Diagnoses of attention deficit hyperactivity disorder are soaring. Figuring out why is a minefield.
Writer Sophie Knight, 37, lives in Amsterdam. Most mornings, she unlocks her bicycle from beside her apartment building so she can ride to work as a freelance journalist and researcher. “There’s a sequence of things I need to do when I unlock it,” she explains. “I need to put my gloves on, put an earphone in and link it to my phone, put my phone in my bag, put my bike cover in my bag.
The net result is that suddenly all of us – kids at school, adults at dinner parties, HSC and VCE students in their exam rooms – are discovering that our friends, colleagues, family members, even we ourselves, have ADHD. What’s more, a bewildering multiplicity of factors – COVID-19 and TikTok, devices and historic under-diagnosis, Big Pharma and Instagram influencers – have been implicated in its rise.
Academic under-achievement is a hallmark, but not a universal characteristic, of ADHD. Just as the condition exists on a spectrum, so too its impacts fall unevenly on people’s lives. Some people function extremely well – it’s common to hear stories of people with ADHD being innovative lateral thinkers; super-social; charismatic charmers.
Today, pharmaceutical companies fund a great deal of the scientific research into ADHD; they also pay for conferences, travel, and medical education for many ADHD professionals. This happens in all areas of medicine, Moynihan acknowledges – “But it shouldn’t. Clearly, if someone is helping pay your bills, you are more sympathetic to them.”
How much of the suffering caused by ADHD is actually the result of social judgment, rather than physical impairment? The fact is, the entire concept of ADHD is intimately connected to what we, as a society, think is acceptable behaviour in public life. Some people with ADHD choose not to medicate on weekends or holidays – when they don’t have responsibilities to the wider world – because it’s their only chance, as Sophie Knight puts it, “to be themselves”.
This might be because she’s distracted by a never-ending, constantly shifting stream of internal demands. If she sits down to watch an hour of TV, “I’ll get up maybe five times, because my brain tells me I need to fetch lip balm, get tea, take off my nail polish, text five people, stretch, do the washing-up, organise my desk.” Even when she’s exhausted or ill, this constant mental insistence never ends.
Importantly, such research doesn’t question the existence of ADHD; only the best way to manage it. There are, however, some groups who struggle to believe ADHD is a real disorder at all.“As an independent neurodevelopmental disorder, that can be treated by specific medications, it does not exist,” says Professor Jon Jureidini, child psychiatrist and head of the University of Adelaide’s Critical and Ethical Mental Health research group within the Robinson Research Institute.
During the Senate inquiry, the committee heard that people seeking diagnosis in Australia can face wait times of more than a year, and a significant lack of resources, especially in the public system. As the Royal Australian College of General Practitioners put it in its submission, “Most public sector mental health services do not provide ADHD services to adults, in effect pushing people to private sector care and support.
“It’s making health inequities worse,” says the University of Sydney’s Brain and Mind Centre’s Ian Hickie. “Because those who can afford get more of it, and those who are more disadvantaged get less.” False diagnosis, finally, is also an issue: either because people genuinely but mistakenly believe that they have ADHD, or because they are pretending to have the condition when they know they don’t. This is understandably an emotive issue for those in the ADHD space, but it certainly occurs, though no one knows to what degree.There are several reasons people deliberately fake it.
In addition, an ADHD diagnosis allows students in both Victoria and NSW to apply for special provisions like smaller exam groups, rest breaks and extra time in exams. These adjustments, of course, also benefit students with incorrect ADHD diagnoses – a fact not lost on parents. Hickie points to figures released by the NSW Education Standards Authority showing that 17.
Psychostimulants are listed as Schedule 8 drugs in Australia. This means they have a high potential for addiction, over-prescription and misuse. But doctors and patients like them because of their speed and effectiveness. In severe cases, medication can seem like a miracle cure.
In the meantime, he adds, the majority of expert opinion internationally, plus that of the AADPA guideline development committee, is that “on balance, medications are going to help most patients, and have a very low likelihood of adverse effects: a very good safety profile. So it’s a balance of benefits to harms that we’re making; a balance of accessibility, and how easily these medications can be used in clinical settings.