Answers to the ADHD Questions You Didn’t Know You Had
We all think we’re experts on ADHD, but even the best of us need a refresher course from time to time. See how you stack up with these questions, answered by two of the biggest experts in the field.
How fast have U.S. rates of ADHD diagnosis been increasing, and why?
The short answer is: really fast. U.S. rates of ADHD were already high at the turn of the millennium, but since 2003, the numbers of diagnosed children and adolescents have risen by 41 percent. Today, more than 6 million youth have received diagnoses. And the fastest-growing segment of the population with respect to diagnosis and medication treatment is now adults, particularly women. The current numbers are staggering: For all children aged 4-17, the rate of diagnosis is now one in nine. For those over nine years of age, more than one boy in five has received a diagnosis. Among youth with a current diagnosis, nearly 70 percent receive medication. U.S. rates are higher than anywhere else in the world.
Aren’t we all getting a little ADHD because of how much we’re all checking Facebook and Twitter?
Everyone in modern society is facing a new world of devices, social media, and demands for rapidly shifting attention. It’s quite possible that the evolution of technology is moving faster than our brains’ capacity to adapt. Still, it’s important to make a distinction between distraction that can be controlled by turning off your e-mail versus genuine ADHD, which arises from the brain’s inefficient processing of important neurochemicals — including dopamine and norepinephrine. While most of us today are facing environmentally caused problems with distraction, people with ADHD are at a significant disadvantage.
Isn’t ADHD just an excuse for bad parenting, lazy, bratty kids, and pill-poppers?
This is a prevalent myth — and one that we spend a lot of time debunking in our book, in interviews, and in our public talks. Despite the skepticism and the stereotypes, substantial research has shown that ADHD is a strongly hereditary neurodevelopmental disorder. The quality of one’s parenting doesn’t create ADHD — although it can influence a child’s development — and children with this condition are not lazy, but instead handicapped in their capacity to focus attention and keep still.
Isn’t ADHD a plot by pharma firms that want to sell meds?
Pharmaceutical firms have worked hard to expand awareness of ADHD as they pursue profits in a global market last estimated at $11.5 billion. But they didn’t create the disorder. Moreover, studies have shown that stimulant medications can be helpful for many people with the disorder and are generally safe, when used as prescribed. There is no “magic bullet,” and medication should be used with caution, due to potential side effects and valid concerns about dependency. But you shouldn’t let pharma’s aggressive tactics dissuade you from trying medication, if a doctor says you need it.
I keep hearing that ADHD is a “gift.” What does that mean?
Celebrities, including the rapper Will.i.am and business superstars such as Jet Blue founder David Neeleman, have talked about the advantages of having ADHD in terms of creativity and energy. Many ADHD advocates have championed the idea that the condition is a “gift.” We support the idea of ADHD as a kind of neuro-variability that, in some contexts and with the right support, can offer advantages. But do look this gift-horse in the mouth: ADHD can also be a serious liability, and it needs to be managed throughout a lifetime. Consider the Olympic swimmer Michael Phelps, who rose to stardom only to be embarrassed by drug and alcohol problems. Longitudinal studies show that people with ADHD, on average, suffer significantly more problems with substance abuse, accidents, divorces, and academic and employment setbacks than others. ADHD is serious business.
How do ADHD symptoms vary between the two genders?
Many girls with the hyperactive-impulsive and combined forms of ADHD look and act surprisingly like boys with the disorder in terms of impulse-control problems, overactive behavior, and even sheer orneriness, even as their rates of outright violent behavior are much lower. At the same time, girls tend to be hyperverbal rather than hyperactive. Their impulsivity may also take a more subtle form — for example, a young girl who is extraordinarily impulsive may be less likely than a boy to run out into traffic but more likely to indiscriminately pick the first answer on a multiple choice test (“cognitive” versus “behavioral” impulsivity).
As a rule, girls more often than boys are socialized from an early age to cooperate and conform. One consequence of this is that girls with ADHD are more likely than boys to become anxious as they try to compensate for their distraction. Girls typically care more about their school performance — and in general what others think of them — than boys. An intelligent girl with ADHD in middle school or high school may succeed in covering up her symptoms with obsessive perfectionism but fall apart later when the work becomes too hard.
Moreover, just as girls tend to be harder on themselves than boys, evidence suggests that other people, including parents and family members, also judge girls more harshly than boys when inattentiveness and impulsivity promote struggles with typically female areas of competence such as paying attention in class, reading social cues, showing self-control, empathizing, and cooperating. Life can be especially hard for the approximately half of all girls with ADHD who fit the criteria for hyperactive-impulsive or combined forms, because they’re more likely to be rejected by peers who judge their behavior as boyish, weird, or out-of-synch with female norms.
What danger might there be of under-diagnosing ADHD?
The same quick-and-dirty evaluations that fuel over-diagnosis can also lead to missing ADHD when it truly exists. That is, the clinician who insists that he or she can detect ADHD in a brief clinical observation may overlook the fact that children and adults may act quite differently in a doctor’s office than they do at school or in the workplace. This is concerning, because whereas over-diagnosis may lead to over-treatment with medication, under-diagnosis means children who truly need help aren’t getting it.
Reprinted from ADHD: What Everyone Needs to Know, by STEPHEN P. HINSHAW, Ph.D., and KATHERINE ELLISON, with permission from Oxford University Press, Inc. Copyright 2016.