It was once thought of as a diagnosis for antsy school-aged boys. Or, according to one 1902 doctor's opinion, an "abnormal defect of moral control." But the last few years have brought the issue of adult ADHD into the mainstream, in large part due to discussions on social media platforms and growing awareness of how the condition presents differently. An October report from the US Centers for Disease Control and Prevention puts a finer point on it, finding that about one half of the estimated 15.5 million adults in the US with ADHD received their diagnosis in adulthood.
Of those adults, about half of them have used telemedicine services for ADHD management and 71.5% of those who take stimulants like Adderall to manage their symptoms have had issues filling their prescription. The results of the CDC findings were based on a nationally representative survey from late last year and promote how research on ADHD and telehealth can aid in the "development of clinical care guidelines and regulatory decision-making around medication shortages and telehealth for ADHD."
ADHD, or attention-deficit/hyperactivity disorder, is currently considered a neurodevelopmental disorder, which means it's categorized based on differences in brain development that can affect the way the mind functions -- things like how you learn, how you socialize and more. In order to get a diagnosis, you need to have reported some symptoms of chronic inattention or hyperactivity before age 12. However, growing awareness of ADHD has shined a spotlight on how it may affect adults differently and potentially how modern demands for our attention blur the lines of what clinical-grade symptoms should be managed with medication and what can be considered normal reactions to an environment competing every second for our attention.
What's changed in terms of ADHD diagnoses?
In 2023, based on the CDC's recent sample, about half of adults with ADHD reported getting diagnosed in adulthood, reflecting an upward trend in ADHD prevalence that started climbing significantly in the 1990s.
Another big thing that's changed in ADHD management is telemedicine and relaxed rules around how stimulants -- including names like Adderall, Ritalin and more, the more common medications used for treating ADHD -- can be prescribed. "Stimulant" is a broad drug category and describes anything that can speed your nervous system up; it includes different substances -- everything from the caffeine in your coffee to the methamphetamine some people make illegally are stimulants. But for ADHD, the controlled (and importantly, tested-for-safety) drugs work mostly by increasing levels of dopamine and norepinephrine in the brain. ADHD stimulants are controlled more strictly by the government compared to other drugs because they have a higher potential for addiction and in some cases, misuse.
During the pandemic, when providers couldn't meet with patients in person, the US Drug Enforcement Agency's relaxed rules around controlled substances like ADHD medication were a "game changer" and allowed for more patients to be treated, according to Dr. Vinay Saranga, a psychiatrist and founder of The North Carolina Institute of Advanced NeuroHealth.
"The problem came about in the pandemic, when all these new telehealth startups popped up and Adderall prescriptions were being handed out like candy," Saranga wrote in an email.
The US Department of Justice, for example, has alleged that the ADHD-centered telemedicine company Done profits off Adderall and other stimulant prescriptions through a subscription-based model that may incentivize providers to write prescriptions that may not meet medical criteria and that the company used "deceptive advertisement." Two leaders at Done were arrested in June. Done didn't immediately respond to a request for comment.
The DEA's currently relaxed rules allowing for more providers to treat and prescribe people controlled drugs via telemedicine are set to expire in December, though they may be extended a third time.
Is it ADHD or burnout? Overlapping symptoms create diagnosis problems
The idea of "burning out" often means you're becoming fatigued, overwhelmed or generally unhappy with your current life routine, structure or activities. While not a strict medical term, it's become common enough in modern life that health agencies like the CDC are using it to describe intense stress levels in the workplace.
But according to Saranga, symptoms of burnout are similar to ADHD -- he named signs like feeling unmotivated, being easily distracted and not paying attention to details -- making it "difficult to distinguish between the two."
"I believe one reason we have seen an influx of adult ADHD cases in recent years is because of more adults dealing with burnout than actual ADHD," Saranga said.
So, is ADHD overdiagnosed or underdiagnosed? There's information that suggests ADHD is underdiagnosed or missed, especially in certain groups like African American and Latinx children and women. The answer may be "a little bit of both," according to Dr. Alex Mageno, a psychiatrist with Meadowbrook Counseling and medical director for Whole Mind.
"A lot of different things can impact the attention and executive function networks in the brain," Mageno explained, adding that sleep apnea, depression and post-traumatic stress disorder can also manifest with ADHD-like symptoms. The "biggest worry" with ADHD being diagnosed via telemedicine is that this nuance would be more likely to be missed, Mageno said.
What it means to be 'neurodiverse' in today's world
Along with growing awareness of ADHD, there are more discussions of "neurodiversity," which -- clinically speaking -- describes people with autism spectrum disorder, ADHD and even other conditions like Tourette's syndrome and dyslexia, according to Saranga. It's also picked up speed and a name of its own on social media, but the concept of neurodiverse vs. neurotypical was originally invented to prove the point that no one's brain is completely "normal," so to speak, and there is a wide range of skills and deficits each person has.
Importantly, some people's skills may be better suited to modern culture, particularly modern work, desk-centered culture, than others.
"ADHD and most psychiatric issues are probably present on a spectrum – it's not an 'on or off' sort of thing," Mageno said. Some people on the lower end of the ADHD spectrum may not have raised any flags in school or another environment, for example, but "place them in our current attention economy where there are tons of different companies and voices -- whoever -- trying to get any sliver of our attention," and it's a different story, he explained.
"You divide that up by 100, and now, someone who might not have had any issues may start to exhibit some issues because a lot of their attention is being taken away."