Researchers are questioning whether ADHD should be viewed as a disorder. peppermint

“It’s like being inside a pinball machine with a hundred balls,” says Lucy. The disorder (ADHD) describes what’s going on in their mind at any given time. There are too many thoughts to concentrate on, which leads to anxiety as well as feelings of inadequacy and depression.

The number of ADHD diagnoses is rising rapidly in many countries, both in children as well as adults like Lucy, Philip and Sarah, who were diagnosed in their 30s. Among 26,000 patients seen in US clinics and hospitals, the number of people newly diagnosed with ADHD increased 60% from 2020 to 2022 (see chart). ADHD medication prescriptions by England’s National Health Service are set to double between 2018 and 2023.

This increase is due to several factors, including a better understanding of how ADHD affects women and girls, and the fact that its symptoms are proving harder to tolerate in a world full of distraction. Timely diagnosis has allowed many people who may have suffered in silence to access appropriate, and sometimes life-changing, medication. But for a growing number of experts, the evolving scientific understanding of ADHD is leading them to question whether it should be viewed as a disorder at all.

Instead, he says, ADHD may represent another point on the spectrum of neurodiversity: the range of different ways of thinking and behaving beyond what is considered normal. They point to other, non-pharmaceutical interventions, ranging from creating a supportive environment for people with symptoms to providing tools that harness their strengths and help them cope with the challenges of daily life. Has been shown to bring about change.

ADHD is not an easy condition to define. Psychologists often link it to “executive function”, a broad term for working memory, cognitive flexibility, and the ability to stop actions and thoughts when necessary. Diagnosis currently depends on a set of questions about inattention, hyperactivity, and impulsivity as well as the severity of the problems causing the symptoms. Estimates of its prevalence depend on clinical guidelines. 1–2% of British children and adolescents are eligible according to World Health Organization criteria; According to the American Psychiatric Association, this rate will be 3-9%.

eye of the beholder

Such subjective diagnoses are, necessarily, incomplete. For example, the way ADHD manifests in girls has long been ignored. (Boys are two to three times more likely to have ADHD but the gender gap in diagnosis has historically been much wider.) One reason is that girls tend to find ways to hide (or “mask” in the jargon) their inattention. are better—something that was missed by four decades of ADHD research focused on boys and men.

Diagnosing ADHD in adults has its own challenges. A child’s physical hyperactivity develops into inner restlessness; Inattentiveness and disorganization manifest as a struggle with larger everyday tasks. Internal restlessness in ADHD can easily be confused with anxiety.

Scientists trying to simplify matters with a checklist of biological markers of ADHD have come up empty-handed. Two people with ADHD may exhibit similar symptoms due to completely different underlying psychological and neurological processes. Imaging studies examining brain structure and functioning have failed to agree on what characterizes the ADHD brain. Studies searching for genetic clues have also revealed little other than the discovery that ADHD is hereditary.

“In the last ten years it has become more accepted that it is not a single biological entity,” says neuroscientist Edmund Sonuga-Barks of King’s College London. This may explain why specific psychological interventions, such as treatments to improve working memory, have failed to make any difference. On the contrary, the drug may be highly effective. Psychostimulants, which are most commonly prescribed, help with attention and concentration and work immediately. Their effectiveness is probably related to the fact that they act on dopamine and norepinephrine receptors, which are found throughout the brain, says Dr. Sonuga-Bark. In other words, the medications stimulate a wide range of brain systems involved in ADHD symptoms.

For people with severe symptoms, they can be life-changing. Recent studies from Sweden have shown that the drug is associated with lower chances of long-term unemployment in people with ADHD, as well as fewer deaths from accidents. But the benefits need to be carefully weighed against the risks. In children such medications can affect physical development and are reserved for severe cases. Side-effects in adults include an increased risk of psychosis and heart problems, and they may worsen mental-health problems.

Better long-term solutions may be possible. Some scientists argue that these would include dealing with the arbitrary diagnostic criteria that exist for ADHD and other cognitive and neurobehavioral disorders such as autism and dyslexia. Common symptoms in people with ADHD are often similar to those in people with other conditions, making it difficult to determine which diagnosis is most appropriate. Additionally, some of the most common symptoms experienced by those diagnosed with one of these conditions are completely excluded from the diagnostic criteria. (Problems with emotional regulation are an example of ADHD.)

To overcome these problems, some experts believe that children and adults may be better served by a “transdiagnostic” approach, in which help is tailored to the individual’s specific cognitive, behavioral, and emotional difficulties without being bothered by diagnostic labels. Involves providing.

Researchers have shown that changes to a person’s environment can have dramatic benefits. Children perform better in life if parents and teachers provide a supportive, warm environment with structure and rewards for academic and behavioral achievements. For many adults, ADHD symptoms “go underground” when they’re in jobs and relationships that play to their strengths, says psychologist Stephen Hinshaw of the University of California at Berkeley. In a paper published October 16, Dr. Hinshaw and his colleagues reported that 64% of nearly 500 children with ADHD had symptoms that fluctuated during the 16 years they were tracked, including Also included were periods when they did not meet diagnostic criteria for the condition. ,

Nancy Doyle of Birkbeck University says that if schools and workplaces were redesigned to accommodate people with ADHD symptoms, much more could be achieved than if those individuals simply adapted to their environments. To be expected. In schools, closing classroom doors and windows reduces distracting noise; Organizing lessons to include standing and moving helps children who find it difficult to sit still for a full period. Dr. Doyle, who advises employers on how to accommodate neurodiversity, has found that the things employees with ADHD and other neurodiverse conditions find most helpful are the ones that are free — like the flexibility to work from home. Or choosing the hours of the day to spend in the office. ,

It remains to be seen whether such interventions can replicate the success of the drug on its own. But they can make life easier for many people with ADHD-like symptoms who turn to medication to fix problems caused by their conditions rather than their biology.

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