Is the incidence of ADHD increasing?
When considering whether ADHD is on the rise, it is important to distinguish between the prevalence of ADHD as a disorder and the prevalence of ADHD diagnosis. A disorder can exist even if it is not diagnosed (or under-diagnosed), a diagnosis can also diagnose what does not exist.
The frequency of ADHD diagnoses (and the use of methylphenidate (“Ritalin”)) has increased significantly in recent decades. This increase, however, is not unique to ADHD. Rather, there has been an overall increase in the awareness and acceptance of mental disorders, which is reflected in a more general increase in medication related to mental disorders. The frequency of stimulant prescribing is actually growing at a much lower rate than the frequency of antidepressant, antipsychotic, or anxiety medication prescribing (here: in New Zealand).1
- 1. ADHD has become more prominent, not more common
- 2. ADHD is not more common, ADHD is better recognized
- 3. More frequent prescribing of ADHD medications with no change in prescribing measures
- 4. Media consumption does not cause ADHD, but makes ADHD more visible
1. ADHD has become more prominent, not more common
The disorder ADHD has been around for a very long time - it has probably always existed. Read more at ⇒ Historical descriptions of ADHD In the article ⇒ ADHD - different explanatory models in the past and today in the chapter ⇒ Emergence.
In the 1970s, however, this disorder was little known. What is not known cannot be diagnosed.
The fact that ADHD also affects adults has only become clear since the millennium.
ADHD was the second most common topic in 5 pediatric journals between 2002 and 2019.2
Due to the increasing awareness and intensive research, the knowledge around and about ADHD became more and more widespread. The experience that affected people can get a much better life through appropriate medication and therapies has spread.
2. ADHD is not more common, ADHD is better recognized
With growing knowledge of ADHD, initially recognized only in extreme cases, more and more disorder effects were understood. This growing knowledge is reflected in the changes of the statistical recording catalogs DSM and ICD.
However, to believe that changing the criteria of the statistical manuals will increase a disease or disorder is unreal. Whether there is strawberry jam in a jar is not decided by the label. Even the decision to call mixtures of 70% strawberry and 30% raspberry jam strawberry jam also changes at most the perception from the outside, but not the content, which has always been si as it was. The suffering of affected persons does not change by a new designation. Treatments that do not bring about an improvement in the living conditions of those affected in each case disqualify themselves, regardless of which label was used.
The diagnosis of ADHD will become even more frequent in the future, because there are several manifestations of ADHD that have not yet reached the awareness of doctors, therapists, teachers, parents and affected persons.
It is no secret that the ADHD-I subtype (without hyperactivity) is diagnosed less frequently due to its internalized symptom expression. For one thing, parents of children with ADHD-I have less suffering pressure to eliminate an extremely disturbing family condition than children with ADHD-HI. On the other hand, many physicians and unfortunately also ADHD specialists are still alarmingly poorly informed about the specific symptomatology of the ADHD-I subtype. The rate of false-negative diagnoses is high.
Until a few years ago, it was virtually unknown that adults can also have ADHD.
Even today, many physicians are unaware that ADHD symptoms change as sufferers grow older. The criteria of the DSM IV statistical manual on ADHD referred exclusively to children, as ADHD specialist Russel Barkley, who was involved in drawing up these criteria, confirms. Barkley himself has developed diagnostic criteria for adults, which reflect the symptomatology in adults much better.
2.1. Diagnostic techniques for ADHD are improving
While for a long time diagnosis was based only on the doctor’s experience, then on questionnaires, and finally, after all, on tests, new, more objective diagnostic methods are just around the corner.
The diagnosis by means of evoked potentials, which are measured in standardized computer test tasks, processed with statistical mathematical means and compared with QEEG databases, has already reached an accuracy of 89% (which corresponds to the diagnostic accuracy of trained diagnosticians and clinical ADHD experts). For more details, see ADHD Diagnosis and Neurofeedback. As the diagnostic accuracy of QEEG databases continues to grow with the amount of diagnosed affected individuals, it is hoped that an objective diagnostic tool will develop here in the coming years.
As of today, however, diagnostic methods based on symptoms are still superior.
2.2. Treatment options for ADHD are improving
Growing successes in the treatment of ADHD (better medications, growing knowledge of dosage, therapy tools) make it more reasonable to diagnose the disorder as such.
3. More frequent prescribing of ADHD medications with no change in prescribing measures
One study examined whether the increase in prescribing of methylphenidate, the most commonly used ADHD medication, was associated with changes in prescribing scales between. The results showed that despite the overall increase in prescribing, the measures of prescribing had not changed between 2008 and 2012.3 Accordingly, the increase in MPH prescribing for ADHD is not due to looser prescribing practices, but is likely due solely to the fact that physicians now recognize ADHD more frequently.
4. Media consumption does not cause ADHD, but makes ADHD more visible
To put it bluntly: Growing media consumption does not cause ADHD.
Growing media consumption, however, causes the too wide open stimulus filter of an already existing ADHD to be overloaded (even faster) and the affected person thus gets into stress.
ADHD involves a stimulus filter that is too wide open. Affected individuals have difficulty sorting out superfluous stimuli, which is why their brains are more easily overloaded. In the last 100 years, the amount of stimuli a person takes in every day has multiplied.
While 100 years ago most journeys were made on foot, motorization accelerated traffic (and with it the pace of life). What came after:
- 1895: first cinema screenings
- 1900: Cinemas in show booths
- 1920s: Cinema palaces spring up in many cities
- 1930s: Radio
- 1940s: long-playing record and single
- 1950s: Television
- 1960s: stereo record, 2 television programs in D, color television, tape recorder
- 1970s: Television as a mass consumer good, first video games (Pong)
- 1980s: Music players (cassette recorders, Walkman, CD players), home computers, microwave ovens, Gameboy, overhead projectors, photocopiers, teletext, private television (1984), MTV (1981 in USA, 1987 in D)
- 1990s: Pay TV (Premiere), e-mail, Internet (modem/ISDN), digital answering machines, fax machines, cell phones (GSM standard), SMS, color copiers
- 1996: 5.5 million mobile lines in D, 0.1 billion SMS in D (1.25 SMS/inhabitant/year; 18 SMS/mobile phone contract/year)
- 2000: Broadband Internet, MP3 players, cell phones for everyone, hundreds of TV channels, video projectors, DVDs, digital cameras, video games, GPS and navigation devices; 48 million mobile phone connections in Germany, 10 billion SMS in Germany (125 SMS/inhabitant/year; 208 SMS/mobile phone contract/year)
- 2007: Mobile Internet, smartphones.
- 2010: Tablets, LTE, 3-D TV, e-bikes, 108 billion mobile phone connections in D (40 billion SMS in D, (500 SMS/inhabitant/year; 370 SMS/mobile phone contract/year)
- 2012: 60 billion SMS in D (thereafter decline in favor of mails etc.) (750 SMS/inhabitant/year)
- In 2016, there were only 12.7 billion text messages, which have since been replaced by Internet messages (WhatsApp, etc.).
This development cannot be reversed.
Overall, media consumption roughly tripled between 1970 and 2014. Even homo sapiens, who are amazingly adaptable in themselves, are likely to be overwhelmed at times by this pace.
ADHD is temporarily reversible when affected individuals live in a very low-stimulus environment. However, the symptoms return immediately and unchanged when they return to a normal environment.
Shipping all ADHDers off to lonely mountain huts is certainly not a practicable solution. Nor does it make sense to keep children away from media or to allow them “only” to consume media as was customary in their parents’ generation: This would reduce momentary stress, but at the same time is likely to prevent the brain from adapting, which is necessary to prepare the child for the media intensity he or she will have to expect later in life. Media consumption, which will continue to grow in the coming decades, would likely further overwhelm those raised in such an “artificially” low-stimulus manner. In addition, there would be exclusion due to a lack of media competence, which would also cause massive stress - then not belonging is the strongest stressor there is.
Barczyk, Rucklidge, Eggleston, Mulder (2019): Psychotropic Medication Prescription Rates and Trends for New Zealand Children and Adolescents 2008-2016. J Child Adolesc Psychopharmacol. 2019 Oct 18. doi: 10.1089/cap.2019.0032. ↥
Schmitt, Wodrich, Lorenzi-Quigley (2019): Current status of pediatric topics in five school psychology journals: Publication trends between 2002 and 2019. Sch Psychol. 2019 Dec 2. doi: 10.1037/spq0000346. ↥
Matthijssen AM, Dietrich A, Kleine Deters R, Meinardi Y, Del Canho R, van de Loo GHH, Buitelaar JK, van den Hoofdakker BJ, Hoekstra PJ. Clinicians’ Adherence to Guidelines When Initiating Methylphenidate Treatment. J Child Adolesc Psychopharmacol. 2022 Nov;32(9):488-495. doi: 10.1089/cap.2022.0060. PMID: 36383094. n = 506 ↥