As an ADHD specialist, I’m often asked why so many more kids seem to have ADHD today compared to previous decades. Is it because kids are spending too much time in front of screens? Or that they’re eating too much processed food? Or is modern parenting to blame? Answering this question is complicated, because changes in rates of ADHD diagnosis aren’t accounted for by any single factor. However, it is unlikely that screens, parenting, or diet are the cause.
First let’s start with the numbers. The increase in ADHD diagnoses is a real phenomenon. The most recent data published by the CDC shows that during 2013-2015 the percentage of kids (ages 4-17) who had ever received a diagnosis of ADHD in their lifetime was 10.4%. Compare this to just 10 years prior (2003) when only 7.9% had received a diagnosis. Such a substantial change over such a short period of time often points to big picture factors that have an impact on a national level. Factors like increased public awareness, changes in public education, and the availability of long-acting stimulant medications to treat ADHD.
Public awareness about ADHD has increased dramatically over the past 30 years, and particularly in the past 15 years with the proliferation of online medical and mental health information. Pharmaceutical companies, advocacy groups, and the media have all taken an interest in sharing stories and information about ADHD symptoms and treatments. Often this information is provided in bite-sized snippets that only briefly describe a handful of ADHD symptoms. And, since so many children have at least a few of these symptoms, like difficulty focusing or sitting still for long periods of time, it’s understandable why many parents and teachers may start to wonder if their struggling child or student has ADHD. Before long, the number of children referred to medical doctors and psychologists goes up, as do the rates of children receiving actual ADHD diagnoses. In many cases, an ADHD diagnosis may be very appropriate, and the increased awareness led to a real benefit for that child. In some cases however, the child’s difficulties are due to other challenges, like anxiety, learning difficulties, sleep problems, slightly delayed social or academic skills, or even simply being a few months younger than most of the children in their classroom. If a thorough diagnostic assessment isn’t completed, then an ADHD diagnosis may be assigned incorrectly.
Changes in Public Education
With the introduction of legislation like No Child Left Behind in 2____, which tied school funding to student test scores, there was a dramatic shift in US public education. Teachers and schools suddenly became much more focused on ensuring that their students performed well on national exams. Underperforming students were being identified more often, and solutions for poor test performance were sought out quickly. Referrals for ADHD evaluations increased, as did rates of diagnosis. A series of studies (published in The ADHD Explosion by Drs. Hinshaw and Scheffler) shows a strong correlation between states with the highest rates of ADHD diagnoses and state laws that penalize schools for poor student performance.
Availability of Long-Acting Stimulant Medication
Stimulant medication remains one of the most common treatments for ADHD, and for many children it is very effective. Early formulations of stimulant medication, like Ritalin, required multiple doses to be taken throughout the day. Kids had to visit their school nurse at lunchtime to take their medication, which led to very real concerns about stigma and skipped doses. In addition, the side effects from these first-generation medications were problematic for many kids. Throughout the 2000s, multiple improved versions of stimulant medications became available. These medications last for 8 hours or longer, have fewer side effects, and some are even available in a skin patch for kids who are not able or willing to swallow pills. With more tolerable, effective treatments available, and increased awareness of these medication options, parents and teachers became increasingly receptive to the idea of an ADHD diagnosis.
While rates of ADHD continue to rise, and our understanding of ADHD continues to grow, so does the controversy surrounding the validity of the diagnosis itself and the use of medication as a first line treatment. Decades of research have shown that ADHD is a very real disorder, and studies suggest that the percentage of elementary school-age kids (in the US and worldwide) who truly have ADHD is around 5-7%. The goal of treatment providers, educators, and parents, should be to limit rates of ADHD misdiagnosis, by insisting on thorough evaluations that consider a range of factors (including, but not limited to, ADHD) that may be contributing to a child’s difficulties.