291. Is ADHD “Caused” by Modern Society?

Dr. Jeremy Sharp Podcast 2 Comments

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With books like Stolen Focus & Dopamine Detox, it makes sense to ask whether modern society is increasing the prevalence of ADHD. There are many layers to this question, so I tackle a few of the key points, including:

  • ADHD & neurodiversity
  • Is ADHD a new diagnosis?
  • What constitutes pathology?
  • Technology’s impact on ADHD symptoms

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I’m a licensed psychologist and Clinical Director at the Colorado Center for Assessment & Counseling, a private practice that I founded in 2009 and have grown to over 30 clinicians. I earned my undergraduate degree in Experimental Psychology from the University of South Carolina before getting my Master’s and PhD in Counseling Psychology from Colorado State University. These days, I specialize in psychological and neuropsychological evaluation with kids and adolescents.

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Comments 2

  1. Two quick caveats, and then a larger topic for food for thought.

    First caveat: We can’t use the fact that ADHD has been described for decades/centuries as evidence that modern life isn’t causing ADHD. When it was first mentioned in the medical literature (by George Still in 1902, and arguably in earlier classic medical texts), it was (a) considered quite rare (indeed, the point of Still’s description was how unusual it seemed that these children with normal intelligence were struggling so much with impulse control), and (b) was probably referring to very severe/highly observable cases, many of which were likely related to hidden medical causes (e.g., nutritional deficiencies; toxic exposure; early catastrophic injury/accident/abuse; complications during childbirth, etc). Now, even though all those mortality and morbidity factors have been dramatically reduced and life is medically a lot safer, ADHD rates have VERY dramatically increased, and continue to do so (e.g., they have gone up 42% in the last twenty years alone). So while we can say that modern life is [probably] not causing *every* case of ADHD because historically some people with ADHD-like syndromes have always existed, we don’t have any evidence that modern life isn’t causing *most* cases of ADHD.

    Which brings me to the second caveat, which is that: We absolutely have good evidence that at least some cases of ADHD are being caused by modern life. As just one incontrovertible example, we know that having a summer birthday dramatically increases your likelihood of being diagnosed with ADHD. The simple act of expectations being just a small amount outside of what is developmentally appropriate is literally ‘causing’ these children to be diagnosed with ADHD. Maybe these children don’t have “true” ADHD that could be detected by a brain scan (if we ever get there), but from a behavioral diagnostic perspective, modern life’s expectations — that they should be able to keep pace with peers up to one year older — is indeed ‘causing’ them to have ADHD.

    But, I don’t think that’s what books like “Stolen Focus” are discussing, really. I don’t think books like that are arguing that modern life is causing TRUE cases of ADHD. I think these authors would say, “sure, there are lots of people with true ADHD, and modern life might not be helping them, but it’s not causing their ADHD, and it’s not who we’re writing our books for.”

    Which brings me to my food for thought topic. Which is that, there has certainly been a rise in people who THINK they have ADHD, and FEEL like they have it. I would imagine every listener of this podcast has experienced that increase in people coming in who believe they have ADHD, but who don’t meet full diagnostic criteria. Specifically, the differences between these “thought/felt cases of ADHD”, and more “classic, meets-the-DSM-criteria cases of ADHD”, are something like:

    (a) The person does not show the true level of functional impairment seen in classic ADHD, and indeed is often functioning at a really high level (even if that feels quite hard for them)

    (b) The person’s collateral raters do not see the ADHD symptoms that are readily observed by raters of people with classic ADHD

    (c) The person does not demonstrate obvious impairment on EF tasks either in the testing room (impairment that is at least sometimes seen in classic ADHD) or in their real life (e.g., as noted, although it feels effortful for them, they often do get their EF stuff done)

    (d) The person reports a lot fewer/lower levels of the DSM symptoms of ADHD, but a lot more/more intense levels of the ‘related symptoms’ of ADHD that are not in the DSM (and which are actually quite prevalent in the general population), such as procrastination, lack of motivation for non-meaningful tasks, feelings of overwhelm, and rejection sensitivity dysphoria

    (e) The person’s developmental history does not clearly support an ADHD diagnosis, and

    (f) The person self-reports they can actually focus, inhibit, and self-regulate quite well in ideal conditions, such as when they are in a flow state or on vacation (which is not compatible with brain-based explanations of a pervasive deficit in these skills)

    Books like “Stolen Focus” are arguing that THESE KINDS of cases of feeling like you have ADHD [with the implied add on of “when you really don’t and are actually probably functioning at a pretty high level despite feeling so miserable”] are caused by modern life. The authors of these books marshal a lot of research — both qualitative and quantitative — showing that modern life is leading *many* people to feel like they have fragmented attention, difficulties doing deep work, feelings of overwhelm and burnout, chronic worries about/intense reactions to being rejected by others, a constant urge to procrastinate through mindless activity, and a sense that everything is just harder than it is “supposed” to be (or that we imagine it is for others). These authors aren’t arguing that modern life is causing actual cases of ADHD — they are arguing that they are dramatically increasing these feelings of misery and burnout in everyone, and perhaps especially people who have the privilege to still *try* to keep up with all of modern life’s demands (aka, the people who are pretty high functioning).

    I think they make a good argument, personally. If anyone else is interested in these topics, Johann Hari’s Stolen Focus is a great start. Other great books include: How to Do Nothing (Odell), Do Nothing (Headlee), 4000 Hours (Burkeman), Laziness Does Not Exist (Price), The Shallows (Carr), Deep Work (Newport), and Can’t Even (Petersen).

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