Are Rates of ADHD Really Rising?

Almost every month a new study reveals rising rates of ADHD in children, adolescents or adults. Virtually every report is met with pushback that these are likely misdiagnoses - and the disclaimers aren’t just media pundits, but even some mental health experts. Yet reports of dramatic increases in depression, PTSD, or anxiety, are treated as documentation that our society is sick.
Why this disparity, when all of our mental health conditions are the product of interactions between our biology and our culture?
Awareness that ADHD has a strong genetic contribution makes many mistakenly resist the notion that changes in our environment can’t result in rapid changes in the rate of genuine ADHD. Methodologically robust studies document increases in ADHD in recent years.
We need to start trying to distinguish between six different groups of individuals diagnosed with ADHD. Categories 2, 3 and 4 below seem to have avoided serious research or discussion. ADHD exists on a spectrum, which means that there is a pool of ready recruits who can move from “subsyndromal” (so mild that it doesn’t mean full diagnostic criteria) to full blown ADHD.
1) Traditionally defined ADHD
2) Subsyndromal cases converted to full ADHD
3) Secondary ADHD - individuals with no previous ADHD permanently displaying full ADHD
4) Tertiary ADHD - individuals with no previous ADHD temporarily displaying full ADHD symptoms
5)Those with depression, anxiety, or PTSD mimicking ADHD
6) Asymptomatic individuals just wanting accommodations or drugs
References:
ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment (2024)
www.tandfonlin...
Surveillance of ADHD Among Children in the United States: Validity and Reliability of Parent Report of Provider Diagnosis (2023)
www.ncbi.nlm.n...
Stimulant Prescription Trends in the United States From 2012-2022 (2023)
www.deadiversi...
ADHD Diagnostic Trends: Increased Recognition or Overdiagnosis? (2022)
www.ncbi.nlm.n....
Changes in the Definition of ADHD in DSM-5: Subtle but Important (2013)
www.ncbi.nlm.n...
General:
Psychiatrist, neuroscientist, and author John Kruse, MD, PhD presents practical, actionable, well-researched information about treatment options that scientists and clinicians recommend for adult ADHD and other mental health conditions. Subscribe if you're curious about how neuro-atypical brains can optimize their functioning in our shared, and somewhat strange, world.
Dr. Kruse has posted talks in both the "live" and the "video" sections of this channel. Thumbnails on ADHD topics have a pink background, and those on more general mental health topics have a purple background. A small collection of ADHD-Trump videos have an orange background.
You're welcome to email him with topics you want discussed, people you think he should interview, or if you would prefer a time for the weekly CZcams Live option other than Tuesdays at 6:00 pm (Pacific Standard Time).
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[@DrHill]

Re ADHD and dementia, there is a longitudinal study out if NYU memory center that screened elders who were presenting with initial complaints, using QEEG. Iirc the average follow up was 7 years later. Seems that those who presented with an initial ratio of theta/beta that was higher (similar to adhd) were much more likely to progress to MCI and dementia, and those without were less so.

[@jacquelinelane3943]

I love these videos! Thankyou

[@DrJohnKruse]

Thank you!

[@DrHill]

I do about 2000 or so QEEGs and CPT assessments each year.. at least half the people coming in with ADHD diagnoses 1) can perform without impulsivity or inattention, for the 25 min of the test (should not be possible for true ADHD), and show large features of fatigue in the brain, either from sleep architecture, neuroinflammatory hints (covid, concussion), etc. But the amount of teens as well as middle aged exeuctivies who have a burnt out wired-tired brain, and don't show actual exec function issues in the performance...
Not just to throw fuel on the fire of the expanding perspective on ADHD.. I wonder if you would speak at some point on the physiological aspects of ADHD (inattention, impulsivity, sleep, time, etc) and perhaps how those might be different from years of living with those resource bottlenecks and differences, even if controlled via stimulants, eventually addressed via neurofeedback, etc.. ie.. what is the non-brain psych stuff and tension of constructionism/constructivism on identity, etc? Maybe this is why stims can mask acute resource limits but not address learned, habit, identity, etc.. ?

[@DrJohnKruse]

Thanks for the information. Remember that people with ADHD tend to be interest driven rather than importance driven. So if the testing situation is particularly interesting / motivating for them, or enough structure is provided to steer them into "proper" behavior, they may well have ADHD without displaying inattention or impulsivity during a 25 minute interval.

[@mr_lemma]

Hello doctor Kruse! Could you maybe make a video on aripiprazole (low dose) adjunction of atomoxetine treatment for ADHD? Does it make sense at all? Is it a good idea?

[@DrJohnKruse]

I've talked a little about aripiprazole and ADHD in this video czcams.com/video/4Helr33tZ3g/video.html (which is not at all obvious from the title.)

[@mr_lemma]

@@DrJohnKruse Thanks! That was an interesting video, but I was wondering if aripiprazole made sense as an ADHD agent, since it normalizes dopamine levels.

[@DrJohnKruse]

@@mr_lemma there is a small amount of published research indicating that Abilify may be helpful for ADHD, and I have seen it help several patients (most of whom were taking other ADHD agents at the same time).

[@mr_lemma]

@@DrJohnKruse Interesting! Thank a lot!