How Should We Feel About the ADHD Epidemic?

when a diagnosis becomes a culture

This is a reader request.

The notion of an epidemic of adult Attention Deficit-Hyperactivity Disorder, or ADHD, has been floating around for a long time. There were already calls to categorize the disorder as an epidemic in 2007. Then, between 2007 and 2016, for instance, ADHD diagnoses in the United States increased by 123%. Once largely considered a juvenile disorder, adults passed children in overall prevalence of the condition in 2015 or so. Today, claims of an epidemic are a dime a dozen. Accused culprits include policy changes at the FDA and Big Pharma. Some ADHD advocates, a position that has mushroomed in recent years, have vociferously rejected the notion of a manufactured crisis and insisted that availability of stimulant medication to treat ADHD, drugs like Adderall and Vyvanse, should not be impeded.

I should preface this by saying that I have had prescriptions for dextroamphetamine over the past five years, and have an old bottle sitting in my medicine cabinet. I don’t have ADHD. This medication was prescribed as a means to combat the cognitive side effects of my antipsychotic medication. (Yes, this is a textbook case of a medication cascade.) I rarely use it now; I have never felt that it makes me more productive and used it primarily as a means to maintain focus in meetings when I had an office job. But the bottle is still on the shelf and I think this disclosure is necessary.

Here’s a set of statements that are not contradictory about ADHD.

1. ADHD is a “real” condition, as real as any in mental health, where the borders are porous and the symptoms not available for empirical confirmation or external review.

2. A lot of people have ADHD, and it causes them various levels and kinds of discomfort. Serious ADHD can be seriously debilitating.

3. People with ADHD deserve compassion for their condition, and every one of them should have access to affordable medical treatment.

4. Some people are likely convincing themselves that they have ADHD, subconsciously at least, due to social contagion, when absent the prevalence of ADHD online they would not be diagnosed with ADHD. It’s impossible to know what percentage of diagnoses they represent, again because there are no firm boundaries or empirical tests for the condition.

5. Some people want access to stimulant medication for productivity reasons and/or to get high and knowingly fake ADHD symptoms to get access to that medication. It’s difficult or impossible to know what percentage of diagnoses they represent.

6. These two statements are non-contradictory: ADHD is real and those who have it deserve medical treatment; ADHD is overdiagnosed.

7. These two statements are also non-contradictory: stimulant medication can be an effective tool for ADHD patients to live productive and minimally-disrupted lives; stimulant medication is overprescribed and poses a potential public health risk given its side effect profile.