Research.

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.

top 66 comments

sorted by: hot top controversial new old
[–] 165 points 8 months ago (20 children)

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.

  • source
  • hideshow 20 child comments
  • [–] 27 points 8 months ago (9 children)

    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.

  • source
  • parent
  • hideshow 9 child comments
  • [–] 6 points 8 months ago

    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.

  • source
  • parent
  • [–] -2 points 8 months ago (7 children)

    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.

  • source
  • parent
  • hideshow 7 child comments
  • [–] 10 points 8 months ago (5 children)

    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".

  • source
  • parent
  • hideshow 5 child comments
  • [–] -3 points 8 months ago (4 children)

    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?

  • source
  • parent
  • hideshow 4 child comments
  • [–] 3 points 8 months ago (3 children)

    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.

  • source
  • parent
  • hideshow 3 child comments
  • [–] 3 points 8 months ago (2 children)

    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.

  • source
  • parent
  • hideshow 2 child comments
  • [–] 1 point 8 months ago (1 child)

    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.

  • source
  • parent
  • hideshow 1 child comment
  • [–] 1 point 8 months ago

    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.

    Thanks for making an effort to understand what I'm trying to get at here. Honestly, this is like my primary point and I appreciate that you're recognising it. It can get tiresome to discuss with people that never seem to understand that you have good intentions, thank you for seeing mine.

    What concerns me about your responses is that “investigating why diagnoses are increasing” is used all the time to cast doubt on ADHD itself.

    And I absolutely agree that that's a big problem. My point is concerning when the same sentence is used in the positive, constructive, sense that this is clearly something we as a society need to look more closely at, because something is very obviously wrong on either an environmental or societal level if a large fraction of the population needs medication in order to function properly.

  • source
  • parent
  • [–] 32 points 8 months ago (2 children)

    To try to explain the increase of stars in the universe without it's correlation with vaccine rates is just disingenuous. \s

  • source
  • parent
  • hideshow 2 child comments
  • [–] 2 points 8 months ago (2 children)

    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.

  • source
  • parent
  • hideshow 2 child comments
  • [–] 1 point 8 months ago (1 child)

    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.

  • source
  • parent
  • hideshow 1 child comment
  • [–] 2 points 8 months ago* (last edited 8 months ago)

    Are you under the impression that everyone was required to be functioning at 100% at all times in order to survive or be a meaningfully-contributing member of a society? Because that is so very very far from the truth. The actual labor involved in hunter gather societies amounts to a few hours a day for each individual on average, but that doesn’t mean every individual had something that needed to be done every day in order to be a valued member of their society. Most tasks didn’t happen every day, and those that did didn’t require all hands to do.

    Even after the agricultural revolution, many months of the year were much slower, allowing recuperation to prepare for the labor intensive period, a schedule I’ve liked in the modern era similarly; 3-6 mth contracts followed by 6-9 mths of vibing and living off what I saved up during the working phase, supplemented by a variety of projects I find compelling to keep my spending very low or sometimes earn a bit of side money. I find it works very well to keep my adhd symptoms from being crippling during the active work phase, and I’ve been unmedicated. Then I take a month or so to ooze into the ground to recover from the burnout, and I become productive in my personal life again. It’s a decent compromise if money has to be involved, but it’s sometimes a financial struggle because we don’t value paying people properly right now, an entirely late-stage capitalism problem.

    Beyond that, knowing a lot of things about a variety of specialties and being curious enough to learn, something ADHD people tend to excel at, makes for a variable worker who can be slotted in to fill different needs for others who were unable, or simply when the labor demanded more bodies. Jack of all trades were also incredibly valuable back before modern transportation, especially for smaller communities. Couldn’t really get an actual expert without months of travel if one didn’t just happen to be around. So they got to feel valuable, like they were actively contributing to the social fabric, because they were, and got to do things that were actively interesting them, and just stop doing those things if they stopped being interesting. Having that sort of self image as well as flexibility would be intensely motivating, at least for me, and help overcome a lot of the inertia and sensitivity.

    I genuinely do think a lot of the dysfunction we face from adhd has to do with how we structure our modern societies to optimize for efficiency and shareholder value over the wellbeing of the people. I mean when even non-adhd people are facing extreme burnout and excessive levels of stress, anxiety, and depression, what chance do we really have without meds?

  • source
  • parent
  • [–] -1 points 8 months ago* (1 child)

    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.

  • source
  • parent
  • hideshow 1 child comment
  • [–] 68 points 8 months ago (14 children)

    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?

  • source
  • hideshow 14 child comments
  • [–] 22 points 8 months ago (8 children)

    It's quite costly to run an fMRI. Not needed if you can get the same results more or less from a questionnaire.

  • source
  • parent
  • hideshow 8 child comments
  • [–] 26 points 8 months ago (6 children)

    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).

  • source
  • parent
  • hideshow 6 child comments
  • [–] 4 points 8 months ago (1 child)

    Do you know if there any studies on whether the effects of the medicine used for ADHD could have similar positive effects on people with CPTSD?

  • source
  • parent
  • hideshow 1 child comment
  • [–] 6 points 8 months ago

    Great question! To my knowledge, they are just starting to look into it, but with PTSD specifically, not CPTSD. There is this case study (n=1) and this pilot study (n=32) that show promise. They are recruiting people for more testing.

    Preliminary evidence shows that it does help - and it makes sense. If cognitive deficits from PTSD are a result of an impaired executive function, then stimulants would help with those particular symptoms, much like in ADHD.

    Here's the thing though - the US healthcare system still doesn't even have CPTSD as a diagnosis, so there is not too much research happening on the topic here. Considering how ADHD (especially in women) is also very understudied, there are so many variables we just don't know or understand.

    If you are interested in novel treatments of PTSD, I also recommend looking into blue light therapy. There is some promising results showing a reduction in symptom severity within 6 weeks of daily 30-min blue light exposure in the morning. Here is a systematic review that looks at 4 studies.

  • source
  • parent
  • [–] 1 point 8 months ago

    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.

  • source
  • parent
  • [–] 1 point 8 months ago (1 child)

    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).

  • source
  • parent
  • hideshow 1 child comment
  • [–] 4 points 8 months ago

    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.

  • source
  • parent
  • [–] 11 points 8 months ago

    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.

  • source
  • parent
  • [–] 4 points 8 months ago

    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.

  • source
  • parent
  • [–] 41 points 8 months ago (6 children)

    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.

  • source
  • hideshow 6 child comments
  • [–] 11 points 8 months ago (3 children)

    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.

  • source
  • parent
  • hideshow 3 child comments
  • [–] 4 points 8 months ago (1 child)

    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.

  • source
  • parent
  • hideshow 1 child comment
  • [–] 3 points 8 months ago

    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!

  • source
  • parent
  • [–] 2 points 8 months ago

    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!

  • source
  • parent
  • [–] 28 points 8 months ago (3 children)

    All of this applies to Autism, as well.

  • source
  • hideshow 3 child comments
  • [–] 4 points 8 months ago* (last edited 8 months ago) (2 children)

    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)

  • source
  • parent
  • hideshow 2 child comments
  • [–] 4 points 8 months ago (1 child)

    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.

  • source
  • parent
  • hideshow 1 child comment
  • [–] 2 points 8 months ago

    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.

  • source
  • parent
  • It’s almost as if we’ve gotten better at understanding the condition overall and in nuance.

  • source
  • [–] 17 points 8 months ago (1 child)

    Most data suggests it is under diagnosed.

  • source
  • hideshow 1 child comment
  • [+] 16 points 8 months ago (1 child)
  • [–] 9 points 8 months ago

    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?

  • source
  • parent
  • [–] 12 points 8 months ago

    It's the left-handedness chart all over again.

  • source
  • [–] 11 points 8 months ago (2 children)

    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.

  • source
  • hideshow 2 child comments
  • [–] 18 points 8 months ago (1 child)

    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.

  • source
  • hideshow 1 child comment
  • [–] 3 points 8 months ago

    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.

  • source
  • parent
  • [–] 34 points 8 months ago (6 children)

    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.

  • source
  • hideshow 6 child comments
  • [+] -19 points 8 months ago (5 children)

    Well you're a severe case, and these people likely are talking about mild cases.

  • source
  • parent
  • hideshow 5 child comments
  • [–] 4 points 8 months ago (4 children)

    This is goal post moving bullshit.

  • source
  • parent
  • hideshow 4 child comments
  • [–] 0 points 8 months ago* (3 children)

    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.

  • source
  • parent
  • hideshow 3 child comments
  • [–] 3 points 8 months ago (1 child)

    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.

  • source
  • parent
  • hideshow 1 child comment
  • [–] 6 points 8 months ago

    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.

  • source
  • load more comments
    view more: next ›