It’s not hard to see that in the United States there is an overwhelmingly negative narrative surrounding ADHD, or Attention Deficit Hyperactivity Disorder, and psychostimulants—drugs that can increase the activity of the body’s central nervous system.
Here’s the story we’re often told: The United States overdiagnoses ADHD and overprescribes these stimulants. This phenomenon some researchers say is a Symptom of hypercompetitive capitalismwill lead to a second “opioid crisis” where we take drugs to vote in rather than out.
Continue reading: Is ADHD Really On The Rise?
The Netflix documentary from 2018 Take your pills illustrates this narrative. The film features interviews with several subjects, some of whom are college students taking Adderall – one using the drug to “sew up” her life, while another has been taking it since childhood. Other characters featured are (conventionally) more successful adults: a Silicon Valley techie who calls Adderall “jet fuel”; a Goldman Sachs banker who lied to get a recipe and Eben Britton; a former NFL player who became addicted to Adderall and took it before every game.
criticism have called the film “short-sighted,” “fear mongering,” and lacking in substance spread of stigma.
The unfortunate reality, however, is that the film’s narrative is not isolated. As a matter of fact, current studies have examined the stigma surrounding adult ADHD and also recognize that adult ADHD is understudied even compared to its child counterpart.
Our understanding of ADHD has undoubtedly improved over the years. Researchers once believed that nearly half of all children diagnosed with ADHD would “grow out of it” by adulthood. but new research has shown that 90% of children with ADHD will still have symptoms as adults, despite periods of intermittent remission.
Really, but let’s not think that it “grows out of this”. “It’s neurodevelopmental,” says clinical psychologist Amy Marschall. “It’s a brain difference, so ‘grow out’ isn’t really the right word. What’s really happening is that kids don’t get to choose their surroundings. They go to the school you tell them to go to. You go to math [class] when they’re told they have math, and then they sit still until they’re let go on recess — unless they misbehave, and then that’s taken away from them. As adults, we get a level of self-selection that children don’t have.”
In other words, it’s not that adults age because of ADHD; It’s that they’ve learned to deal with it, or have chosen career paths that are more stimulating and active than, say, sitting in a classroom all day. Marshal contrasts the United States with Finland, whose school system is very different from ours. Instead of punishing children for speaking up in class, for example Finnish teachers customize the environment according to the needs of the students. In addition, Finland also has lower rates of diagnosed ADHD than in the US As Marshal notes, however, this does not mean that a smaller percentage of Finns have ADHD, but rather that the difference in statistics is due to how ADHD is diagnosed.
“It’s not like their kids don’t have ADHD. It’s that her ADHD isn’t a ‘deficit,'” Marshal says. “That’s the medical model: If it’s not a deficit, then you don’t have it.” In fact, Marschall himself was diagnosed with ADHD as an adult, but has also been evaluated for autism. The only thing that differentiated her diagnosis, she says, was that “[she] didn’t fight enough to be autistic.”
In short, since we only diagnose diseases when they affect a person’s quality of life, the difference in diagnosis rates between the US and Finland can be attributed to the systems in which these diagnoses occur. When we claim that the US overdiagnoses ADHD or prescribes too many stimulants, we are treating ADHD as a problem. This is an unfortunate by-product of social systems that require adherence to norms well suited to neurotypical brains, often to the detriment of neurodivergent people.
Marshal points out how demoralizing it can be to live in a world that isn’t tuned to your brain type, whether you’ve received any kind of diagnosis or not. “But especially for those of us who were diagnosed later in life, we’ve spent decades thinking, ‘How come I just can’t? How come I’m so lazy? How come I’m not as smart as everyone else?’”
Because half of the adults with ADHD also suffers from anxiety, Questions like these can directly trigger those anxious feelings. Marshal compares the relationship to that Meme of a building held up by sticks: ADHD is the falling building, and anxiety acts as a “support” that motivates someone to act in an adrenaline-fuelled frenzy. Because some people with ADHD often hesitate, last-minute panic can be a powerful motivator. Of course, this is not a healthy cycle.
Additionally, and especially in undiagnosed people, the self-mockery of wondering why you are unable to function normally can lead to it feelings of depression. Compound ADHD, anxiety, and depression can severely impact quality of life, leading to further complications in school, work, relationships, and more—all of which are already impacted by ADHD. Again, we can see that this becomes a vicious cycle. Miscellaneous studies also report that subtle, negative prejudices about ADHD lead to social, academic, romantic, and professional rejection.
Fortunately, we are now at a point where more people are becoming aware of this issue, due in large part to the ongoing pandemic. Marshal is qualified to screen patients for ADHD and says she used to schedule appointments within days. Now she’s booking appointments in two months time. “We had the idea that if you meet all your requirements – pay your taxes, get your job done, be good on capitalism in general – you’d be fine, but with the stress of the pandemic, working from home and the uncertainty, People are finally starting to take a step back and say, ‘Hey, I think something’s wrong.’ Then they look back on their lives and it all falls into place.”
Hopefully, as more people learn and talk about ADHD, we will see more options available to support neurodivergent brains at all levels.