Ask HN: Has ADHD Become Overdiagnosed?

The decreasing usage of nicotine products in western civilization over the last 30 years should be considered in all doscussions on the increasing prevalence of ADHD. At least one study has shown nicotine use results in increased concentration for those with ADHD; it's possible the true number of ADHD adults in western society has been accidentally covered up by the last 400 years of nicotine usage.

My layperson theory goes something like: In the early 90s when the medical community had a hammer, everything started to look like a nail. The result being over-prescribing in children.

Fast forward to pervasive digital devices which represented a continuation of existing trends to an optimized extreme, and you have the fragmentation and destruction of attention on a societal scale that now spans generations.

American corporate culture's attempt at wringing every last bit of profitability out of human beings doesn't help matters either.

>Recently, my feed has become full of content about ADHD.

With a dx that's legitimately pervasive, add in basic human social dynamics but amplified by that same optimized extreme, and for better or worse a whole subculture develops around said dx that—as a side effect—dilutes legitimacy to some degree.

In my opinion the "ADHDer" thing is cringe and the rosy picture it tends to paint kind of glosses over how shitty having it is.

>Just a couple of days ago, I saw a tweet where a girl on a beach was holding amphetamines and joking that she takes them to focus on relaxing.

The sad part is that it has an element of truth to it: for some people stims do a decent job of negating depression or anxiety; let alone just avoiding stim crash or remaining functional during time off.

I saw an interview with Gabor Maté, who framed ADHD as a coping mechanism acquired during early development. He has some books on the topic, though I haven’t read them.

These days it seems trendy to have some mental health issues to deal with. While I don’t think people should be shamed for having real issues, I think people reaching for a diagnosis to gain acceptance with a peer group, or to get some pills to use as a study aid, is very problematic. Maybe some form of Munchausen syndrome.

I have seen a huge increase in ADHD diagnosis over the past 30 years.

So for me its a big yes, ADHD has become over diagnosed?

retired psychotherapist

Reason:

DSM-5 Diagnostic Criteria for ADHD

Symptoms and/or behaviors that have persisted ≥ 6 months in ≥ 2 settings (e.g., school, home, church). Symptoms have negatively impacted academic, social, and/or occupational functioning. In patients aged < 17 years, ≥ 6 symptoms are necessary; in those aged ≥ 17 years, ≥ 5 symptoms are necessary.

INATTENTIVE TYPE DIAGNOSIS CRITERIA:

• Displays poor listening skills - • Loses and/or misplaces items needed to complete activities or tasks - • Sidetracked by external or unimportant stimuli - • Forgets daily activities - • Diminished attention span - • Lacks ability to complete schoolwork and other assignments or to follow instructions - • Avoids or is disinclined to begin homework or activities requiring concentration - • Fails to focus on details and/or makes thoughtless mistakes in schoolwork or assignments.

HYPERACTIVE/IMPULSIVE TYPE DIAGNOSIS CRITERIA

HYPERACTIVE SYMPTOMS:

• Squirms when seated or fidgets with feet/hands - • Marked restlessness that is difficult to control - • Appears to be driven by “a motor” or is often “on the go” - • Lacks ability to play and engage in leisure activities in a quiet manner - • Incapable of staying seated in class - • Overly talkative

IMPULSIVE SYMPTOMS:

• Difficulty waiting turn - • Interrupts or intrudes into conversations and activities of others - • Impulsively blurts out answers before questions completed -

THIS IS NORMAL CHILDHOOD BEHAVIOUR.

50% OF ALL THE CHILDREN I WORKED WITH AS A PLAY THERAPIST AND CHILDEN AND FAMILIES THERAPIST EXHIBIT THESE SYMPTOMS AND DO NOT HAVE ADHD.

Psychiatrist Peter Kramer writes about how the availability of a technological solution prompts us to see the problem everywhere - such as lithium for bipolar, Prozac for depression, Xanax for panic attacks, and now Adderall for ADHD. What problem is next that we find a solution for? I think it will be something for impulse control perhaps.

My layman take is it's analogous to diabetes. Diabetes is low insulin. ADHD is low dopamine. Some of both is caused by a person's environment. I think today's high dopamine lifestyle could be causing a similar effect as high sugar and diabetes.

This is a question you already know the answer to.

No, because a broad and vague set of self-reported symptoms can't "become" anything, or act at all.

Psychologists and psychiatrists seem to over-diagnose all kinds of disorders, because they profit from dispensing medications.

Claiming to suffer from this or that disorder, labeling oneself as ADHD, autistic, "on the spectrum," introverted, neurodivergent, etc. indicate a rise in narcissism and self-absorption more than anything else, combined with the American tendency to victimhood. Those disorders do afflict people to varying degrees, but I think they have turned into a kind of badge of specialness, more claimed and used as an excuse than treated by professionals. And the professionals don't agree and may not know what to do beyond creating more addicts.

I got "diagnosed" with both ADHD -- they called it "hyperactive" back then -- and borderline autism, as a child. Those professional opinions came from elementary school teachers and school nurses. My mother refused to medicate me, believing children should not take psychoactive drugs just to sit still in school. She put me in a better school instead. I thank her for that. Two of my own children got similar crackpot diagnoses from teachers and principals. We decided to homeschool them, they turned out fine.

No.