Yeah, this all sounds like total nonsense to me. You seem to be essentially saying that as long as autism or adhd is not totally disabling for an individual there are no benefits to diagnosing it and we shouldn’t. Well, I’m very bright and I did well enough in school despite having never been able to pay attention to an entire lecture, not even when it was my favorite subject that I was passionate about and was super determined to pay attention. And yeah I’m still bitter at how hard I tried and how shitty I felt about it. And yeah I would be neither homeless not in a hospital if I didn’t have ADHD meds - I can function, I have compensatory strategies. But when I started Ritalin and it killed the noise and attention pulling that I was constantly fighting all day at work I went from having to fight my own brain every day to be a mediocre attorney to being a fantastic attorney with little effort and much happier. Before I took it the first time I couldn’t have even told you that there was that noise. So tell me, how is anyone in the world hurt by me taking Ritalin on work days? I get enough food and sleep. How does it make the world better for me to suffer and resign myself to not being able to reach for my dreams? I don’t get it.
Autism diagnosis are sought so people can feel like a normal zebra and not a defective horse - so that they can stop trying to change things that are impossible to change about themselves and focus on figuring out accommodations and how to get the life they want (including socialization) - not as an excuse for anything.
And to be super clear here, I’m working 7.5 hour days, five days a week - not pushing beyond what most people can manage without speed, and sometimes I only take one pill, which wears off half way through. The meds have really just been the most amazing, wonderful, life changing thing to happen to me as an adult.
Hilarious. Actually the bit about "who am I hurting, how does it help the world for me to suffer" sounds exactly like me when they made it so you couldn't get codiene over the counter anymore lol
Great essay but the title is off, it sounds like rage bate. Never should you say ADHD is stupid, even when making a point. I agree social media is the cause for the rise in misdiagnoses. I've seen people making videos saying "3 signs you have ADHD" and one of the signs will be not being able to focus in class. Yes not focussing in class can be a result of ADHD, but it doesnt mean you have it. The way you wrote this piece, saying you immediately judged your patient, although you knew nothing of her mental health outside of your conversation is one reason people are scared to open up and express themselves to medical practisers. You made a good point, the idea of being mentally drained it trending, but it is a reason issue, and a disorder is never stupid
Thank you, you're right about the title. Tbh I didn't expect many people to read it because I didn't have many subscribers. I tend to just blurt out what I'm thinking, problem of being a blunt hammer personality. (My husband also pointed out to me that the title was a bit offensive.) I suppose now that I'm aware perhaps more people might read my writing I need to be a bit more thoughtful.
(Also about the patient, please note that I was recording in this piece my internal reactions, not everything I said out loud. In this case the details of the consultation remain confidential and also irrelevant to the rest of the piece. I try to practice non-judgmental medicine. If I don't agree with what a patient wants I will provide a referral elsewhere. :) I'm of the belief that my work and my beliefs are overlapping but not the same sphere.)
That’s why you do actual testing, and not just the questionnaire. The questionnaire can get you thinking, and you can talk to your therapist or psychiatrist about the possibility, and if it seems plausible, get tested. I’m lucky that my assessment was covered by my insurance. After multiple meltdowns and decades of horrific anxiety and depression and a general failure to be a normal adult like everyone else, the tests showed marked deficits in my perceptual reasoning, working memory, and processing speed. I was able to barely scrape by into my 30s because I also happen to be in the 99th percentile in verbal reasoning - I would put off the essay until the night before it was due but still get an A+. But that doesn’t work for all areas of adult life - and adhd is not just attention regulation difficulties, it’s also emotional regulation. It doesn’t affect just the ability to “be productive,” but to just function in this world and have healthy relationships with others. I’ve lived a life of, “But you’re so smart, why can’t you do this?” Yes, I’m smart. AND I have adhd, because adhd is not about intelligence. I’ve been ‘smarter’ than most of my peers my whole life, but that never mattered when my peers could actually DO things. It’s not about not being able to do things that are boring… have you ever wanted to do something, something you actually love to do and know would make you feel better if you did it, but you STILL couldn’t do it? No matter how bad you want it or how hard you try? No? Then congrats, you don’t have adhd.
My therapist, who’s also a woman with adhd, was the very first person who ever floated the idea that I might have adhd. I thought on it, and eventually brought it up to my psych. He basically said, “I don’t think you have adhd, everyone is just on their phone these days.” This was a psychiatrist. Someone trained to diagnose mental health issues. And he said “nah just get off your phone.” … So I got a second opinion, advocated for myself, and got testing. And like I said, the testing was clear - my scores reflected my experience. It was validation, finally, after years of struggling in the dark. I remember as early as 10, way before smart phones were a thing, struggling with symptoms. Did anyone ever stop to think, “hey, maybe being glued to a shiny colorful exciting screen all day is…a symptom of a disorder in which there’s not enough dopamine in the brain?” So no, I don’t think it’s just a trend. Maybe some doctors prescribe without actual testing, but that’s not what I did. I wouldn’t want a psych that lazy anyway. I wanted to KNOW, for a fact, what was wrong with me. So I found out.
If someone is prescribed a stimulant when they don’t have adhd, is that not the doctor’s fault? Aren’t they the ones who are supposed to be able to tell the difference? A patient can’t demand a prescription from a doctor who refuses the diagnosis. I don’t think it’s a “trend,” I think it’s medical research finally showing that females can have adhd and that it can present differently from males, and now doctors (well, some doctors) are finally paying attention. The rates of left handedness shot up once it stopped being demonized and forbidden in school. Thousands of women have been left behind by society, and now we’re just catching up. If the medical researchers had known jack shit about how adhd presents in girls when I was in elementary school, I would’ve been diagnosed then. THAT’S why it’s all happening to adult women now.
I think you're mostly right and very happy for you having got your diagnosis finally! Just wanted to point out that these two explanations - more people getting rightly diagnosed and more people following a psychiatric "fad" - do not exclude each other. They can both be happening, as such strange temporary fads of mental problems seem to actually occur every now and then, especially, but not only, among ladies. And I think maybe it's almost inevitable that getting help to more people who actually need it leads to diagnosing a number of fake positives as a collateral damage. But I have a hope that even if this is partly a fad, the fad will calm down soon enough, and a new fad will take over, whatever it's gonna be.
If someone is struggling enough to the point where these “do you have adhd?” TikToks are heavily resonating with them, then ~something~ is going on, even if it’s not adhd. If thousands of people are finally learning that something they struggle with might be a symptom instead of a character flaw, I think that’s way more positive than negative. If they feel strongly enough to talk to a psychiatrist and get tested and it’s not adhd, then cool. Because through that process they could find out instead that it’s anxiety, depression, OCD, BPD, autism, etc etc etc. Knowledge is power; knowing that it’s NOT adhd is still helpful. The only problem is if someone self diagnosed based on tiktoks alone without a doctor, therapist, or psychologist’s input. But not everyone can afford testing and sometimes self diagnosis can still be accurate. People just have to make sure to not spread misinformation about what adhd is, which is more up to the creators of these videos and posts than the people who consume them. But it’s the internet, misinformation will, and does, happen about every single subject, not just psychological “fads.” I’d rather someone follow a fad that turns out to eventually be false than for thousands of people to be left in the dark because they’re just not getting that information. I do think it’s necessary collateral damage if it means that the vast majority of these people who have been in the dark their whole lives finally get help. And like I said, symptoms can be something else, and that should be diagnosed and treated as well. I don’t think people are following this fad just because they feel left out. I think they’re seeing things they relate to and are trying to figure out why they’re struggling, whether that ends up being adhd or not. If it gets them to some kind of a diagnosis and getting some kind of help from a psychiatrist or therapist then it’s worth it. I think choosing to stay in the dark because something ~might~ not be an accurate diagnosis is ridiculous. Whatever gets people to seek HELP for their struggles is a good thing.
For years I have been shouting and clapping my hands over this cultural myopia. Having worked with children in special education who had legitimate mental health issues and attentional deficit, it has been a real struggle for me to zip my lips and sit on my hands while everyone and their mother blames their failure of discipline on ADHD.
I, too, thought I had ADHD a few years ago, for all the reasons listed (difficulty starting and finishing tasks, emotional dysregulation, sleep problems, the whole nine). Got tested and was diagnosed with something completely different. What I didn't think to tell my doc at the time was that I had been severely sleep deprived for years due to circumstantial issues, not mental ones. I was working multiple jobs and dealing with interpersonal crises often, and was supplementing my poor sleep with occasional 8-minute power naps and dry scoops of high-power pre-workout. We're talking 300mg of caffeine down the hatch in the middle of the afternoon, AFTER my 2 cups of coffee in the morning had worn off. I showed up to my psych assessment 20 minutes after crushing an energy drink and briefly napping in my car in Dr. S.'s parking lot.
It's now just over a year later and almost none of the identified behaviors that led to my diagnosis are still present, almost directly due to me quitting 2 of my 3 jobs and getting back to sleeping at night. Last year I was about ready to get on mood stabilizers, but what I really needed was to stabilize my lifestyle. I needed stable relationships and a stable income. I needed a stable schedule and stable habits. It is known that sleep deprivation and loneliness cause all kinds of physical and mental health problems, including depression, anxiety, mood swings, confusion, memory loss, irritability, etc.
I've been hesitant to speak on this issue because I know that my personal experience is confounded and does not necessarily generalize to the broader population. Also, I don't have the requisite education in medicine and psychology to confidently back up my intuitions here. At the same time, I've been deeply concerned that my friends, family, and acquaintances who carry on about this and that disorder are right about only half of the equation. There is a disorder, but it's not what we've been led to believe. Rather, 95% of the time it's a disordered lifestyle due to improperly ordered priorities.
It's wonderful to see a doctor who has both the education and the experience to say, hey, this is a real problem. (So I'm not crazy?!) Your article is clearly long-considered, well-written, morally grounded (without the upturned nose of moral superiority), sensitive to the future direction of the field, and still hopeful that maybe we can turn the corner on this, chuck the victim mindset, own up to our self-discipline issues, and accept that "weird" does not mean "mentally unwell." Thanks for saying the quiet part out loud.
ADHD IS stupid but that’s because it situates a collection of symptoms as a disease in a person instead of a mismatch between social expectations and demands and human beings that affects some people more than others…. the pills help somewhat whether or not you consider them a consequence of correcting malfunctioning biology or providing a small performance enhancement that enables a person to meet expectations and demands. I’m 43 and rejected the label, spent years off of drugs trying to “fix” myself and try other stuff - which helped many things in life except my ability to dissociate from my humanity and grind out work product in accordance with the expectations of my industry. my conclusion is that I’m fine - I don’t have a real disease and society is messed up - but I’ve also accepted that I’m sbetter off taking the pill so I can fit my square self into the round peg and make a living….. my doctor and I talk frankly about this and I’m grateful she is also a pragmatist.
Do you know, I actually think that's a practical approach. As long as you don't put yourself down by thinking there's something wrong with you, but also admit that there is a mismatch between the place you want/need to occupy in society and your ability to stay there and therefore need pills to make it happen... then you're being honest and that's fine- I would totally support that. It's dishonesty that ends up being unhelpful for people.
Love this Esther. I thought I had ADHD and now I realise it was childhood trauma and cannabis dependency. Dropped the weed and worked on my mental state and I’m a whole lot closer to happy. Thank you for putting words to these valuable thoughts
I am also aware that had I been born a decade later I'd be currently an adult diagnosed with ADHD and probs autism. I sometimes think that maybe the medication is just what I need to succeed like anyone else. But other times I know that I was born to want, do, experience and feel more. Sometimes I can't imagine anything worse than diagnosis and medication to dull the life I've been able to experience.
I think you have put your finger on it. Why have we been conditioned to want to succeed like anyone else? I want to succeed like me, even if no one else would want the same kind of success.
Very interesting! We had a teaching morning yesterday which somehow led to a long debate about this very topic.
One of the consultants said he thought there was no issue in people self diagnosing themselves with diagnoses which are basically just descriptors of a personality type anyway (personality disorder, autism, ADHD ect.). In his words, "If you think you look like the picture in the book then who am I to tell you that's its not you?" He talked about people waiting years for a diagnosis and once they'd filled in their self report form in the waiting room 90% would be given the diagnosis they came for because they would answer all the questions in the way they knew would get them the diagnosis. He also thought that the medications for ADHD should be available over the counter.
Pretty much everyone else in the room disagreed with him, they felt that if someone is presenting to a medical professional then it is our duty to tell them what our professional is and whether we think they meet the diagnostic criteria or not. They felt particularly the medication should be safeguarded due to side effects and possible abuse.
Unfortunately, I was away in a corner and didn't get to contribute my thoughts, but I wanted to say that I think if we were to embrace the self diagnosis and use it as a descriptor then we will need to change the weight it is given in society. If anyone can get these diagnoses then funding will taken away from those who need it; schools need to support the children with these diagnoses more than others, people with these diagnoses have better access to services and psychological therapy. Therefore, as it stands at the moment I think we as clinicians do have an obligation to 'gatekeep' some of these resources.
I really like the part where you say, "Believing that feeling weird is equivalent to a disease, instead of accepting that most of us have no pathology- we are just all individuals who speak and behave slightly different from everyone else." And I would mostly agree with this, we should normalise that everyone procrastinates, struggles with boring things and focussing for long periods!
I also saw a comment saying "Something I think impacts the increase in ADHD diagnoses is that many white collar jobs genuinely require people to operate at a very high level of focus, one that not everyone is capable of maintaining without amphetamines or significant modifications to their lives" and I wonder if there's some truth to this? We're all pushed towards office jobs that require us to sit still all day, no wonder so many people feel they're not suited for our society, it can't be a particularly natural way to live.
Personally, I don't want to slip towards a dystopia where everyone takes a stimulant to be good at their job, a benzo to wind down and a sedative to sleep. (A benzo is a sedative but it sounded prettier if there are three examples!)
Perfectly articulated. Actually this is a great example of different types of government- should we let people live their own lives even if services for other people are impacted adversely, or should we make sure everyone gets what they need even if some people don't get to do what they want and can afford?
Thank you so much for writing this. You express very well some of the inchoate thoughts I’ve been having about this trend.
I can’t tell you how frustrating it is to see someone you love limit themselves with a self diagnosis. It’s infuriating to see someone you love ignore sensible advice such as limiting screen time and getting fresh air because of a fatalism about this issue. It drives me mad that someone who I know used to devour books and no longer believes they can.
Thank you for writing this and validating what I’ve been noticing for some time re: self diagnosis. I even wrote about the summer all of my female friends (myself included) decided we had ADHD and how weird it was to find myself colluding with that particular cultural moment. Sorry to hear you don’t think it’ll be going away anytime soon.
I don't think much of the modern education system tbh. I wonder how many boys would lose their ADHD diagnosis if they were allowed to move more, or learn physically. (No idea how you'd learn maths and reading with body movements but I think where there's a will there's a way.)
Don’t love how you imply that typically young men/boys have ADHD and autism, and now the hordes of people looking for psychotherapy and referrals are women who think they have ADHD or autism but don’t actually have it.
Women have actually been historically under diagnosed with ADHD and autism because their symptoms are less obvious/studied. You’re just contributing to that narrative.
Something I think impacts the increase in ADHD diagnoses is that many white collar jobs genuinely require people to operate at a very high level of focus, one that not everyone is capable of maintaining without amphetamines or significant modifications to their lives
"The Older I Get The More Things Get Stupid" - I couldn't have said it better myself. haha! Our society is becoming more dumbed down the more it "advances." I appreciate the foundational points that you brought up in this post about the human experience and what has changed in the past 100 years that allows for much of the dysfunction we see today.
As a practitioner, I see a lot of functional labs for kids and adults with the ADHD diagnosis. Every single one I've seen usually has a mixed bag of serious health problems. They've got stored heavy metals in their body (which impacts many regions of the brain), gut dysbiosis, hidden infections, disconnected from nature (living inside too much), and eating a heavily processed food diet. Some of these things are inherited from mom's diet/exposures before and during pregnancy. Also, poor mitochondria function and adrenal burn out (some babies are born into such a state, sadly), is usually a huge part of folks with ADHD. But nobody wants to hear this. >_<
I don't know, I've read that ADHD is highly heritable and environmental effects have been proved only for some pre-birth factors, like the mother poisoning herself with nicotine/alcohol, or some infections during pregnancy. Maybe I don't know the newest findings? I suppose bad lifestyle can definitely worsen all the different brain functions. But if you have a genetic case of actual retardation* - meaning slowed development - of certain brain areas, can it be meaningfully fixed by healthy lifestyle? We can't fix Down syndrome by lifestyle, right? The medicine, on the other hand, even though it doesn't fix the underlying problem, takes care of symptoms pretty well.
*pardon the term, I know ADHD people are often brilliant, but one (PFC) or maybe two parts of their brains are not doing their jobs as well as expected.
(BTW, I'm a layperson in this field, you are the expert, I take your arguments seriously and change my mind if it seems necessary. It's easier to do if we keep a neutral tone. :) )
Am I correct in the points below? If not, how should we phrase them?
* ADHD (i.e. a bunch of symptoms that get bundled together) is partly a polygenic trait and partly affected by various badly known environmental factors
* ADHD is positively correlated with several other mental disorders
* This suggests that ADHD can sometimes result from more general issues in brain development (either genetic or environmental) that manifest as a range of different symptoms.
* The latter doesn't exclude other cases where ADHD-like symptoms are just a matter of a combination of genes (+some environment) affecting behavior that you happened to inherit, no brain damage or developmental problems, or unfavorable environment during development. Just low conscientiousness and high motor activity. Similar to the case where a person can inherit a combination of genes that make him very tall without this being a pathology of growth hormones or suchlike. Does this make sense?
* Good environmental factors, including physical (nutrition, sleep) and emotional (support, kindness, not feeling low-status) are good for people's health in practically all matters, including defence against pathogens, wound healing, and reducing symptoms of mental disorders.
* Suspiciously many ADHD-diagnosed grownups claim that their lives are very much better under stimulants. The effect is very big, incomparable to SSRIs that barely manage to exceed placebo effect.
* We should take the latter seriously and give stimulants to the grownups who claim to be helped by them very much. The ones who are not helped by stimulants (at least a third of the group) should not take stimulants.
* In case of children it's more uncertain and we should be more cautious, as usual. (I suddenly had a hunch to google the amounts of stimulant medications consumed per child by country, and realized that the amounts in USA are shockingly high compared to where I live. So it may make sense to advocate for less meds in the US and for slightly more here.)
Oh my gosh so refreshing to hear from a medical practitioner that most of the adhd diagnosis in adults is bogus! I’ve had same thoughts as you. I’ve seen women my age in their 40’s announce on their social media platforms that “they’ve got adhd and it makes total sense why they are the way they are” like it’s a gender reveal moment online! I cannot recall when I heard so many women over 30’s announce adhd diagnosis than in the last two years particularly it’s been trending. If that’s the case then we all have adhd at this rate and I strongly suspect social media has a lot to do with adhd, in that the mechanism of scrolling on our phones for hours, a one minute video cannot even hold our attention, over the last few decades I’ve observed as a photographer how attention spans have dwindled when editing videos, it is now believed the average attention has dropped to 10 seconds. You have 10 seconds now to capture their attention in a video. I think due to the repetitive nature of scrolling, scrolling for hours a day on various social media platforms, has changed the way not only how we consume media, information and entertainment but that repetition as we know in neuroscience is creating neural pathways, while others in less use, become slower connections in processing.
As you mentioned, the instant gratification has been neurally networked into our brains, that even as adults who have grow up since the rise of Instagram since 2012, to TikTok in 2020, has reprogrammed our brains and now we have all developed to different degrees adhd tendencies.
Personally I noticed in myself, 10 years ago I could read a book in two or three days, with the focus and attention span to complete it rapidly. Then I found myself reading less and less, not even one book in a year until I started back a few years ago and struggled to read and complete one book without starting another book and another book until I became a serial book jumper - “reading” about 5 books simultaneously. However I pushed through and now I find it getting easier and easier the more I read books, to have greater attention span for reading and completing books
It’s a lifelong condition, Katriena. Unless your brain is wired this way or you live with someone who is ADHD it is no doubt hard to understand but it’s nothing to do with screens. My symptoms go back to the 1970s when we didn’t even have basic mobile phones.
Sorry to hear about your diagnosis and suffering. I think diagnosis is meant to be helpful in that it’s a tool for mitigating symptoms or causes but what I have a problem with, is when the diagnosis becomes one’s identity
Yes, it’s not that. It’s been hugely helpful explaining to me (and my husband and kids) why I have certain difficulties and can’t simply “be different”. They are more tolerant of my foibles as a result. I agree that when anything diagnostic becomes an ‘identity’ it tends to cause problems.
This is kind of a wild read for me. I was diagnosed with adhd in the 80s as a girl. Not medicated, just labeled and meant to work on it. And I have. I have organization systems and a place for everything. Because if things fall out of place or something isn't written down it's just gone. Forever. And I do alright for myself. I've done well in education as a teen and adult and I've held it all together well enough to maintain a job and family.
I went back this year, thirty plus years after my childhood diagnosis, to seek confirmation of diagnosis as an adult. I was told I don't qualify and to look into anxiety and depression.
Knocked me for a bit of a loop. Been referred out for further guidance. But it is very strange to have something that I've held onto for so long as a part of my identity suddenly pulled away.
I'm left wondering if thirty years of survival and adaptation means I'm functional enough that I don't show up as adhd anymore or if I really did grow out of it.
Yeah, this all sounds like total nonsense to me. You seem to be essentially saying that as long as autism or adhd is not totally disabling for an individual there are no benefits to diagnosing it and we shouldn’t. Well, I’m very bright and I did well enough in school despite having never been able to pay attention to an entire lecture, not even when it was my favorite subject that I was passionate about and was super determined to pay attention. And yeah I’m still bitter at how hard I tried and how shitty I felt about it. And yeah I would be neither homeless not in a hospital if I didn’t have ADHD meds - I can function, I have compensatory strategies. But when I started Ritalin and it killed the noise and attention pulling that I was constantly fighting all day at work I went from having to fight my own brain every day to be a mediocre attorney to being a fantastic attorney with little effort and much happier. Before I took it the first time I couldn’t have even told you that there was that noise. So tell me, how is anyone in the world hurt by me taking Ritalin on work days? I get enough food and sleep. How does it make the world better for me to suffer and resign myself to not being able to reach for my dreams? I don’t get it.
Autism diagnosis are sought so people can feel like a normal zebra and not a defective horse - so that they can stop trying to change things that are impossible to change about themselves and focus on figuring out accommodations and how to get the life they want (including socialization) - not as an excuse for anything.
And to be super clear here, I’m working 7.5 hour days, five days a week - not pushing beyond what most people can manage without speed, and sometimes I only take one pill, which wears off half way through. The meds have really just been the most amazing, wonderful, life changing thing to happen to me as an adult.
Yes
Hilarious. Actually the bit about "who am I hurting, how does it help the world for me to suffer" sounds exactly like me when they made it so you couldn't get codiene over the counter anymore lol
This is quite a disrespectful reply to her comment. Was that your intention?
Somewhat ironically you're demonstrating increased irritation, rigid thinking and a narcissistic lack of empathy.
Great essay but the title is off, it sounds like rage bate. Never should you say ADHD is stupid, even when making a point. I agree social media is the cause for the rise in misdiagnoses. I've seen people making videos saying "3 signs you have ADHD" and one of the signs will be not being able to focus in class. Yes not focussing in class can be a result of ADHD, but it doesnt mean you have it. The way you wrote this piece, saying you immediately judged your patient, although you knew nothing of her mental health outside of your conversation is one reason people are scared to open up and express themselves to medical practisers. You made a good point, the idea of being mentally drained it trending, but it is a reason issue, and a disorder is never stupid
Thank you, you're right about the title. Tbh I didn't expect many people to read it because I didn't have many subscribers. I tend to just blurt out what I'm thinking, problem of being a blunt hammer personality. (My husband also pointed out to me that the title was a bit offensive.) I suppose now that I'm aware perhaps more people might read my writing I need to be a bit more thoughtful.
(Also about the patient, please note that I was recording in this piece my internal reactions, not everything I said out loud. In this case the details of the consultation remain confidential and also irrelevant to the rest of the piece. I try to practice non-judgmental medicine. If I don't agree with what a patient wants I will provide a referral elsewhere. :) I'm of the belief that my work and my beliefs are overlapping but not the same sphere.)
That’s why you do actual testing, and not just the questionnaire. The questionnaire can get you thinking, and you can talk to your therapist or psychiatrist about the possibility, and if it seems plausible, get tested. I’m lucky that my assessment was covered by my insurance. After multiple meltdowns and decades of horrific anxiety and depression and a general failure to be a normal adult like everyone else, the tests showed marked deficits in my perceptual reasoning, working memory, and processing speed. I was able to barely scrape by into my 30s because I also happen to be in the 99th percentile in verbal reasoning - I would put off the essay until the night before it was due but still get an A+. But that doesn’t work for all areas of adult life - and adhd is not just attention regulation difficulties, it’s also emotional regulation. It doesn’t affect just the ability to “be productive,” but to just function in this world and have healthy relationships with others. I’ve lived a life of, “But you’re so smart, why can’t you do this?” Yes, I’m smart. AND I have adhd, because adhd is not about intelligence. I’ve been ‘smarter’ than most of my peers my whole life, but that never mattered when my peers could actually DO things. It’s not about not being able to do things that are boring… have you ever wanted to do something, something you actually love to do and know would make you feel better if you did it, but you STILL couldn’t do it? No matter how bad you want it or how hard you try? No? Then congrats, you don’t have adhd.
My therapist, who’s also a woman with adhd, was the very first person who ever floated the idea that I might have adhd. I thought on it, and eventually brought it up to my psych. He basically said, “I don’t think you have adhd, everyone is just on their phone these days.” This was a psychiatrist. Someone trained to diagnose mental health issues. And he said “nah just get off your phone.” … So I got a second opinion, advocated for myself, and got testing. And like I said, the testing was clear - my scores reflected my experience. It was validation, finally, after years of struggling in the dark. I remember as early as 10, way before smart phones were a thing, struggling with symptoms. Did anyone ever stop to think, “hey, maybe being glued to a shiny colorful exciting screen all day is…a symptom of a disorder in which there’s not enough dopamine in the brain?” So no, I don’t think it’s just a trend. Maybe some doctors prescribe without actual testing, but that’s not what I did. I wouldn’t want a psych that lazy anyway. I wanted to KNOW, for a fact, what was wrong with me. So I found out.
If someone is prescribed a stimulant when they don’t have adhd, is that not the doctor’s fault? Aren’t they the ones who are supposed to be able to tell the difference? A patient can’t demand a prescription from a doctor who refuses the diagnosis. I don’t think it’s a “trend,” I think it’s medical research finally showing that females can have adhd and that it can present differently from males, and now doctors (well, some doctors) are finally paying attention. The rates of left handedness shot up once it stopped being demonized and forbidden in school. Thousands of women have been left behind by society, and now we’re just catching up. If the medical researchers had known jack shit about how adhd presents in girls when I was in elementary school, I would’ve been diagnosed then. THAT’S why it’s all happening to adult women now.
I think you're mostly right and very happy for you having got your diagnosis finally! Just wanted to point out that these two explanations - more people getting rightly diagnosed and more people following a psychiatric "fad" - do not exclude each other. They can both be happening, as such strange temporary fads of mental problems seem to actually occur every now and then, especially, but not only, among ladies. And I think maybe it's almost inevitable that getting help to more people who actually need it leads to diagnosing a number of fake positives as a collateral damage. But I have a hope that even if this is partly a fad, the fad will calm down soon enough, and a new fad will take over, whatever it's gonna be.
If someone is struggling enough to the point where these “do you have adhd?” TikToks are heavily resonating with them, then ~something~ is going on, even if it’s not adhd. If thousands of people are finally learning that something they struggle with might be a symptom instead of a character flaw, I think that’s way more positive than negative. If they feel strongly enough to talk to a psychiatrist and get tested and it’s not adhd, then cool. Because through that process they could find out instead that it’s anxiety, depression, OCD, BPD, autism, etc etc etc. Knowledge is power; knowing that it’s NOT adhd is still helpful. The only problem is if someone self diagnosed based on tiktoks alone without a doctor, therapist, or psychologist’s input. But not everyone can afford testing and sometimes self diagnosis can still be accurate. People just have to make sure to not spread misinformation about what adhd is, which is more up to the creators of these videos and posts than the people who consume them. But it’s the internet, misinformation will, and does, happen about every single subject, not just psychological “fads.” I’d rather someone follow a fad that turns out to eventually be false than for thousands of people to be left in the dark because they’re just not getting that information. I do think it’s necessary collateral damage if it means that the vast majority of these people who have been in the dark their whole lives finally get help. And like I said, symptoms can be something else, and that should be diagnosed and treated as well. I don’t think people are following this fad just because they feel left out. I think they’re seeing things they relate to and are trying to figure out why they’re struggling, whether that ends up being adhd or not. If it gets them to some kind of a diagnosis and getting some kind of help from a psychiatrist or therapist then it’s worth it. I think choosing to stay in the dark because something ~might~ not be an accurate diagnosis is ridiculous. Whatever gets people to seek HELP for their struggles is a good thing.
'Advocate for yourself' is one of my biggest mantras/messages in life. So glad you did, and so sorry you had an unhelpful psychiatrist.
For years I have been shouting and clapping my hands over this cultural myopia. Having worked with children in special education who had legitimate mental health issues and attentional deficit, it has been a real struggle for me to zip my lips and sit on my hands while everyone and their mother blames their failure of discipline on ADHD.
I, too, thought I had ADHD a few years ago, for all the reasons listed (difficulty starting and finishing tasks, emotional dysregulation, sleep problems, the whole nine). Got tested and was diagnosed with something completely different. What I didn't think to tell my doc at the time was that I had been severely sleep deprived for years due to circumstantial issues, not mental ones. I was working multiple jobs and dealing with interpersonal crises often, and was supplementing my poor sleep with occasional 8-minute power naps and dry scoops of high-power pre-workout. We're talking 300mg of caffeine down the hatch in the middle of the afternoon, AFTER my 2 cups of coffee in the morning had worn off. I showed up to my psych assessment 20 minutes after crushing an energy drink and briefly napping in my car in Dr. S.'s parking lot.
It's now just over a year later and almost none of the identified behaviors that led to my diagnosis are still present, almost directly due to me quitting 2 of my 3 jobs and getting back to sleeping at night. Last year I was about ready to get on mood stabilizers, but what I really needed was to stabilize my lifestyle. I needed stable relationships and a stable income. I needed a stable schedule and stable habits. It is known that sleep deprivation and loneliness cause all kinds of physical and mental health problems, including depression, anxiety, mood swings, confusion, memory loss, irritability, etc.
I've been hesitant to speak on this issue because I know that my personal experience is confounded and does not necessarily generalize to the broader population. Also, I don't have the requisite education in medicine and psychology to confidently back up my intuitions here. At the same time, I've been deeply concerned that my friends, family, and acquaintances who carry on about this and that disorder are right about only half of the equation. There is a disorder, but it's not what we've been led to believe. Rather, 95% of the time it's a disordered lifestyle due to improperly ordered priorities.
It's wonderful to see a doctor who has both the education and the experience to say, hey, this is a real problem. (So I'm not crazy?!) Your article is clearly long-considered, well-written, morally grounded (without the upturned nose of moral superiority), sensitive to the future direction of the field, and still hopeful that maybe we can turn the corner on this, chuck the victim mindset, own up to our self-discipline issues, and accept that "weird" does not mean "mentally unwell." Thanks for saying the quiet part out loud.
Thank you for your encouragement. There's been a lot of self doubt.
ADHD IS stupid but that’s because it situates a collection of symptoms as a disease in a person instead of a mismatch between social expectations and demands and human beings that affects some people more than others…. the pills help somewhat whether or not you consider them a consequence of correcting malfunctioning biology or providing a small performance enhancement that enables a person to meet expectations and demands. I’m 43 and rejected the label, spent years off of drugs trying to “fix” myself and try other stuff - which helped many things in life except my ability to dissociate from my humanity and grind out work product in accordance with the expectations of my industry. my conclusion is that I’m fine - I don’t have a real disease and society is messed up - but I’ve also accepted that I’m sbetter off taking the pill so I can fit my square self into the round peg and make a living….. my doctor and I talk frankly about this and I’m grateful she is also a pragmatist.
Do you know, I actually think that's a practical approach. As long as you don't put yourself down by thinking there's something wrong with you, but also admit that there is a mismatch between the place you want/need to occupy in society and your ability to stay there and therefore need pills to make it happen... then you're being honest and that's fine- I would totally support that. It's dishonesty that ends up being unhelpful for people.
Love this Esther. I thought I had ADHD and now I realise it was childhood trauma and cannabis dependency. Dropped the weed and worked on my mental state and I’m a whole lot closer to happy. Thank you for putting words to these valuable thoughts
I am also aware that had I been born a decade later I'd be currently an adult diagnosed with ADHD and probs autism. I sometimes think that maybe the medication is just what I need to succeed like anyone else. But other times I know that I was born to want, do, experience and feel more. Sometimes I can't imagine anything worse than diagnosis and medication to dull the life I've been able to experience.
I think you have put your finger on it. Why have we been conditioned to want to succeed like anyone else? I want to succeed like me, even if no one else would want the same kind of success.
Very interesting! We had a teaching morning yesterday which somehow led to a long debate about this very topic.
One of the consultants said he thought there was no issue in people self diagnosing themselves with diagnoses which are basically just descriptors of a personality type anyway (personality disorder, autism, ADHD ect.). In his words, "If you think you look like the picture in the book then who am I to tell you that's its not you?" He talked about people waiting years for a diagnosis and once they'd filled in their self report form in the waiting room 90% would be given the diagnosis they came for because they would answer all the questions in the way they knew would get them the diagnosis. He also thought that the medications for ADHD should be available over the counter.
Pretty much everyone else in the room disagreed with him, they felt that if someone is presenting to a medical professional then it is our duty to tell them what our professional is and whether we think they meet the diagnostic criteria or not. They felt particularly the medication should be safeguarded due to side effects and possible abuse.
Unfortunately, I was away in a corner and didn't get to contribute my thoughts, but I wanted to say that I think if we were to embrace the self diagnosis and use it as a descriptor then we will need to change the weight it is given in society. If anyone can get these diagnoses then funding will taken away from those who need it; schools need to support the children with these diagnoses more than others, people with these diagnoses have better access to services and psychological therapy. Therefore, as it stands at the moment I think we as clinicians do have an obligation to 'gatekeep' some of these resources.
I really like the part where you say, "Believing that feeling weird is equivalent to a disease, instead of accepting that most of us have no pathology- we are just all individuals who speak and behave slightly different from everyone else." And I would mostly agree with this, we should normalise that everyone procrastinates, struggles with boring things and focussing for long periods!
I also saw a comment saying "Something I think impacts the increase in ADHD diagnoses is that many white collar jobs genuinely require people to operate at a very high level of focus, one that not everyone is capable of maintaining without amphetamines or significant modifications to their lives" and I wonder if there's some truth to this? We're all pushed towards office jobs that require us to sit still all day, no wonder so many people feel they're not suited for our society, it can't be a particularly natural way to live.
Personally, I don't want to slip towards a dystopia where everyone takes a stimulant to be good at their job, a benzo to wind down and a sedative to sleep. (A benzo is a sedative but it sounded prettier if there are three examples!)
Perfectly articulated. Actually this is a great example of different types of government- should we let people live their own lives even if services for other people are impacted adversely, or should we make sure everyone gets what they need even if some people don't get to do what they want and can afford?
Thank you so much for writing this. You express very well some of the inchoate thoughts I’ve been having about this trend.
I can’t tell you how frustrating it is to see someone you love limit themselves with a self diagnosis. It’s infuriating to see someone you love ignore sensible advice such as limiting screen time and getting fresh air because of a fatalism about this issue. It drives me mad that someone who I know used to devour books and no longer believes they can.
It does help reading something like this though.
I feel you. Have similar friend.
Thank you for writing this and validating what I’ve been noticing for some time re: self diagnosis. I even wrote about the summer all of my female friends (myself included) decided we had ADHD and how weird it was to find myself colluding with that particular cultural moment. Sorry to hear you don’t think it’ll be going away anytime soon.
https://open.substack.com/pub/articulations/p/self-diagnosis?r=5c6zv&utm_medium=ios
I just read. Thanks for sharing. I hope you can continue to walk in daily peace with your grief.
Do you see a correlation with the education system? An ADHD diagnosis gets you extra time on tests, which is a big advantage.
For cut-throat parents aiming for Harvard/etc, getting their kid a diagnosis is now standard.
I'm wondering how long until that practice drifts to other class rungs
I don't think much of the modern education system tbh. I wonder how many boys would lose their ADHD diagnosis if they were allowed to move more, or learn physically. (No idea how you'd learn maths and reading with body movements but I think where there's a will there's a way.)
Don’t love how you imply that typically young men/boys have ADHD and autism, and now the hordes of people looking for psychotherapy and referrals are women who think they have ADHD or autism but don’t actually have it.
Women have actually been historically under diagnosed with ADHD and autism because their symptoms are less obvious/studied. You’re just contributing to that narrative.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10173330/#:~:text=In%20childhood%2C%20the%20ratio%20of,et%20al.%2C%202020).
https://www.psychologytoday.com/us/blog/understanding-the-diversity-in-neurodiversity/202202/why-autism-has-been-underdiagnosed-in?amp
Something I think impacts the increase in ADHD diagnoses is that many white collar jobs genuinely require people to operate at a very high level of focus, one that not everyone is capable of maintaining without amphetamines or significant modifications to their lives
I've been thinking about this lately and I wonder whether symptoms/diagnoses have spiked since everyone was encouraged to get a tertiary degree.
"The Older I Get The More Things Get Stupid" - I couldn't have said it better myself. haha! Our society is becoming more dumbed down the more it "advances." I appreciate the foundational points that you brought up in this post about the human experience and what has changed in the past 100 years that allows for much of the dysfunction we see today.
As a practitioner, I see a lot of functional labs for kids and adults with the ADHD diagnosis. Every single one I've seen usually has a mixed bag of serious health problems. They've got stored heavy metals in their body (which impacts many regions of the brain), gut dysbiosis, hidden infections, disconnected from nature (living inside too much), and eating a heavily processed food diet. Some of these things are inherited from mom's diet/exposures before and during pregnancy. Also, poor mitochondria function and adrenal burn out (some babies are born into such a state, sadly), is usually a huge part of folks with ADHD. But nobody wants to hear this. >_<
Magic pill is an easier fix than complete lifestyle and culture change.
I don't know, I've read that ADHD is highly heritable and environmental effects have been proved only for some pre-birth factors, like the mother poisoning herself with nicotine/alcohol, or some infections during pregnancy. Maybe I don't know the newest findings? I suppose bad lifestyle can definitely worsen all the different brain functions. But if you have a genetic case of actual retardation* - meaning slowed development - of certain brain areas, can it be meaningfully fixed by healthy lifestyle? We can't fix Down syndrome by lifestyle, right? The medicine, on the other hand, even though it doesn't fix the underlying problem, takes care of symptoms pretty well.
*pardon the term, I know ADHD people are often brilliant, but one (PFC) or maybe two parts of their brains are not doing their jobs as well as expected.
Thank you!
(BTW, I'm a layperson in this field, you are the expert, I take your arguments seriously and change my mind if it seems necessary. It's easier to do if we keep a neutral tone. :) )
Am I correct in the points below? If not, how should we phrase them?
* ADHD (i.e. a bunch of symptoms that get bundled together) is partly a polygenic trait and partly affected by various badly known environmental factors
* ADHD is positively correlated with several other mental disorders
* This suggests that ADHD can sometimes result from more general issues in brain development (either genetic or environmental) that manifest as a range of different symptoms.
* The latter doesn't exclude other cases where ADHD-like symptoms are just a matter of a combination of genes (+some environment) affecting behavior that you happened to inherit, no brain damage or developmental problems, or unfavorable environment during development. Just low conscientiousness and high motor activity. Similar to the case where a person can inherit a combination of genes that make him very tall without this being a pathology of growth hormones or suchlike. Does this make sense?
* Good environmental factors, including physical (nutrition, sleep) and emotional (support, kindness, not feeling low-status) are good for people's health in practically all matters, including defence against pathogens, wound healing, and reducing symptoms of mental disorders.
* Suspiciously many ADHD-diagnosed grownups claim that their lives are very much better under stimulants. The effect is very big, incomparable to SSRIs that barely manage to exceed placebo effect.
* We should take the latter seriously and give stimulants to the grownups who claim to be helped by them very much. The ones who are not helped by stimulants (at least a third of the group) should not take stimulants.
* In case of children it's more uncertain and we should be more cautious, as usual. (I suddenly had a hunch to google the amounts of stimulant medications consumed per child by country, and realized that the amounts in USA are shockingly high compared to where I live. So it may make sense to advocate for less meds in the US and for slightly more here.)
Oh my gosh so refreshing to hear from a medical practitioner that most of the adhd diagnosis in adults is bogus! I’ve had same thoughts as you. I’ve seen women my age in their 40’s announce on their social media platforms that “they’ve got adhd and it makes total sense why they are the way they are” like it’s a gender reveal moment online! I cannot recall when I heard so many women over 30’s announce adhd diagnosis than in the last two years particularly it’s been trending. If that’s the case then we all have adhd at this rate and I strongly suspect social media has a lot to do with adhd, in that the mechanism of scrolling on our phones for hours, a one minute video cannot even hold our attention, over the last few decades I’ve observed as a photographer how attention spans have dwindled when editing videos, it is now believed the average attention has dropped to 10 seconds. You have 10 seconds now to capture their attention in a video. I think due to the repetitive nature of scrolling, scrolling for hours a day on various social media platforms, has changed the way not only how we consume media, information and entertainment but that repetition as we know in neuroscience is creating neural pathways, while others in less use, become slower connections in processing.
As you mentioned, the instant gratification has been neurally networked into our brains, that even as adults who have grow up since the rise of Instagram since 2012, to TikTok in 2020, has reprogrammed our brains and now we have all developed to different degrees adhd tendencies.
Personally I noticed in myself, 10 years ago I could read a book in two or three days, with the focus and attention span to complete it rapidly. Then I found myself reading less and less, not even one book in a year until I started back a few years ago and struggled to read and complete one book without starting another book and another book until I became a serial book jumper - “reading” about 5 books simultaneously. However I pushed through and now I find it getting easier and easier the more I read books, to have greater attention span for reading and completing books
It’s a lifelong condition, Katriena. Unless your brain is wired this way or you live with someone who is ADHD it is no doubt hard to understand but it’s nothing to do with screens. My symptoms go back to the 1970s when we didn’t even have basic mobile phones.
Sorry to hear about your diagnosis and suffering. I think diagnosis is meant to be helpful in that it’s a tool for mitigating symptoms or causes but what I have a problem with, is when the diagnosis becomes one’s identity
Yes, it’s not that. It’s been hugely helpful explaining to me (and my husband and kids) why I have certain difficulties and can’t simply “be different”. They are more tolerant of my foibles as a result. I agree that when anything diagnostic becomes an ‘identity’ it tends to cause problems.
This is kind of a wild read for me. I was diagnosed with adhd in the 80s as a girl. Not medicated, just labeled and meant to work on it. And I have. I have organization systems and a place for everything. Because if things fall out of place or something isn't written down it's just gone. Forever. And I do alright for myself. I've done well in education as a teen and adult and I've held it all together well enough to maintain a job and family.
I went back this year, thirty plus years after my childhood diagnosis, to seek confirmation of diagnosis as an adult. I was told I don't qualify and to look into anxiety and depression.
Knocked me for a bit of a loop. Been referred out for further guidance. But it is very strange to have something that I've held onto for so long as a part of my identity suddenly pulled away.
I'm left wondering if thirty years of survival and adaptation means I'm functional enough that I don't show up as adhd anymore or if I really did grow out of it.