ADHD is on the rise; key reasons to know

Attention-deficit/hyperactivity disorder, more popularly known as ADHD, is among the most common mental disorders in children and teens. Not just children and teens, plenty of adults have it too. An estimated 7 million (11.4%) U.S. children aged 3–17 years have ever been diagnosed with ADHD, according to a national survey of parents using data from 2022. It's estimated that adult ADHD affects more than 8 million adults (or up to 5% of Americans). Many of them don't even know it. In 2022, an additional 1 million U.S. children aged 3-17 years had ever received an ADHD diagnosis compared to 2016.

The average age of ADHD diagnosis is 7 years old. Symptoms of ADHD typically first appear between the ages of 3 and 6. Boys (15%) are more likely to be diagnosed with ADHD than girls (8%). About 6 in 10 children had moderate or severe ADHD. Despite these concerning numbers, ADHD is nowhere near ‘under control’. Rather, the graph is inclining upward.

The American Centers for Disease Control and Prevention (CDC) put the prevalence at 11.4% in children in 2022. The Swedish Board of Health and Welfare reports that in 2022 10.5% of boys and 6% of girls received an ADHD diagnosis, which is 50% more than in 2019. And the board forecast that the rates will eventually plateau at 15% for boys and 11% for girls. All these numbers and statistics only end up posing one glaring question regarding the rise of ADHD -- what might be the reasons behind the steep rise of the syndrome?
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The exact cause of ADHD is unknown, but researchers believe it's likely a combination of factors, including genetics, environmental factors, and problems during development:

Genetics: ADHD tends to run in families, and studies suggest that genes play a significant role. However, the way ADHD is inherited is likely to be complex. ADHD tends to run in families, with first-degree relatives of people with ADHD being about nine times more likely to develop the condition. Twin studies show that ADHD has a high heritability rate of around 71–90%. Genome-wide association studies (GWAS) have identified several genetic loci that may be involved in ADHD.

Environmental factors: Exposure to environmental toxins, such as lead, PCBs, and other chemicals, may increase the risk of developing ADHD. Habits like maternal smoking, alcohol use, drug use, and stress or anxiety during pregnancy are associated with ADHD. Most studies find evidence of an association between ADHD and low birth weight and prematurity. Some systematic reviews have reported a positive association between gaseous air pollution and ADHD. Besides, exposure to environmental toxins, such as lead, found mainly in paint and pipes in older buildings, may increase the risk of developing ADHD. Apart from these, low socioeconomic status (SES, adverse social and family environments may be associated with ADHD.

Problem with nervous system: Problems with the central nervous system (CNS) during development may play a role in the development of ADHD. While the exact cause of ADHD is unknown, research suggests that peripheral inflammation may play a role in the development of ADHD. Research has identified various abnormalities in the CNS of people with ADHD. These abnormalities include reduced brain volume, thinning of the cerebral cortex, and impairments in brain function.

Changes in familiar setting: Kids and teenagers are often found struggling while being in the middle of some transition. Whether it is a change in habitat, or school or friends and surroundings, the change in familiar setting seem to affect them more vividly. Sometimes, that sudden change without an ease attached to it can lead teens to develop ADHD.

Schools today have gone through substantial changes in how they teach, such as digitisation and introducing more project- and group-based learning, as well as much more self-guided education. These changes have led to a less clear learning environment, including increased demands on students’ motivation and their cognitive skills, factors that can make it harder for students with even just a few traits of ADHD to succeed. It has also caused schools to refer more students whom they suspect of having ADHD for assessment.

Pressure on cognitive skills: ADHD is not a disease but a condition that is caused by malfunctioning composition of cognitive traits that exist on more functional levels even in the general population, such as ‘attention control’ (concentration) and organisational and self-regulation skills. Today’s face-paced and complex hustle culture tends to place high demands on these cognitive traits that allows people to ‘earn‘ their livelihood which induces extra stress. So people with lower than average skills in these key cognitive areas begin struggling to cope with everyday demands and might receive an ADHD diagnosis.

Higher expectations of performance: People’s expectations of their own and others’ performance are skyrocketing. The pressure of productivity exerts a pressure heavier than a hydraulic press and the so-called ‘social baseline’ of average performance is tagged as a stigma that people need to overcome. People expressing concerns about their own and others’ functioning earlier and more often, are succumbing to ADHD.

Multiple diagnoses in the same person: Previously, doctors were recommended by diagnostic manuals and trained to limit diagnoses in an individual to the most prominent one, and not to make certain combinations of diagnoses at all – for example, autism and ADHD. Today, it is recommended and common practice in the mental health sector to make as many diagnoses needed to meaningfully describe and cover the symptoms and challenges of a person.

Increased knowledge and awareness by professionals: Today, there is a new generation of professionals working in services with higher awareness and knowledge of ADHD. This has led to earlier detection and to ADHD being diagnosed in groups that were previously neglected, particularly girls and women - but also in adults.

Reduced stigma and reassurance of support: Compared to previous times, ADHD is far less stigmatised today. Doctors, being better equipped today, have fewer doubts about making the diagnosis, and those receiving it feel less stigmatised. Services are constructed as such that a clinical diagnosis guarantees access to support and resources. So people in need of support are more likely to actively seek a diagnosis. And professionals are more inclined to assist them by giving a diagnosis, even if the person doesn’t quite meet the diagnostic criteria for ADHD – a phenomenon called ‘diagnostic upgrading’.
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