ADHD is likely under-diagnosed so TikTok can help

You may have heard of the hashtag ADHD on TikTok, which by this year was showing 11.2 billion views. There have been countless stories in the media about people realising they might have this condition as an adult, but could this be a case of over-diagnosis fuelled by social media?

It’s a complex issue but put simply: I doubt it. I have had over 20 years of experience researching neurodiversity - the term used to describe those whose brains are wired differently from birth. One such neurodiverse condition is ADHD (attention deficit hyperactivity disorder). While ADHD is officially defined as a ‘disorder’, neurodiversity is a more inclusive term for those with brain differences that have a biological basis, emphasising differences rather than ‘disorder’.

There is growing recognition of ADHD in New Zealand, but it would still be likely to be under-diagnosed here, where access to assessment or treatment for ADHD (and other neurologically based conditions such as autism) is woefully under-resourced. Self-diagnosis via TikTok isn’t ideal, but it might lead people to recognise certain symptoms in themselves and then seek expert advice. For people who can’t reach or afford those services, there is a lot of good information readily available about ADHD such as on ADHD New Zealand and CHADD.

You can be diagnosed with ADHD as an adult, but a clinician will ask for evidence of symptoms from childhood. That is, although it might be diagnosed in adulthood, it doesn’t develop later in life (except in certain “acquired” situations such as damage to the frontal lobes). It’s also likely adults are using social media to determine that their symptoms are more aligned with ADHD rather than something else they’ve been diagnosed with such as bipolar disorder.

This is particularly the case with women, who are more likely than men to have the “inattentive” presentation of ADHD and therefore didn’t get help as children because they didn’t have problematic behavioural issues. These people often have effective and productive lives without diagnosis because they are intelligent and have a history of masking their symptoms or using compensatory strategies. But things might start to fall apart for adults who are then trying to juggle work with childcare and even parent care.

Many people first suspect they have ADHD when they take their child to a clinician for an assessment. They can see, sometimes for the first time, that they too have problems with impulse control, regulating emotions and sustaining attention. A diagnosis can be a very powerful and positive thing. People who might have struggled with their thoughts, feelings, emotions and behaviour their entire life, now have a label; they can then use it to find out more about themselves and what makes them different.

ADHD was first described about 100 years ago and is likely not significantly more common now than it was then. It is, however, better recognised. Teachers, GPs, and even your neighbours have more awareness of neurodiversity. ADHD is about 70 percent heritable – that is, 70 percent of the variation within the population with ADHD is because of a variation in the genes. So, as already mentioned, children who are seen by a clinician and diagnosed with ADHD might have parents who realise they should also probably get assessed.

Yet there is still scepticism about how ‘real’ it is, and if ADHD is a modern medicalisation of what we might have described in the past as a range of human eccentricities. Globally, it affects 2-5 percent of all children; in New Zealand, an estimated 280,000 Kiwis have ADHD.

We know there is a biological basis for ADHD. There are brain differences between neurodiverse people and neurotypical people. We know that ADHD is a neurodevelopmental disorder influenced by lower levels of the neurotransmitters dopamine or norepinephrine or both. These neurotransmitters affect the part of the brain that enable us to plan, focus, remember instructions, juggle multiple tasks successfully, and control our impulses (so-called executive functions).

One of the problems with ADHD is that it can’t be physically diagnosed with a blood test such as you can with diabetes. People also can’t yet get a brain scan to aid in the diagnosis of ADHD. This is an area that holds some promise, however. Along with the University of Auckland Bioengineering Institute and the Matai Research Institute in Gisborne we aim to identify potential biomarkers for ADHD using Matai’s state-of-the-art fMRI technology.

An ADHD/ diagnostic evaluation is typically done by a qualified educational psychologist, mental health care professional or physician. They gather information from multiple sources (including parents, teachers, colleagues) such as ADHD symptom checklists (from our diagnostic manual, the DSM-V), standardised behaviour rating scales, cognitive tasks on a computer and a detailed history of past and current functioning. A diagnosis of ADHD in adulthood requires evidence of symptoms and distress from early age. Children must have at least six recognised symptoms, and older adolescents and adults (over the age of 17) must have five to be diagnosed with ADHD.

ADHD comes with a range of characteristic features, such as disorganisation, forgetfulness, impulsivity, problems with time management, and so on. It can manifest in myriad ways. In some people it might mean failing to pay attention to the details. In others it can mean paying too much attention, and getting lost in the details.

Most of us will exhibit some symptoms and characteristics of ADHD at various stages of our life, contingent on context. What makes ADHD different from the garden-variety imperfections of human nature is its impact on the life of those with it and those around them. Most of us would be guilty of occasional acts of impulsivity, but when that impulsivity affects our ability to maintain friendships or a job, then it likely becomes a problem.

I might impulsively buy a dress I didn’t really need. That’s normal. Racking up a $30,000 credit card bill that you can’t afford to pay off isn’t. I might interrupt people when I get too excited to wait my turn, but never letting anyone finish a sentence (your teacher, your partner, your boss) suggests a problem that might affect your relationships. In other words, it’s extreme manifestations of common human personality traits that might indicate ADHD.

Getting a proper diagnosis of ADHD is the first step of getting treatment, to ultimately gain some control over symptoms. This can be through medication and therapy (such as Cognitive Behavioural Therapy) or by developing and practising strategies to control the symptoms that make life difficult.

Many think it’s paradoxical a child or adult with ADHD would be prescribed a stimulant medication such as Ritalin. But it works by increasing certain neurotransmitters in the frontal lobe and the connections to the motor and emotional brain centres. This can help them control their hyperactivity, impulsivity, and many of the socio-emotional manifestations of ADHD.

I’ve seen a lot of parents who say that, following medication, they can now have a rational conversation with their child. They often feel they have been given their child back. For adults, it can help them regain some control over their lives.