Is ADHD over-diagnosed?

‘Oh, everyone thinks they have ADD nowadays.  It’s over-diagnosed.  It’s the internet.  And cell phones.  And everyone’s trying to do 9 things at once.  Fifty years ago there was no such thing as ADHD.’ Comments like that used to set me off on a rant, ‘Actually, no.  Everyone does not have ADHD! Attention Deficit Hyperactivity Disorder is driven by genes.  It runs in families.  It’s highly heritable.  And it’s usually there at birth.  Or even before!   In fact, one doctor in our film, ADD & Loving It?! who has four sons said…’ The other person would tune out.  While I yammered away… My message, though one I never openly stated, was simple: ‘You’re an idiot for saying that! You have no idea what you’re talking about!’

Actually, they may be right!

But many years after we launched TotallyADD.com, having read a library of books on ADHD, (And co-written one book on ADHD) and having interviewed scores of experts for our videos on ADHD,  thousands of adults who have ADHD (Or who love someone who does) I can see the truth in those dismissive comments. Or should I say, SOME truth. Which surprises me.

First, Let’s Define ‘Over-Diagnosed’

What constitutes ‘over-diagnosed’?  You could argue that if even one person is diagnosed with something that they don’t actually have it’s been over-diagnosed.  But that’s true of every medical condition there is. In fact, a proper diagnosis is tricky.  One of our most popular videos, Embracing the Diagnosis, lays out 13 common challenges to getting a proper ADHD diagnosis.  (And how to overcome each one.) Clearly this is not what most people mean when they claim it’s, ‘over-diagnosed.’ Perhaps what they mean is that it’s ‘misdiagnosed.’ Someone suffering from Bi-Polar, who is incorrectly diagnosed as having ADHD, is not ‘Over-Diagnosed.’  They’ve been ‘Misdiagnosed.’ They’re struggling with a real problem.  It’s just not properly identified. My public school teachers ‘Misdiagnosed’ me as bored, messy, uninterested, and slow.  (And I suppose I was bored, messy, and uninterested in school.)  Cause they didn’t have a better name for it. They did have a few names for me, however. But I digress. But I don’t think ‘It’s misdiagnosed’ is what people mean when they sneer, ‘ADHD is so over-diagnosed.’ My sense is that they mean, ‘There’s nothing wrong with you that a smack on the side of the head wouldn’t fix.’  But that’s not polite to say out loud. So they suggest this mental health issue is over-diagnosed.  Or that it’s not even a ‘real’ disorder. Despite 4,000 studies and millions of people’s experience. Alternative facts, as it were.

Consider what they actually said

Now, let’s look at their initial ‘dismissal’ again.  Read it slowly.  Calmly, if you can. ‘Oh, everyone thinks they have ADD nowadays.  It’s the internet.  And cell phones.  And everyone’s trying to do 9 things at once.  ADHD is over-diagnosed.  Fifty years ago there was no such thing as ADHD.’ That kind of attitude is what inspired me to make ADD & Loving It?! It was infuriating!  And total nonsense!  Or is it? Could there be a tiny bit of truth in there?  Hmm.. Let’s break it down, line by line. First…

‘Oh, everyone thinks they have ADD nowadays’

Notice, they didn’t say everyone has ADD nowadays.  They claimed that everyone thinks they do. Which these days, might be true, right? Well, okay, maybe not every single person on the planet, but far more than the 4 to 5% of adults who are actually struggling with this mindset have wondered if they indeed had a ‘bit of that ADHD.’ Our friend, Jennifer, set her twitter account to notify her every time someone tweeted #ADHD or #ADD.  It was astounding. ‘Overwhelmed today!  I think I’m developing ADD or something!’ ‘I lost my new sweater.  I’m so ADHD sometimes.’ ‘So antsy when my mom visited.  My wife said I must have ADHD.  LOL.’ So yes, you could argue that these days, with the pace of life and the amount of change, almost everyone thinks they have ADHD.  It’s a bit of a joke. To those who don’t have it, anyways. For those of us who do, who are always overwhelmed, losing things, and restless, it’s not all that funny. (Though the TotallyADD community can laugh about it with each other.) Every ADHD specialist I’ve spoken to concedes that, yes, in some parts of the country it’s over-diagnosed amongst kids.  And that needs to be addressed.  In other areas it’s the opposite. But amongst adults, ADHD is still woefully under-diagnosed.  The exact figure is difficult to know.  I’ve heard that less than 1 in 6 adults in North American who have this mindset are aware of it.  In the rest of the world it’s even lower. Let’s consider the next sentence:

‘It’s the internet.  And cell phones’

Based on my own experience and talking with other adults who have ADHD, we are more susceptible to the lure of the web.  Endless novelty.  Odd connections.  Constant surprises.  Anything you can think of, no waiting. And there’s a growing body of evidence that this technology is rewiring our brains and shortening our attention spans. But having 90 open tabs doesn’t cause ADHD.  It may be something a person with ADHD does… (Sound of me clearing my throat) But it doesn’t cause ADHD…  At least, that’s been the standard belief. Internet Addiction is starting to become a series subject for research. Several years ago I read a study that found a few hours on the internet started to rewire how the brain worked. Last year an ADHD specialist told me there’s actually interest in researching whether social media and mobile technology is actually creating ADHD symptoms. YouTube?  Messaging?  Poking?  Tweeting?  Texting?  Sexting?… It does seem attention spans are shorter.  Things are rushed.  Messages are full of mistakes. So, yes, I’d have to concede that more and more people show some signs of ADHD. That doesn’t mean being online all the time is creating people who qualify as having ADHD.  But who knows.  Time, and some reliable scientific research, will tell. What you should know, is that doctors were describing kids who struggled with all the symptoms of ADHD long before the Internet, computers, cell phones…  or even phones.  As far back as the 1700’s! (The video, ‘What Is ADHD,’ delves deep into the history of the diagnosis, the neurology, and the symptoms.) Next statement?

‘And everyone’s trying to do 9 things at once’

I’m guilty of this.  Or I was.  Until research revealed that multi-tasking is not more efficient.  (Dang!) I had lots happening, which felt great, but nothing finished, which caused me to pay fines and late fees. Who isn’t doing the work of 2 people these days?  Most people I know complain about being overwhelmed. Having a ton on the go is a source of pride.  Or a necessity to make ends meet.  And that pressure leads to overwhelm, struggling with time, distractions, restlessness, forgetting things… All signs of ADHD. Next sentence:

‘ADHD is over-diagnosed’

When we were making ADD & Loving It?!, the star of the program, comedian Patrick McKenna, asked Dr. Margaret Weiss about the common belief that, ‘Stimulant medications for ADHD are over-prescribed.’ Dr. Weiss paused for a moment, then explained, ‘I think that the difficulty with that statement is that it implies that medication is either over-prescribed or under prescribed.’ She admitted that many families are expecting too much from their children, filling their spare time with dozens of activities: Sports.  Competitions.  Music classes.  Dance lessons. Dr. Weiss also noted that the percentage of people who actually find a doctor they trust, then learn about medication, start a regimen, and stick with it, is actually a small subset of the ADHD population. Compliance is terrible. (But that’s true of every medication.) Every parent and most adults we’ve interviewed were extremely reluctant to try medication. Including me. Medication is, as one doctor points out, ‘The last thing anyone wants to try.’ Next statement?

’50 years ago there was no such thing as ADHD’

Technically, yes, that’s true. Half a century ago, ADHD was called Minimal Brain Dysfunction.  Which a few folks think might actually be a more accurate name.  (I explained why in other blogs.) Lately specialists and researchers are framing ADHD as an Executive Function Disorder, which I kind of like as well. So the name may change again.  But doctors were describing children with ADHD-like symptoms way back in the 1700’s, and 1800’s. (Mostly German doctors.  Apparently being restless, impulsive, talkative, interrupting, and scattered are not proper Teutonic traits.  I wonder if they had T-Shirts, ‘Don’t be rushin’ if you’re a Prussian.’) So, yes 50 years ago kids were diagnosed with, ‘Minimal Brain Dysfunction.’ If they were lucky. If they weren’t lucky, they were labeled as lazy, stupid, trouble-maker, difficult, underachiever, or loser.  And the treatment plan was simple: ‘Try Harder.’ As for Adult ADHD?  That wasn’t on anyone’s radar until the late 1980’s. Okay, the final statement:

‘I don’t believe in ADHD.  I think it’s just an excuse’

Okay… Hmm. Technically, that’s true.  They honestly believe ADHD is an excuse.  Fine.  They can believe whatever they like. I used to argue with them.  But then I realized that’s what I used to think before I was diagnosed. And in fact, more than one person with ADHD has confessed to me that when they were first diagnosed they did use it as an excuse now and then. Difficult not to, especially in the early days. I can tell you that most people soften their opinions when they learn about things like the genetic research, the neuro-imaging studies that shows ‘this brain is different,’ the role of neuro-transmitters, and especially, the difference that treatment makes. But education takes time.  And if you push people… it backfires. Any first year Psychology student can tell you that no human being has ever changed their mind when told, ‘You’re an idiot for saying that! You have no idea what you’re talking about!’ It took me years to realize this.  (Eventually, I discovered a much better strategy. See below.)

Three Ways to Deal With Denial?

So, how do you change people’s minds? Here are five strategies. Strategy #1 Be generous! ‘You may be right,’ is a more diplomatic way of saying, ‘Yes, and pigs may fly.’ Strategy #2 Show them ADD & Loving It?!  Scores of people have thanked us for making this film. It transformed how their spouse, parent, colleague, or relatives viewed ADHD.  ‘They finally got it!’ It’s funny, dark, surprising, and built on solid science. My whole purpose in creating this program was to get through to people who were dismissive of my own ADHD. I was shocked to learn how many people have had their stubborn beliefs and dismissive opinions swept aside by this. When I asked one of the ADHD specialists I talk to a lot, he said it works because it’s not a ‘the person who has it trying to convince them. The family has already dismissed the person’s claims.  They can talk themselves blue in the face, and it will only make other people even more entrenched in their beliefs. Plus, you have a wide range of experts, and you have a lot of humor, and Patrick and Janis’s story touches people in a way that medical checklists never will.’

The Simplest Option?

Strategy #3 Don’t bother.  Life is short.  Just nod and walk away. ‘  Save your breath.  And use your energy to deal with your ADHD so you can get on with your life. You are not the ‘Idiot Whisperer.’ I like this strategy.  But I’ve never been able to do it.  (Too self-righteous I suppose.) Best, Rick Green