Not so long ago,the popular conceptualization of attention-deficit/ hyperactivity disorder, or ADHD, began and ended with visions of an elementary-aged boy bouncing around a classroom — even among mental health professionals.
In fact, it wasn’t until 1994 that the American Psychiatric Association recognized, in a new edition of its Diagnostic and Statistical Manual of Mental Disorders, that children may not “grow out of ” ADHD, as previously thought. So striking was this reversal that Time magazine blazoned it across its cover: “Disorganized? Distracted? Discombobulated? Doctors Say You Might Have ATTENTION DEFICIT DISORDER. It’s not just kids who have it.”
But the tables have since turned. Adult ADHD diagnosis rates are rising four times faster than those of children in the U.S., with the number of Michigan adults affected by the condition estimated to be around 324,000. All this has fostered rising public awareness and waning stigma around ADHD, but it has some wondering how a congenital disorder could suddenly appear so … contagious.
Fran Parker is a clinical psychologist who specializes in ADHD at Dennis, Moye, Branstetter & Associates mental health clinic in Bloomfield Township. She has also served as coordinator for the Eastern Oakland County chapter of Children and Adults with Attention Deficit Disorder, or CHADD — an ADHD education and support organization — for more than 20 years.
For her part, Parker isn’t surprised by the recent surge in cases of adult ADHD. “We live in a highly distracted world,” she says. She believes the constant overstimulation from social media, the 24-hour news cycle, and all the other distractions of modern life exacerbate the symptoms of ADHD. As a result, even those with mild cases that might have gone unnoticed in childhood are now finding themselves in need of treatment.
“There’s so much going on that I think people with ADHD who were once able to keep it together can no longer keep it together as well.”
A similar theory from Jennifer Kowalkowski, director of behavioral medicine for the Corewell Health Hospital Grosse Pointe Family Medicine Residency Program and assistant professor at Oakland University’s William Beaumont School of Medicine, is also based on the idea that some have, until recently, gotten along by managing or compensating for their ADHD symptoms.
“There are many psychologists, including myself, who wonder if the stress of the pandemic and everything else that’s going on has been the tipping point for some people.”
In fact, it’s not particularly rare that ADHD goes unrecognized during childhood, and statistics show that ADHD is particularly common among women.
“You’ve got some especially brilliant, gifted ADHD people who manage to keep it together and don’t have a problem getting through school, so they never needed treatment,” Parker says. But as those children become adults and the scope of their responsibilities broadens, it can become harder to maintain that level of control.
It’s here that Parker says another likely contributor to rising adult ADHD rates comes into play. As their genetically predisposed children are diagnosed, those “gifted ADHD people” are often diagnosed as well. “A therapist might ask if it runs in the family. And then you start looking at the symptom list and notice a lot of similarities.”
This now-frequent occurrence has only developed in the years since the relatively recent acceptance of adult ADHD.
It’s something Parker has experienced personally. “When my son got diagnosed at the age of 5, I started looking at my husband and seeing everything I saw in my son.” At her suggestion, her husband, who was in his 40s at the time, visited a specialist and received a matching diagnosis. These experiences inspired her to take up the condition as her clinical focus 35 years ago. Since then, she has published articles, taught classes, and spoken at local and national conferences on the topic of ADHD.
While Parker has no doubt there’s been an uptick in valid diagnoses, she also suspects those dramatic statistics are — to a degree — inflated. “To be honest, some people just want accommodations from their college. Or they want the medication,” she says. She’s referring to Adderall, which is used to treat ADHD and is sometimes misused by college students as a performance enhancer.
Kowalkowski agrees that the spike in adult ADHD is likely exaggerated, but she offers a different explanation for this phenomenon. “I think many people may not be getting an accurate diagnosis,” she says.
She believes most adults who end up misdiagnosed are truly experiencing symptoms, such as difficulty concentrating, and ADHD is simply what comes to mind — perhaps due to increased awareness and social media content about the condition. The actual cause could be anything from depression or anxiety to one of the many physical conditions that mimic ADHD symptoms, such as hypoglycemia, seizure disorders, and thyroid issues
“Unfortunately, most of these diagnoses are made in primary care, where we have 15 minutes with a patient and we also have to discuss all kinds of other things. … Perhaps they’re getting a quick diagnosis from someone who may not be skilled at detecting ADHD in adulthood.”
Still, there are likely many genuinely suffering who remain unaware they have ADHD — especially since the condition presents itself differently in adults than it does in children. This includes ADHD’s trademark hyperactivity, which in adulthood evolves into a nagging restlessness. According to Parker, other impairments common among adults with ADHD include self-regulation issues, such as compulsive overeating and verbal impulsivity, as well
as forgetfulness and difficulty meeting deadlines or paying bills on time.
So, for those watching the adult diagnosis rates climb and wondering, “Could I have ADHD, too?” Parker recommends doing your homework. “Start reading about ADHD. Go to some CHADD meetings. As with anything in life, knowledge is power.”
This story is part of the 2023 Health Guide. Read more in our Digital Edition.