TikTok trends or pandemic? What is the reason for the high diagnosis of ADHD?

Danny Donovan almost never published the illustration that changed her life: a stark visual gag that translated her ADHD-infused storytelling style into a 12-point flowchart.

When she was Release her Having entered the world of Twitter in December 2018, I realized that few people would be watching it. Instead, the post went viral “almost instantly”, racking up more than 100 million views across social media channels. A little over a year later, she quit her graphic design job to make cartoons about ADHD full time.

Donovan, 31, has become something of a major mayor in the vast arena of ADHD influencers, a niche that almost didn’t exist when she shared her inaugural position just three and a half years ago.

Attention deficit hyperactivity disorder, or ADHD, is having a moment. On TikTok, videos tagged with #ADHD have been viewed over 11 billion times. Most creative people are 20 to 30 years old who are known to have executive function disorder, the symptoms of which usually include difficulties concentrating and regulating emotions. Some are medical practitioners who use their platforms to correct misconceptions (and discourage self-diagnosis). Altogether, they post to ever-growing audiences.

The trend indicates an increase in ADHD diagnoses in adults over a decade ago. The continuing rise of juvenile ADHD has already been a concern (and interesting). But between 2007 and 2016, the incidence of ADHD in adults increased by 123% in the United States, far outstripping the rate of increase in cases in children and adolescents. In the mid-2010s, adults replaced children as the primary market for ADHD medications.

The comedian who launched Kelly Donovan's career.
Photography: Kelly Donovan

There is some anecdotal evidence that this phenomenon accelerated at least during the pandemic, and most likely it did. In a survey published by ADDitude in March, more than a quarter of 2,365 adult readers of the publication focused on ADHD reported having received an official diagnosis of ADHD within the past year. Online pharmacy SingleCare saw a 16% increase in prescriptions for generic Adderall, a known stimulant drug for ADHD, from the beginning of last year to the beginning of 2022.

Some attribute this pattern to social media. Donovan testifies to this firsthand, that she has received more than 1,000 messages from people who have followed clinical assessments and received diagnoses thanks to her content. The ten-year-old Reddit r/ADHD page has grown from 643,000 subscribers in March 2020 to more than 1.4 million today, accurately charting the increased ADHD curiosity (if not necessarily diagnosis) that coincides with the epidemic. But the growing prevalence of this disorder is not so much a fad fueled by overexposure to social media as the tangle of distinct cultural and diagnostic threads, each complex in their own right. The age of ADHD is the clash of science and society, and the resentment of both.

It helps to break things down. ADHD exists as a neurodevelopmental impairment with known anatomical correlates (think of the small amygdala and hippocampus of the brain), and ADHD as a clinical diagnosis with huge profit potential for the pharmaceutical industry. Then there is #ADHD as an algorithmic content motivator and experience confirmation.

Dr. Margaret Sibley, a clinical psychologist and ADHD researcher, says: “People can make a diagnosis of ADHD to school or the workplace, and their responsibilities may be reduced because of that, or facilities for testing, etc. When there are advantages like that, you have different types of consumers.”

In other words, ADHD can give people a measure of grace for not meeting productivity expectations that would strain the most basic ability of most humans. To this end, the pandemic may have provided an even greater incentive to seek diagnoses of ADHD. With the advent of Covid-19, many people suddenly found themselves unable to read books or maintain basic email correspondence, as their focus was completely and uncharacteristically filmed. This phenomenon has been so obvious and widespread that it has fed a media subtype of interpretations of psychological reassurance, helping readers anticipate a decline in cognitive ability, given the “unprecedented” challenges of the era.

The striking overlap between ADHD symptoms and the park’s diverse “epidemic brain” only exacerbates a common misunderstanding of the former. Simply put, ADHD symptoms can seem like the struggles that define the daily functioning of many people, often fragmented by push notifications and digital dopamine hits. From no Having trouble multitasking or keeping track of tasks? And from no Fighting the urge to scroll on social media during especially boring moments any afternoon? In the past two years, these difficulties have become more and more apparent.

But whether or not ADHD is overdiagnosed is a separate question, and one without simple answers. Two things for sure. For example, research indicates that ADHD is not an obvious disorder that a person has or does not have, but rather a combination of challenges that appear on a spectrum of vulnerabilities. According to Sibley, strict psychological evaluation criteria must be able to determine between a clinical presentation of the disorder and the mere presence of certain features of ADHD.

The second thing that is certain is that the stimulant medications often prescribed to treat ADHD are very controversial. Skeptics are quick to point out that drugs like Adderall and Vyvanse are, effectively, industry-regulated speed doses. Whether or not everyone with ADHD has the disorder is a statement of the uncomfortable fact that most people’s productivity will see improvement from the medications prescribed to treat it.

The result is what Sibley describes as a “philosophical debate,” albeit often cloaked in safety language.

“You could ask yourself a similar question about people who use steroids in sports,” Sibley says. “People can bring up the pros and cons, but in the end it’s about what people value more than it’s a safety issue, because you can administer stimulants safely in anyone, even someone with ADHD.”

Aside from the discussions, getting ADHD diagnoses — and the medications that treat the condition — are much easier during the pandemic. Social distancing measures have removed legislative barriers that previously restricted remote providers from prescribing controlled substances, a class of medication that includes many ADHD medications. This has allowed a number of project-backed telehealth startups to expand their allocation, and has led some to redirect focus to diagnosing ADHD and prescribing medications for its treatment.

The transformation did not go unnoticed. The same algorithmic mechanisms that underpin the vision of #ADHD TikToks and Instagram memes are also underpinning ADHD treatment offerings from startups with judging names like Klarity, Done, and Cerebral. The ads promoted by these companies have become an inescapable window into the social media feeds of many people.

But the opposition is underway. At the end of April, a former Cerebral CEO launched a business lawsuit against his former employer, alleging he was fired for expressing concern that the company had “blatantly put profits and growth on patient safety” by prescribing excessive medication for ADHD. In recent weeks, an increasing number of online pharmacies and traditional pharmacy chains have stopped filling prescriptions for controlled substances like Adderall placed by telehealth providers.

A plate of white discs immersed in a bluish light.
The pandemic has removed legislative barriers that previously restricted remote providers from prescribing controlled substances, such as Adderall. Photo: GB Read/Bloomberg News

The massive upheaval of stimulant medication paints a misleading picture of what some patients actually want or need. “The thing is, drugs aren’t a panacea,” says Joy Hoy Lin, a freelance journalist in Southern California in her early forties. “You need a structure.”

Hui Lin was diagnosed nearly five years ago, after learning about her struggles in an article about ADHD in women. I quickly learned that due to social gender expectations and societal bias, ADHD is often misdiagnosed or overlooked in girls and women, especially girls and women of color.

What I perceived as personality deficiencies turned out to be biblical features of the disorder. She also realized that while the medications were a helpful aid, she benefited most from implementing routines to help stay on top of her daily responsibilities.

A similar feature is echoed by “Cindy Noir”, the online personality of the 26-year-old social media content creator based in Dallas. Last summer, a licensed psychiatrist reached out to Noir after she watched a live broadcast on TikTok in which Noir talked about the difficulty of completing household tasks and communicating ideas in line with her fast-fire brain. The therapist was unable to give Neuer a formal diagnosis of ADHD from a single phone call and email exchange, but he expressed the view that Neuer likely met the diagnostic criteria for the disorder and recommended that an evaluation be sought.

“Unfortunately, as a woman and as a minority, she said, actually being diagnosed with ADHD is one of the biggest uphill battles because they will diagnose your symptoms as other things and not as ADHD,” says Noir, who is black. She ultimately chose not to pursue a formal evaluation for ADHD or a course of pharmaceutical treatment due to a lack of health insurance coverage, but she says her life has improved from adopting organizational strategies recommended for ADHD patients, such as preparing to-do lists and setting electronic reminders. She feels in control and empowered.

What the mainstream debate often overlooks is that most people do their best with the resources at their disposal. The corporate cynical exploitation of individuals’ deepest vulnerabilities, amid the unethical landscape of the for-profit healthcare system, deserves scrutiny. But it seems unfair to dismiss the relief people find with a diagnosis of ADHD, or from social media content that affirms and supports their efforts to live their lives to the fullest.

“I see the relief and belonging that started to happen from people who felt they didn’t fit in anywhere else,” says Donovan, an ADHD comic artist. “They found this space, like, ‘OK, these are my people.’ These are my people.”

2022-06-02 08:00:00

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