How real is your ADHD?

Why does everyone suddenly seem to have ADHD? It’s a question that many of us working in mental health have been asking each other recently. Just a decade or so ago I rarely saw anyone in clinic with ‘attention deficit hyperactivity disorder’; now I see at least one case a day. It’s bewildering. Have all these people simply been undiagnosed for years? Is ADHD a medical fad? No one yet knows.

ADHD used to be mainly diagnosed in children, but more and more people are now getting a diagnosis in adulthood. These adult patients tend to assume that they have had ADHD since childhood but what they don’t grasp, and don’t want to grasp, is that even the existence of childhood ADHD as a condition is up for debate.

Research suggests that far from being under-diagnosed in children, ADHD is now wildly over-diagnosed – and that this is actually dangerous. A hasty diagnosis stops medics from making in-depth assessments and analysing properly what is happening in a child’s life – how they are being parented, for example. But of course it’s easier to whack a label on a child – to medicalise their behaviour – than it is to confront parents with the idea that they might be at least in part to blame for the way their offspring behave.

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There are also concerns that the mainstay of ADHD treatment – powerful stimulant medications such as methylphenidate – can have serious side-effects. The evidence is anyway not clear that this medication is truly effective, and the majority of trials into the use of methylphenidate have been deemed by Cochrane (a body which independently evaluates research) as being ‘at high risk of bias’.