Forty percent of internet users turned to the world wide web for health information in 2015, just a few short years ago, research published at the time found. Of those, just under 4 percent used public chatrooms to find information.
That number had skyrocketed by 2021 — in the age of COVID-19, an era of health worries and decreased access to face-to-face healthcare, 76.1 percent of netizens used the internet to gain insights into their health. An even bigger 92.6 percent searched for information about a condition they had already been diagnosed with or looked to the internet for information about a loved one's health.
Shockingly, Whatsapp, YouTube, Instagram, Facebook, and Twitter were among the most popular sources of health information — this research came out just before TikTok exploded.
You could be right. You could also be wrong. The world we live in doesn't need more widespread awareness of ADHD — it needs more in-depth awareness.
On the one hand, greater openness about mental health struggles is wonderful — it allows patients to connect with others who understand and develop strategies that improve their quality of life. On the other hand, this same openness poses a very real danger.
When videos content creators make, often simultaneously to help others and to make a profit, invite internet users to wonder if they have ADHD because they're occasionally forgetful and get distracted when they have to do boring work. The true clinical picture is far more complex.
How Are Mental Disorders Defined?
The American Psychological Association is responsible for curating the document used to guide mental health diagnoses in the United States and beyond. This document, called the Diagnostic and Statistical Manual of Mental Disorders (DSM), undergoes periodic updates that usher in a new version.
As professionals learn more about the nature of a disorder, the diagnostic criteria can change — and so can the name of a disorder, or even whether a specific symptom cluster should be considered a disorder at all.
The DSM, informally called the "Psychology Bible", doesn't always get it right. That's why the first version looks very little like the current one. But it's the best we've got at the moment.
How Is ADHD Diagnosed?
Clinicians don't merely ask patients about their symptoms. An adult or adolescent diagnosis of ADHD requires that "several" symptoms of ADHD were present before the patient reached the age of 12. Symptoms must occur across settings — not only at school or work, for instance, but everywhere the person goes.
To increase the odds of making an accurate diagnosis, clinicians look to "consulting informants" whenever they can. That is, clinicians interview people in the patient's life who have observed the patient in multiple settings, to get a better view of their behavior. This often includes parents and other relatives, and can also involve teachers and coworkers, or even friends.
The DSM notes that "adult recall of childhood symptoms" is especially unreliable.
Clinicians also have to consider a wide variety of differential diagnoses — other mental disorders that may better explain the symptoms patients present with. These could be disorders patients have never heard of, because while ADHD is a disorder that's attracted much public attention, the same is not true for all mental disorders.
Clinicians are in a better position to judge whether the symptoms a patient has fall within the norm, or if they truly warrant a diagnosis. That is, not everyone who seems to meet the diagnostic criteria for ADHD at first glance has a mental disorder at all. All ADHD symptoms are a normal part of the human experience — it is their extent, and the impact they have on the person's functioning, that matters.
ADHD: A Closer Look at the Diagnostic Criteria
ADHD stands for "attention-deficit/hyperactivity disorder". The DSM-5 concisely defines it as "a persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning or development". The diagnostic criteria are separated into two parts.
1. The Inattentive Symptoms of ADHD
The internet is full of diagnostic lists for ADHD. We'll abbreviate and rephrase the DSM slightly for clarity, but keep it as close to the original as possible:
- Often fails to pay attention to details or makes careless mistakes [in tasks].
- Often has difficulty sustaining attention in tasks or play activities.
- Often doesn't seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish [tasks].
- Often has difficulty organizing tasks and activities — with failing to meet deadlines and being messy serving as some examples.
- Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort.
- Often loses things necessary for tasks or activities.
- Is often easily distracted by extraneous stimuli — in adolescents and adults, these may be thoughts.
- Is often forgetful in daily activities — forgets to do important things.
Note that "often" features heavily. Everyone sometimes does these things. These symptoms become a problem only when they interfere with daily functioning to a noticeable extent.
1. The Hyperactive and Impulsive Symptoms of ADHD
- Often fidgets with or taps hands or feet or squirms in seat.
- Often leaves seat in situations when remaining seated is expected.
- Children often run about or climb in inappropriate situations. Adults may just feel restless, something that others can observe.
- Often unable to play or engage in leisure activities quietly.
- Is often “on the go,” acting as if “driven by a motor”.
- Often talks excessively.
- Often blurts out an answer before a question has been completed.
- Often has difficulty waiting for his or her turn.
- Often interrupts or intrudes on others.
Again, these symptoms form part of a pattern.
3. Additional Diagnostic Criteria for ADHD
The DSM-5 specifies that "several" symptoms must have been present before age 12, without specifying the number.
The symptoms have to be consistent across settings — if they only happen at school, for instance, it may point to a problem at school rather than an overarching clinical pattern.
There must be clear evidence that the symptoms interfere with social functioning or functioning at work or school — having "the right number" of symptoms isn't enough; they must also have an undeniable negative impact on the patient's quality of life.
Finally, for an ADHD diagnosis to be made, the clinician has to be confident that the symptoms are not better explained by another chronic or acute disorder.
What Else Should You Know About How ADHD Diagnoses Are Made?
The DSM-5 defines inattention as:
- An inability to stay on task
- Lacking persistence and focus.
This must not be caused by defiance (that is, "doesn't want to do it") or result from not understanding the task. It is also normal for people to have trouble completing tasks they experience as mind-numbingly boring. For that matter, it is also normal for children who lack supervision to head to TikTok to watch videos about ADHD rather than do their homework.
- Fidgeting, running around
- Being excessively chatty
Keep in mind that children have more energy than adults, and they take time to learn to sit still; it's not their normal state of being. That does not need to be pathologized. As an example of what hyperactivity means, the DSM-5 specifies that ADHD-related hyperactivity often leads to injuries, for example, due to running into the road.
Impulsivity means making decisions without considering the consequences, and craving instant rewards rather than being willing to wait. Impulsivity can also manifest as butting into conversations other people are having.
Young children and adolescents are already impulsive by nature — a diagnosis can only be considered if the extent is unusual.
ADHD Can Go Into Remission
"Once ADHD, always ADHD" isn't true. The DSM-5 notes that about 5 percent of children can be diagnosed with the disorder, while only 2.5 percent of adults would meet the criteria.
If many of the symptoms have gone away, but some remain, clinicians can say a patient's ADHD is "in partial remission".
Factors That Contribute to the development of ADHD
The DSM-5 further notes that:
- Children who lack inhibition (do whatever comes to mind) and crave new experiences are more likely to have a diagnosis of ADHD.
- Pregnancy complications including toxin exposure and low birth weight are associated with ADHD.
- Each culture has different ideas about what constitutes normal behavior in childhood. This impacts the rate at which ADHD is diagnosed in different places, and even among different ethnic groups in the same country.
- Males have ADHD more often than females. When females have ADHD, the symptoms are usually mostly inattentive.
How Does ADHD Impact People Who Have It?
The DSM-5 notes that:
- People with ADHD perform less well at work and in school on average.
- People with ADHD are more likely to miss days at work or school.
- People with ADHD are more likely to be unemployed.
- Conflict with other people is common in people with ADHD.
- People with ADHD are more likely to go to prison and to develop substance use disorders.
- People with ADHD are more likely to be injured and cause accidents.
Is ADHD Overdiagnosed?
Overdiagnosis can be defined as diagnosing someone with a disorder when that person does "not have significant impairment and would not be expected to benefit from treatment". That includes people who meet the diagnostic criteria but are fully functional.
There is little research to indicate whether ADHD is overdiagnosed in adults and adolescents, or what the consequences are if this is the case. Increased healthcare costs and taking unneeded medications are likely the most severe consequences.
There is lots of evidence to suggest that ADHD is overdiagnosed in children. Children diagnosed with ADHD are much more likely to be the youngest in their class. If they had been enrolled in a younger grade, their behavior would be considered normal — these kids are immature, as kids are, and not disordered. See the links box below for a list of studies that all prove this same thing.
A Final Word
The cluster of symptoms that's called attention-deficit/hyperactivity disorder is real — and it has a profound impact on those living with it.
The danger, however, is that the diagnostic criteria are so general that anyone reading them would be hard-pressed not to recognize themselves. Don't diagnose yourself with ADHD. Definitely don't diagnose your young child with ADHD. A diagnosis can only be made by a trained clinician who deeply understands ADHD, normative behavior, and differential diagnoses.
We risk pathologizing ourselves and our kids if we think high-energy behavior and distractibility are signs of a mental disorder. We also risk making light of the very real struggles that people who do have ADHD suffer.
Do yourself a favor, and stay away from Dr TikTok or Dr Google. The only doctor who can diagnose anyone with ADHD has studied long and hard for that, and undertakes a thorough process to ensure that you end up with the right label (if any).
Your thoughts on this