Do more people really have ADHD or are we misdiagnosing ourselves?

Growing up as a child with attention deficit hyperactivity disorder (ADHD), I painfully remember the stigma associated with the condition. For every adult who offered understanding and accommodations, there were others who insisted I was using my ADHD diagnosis as an "excuse" for laziness or that I simply needed to "buck up." In some respects, though, I was actually lucky; in eras before my own people with ADHD were accused of being outright bad people.

Yet when I reached out to experts for this article, I repeatedly heard the same observation — that the pendulum may have actually swung too far in the other direction. These mental health professionals shared the observation that because ADHD is a "trending" condition, people may inaccurately self-diagnose as ADHD when they in fact have something else.

"There may once have been a stigma, but now I see just the opposite," Dr. Jessica January Behr, a licensed psychologist who practices in New York City, told Salon by email. "It seems that people are more accepting of ADHD as a diagnosis than most others conditions and will identify with the diagnosis whether or not they have been formally assessed and diagnosed by a professional." (Behr also added that "many people often seek ADHD assessment to ascertain academic or work accommodations.")

There have been increased prevalence of ADHD over the years, but some experts question whether this is due to increased recognition or overdiagnosis. Behr described ADHD as "trending" but added that this "doesn't mean that everyone actually meets criteria, or that everyone who does requires medication or intervention." Even though self-diagnosing as ADHD can be comforting because it can validate a person's personal challenges or demystify certain behaviors, that does not always mean ADHD is the actual clinical answer to a person's mental health struggles.

Dr. Ramani Durvasula, a licensed clinical psychologist and professor of psychology, also expressed concern about people self-diagnosing. While there is still a stigma surrounding ADHD, Durvasula told Salon that the disorder "may carry less stigma than other issues that also need to be considered, such as depression or anxiety or even personality issues."

There are underlying conditions such as learning issues and reading impairments which are distinct from ADHD but may appear to an untrained eye as being that condition. At the same time, Durvasula is compassionate about why people who display ADHD-like symptoms may prefer to self-diagnose rather than receive a formal diagnosis.

"I think with any neurodivergence or mental health issue, there is a fear that others won't believe it and will just say 'buck up,' and that also can raise anxiety and perhaps keep people from getting evaluated," Durvasula said. "And keep in mind, it ain't cheap to get formally evaluated for ADHD either."

The symptoms that Durvasula said are most likely to indicate ADHD include distractibility, such as losing track of a conversation; chronically forgetting where to put important property, like keys; losing one's train of thought; forgetting important details that cause problems in relationships; struggling to sit still, fidgeting or otherwise moving their body; being easily bored and distracted; procrastinating and struggling with time management and completing tasks.

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In addition to paying attention to the potential symptoms of ADHD, people who think they may have the condition should also rule out any factors in their lives that could lead to a misdiagnosis, according to Dr. Catherine Lord, the George Tarjan Distinguished Professor of Psychiatry and Education at UCLA's Semel Institute of Neuroscience and Human Behavior.

"For a new diagnosis of ADHD, the first thing someone probably needs to do is to ask if anything has changed in their lives," Lord said, such as whether their job has given them greater demands or whether their symptoms might be caused by anxiety or depression.

"You want to try to rule out other possibilities than ADHD," Lord advised, adding that "usually ADHD doesn’t suddenly appear in adulthood, but it may be that demands have changed or past-coping strategies can’t work (e.g., can’t get as much exercise, or miss an understanding group of friends)." Like Durvasula, Lord identified common ADHD traits as including trouble with concentrating and carrying out tasks, difficulty with organization and regularly losing or forgetting important items like keys or glasses. Lord also said that people with ADHD may struggle with impulsive actions and speech.

"There are many ways people can cope once they recognize that these things occur and realize they can do something about them," Lord told Salon, suggesting that people who have difficulty paying attention can start by "breaking tasks into small components, using technology or schedules to make sure they have enough time or to remember where things are (where they parked?) and making sure they meet mini-deadlines." If you struggle with impulse control, you can learn "to wait before you do something impulsive such as firing off an angry text." A person with ADHD-like symptoms can also focus on training themselves to listen — and, if a doctor advises it, to take medication.

Behr also suggested that people who have to manage ADHD symptoms can work "on emotion regulation skills typically taught under the [dialectical behavioral therapy] framework can be helpful as well as building executive functioning skills that focus on working memory, mental flexibility and impulse control. Both of these skills can be done with a trained therapist in individual or group therapy, or alternatively with a coach or even on your own."

Durvasula observed that because there are so many possible reasons why someone may struggle with paying attention, it is imperative not to throw out a diagnosis until "all pathways are considered for inattention."

"We live in a distracting world — devices yelling at us all the time, showing images, giving validation," Durvasula wrote. "You have to have nerves of steel to not get pulled in a million directions. That is why we do look at these disruptions in trains of thought, disorganization, time management struggles, and also look at whether other people are noticing these difficulties before we consider ADHD as a 'diagnostic' issue. With so may coaches and self-help sites out there, there is a concern that people may miss other things happening to them and calling their inattention ADHD, or vice versa may miss the opportunity to recognize how ADHD is causing frank issues in their life and pursue treatment and intervention."