Overdiagnosis is not a problem, but misdiagnosis may be as people are driven into the private sector by long waits, and sadly, missed diagnoses remain common —Tamsin Ford
Experts are warning that far from being over-diagnosed, people with ADHD are waiting too long for assessment, support and treatment.
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Isn’t it strange how we discovered a lot more stars after inventing telescopes?
Obviously there was an unrelated increase in stars born at that exact time.
To try to explain the increase of stars in the universe without it’s correlation with vaccine rates is just disingenuous. \s
This is actually the most apt analogy for the whole “sudden increase in diagnosis” bullshit line that anti-vaxxers and anti-science people continually vomit out.
A culture where people believe ignoring your mental health issues makes you more strong, more independent, more of a role model… They think people have been fine for generations, and all of a sudden “fine” people are now being diagnosed with all kinds of problems.
I can understand their logic when I first understand their mistakes.
I’m in no way an anti-vaxxer or anti-science (I’m a researcher myself). I still think it can be justified to look closely at the large increase in, and volume of, various mental disorders. First of all: There’s no doubt that a lot more people are being diagnosed due to better diagnosis tools.
However, a major difference between psychological and somatic illness is that the divide between sick and healthy is (typically) a lot sharper in the latter case. Either you have an injury or infection, or you don’t, and we can measure that. In the case of e.g. depression or ADHD, there’s a much wider gray zone from e.g. “healthy person having a bad day” to “clinically depressed”.
The point I’m getting at is this: When a certain percentage of the population is diagnosed with a disorder, you have to ask whether we’ve started diagnosing ordinary human existence as a disease. Alternatively, you have to start looking at a systematic level for why an enormous portion of the population has a certain disorder. Where that limit should be is an open question, but I would argue that when something like 10-20 % of the population has a specific disorder, we’re no longer just looking at individual cases of disease but rather at (a) the possibility that the criteria for diagnosis are two wide, so we’re catching “healthy” people with it, or (b) we have a society-level problem (e.g. an epidemic).
I know of areas with ADHD-rates around 20 %. For a somatic illness, we would never let that kind of infection rate pass without taking a closer look at what’s going on at the societal level.
You cannot equate ADHD and spectrum mental conditions with disease. For one they are not a disease, you cannot catch them and you cannot give them to other people. They are the way people’s brains work. People are just born that way, same way people are born gay or trans, smart or dumb, handsome or ugly. You can’t have an outbreak of ADHD or autism the same way you have an outbreak of the flu or covid.
People have been searching for environmental factors for autism, ADHD, depression, and all kinds of mental conditions for years. Other than crackpot anti-vaxxers and people like RFK Jr who try to throw life saving vaccines and common medications like Tylenol under the bus with literally no literature whatsoever to back it up, there has been no links discovered. Genetics and fetal gestation is weird and people just get born different sometimes. We as a society need to accept that and stop thinking these are diseases that need to be “fixed”.
You cannot equate ADHD and spectrum mental conditions with disease.
I agree, the only way I meant to compare them is that we diagnose and treat both with medication.
We as a society need to accept that and stop thinking these are diseases that need to be “fixed”.
I also agree 100 % with this, and it’s part of what I’m trying to get at with my “option a”. As of today, there are regions where over 20 % of the population are diagnosed with, and treated for, ADHD. At that point, I’m asking the question if we’re creating a problem by treating something that appears to be within the spectrum of how “normal people just are” as a problem that needs to be fixed. My point is exactly what you’re saying here: If a large fraction of the population has this “problem” that needs to be “fixed”, haven’t we just gotten to a point where we have a too narrow definition of what is “normal” and “healthy” human behaviour? Shouldn’t we in that case rather be looking at how we can structure our society in such a way that a larger span of the population is capable of functioning in it without medication, rather that trying to force everyone to conform to the same, ever narrowing, mould?
The minority will never be adequately provisioned for without access to intervention. In theory, that can instead be legal or political. Many schools or workplaces put in provisions for ADHD, mostly because of laws. Society does have a “problem” that needs to be “fixed”. The “mould” problem is a deliberate authoritarian tool, beyond the scope of this discussion.
But you need to understand that this is access to medication, nobody is forcing this down our throats. If people want it, it exists, and it helps reduce scary mental health (we’re talking suicide), ableist restriction of access to interventions is super dangerous.
I honestly have the impression that we agree on pretty much all points here but that we’re talking past each other. I agree to pretty much everything you’re saying, and I’m all for helping as many people as possible live as good lives as possible.
What I’m trying to say is basically that problematising the large volume of (and increase in) psychological diagnoses can be valid, and doesn’t have to be founded in trying to downplay those diagnoses. To take a very concrete example: Kids that are disposed to growing very short or tall can be offered growth (blocking) hormones, such that they grow to a “more normal” height. Today, very few kids are offered, or take, these hormones. Now, let’s say some area suddenly saw a rapid increase where 20 % of kids needed growth hormones to grow to “ordinary” height. I would say that we need to figure out what has happened: Is there something about the environment that has caused stunted growth to become ver common? Has the window for what is “normal” gotten narrower?
Of course, in this example, it’s very was to compare to historical records of human height. The same isn’t true for mental disorders. That doesn’t mean the same discussion isn’t worth having- at its core, this is a discussion about how we can make society as good as possible for as many as possible. That also involves discussing what should be treated as a disorder that disproportionately makes people’s life objectively worse, and what is within the “normal” range that we should rather build society around accepting.
Yeah look if we really are seeing diagnoses suddenly rise, and it’s not just “a better telescope”, maybe it is worth considering exploring environmental causes, diagnostic criteria, societal tolerance of certain traits etc. That’s fair.
But idk about the height example. People can’t self-medicate height. For adhd, people absolutely self-medicate caffeine, nicotine, illicit stimulants, grey-market ADHD meds, etc. That alone suggests there’s a real functional problem exerting pressure that needs immediate addressing. Stimulants do not work the same way on people with adhd.
What concerns me about your responses is that “investigating why diagnoses are increasing” is used all the time to cast doubt on ADHD itself. Obviously there’s a substantial body of neurological and clinical evidence that it’s real, and dramatically affects attention regulation and executive function.
So I think people who legitimately believe in it falling for this mainstream theatre, risk letting us all slide down the slippery slope to believing the condition is mainly a societal construct and we should limit access to medication, whilst people top themselves.
I mean, wouldn’t something like tuberculosis have an infection (not necessarily symptomatic) rate of 20% globally?
I have an ADHD diagnosis, and I do think this is 60% just being better at diagnosing it, but I do also believe ADHD is sort of on the rise.
There is an incredible book called Scattered Minds by Gabor Maté, which is the significant book on ADHD in the same way that The Body Keeps the Score is for trauma, which delves into the potential ADHD causes beyond it being hereditary.
Of course modern dopamine-consumerist culture is part of the problem, but it largely makes ADHD symptoms obvious, and various unmet attention needs in early childhood are significantly more linked to developing ADHD, not to fault the parent or other caregiver who may not have the availability or ability to provide that attention due to modern societal demands. It’s been some years since I read it but I really remember one part clearly; it’s basically impossible to test nature Vs nurture in separated-at-birth twins because the act of separating twins at birth spikes the likelihood of having ADHD so much.
But honestly I think the largest contributor to increased ADHD cases is not that we’re better at diagnosing it, it’s that modern society increasingly warrants its diagnoses. 12000 years ago ADHD traits weren’t a disorder, as much as having different physical strength or height to your peers isn’t. Modern capitalist society demands an efficiency of its workforce and ADHD is an inherently inefficient trait, and therefore suddenly warrants treatment.
Don’t get me wrong, medication is incredible, and has turned days I’ve barely been able to get out of bed into productive days, but that’s still valuing being productive.
Erase capitalism from this and it’s still “days I’ve barely been able to get out of bed to hunt/reinforce important relationships/create art”. Inability to focus, relentless forgetfulness, rejection sensitive dysphoria, much of the ADHD experience interferes with non-“productive” life just as much as a job and shit.
I’ve always liked the left-handedness analogy, but I am definitely stealing the stars one as well. It’s very pithy.
I will just add one thing perhaps in contrast to this. But inasmuch as I’m offering an analysis of how people think about this, please don’t infer that I agree with them
With some things, ADHD being one, I think the grumbling we hear is not really that there can’t be all these new cases suddenly. It’s that we’re pathologizing something that’s a normal part of being a kid.
Again, I’m not saying ADHD is like that, just that “no one had this when I was a kid” isn’t the most on-point way to characterize people’s incredulity about ADHD. They think we’re over diagnosing it because we want to turn something into a problem, and turn boys into girls, and yadda yadda.
It’s a bit of that too. And also “our attention spans have been stolen”. It’s a mixed aetiology.
My cousin was diagnosed by a brain scan. She signed up to be part of a clinical trial for something else, got kicked out of the trial because her fMRI showed she had ADHD.
So if we can literally scan someone’s brain and diagnose them from a picture instead of all these vague “describe your symptom” guessing… why don’t we?
Money
It’s quite costly to run an fMRI. Not needed if you can get the same results more or less from a questionnaire.
In my professional experience, it can be hard to tell between ADHD symptoms and CPTSD symptoms. The checklist is not a great way to diagnose people. We usually do a lot more assessments, I also use a computerized test to measure reaction time and error commission.
I wish we (therapists) at least had the option to order an MRI or recommend a doctor orders one in difficult cases (I can do the latter but they will just laugh at me).
Ya, it could be better. Maybe a compromise would be to go with EEG machines which are less costly and can probably still differentiate fairly well (maybe).
I would be down with that as long as it’s a viable way to diagnose (I don’t know enough off the top of my head about it).
Basically anything other than self-report and the clinician’s opinion would be nice.
I wish we (therapists) at least had the option to order an MRI or recommend a doctor orders one in difficult cases (I can do the latter but they will just laugh at me).
God, that’s awful. The most common sense thing to do there is is to use what’s availiable (fMRI) when it is, and if availability is the problem, fill the gaps with questionnaires - those who you’re sure about might not need an fMRI, but others might. Which you, as a person who’s supposed to sign off on the diagnosis, should be able to order.
I prefer objective, unqestionable evidence, since I tend to self-sabotage I guess.
It’s also worth noting that ADHD, as a condition, is mostly a Gordian knot of maladaptations. Built up over childhood (and beyond). While there are a lot of commonalities, you need to do a detailed investigation to pick out what bits are a problem to the individual.
If you’re going to go through that process, then you might as well not tie up an MRI machine for no reason.
Drugs can treat the base problem, but don’t work well without the follow-up care to repair the behavioural damage.
An mri would kill me because my diet includes a tablespoon of 2mm iron pellets daily.
Is this for your shotgun arm
You can’t get diagnosed with an fmri alone. It’s just one sign, a weak one, so you’d need the professional doing questionnaires anyways. They are way cheaper and faster (in terms of waiting times) than fmris too. Might as well skip it.
I spent most of my life undiagnosed, because it used to be believed that only boys could have ADHD. But I knew, and was formally diagnosed as an adult only at the insistence of my partner.
Like many adults I just got recently diagnosed in my mid 30s.
For me it was that I can’t have adhd because I was good at school and uni. Then I completely fell apart when I entered work.
I had to go through depression and burn out and bore out and more. Eventually someone said I could have adhd and just been able to deal due to high IQ.
Turns out that’s what it was. I’m really good at learning new stuff. So school and uni. I really suck at repeating the same shit all day. So work. Welp. Helps to know.
Wow, this could have been written by me. I got diagnosed last year in my early 50s after my 4th burnout. I’m currently assessing career options and try to work out what to do next. Unfortunately one has to make money to survive, I’m just trying to find something that won’t break me again. Bonus points if it’s interesting too.
This is where I am too, in my late 30s. Had a really bad year last year reaching burn out and ending up with panic disorder 😵 I wonder if changing to a job that’s more systematic would help, but also the boredom kills me and I need money. I hope you figure it out!
Huh, never conceived of it that way. I was stellar in secondary school, burnt out in university and crashed out in post-grad plans/attempts. Still trying to revisit those, but have to go at a slower pace.
I’ve felt like my brain just works… slowly. But I also seem to be pretty good at learning/picking up new things, because the novelty is key. That is definitely a helpful way to reframe it!
To my understanding it shows up differently in women. What were your symptoms? Also some women get diagnosed with it during perimenopause.
This thread somehow brought out some of the most misinformed, boomer-brain takes imaginable and comes dangerously close to anti-intellectualism. We can all agree that labels can be reductive and unhelpful, but as someone with a neurological disability, seeing people debate whether a disorder that makes it incredibly hard to enjoy my life is even real or not is fucking horrible.
Well you’re a severe case, and these people likely are talking about mild cases.
This is goal post moving bullshit.
Why, there should be varying degrees when it comes to over prescription. Like opioids, I’m sure some people need them for good reason, but they were over prescribed.
Because the people making the claim that ADHD is overdiagnosed and medication is overprescribed are not only talking about mild cases. Then when someone with a good point comes along, suddenly we are only talking about mild cases.
So, moving goal posts.
It doesn’t matter how mild or serious you have ADHD. If you need treatment there shouldn’t be a boomer shaped barrier in the way making it seem like it isn’t real.
Maybe I read different comments, when this was posted.
That doesn’t matter; that kind of ‘criticism’ ends up stigmatizing medication altogether, even for whom it can be lifesaving.
All of this applies to Autism, as well.
Indeed and I still don’t get my diagnosis because I can look people in the eyes and am friendly.
(yes, some ‘expert’ actually said that as a paid diagnosis. This is supposed to be first world but hey… Nobody gives a fuck)
Ugh I’m sorry to hear that, it can be incredibly frustrating and discouraging to seek a professional just to have them dismiss and misdiagnose you.
I wish you the best in your journey to get the answers and help you need and deserve. Please keep looking, the right fit has to be out there.
Thanks! I found most of the answers on my own and all situations in the past I was puzzled about my own behavior ist perfectly clear to me now (esp. reactions due to overload situations and masking).
I actually have no direct use for the diagnosis; it would only be the last confirmation, taking a huge load off my shoulders and providing that last bit of rest. However, I myself and my surroundings don’t need the approval to know.
It’s almost as if we’ve gotten better at understanding the condition overall and in nuance.
The moral panic of overdiagnosis comes from conservatism’s obsession with hypernormalcy. Basically unless your really-really failed to be normal, you’re not allowed to stray from it, and even then, it would be good if you were normal, because they like the virtue of normalcy, and also thinking is hard, and also also change is bad.
Yes this explains modern transphobia a lot. Some admitted, that it has to be “all undone”, because people stopped trying to be normal first and foremost. This also partly explains gatekeeping in fandoms.
Any diagnosis means someone might demand something of them. It might be consideration, tax money, or some other inconvenience like actually having to apply thought and accommodation to anyone not fitting their idea of conformity. I agree with where you’re pointed, but it isn’t a “moral panic”, it’s their unwillingness to expend anything of themselves for others.
Most data suggests it is under diagnosed.
Especially in women, like by a lot.
Serious question: how would we be able to detect if we’ve over diagnosed a mental disorder such as ADHD? What would evidence for that look like?
From the linked research article:
‘Over-diagnosis’ is observed when the prevalence of diagnoses made in clinical services, referred to as administrative prevalence (based on healthcare databases or insurance claims) exceeds prevalence estimates based on accurate assessments in representative population-based samples. Over-diagnosis may occur when diagnostic criteria are not applied with sufficient rigour, leading to false-positive cases. Over-diagnosis may also happen when people inappropriately self-diagnose. Notably, for individuals with milder or subclinical symptoms, a diagnosis can sometimes do more harm than good, creating stigma or leading to low-benefit treatments with significant side-effects.
So is Admin Prevalence > Prevalence Estimates where the estimates are made based on representative population-based samples?
It’s the left-handedness chart all over again.
I was diagnosed in my late 50’s. It was a complicated process because there is another mental health co-morbidity that shares some traits.
After going through the more than a year long process, we are working on dialing in the meds.
One of the challenges for diagnosis is that the attention economy is shortening a lot of people’s attention span, causing many people to feel that they have ADHD, and diverting resources from diagnosing people who actually have ADHD. Not saying that the issue shouldn’t be addressed. The combination of these factors, and the rather long and complicated process of a proper diagnosis is a challenge.
Was it worth it at 50? How it been going?
Worth it 100%. Knowledge is power. Simply knowing why shit was happening in my life, and how to be ready and prevent/mitigate, has changed my life. Meds for ADHD and the other issue have also made my life much, much better.
Why is there never any nuance in these discussions? We can both believe that under-diagnosis occurs, and that over-diagnosis occurs. 20% of all pupils in the UK are now classified as so disabled that they require specialised assistance. “SEND” assistance for this can range from free taxi services to and from school (which recently reached £1.2 billion), to support payments, to special assistants in school. The number of ECHP students (those with the highest needs) increasing by 71%, from 253,679 in 2018 to 434,354 in 2024. SEND spending is out of control.
So what happened, exactly? The average child disability rate in Europe is 4.6%. How did the UK end up with 20%? Did the UK suffer a catastrophic nuclear event? A war? Famine? None of the above. It is clear that categorisation has become EXTREMELY loose over time on average. This does not mean that there are not children who are struggling to get diagnosed with ADHD. However ADHD and autism are a spectrum disorder. It is not binary. The UK has drawn the line far closer to the normal side of the spectrum than any other nation on Earth. If costs continue to rise at this rate, it risks destabilising the entire health system. Public sentiment will shift, and we risk undermining children getting any diagnosis at all.
IMHO, this requires at least two tactics at the same time. 1) Invest sufficiently into diagnosis resources. Stringing parents and children along for years while they wait in the system can make the issue much worse than it needs to be. 2) Draw the diagnostic line closer to where the rest of Europe does it. This will mean far fewer children are diagnosed with disabilities, but those who genuinely have a disability are treated much faster and actually receive the resources they need.
This will mean far fewer children are diagnosed with disabilities, but those who genuinely have a disability
You’re going to have to elaborate on what a genuine disability is there chief. Let me help you out:
- lead poisoning.
- microplastics
- plastics in general
- glyphosate (round up)
- air pollution
- mosquito spraying
- etc.
You’re going to have to elaborate on what a genuine disability is there chief. Let me help you out:
The UK Equality Act defines a person disabled if they have a physical or mental impairment, and the impairment has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities.
I believe all of those things you listed were much worse in the 70s (with the potential exception of microplastics) when disability rates were much lower. There is no proof that microplastics are causing autism and ADHD (and a thousand other disabilities). What has changed is diagnostic criteria. In the UK they have become much looser.
I believe all of those things you listed were much worse in the 70s
Who are the current young people’s parents? Do you think any adverse effects are biologically inherited?
There is no evidence that lead poisoning, for example, can be inherited. There is some research that certain epigenetic changes can be inherited. The context is sometimes war and famine. But that is 2-4 degrees of abstraction away from your question, and we are many decades away from any kind of causative conclusion to that.
If I were to steelman your position, I think there are simpler changes to point to as potential causes here. Social media. Screen time. Time spent outside and exercising. Obesity. Time spent socialising. The new “permissive” method of parenting and teaching.
All of those things are at lower levels than the 1970s.
There’s less microplastics now than in the 70s?
Yes.
This is a recurring issue. Too many trans people? Liberal agenda spreading!
It’s like they don’t understand causations.
I’m just sick of being unmedicated because there’s always a shortage of medicine or my insurance wants to be a fuck nugget. I can’t even function properly without mine and have severe anxiety over losing my job because of this shit. Fuck American healthcare, fuck insurance companies.
Why do we need to have a study on this when we can just listen to grandpa’s opinion, planted in his mind by Fox News?
