Rising ADHD Diagnoses: Understanding the Surge

In late 2023, during a conference break in Baltimore, I shared a chart from the New York Times with a colleague at the CDC. This chart illustrated a significant rise since 2020 in Americans experiencing serious difficulties with memory, concentration, or decision-making—symptoms commonly associated with ADHD. Interestingly, my colleague had just presented a similar graph that tracked the increase in adult stimulant prescriptions since 2020. By 2023, CDC data revealed that 7.8 percent of American adults reported being diagnosed with ADHD. Searches for ‘ADHD’ on Google skyrocketed, and TikTok videos under the #ADHD tag garnered over 20 billion views. We could be facing an adult ADHD epidemic in the U.S., or at the very least, ADHD seems to have gained a new kind of public attention. Another possibility is that the criteria for diagnosing ADHD are becoming more inclusive.

So, can adults actually develop ADHD? To explore this, we should consider if there’s a valid phenomenon of adult-onset ADHD. The Diagnostic and Statistical Manual of Mental Disorders (DSM) classifies ADHD as a neurodevelopmental disorder, which generally starts in childhood and lasts a lifetime. This disorder is believed to be primarily genetic but can also be affected by environmental factors. The DSM specifies that symptoms must appear by age 12. While research supports ADHD being a chronic condition, studies looking for evidence of adult-onset ADHD have been largely inconclusive. So, what’s driving the rising rates of adult ADHD diagnoses in the U.S. over the past few years?

One possible explanation is that the DSM criteria have become more lenient. In 2013, revisions expanded the diagnostic criteria for ADHD. The age of onset was pushed from seven to twelve, and the number of required symptoms for adult diagnosis was reduced from six to five. However, it’s unclear how much these changes have impacted diagnosis rates. While these relaxed criteria might have contributed to the recent surge, it seems unlikely they solely account for the increase seen in the 2020s.

ADHD exists on a spectrum rather than as a binary condition, meaning symptoms can vary widely. Medical professionals typically use a checklist of behaviors to determine a person’s level of ‘trait ADHD’. Everyone falls somewhere on this continuum, with some excelling in attention and task organization, while others struggle significantly. A significant challenge arises when assessing whether a person’s symptoms warrant a formal diagnosis, especially when they present only mild issues without major impacts on daily functioning.

Consider Jake*, a 26-year-old who stands out due to his evident childhood struggles with ADHD. He had a hyperactive nature as a child and faced bullying, leading to academic challenges. His devoted parents can vouch for his difficulties, which continue to affect his life. Now, he works at a zoo ticket counter, having completed a degree but lacking motivation for a job search due to his ongoing issues related to ADHD. His situation makes it clear how deeply ADHD can impact daily life and functioning.

On the other hand, we have individuals like Rebecca*, who walked into a clinic seeking an ADHD diagnosis in her 40s. She never considered she might have ADHD until seeing social media ads suggesting self-assessments for it. Reflecting on her life’s struggles, including tumultuous relationships and job instability, she started to wonder whether ADHD could explain her experiences.

For professionals, diagnosing someone like Rebecca can be difficult. She lacks a clear history of symptoms in childhood, prompting some to overlook the possibility of ADHD. Despite reporting some instability in relationships and employment, her self-assessment reveals symptoms falling short of formal diagnosis criteria. However, further conversations with her boyfriend reveal quirks indicative of ADHD, adding depth to the diagnostic dilemma. Ultimately, the clinician opts to diagnose her, guided by the idea that her symptoms do affect her functioning—even if minimally.

This complicates the conversation about diagnosing what’s referred to as ‘light’ or subclinical ADHD. Some argue that identifying and treating these individuals preemptively could prevent more severe issues in the future. Research shows that those with subclinical ADHD might experience fewer cognitive challenges, but they are still susceptible to secondary complications, like anxiety or substance abuse. Treatment could still be beneficial, justifying a diagnosis to include them in care options.

Another cultural shift may be influencing the rise in ADHD diagnoses: the neurodiversity movement. People like Rebecca report feeling relief upon receiving a diagnosis, leading advocates to argue for broader definitions of ADHD that resonate with diverse lived experiences. This movement is gaining traction, particularly post-pandemic, as many start to identify with ADHD in ways that challenge traditional diagnostic rigidity.

With the rise of online platforms, many are sharing ADHD stories, contributing to a richer public understanding of the disorder. Notably, women are increasingly self-referring for diagnoses—many feeling previously overlooked due to gender biases in diagnostic criteria. The pandemic helped catalyze this moment, as social media connected individuals who found solace in shared experiences.

While some research suggests ADHD can fluctuate significantly over a person’s lifetime, many may have developed symptoms or found their underlying issues exacerbated during the pandemic. An increase in online diagnostic services has also facilitated more people seeking help. According to CDC reports, a significant number of adults with ADHD are now obtaining their diagnoses via telehealth.

This presents a dilemma for clinicians: should they diagnose an individual when their symptoms might fluctuate? It’s crucial to acknowledge that ADHD’s presentation can shift between periods of severity and inconsistency throughout life. As we adapt to this reality, diagnostic frameworks may need to expand and evolve.

Public opinion and clinician approaches to ADHD are diverging. Patients often describe symptoms built from popular discourse, complicating the traditional diagnostic landscape. There’s uncertainty about whether the adoption of neurodiversity perspectives is as widespread among healthcare providers as it is online. Nevertheless, a tension exists between traditional diagnostic criteria and evolving understandings based on patient narratives.

The complexities don’t stop there; ADHD is often prone to misdiagnosis. Many individuals with ADHD often present with co-occurring disorders that mask the underlying ADHD symptoms. Conversely, others with ADHD go undiagnosed while struggling with related issues like anxiety or depression.

The pandemic exacerbated mental health issues and increased the need for support related to ADHD. As more adults seek diagnoses, the healthcare systems have begun to evolve, with more providers stepping into the role of diagnosing ADHD. However, newer practitioners may rely on popular information without extensive training, leading to both opportunities and challenges in diagnosing ADHD accurately.

There’s an ongoing conversation about whether ADHD should be segmented into distinct disorders, akin to how depression has been categorized. Future diagnostic discussions must explore the spectrum of ADHD manifestations to create a more nuanced understanding of the condition. Our current diagnostic categories should strive to reflect individuals’ varied experiences and ensure that help is accessible for everyone.

* Names and key identifying details have been changed to protect patient confidentiality.