Rethinking ADHD: disorder or variance?

There is wide controversy about ADHD and many people are cynical about the use of labels, overdiagnosis, even its very existence.

ADHD is described as a mental health disorder, a brain disorder, a neurodevelopmental disorder and a disability, depending on where you look. It is thought to be an ongoing pattern of inattention, hyperactivity/impulsivity observed in childhood and present for at least six months or more, and persists into adulthood. It also involves cognitive executive function challenges and emotion regulation difficulties.

Many of my ADHD clients struggle to make sense of their diagnosis. Many not yet diagnosed are anxious about getting a diagnosis or not, longing for the sense of relief and validation for their struggles. Others, once they have a diagnosis, have a challenge, wonder how to make sense of it and integrate it into who they are and how they see themselves in the world.

ADHD: increase in diagnosis

There has been an increase in referrals for diagnosis and treatment of ADHD, and a 51% increase in prescriptions for ADHD medication, according to the Nuffield Trust. Between 2000 and 2018, there was approximately a 20-fold increase in diagnoses and nearly 50-fold in prescriptions in men between the ages of 18 to 29. The recent increase in prescriptions has meant a struggle to meet demand, the shortage affecting most people who rely on this treatment.

Despite the concerns surrounding rising diagnosis rates, there is also evidence of under-diagnosis and limited treatment as indicated by a 2006 U.S. survey showing only 11% of adults with ADHD receive treatment. There is a pressing need to acknowledge the shortcomings of our healthcare systems in order to improve treatment and support options.

Diagnosis misinformation

In just a six month period in 2022, there were 5.8 billion tracked views of ADHD on TikTok, playing a significant role in raising awareness about ADHD. Many individuals credit social media platforms for helping them recognise their own symptoms and seek treatment. However, the internet and social media landscape is rife with misinformation, and a recent study found that over half of ADHD content on TikTok was misleading, primarily posted by non-healthcare professionals. Content posted by healthcare providers was found to be much more accurate and beneficial.

BBC’s Panorama called out diagnostic procedures in an undercover investigation into several private clinics, including a Harley Street psychiatrist, ADHD Direct, and ADHD 360 after receiving reports of rushed and inadequate assessments from patients and whistleblowers. Rory Carson, an undercover reporter, feigned symptoms of a neurodevelopmental disorder and, alarmingly, still received a diagnosis from all three clinics. This is concerning given that the condition is recognized as a disability that impacts behaviour and is classified as a protected characteristic under the Equality Act 2010.

However, the Panorama programme has added fuel to the fire of the ongoing controversy around the nature of ADHD. While their perspective may seem sceptical, it has brought up important questions about reliability of diagnosis based on assessment processes taking place.

Is ADHD a disorder or cognitive variance?

As the conversation around ADHD diagnosis continues to evolve, it is essential to examine the implications of labelling it as a disorder; if such a large portion of the population may have ADHD, what are we to make of this prevalence? While diagnosis can provide valuable insights and access to treatment, it is crucial to consider whether this classification is truly accurate or beneficial for those affected. In exploring this question, we must delve into the nuances of neurodiversity and consider alternative perspectives that challenge traditional views.

A growing body of thought posits that ADHD may not be a disorder at all, but rather a natural variation in human cognition that has evolved to be advantageous in certain contexts. The social model of disability suggests that disability arises from societal barriers rather than intrinsic deficits. In addition, the evolutionary mismatch theory posits that modern societal expectations, such as prolonged focus on academic tasks, conflict with the behaviours that were advantageous in our ancestral environment.

In the case of ADHD, this implies that the challenges associated with ADHD may be more accurately viewed as a result of society’s expectations and structures rather than as an inherent disorder.

However, the argument for ADHD not really being a disorder must not minimize the very real struggle of people with ADHD and the possibility that it IS in fact a disorder.

Evolutionary benefit

The concept of environmental mismatch proposes that traits associated with ADHD may have been beneficial throughout our evolutionary history. For instance, the ability to hyperfocus on a task, impulsivity, and quick shifts in attention could have been advantageous for early humans navigating dynamic, unpredictable environments.

Some research shows scientific findings to support the notion that ADHD results from variations in brain development rather than inherent defects. This may explain that ADHD-related behaviours could have once provided an evolutionary benefit, and why associated genes persist so frequently today.

For example, a study measuring foraging skills (through a digital simulation) found that those who frequently shifted their gaze between bushes and spent less time lingering on one bush, moving on more quickly, gathered significantly more berries than non-ADHD participants. This could reframe traits like impatience, or inability to focus on one thing for a long time as an advantage in this situation given the demands of the environment and task.

Other research looked at nomadic tribes in Africa that carry the genes associated with ADHD in greater proportions, and that those that carried more of those associated genes demonstrated greater success and well-being than those that didn’t. In this nomadic culture, we can clearly reframe the ‘always on the go’/ restless trait from a negative to a positive.

Considering ADHD through this lens encourages us to evaluate the way we frame it in terms of the wider context in which we are operating, and so we need to ask, is the person suited to the environment? Many a physiotherapist would concur that we have not evolved to sit at desks for eight hours a day and live such sedentary lifestyles.

Rethinking ADHD

The recent surge in ADHD diagnoses and subsequent medication shortages underscore the urgent need to better understand the complexities of the condition. By examining the potential and strengths of neurodiverse minds, we can move beyond the constraints of labels, overdiagnosis concerns and limitations, and fostering a more nuanced understanding of ADHD that acknowledges individual experiences and empowers those affected. The positive psychology movement offers a fresh perspective that moves away from the medical model and encourages a strengths-based approach.

Chris Packham states:

“Neurodiversity is an inbuilt, important part of our species. We’re all manifestly physically different. We need variation in any species, because if resources change and conditions change, certain members of that species will prosper above others. It’s a survival mechanism.

“You can’t argue that neurodiverse people haven’t been shaping civilization – perhaps it’s an important part of our function, perhaps that’s why we’re there. There’s an expression ‘ Oh, that person sees outside the box’, I don’t see a box. In a time of crisis, we need people who don’t see boxes. I’m not saying it’s all down to them but I’m saying we have a role to play.”

This article was first published on Central Bylines:

https://centralbylines.co.uk/news/health/rethinking-adhd-disorder-or-variance/