‘Social contagion’: What’s behind the rapid rise of midlife ADHD?

Adults with ADHD can be treated with medication such as methylphenidate (otherwise known as Ritalin) and cognitive behavioural therapy. Photo / Christina Victoria Craft, Unsplash

Rates of Attention Deficit Hyperactivity Disorder (ADHD) are skyrocketing in the UK: up 80 per cent in the last five years, with official figures showing a sharp rise in prescriptions among over-40s. According to the charity the ADHD Foundation, there has been a 400 per cent increase in the number of adults contacting the organisation to arrange an assessment since 2020.

What is behind these startling figures? After all, ADHD - a condition that makes it difficult to concentrate, follow directions and control impulsive behaviour - is traditionally associated with children. According to experts, there are two possible explanations: either the rise is the result of children of three decades ago being severely under-diagnosed, or it is the byproduct of the growth of the so-called “neurodiversity movement”.

“Many people are feeling unable to meet certain social demands and expectations and root this in their being neurodiverse,” says Professor James Davies, a reader in medical anthropology and psychology at the University of Roehampton. “The diagnosis of ADHD is seen to bring acknowledgement of that difference. [Having that label] is increasingly seen as a way to get validation, help and support, and this is driving up requests for a diagnosis.”

The number of people in the UK affected by ADHD currently stands at around 2.6 million. Children under 12 - who make up the lion’s share of this number - are treated either with special-needs support at school or medication such as methylphenidate (otherwise known as Ritalin).

For adults, medication is often taken in combination with cognitive behavioural therapy. And, for many, a diagnosis proves enormously helpful, providing an explanation as to why they struggle in certain scenarios. In particular, ADHD may have led to underachievement at work or problems in relationships. Adults with ADHD can also sometimes be dangerous drivers.

But a growing number of experts believe that adult ADHD is being over-diagnosed. In fact, according to Dr Joel Paris, professor emeritus of psychiatry at Montreal’s McGill University, the West is in the midst of a “diagnostic epidemic”. “We don’t understand how a lot of these things work,” he says of the behaviours that characterise the condition. “And a simple answer [of] a pill to solve them is very attractive.”

Telltale signs

A clinical diagnosis of ADHD in adults requires the presentation of five or more symptoms of inattentiveness (such as seeming easily distracted, forgetful, or unable to carry out instructions), or five or more signs of hyperactivity and impulsiveness (being unable to sit still, talking excessively, fidgeting) and involves a series of interviews between an individual and a specialist and interviews or reports from significant people in their life, such as partners.

Some people wait to see a specialist on the NHS, but, with waiting times up to six months, many prefer to be seen privately, spending up to £615 (about NZ$1186) for an assessment, titration, and a month’s worth of medication. And sceptics say these fees can act as an incentive for a specialist to medicalise what may not always be ADHD.

Other people don’t bother seeing a specialist at all and simply self-diagnose. In fact, in some online circles, ADHD has social kudos and is rebranded as a “superpower”. Far from ADHD being a disabling condition, and coming with comorbidities such as autism and anxiety (as it does in 80 per cent of cases, according to a 2017 paper), a tranche of adults have found that the tag “brings certain advantages”, according to Davies. “As the superpower idea of neurodiversity becomes more popular, being neurodiverse becomes a less stigmatised (and more attractive) identity.”

Paris agrees that it has become a go-to for those looking for a “quick fix”. The diagnosis, he adds, is essentially a medical sign-off that “it’s not your fault. Nobody can say that you just have a bad personality, or you don’t know how to cope.”

Online presence

Recently, the condition’s online profile has been boosted by ADHD influencers on platforms such as TikTok, whose videos are watched and shared in the tens of millions. While raising awareness can help to reduce stigma, research published earlier this year found that over half of the videos shared contained misinformation.

ADHD's online profile has been boosted by influencers on platforms such as TikTok.

These posts have become so prevalent that when one popped up unprompted on her feed, followed by another, Eliza Rowe* began to question whether she had ADHD. The videos made her wonder whether her lack of concentration and occasional brain fog were, as those on her screen were suggesting, a sign that she belonged to the “spoonies” community (a nickname derived from spoon theory, a metaphor for the limited energy those with ADHD have for daily tasks). After considering whether to get herself tested, she decided against, believing that the videos were aggrandising common personality quirks, rather than highlighting serious areas for concern.

“I know [ADHD] is a real thing and it must be hard to live with for those diagnosed, but the way people almost brag about having a disorder these days, I find quite strange,” the 36-year-old says. “To me, it seems every human flaw seems to be a ‘disorder’ recently and I question whether it’s a social contagion or a symptom of unnatural modern living.”

Some parents of longtime ADHD sufferers feel that this “trend”, at its most damaging, is trivialising what can be an utterly debilitating way to live. One mother says that her son, who is in his early twenties, struggles to go outside independently as a result of his ADHD, and remains living at home as a result. The online superpower cohort is “offensive”, she thinks, and often espoused by “a lot of people in midlife [who are] feeling invisible and want something to show off about… Their careers have hit a wall. They decide that something is wrong with them and hit on ADHD.”

She says that she was “traumatised” by her son’s childhood diagnosis, and that the day-to-day reality of being a parent of someone severely afflicted is entirely undermined by those now “cosplaying at being disabled”. But most galling, she adds, is the wider impact it could have on the perception of ADHD. Over the last few decades, parents “have tried to overcome the ‘naughty child’ stereotype. Now there is the idea that it’s not even a disability.”

Others in the neurodivergent community are more hopeful, believing the rising rates in adults mean that awareness among children will be heightened. “I think this is a wonderful thing,” says Lucy Baker, whose daughter was diagnosed aged nine after a “fight”. The condition remains “wildly misunderstood… it is a disability. This is a really key point. ADHD is not made up, it is a disorder, it is not an easy thing to live with. The increase of adults being diagnosed will have a positive effect on the current and next generation of children who go through school, and into work.”

Lorna Watkinson, whose 14-year-old daughter was diagnosed in May, agrees that a medical verdict has been transformative. Without it “we would be battling against a misguided belief she just needed to try harder”, she says. Pursuing her daughter’s ADHD diagnosis also uncovered something surprising - her own, via a private assessment. But, while glad to have clarity over her own condition, Watkinson is firm that “children should be assessed, diagnosed and tested as a priority over adults. Because the earlier a child can be diagnosed and interventions made, the better - the less impact there is on their mental health, [and] the more they can be themselves without apology.”

* Name changed