rate pass without taking a closer look at what’s going on at the societal level.
Its pretty mich a known fact that autism and ADHD were a somewhat beneficial trait in our hunting and gathering era. Hypervigilance makes you really good at spotting prey or predators and unsatisfied curiosity pretty mich forces innovation over a long enough time. The side effects that make life aliving hell in modern society weren’t nearly as detrimental back then. People lived in more communal small tribes and being a bit weird didn’t mean you get cast out and left to die alone.
Over time it became less and less useful. When the industrial revolution came along and everyone was supposed to let go of their individuality to instead work 12+ hour shifts pretty much only the negatives prevailed.
So yes, we are diagnosing a normal part of human existence as a disorder because in today’s society it is one. Mind you, its not diagnosed as an illness, something with a cause and potentially a treatment, its specifically diagnosed as a disorder, something that disrupts normal physical or mental function. It doesn’t really matter which genetic marker is the reason for your specific case of serotonin deficite that leads to the inability to concentrate and keeps your brain on 120% to compensate. The symptoms and their treatment are the same either way.
You cannot equate ADHD and spectrum mental conditions with disease. For one they are not a disease, you cannot catch them and you cannot give them to other people. They are the way people’s brains work. People are just born that way, same way people are born gay or trans, smart or dumb, handsome or ugly. You can’t have an outbreak of ADHD or autism the same way you have an outbreak of the flu or covid.
People have been searching for environmental factors for autism, ADHD, depression, and all kinds of mental conditions for years. Other than crackpot anti-vaxxers and people like RFK Jr who try to throw life saving vaccines and common medications like Tylenol under the bus with literally no literature whatsoever to back it up, there has been no links discovered. Genetics and fetal gestation is weird and people just get born different sometimes. We as a society need to accept that and stop thinking these are diseases that need to be “fixed”.
I agree, the only way I meant to compare them is that we diagnose and treat both with medication.
I also agree 100 % with this, and it’s part of what I’m trying to get at with my “option a”. As of today, there are regions where over 20 % of the population are diagnosed with, and treated for, ADHD. At that point, I’m asking the question if we’re creating a problem by treating something that appears to be within the spectrum of how “normal people just are” as a problem that needs to be fixed. My point is exactly what you’re saying here: If a large fraction of the population has this “problem” that needs to be “fixed”, haven’t we just gotten to a point where we have a too narrow definition of what is “normal” and “healthy” human behaviour? Shouldn’t we in that case rather be looking at how we can structure our society in such a way that a larger span of the population is capable of functioning in it without medication, rather that trying to force everyone to conform to the same, ever narrowing, mould?
The minority will never be adequately provisioned for without access to intervention. In theory, that can instead be legal or political. Many schools or workplaces put in provisions for ADHD, mostly because of laws. Society does have a “problem” that needs to be “fixed”. The “mould” problem is a deliberate authoritarian tool, beyond the scope of this discussion.
But you need to understand that this is access to medication, nobody is forcing this down our throats. If people want it, it exists, and it helps reduce scary mental health (we’re talking suicide), ableist restriction of access to interventions is super dangerous.
I honestly have the impression that we agree on pretty much all points here but that we’re talking past each other. I agree to pretty much everything you’re saying, and I’m all for helping as many people as possible live as good lives as possible.
What I’m trying to say is basically that problematising the large volume of (and increase in) psychological diagnoses can be valid, and doesn’t have to be founded in trying to downplay those diagnoses. To take a very concrete example: Kids that are disposed to growing very short or tall can be offered growth (blocking) hormones, such that they grow to a “more normal” height. Today, very few kids are offered, or take, these hormones. Now, let’s say some area suddenly saw a rapid increase where 20 % of kids needed growth hormones to grow to “ordinary” height. I would say that we need to figure out what has happened: Is there something about the environment that has caused stunted growth to become ver common? Has the window for what is “normal” gotten narrower?
Of course, in this example, it’s very was to compare to historical records of human height. The same isn’t true for mental disorders. That doesn’t mean the same discussion isn’t worth having- at its core, this is a discussion about how we can make society as good as possible for as many as possible. That also involves discussing what should be treated as a disorder that disproportionately makes people’s life objectively worse, and what is within the “normal” range that we should rather build society around accepting.
I mean, wouldn’t something like tuberculosis have an infection (not necessarily symptomatic) rate of 20% globally?
To try to explain the increase of stars in the universe without it’s correlation with vaccine rates is just disingenuous. \s
Everyone knows that if the nebula takes paracetamol during pregnancy it increases the chance of K-type star creation.
The nebula: “Cut me sing some slack, i had an astronomical headache”
I will just add one thing perhaps in contrast to this. But inasmuch as I’m offering an analysis of how people think about this, please don’t infer that I agree with them
With some things, ADHD being one, I think the grumbling we hear is not really that there can’t be all these new cases suddenly. It’s that we’re pathologizing something that’s a normal part of being a kid.
Again, I’m not saying ADHD is like that, just that “no one had this when I was a kid” isn’t the most on-point way to characterize people’s incredulity about ADHD. They think we’re over diagnosing it because we want to turn something into a problem, and turn boys into girls, and yadda yadda.
It’s a bit of that too. And also “our attention spans have been stolen”. It’s a mixed aetiology.