between 2007 and 2016, ADHD rates have increased by 123% in adults. The rates of ADHD prescriptions have gone up by 30% just from 2020 to 2022. And this problem is getting so extreme that multiple countries have actually reported shortages in medication. And like, to be honest, if you spend 15 minutes on the internet, you'll either find a video that tries to convince you that you've got ADHD or a video that feels like it's trying to give you ADHD. So, it can feel like maybe everyone has ADHD today. But I do want to investigate this because there are some great successes that we've made in the last few decades, but also some areas of concern, some things that worry me, and some things that you should probably be aware of. First of all, I mean, we need to start with like, what is ADHD? Depends who you ask, right? We've known about ADHD-like symptoms for hundreds of years, but I think a useful place to start is 1902 with Dr. George

still, who was a really famous pediatrician. He described ADHD symptoms as a morbid defect of moral control, which is so extra. Not exactly the most comprehensive description, but if we fast forward to 1987, ADHD became like an official term in this book, the DSM. The DSM is like the book that psychologists and psychiatrists use to diagnose people, and in the third version, it was officially defined. It's since gone through two more updates, and each of these has progressively changed how we understand ADHD today. It's divided into three different subtypes, three different presentations: the inattentive kind, the impulsive kind, and a combination. So, this is obviously, you know, not medical advice. You should actually see a doctor if you want medical advice, but these are a few of the symptoms of ADHD: has difficulty sustaining attention to tasks or play activity, is easily distracted by extraneous stimuli, is forgetful in daily activities, talks excessively, blurts out an answer before a question has been completed, or avoids, dislikes, or is reluctant to engage in tasks that

require sustained mental effort, all of which, uh, you know, somewhat relatable. And here in is where we have our first problem, right? Because simply having these symptoms doesn't mean that you have ADHD. Typically, you need to also have an actual assessment by a medical professional who can tell you whether or not your case is legitimate. That is unless you decide to go online because people are struggling to access medical care in actual hospitals. They're turning to these technology startups who are promising to be able to do that in just under half an hour. However, the promise that they make is actually not great, and you'll see quite quickly that these guys are like the poster child for everything wrong with ADHD treatment at the moment. If there's one thing we know about technology companies, it's that they have the public's best health interests at heart. I just want to talk to you about this company, Cerebral. This company has actually been valued at around $4.8 billion. They've also been sued by their own vice president of engineering, who alleged that the CEO was

tracking whether giving people stimulant medication would keep them as loyal customers. This is crazy. This is a direct quote from this lawsuit. When Cerebral determined that the patients who were prescribed stimulants were more likely to remain customers, the CEO directed employees to find ways to prescribe stimulants to more ADHD patients to increase retention. Unsurprisingly, this same company was also fined $7 million over careless privacy violations, which means that they were selling patient data to advertisers. D Health, another virtual prescriber, has been in similar trouble. The founder and CEO has been arrested and is on trial with the Department of Justice in the USA. So, this is another quote from this lawsuit that was filed by the American government. The CEO and president allegedly obtained subscribers by targeting drug seekers and spending tens of millions of dollars on deceptive advertisement on social media networks. They also allegedly intentionally structured their platform to facilitate access to Adderall and other stimulants, including by limiting the information available to the prescribers, instructing their prescribers to

prescribe Adderall and other stimulants even if the member didn't qualify and mandating that the initial encounters would be under 30 minutes. Interestingly enough, you'll see that if virtual health appointments are carried out by actual hospitals, then they don't have the same problem of over-prescribing medication. It's purely a problem with tech startups that masquerade as healthcare companies. But ADHD rates have been rising for long before this; it's been a trend for several decades, whereas these companies have simply arisen in the last few years. And if we do consider this question from a few different other angles, we get a conclusion that feels a lot more comprehensive and that reveals a lot of big positives, actually, in the space. It's really important to consider the gender dynamic because the reality is women are still today far less likely to be diagnosed than men. Currently, the ratio is 2:1, and yet there seems to not be too much evidence that there's actually a biological difference that predisposes men towards ADHD than women.

and if we look at what you know researchers say about this, we find that there's a really big problem in how we've actually researched ADHD over the last few decades. This is Dr. Kathleen Nedu, the director of the Chesapeake Center on ADHD Learning and Behavioral Health, and she talks about the history of ADHD research and the changes that have happened pretty significantly over the last few decades. She says that historically, research on ADHD has focused almost exclusively on hyperactive little boys, and only in the past six or seven years has any research focused on adult ADHD. This kind of tracks a lot with what we think of as the general perception or the general stereotype of what ADHD looks like—the hyperactive little boy in a classroom. And this isn't just like a social stereotype; it's something that affects actual research in clinical studies. The male-to-female ratio is actually around 4 to 1, so even if men are twice as likely to have ADHD in general, in actual research, men are even more overrepresented, which

has had kind of like a self-reinforcing effect, right? This tracks with the fact that a lot of this rise is especially amongst women. The percentage newly diagnosed between 23 to 49 has nearly doubled just between 2020 and 2022. A few days ago, I made a community post asking members of the community what their experience was getting diagnosed, and I just copied one comment from Ruth who described her experience. She says that I got diagnosed at 24. It took me 3 years of seeking help and failing college to finally get diagnosed because the nurse practitioner was refusing to believe me. She kept telling me that I just had childhood trauma and depression as if I can't have those things and ADHD. Eventually, I had to seek out someone else and pay out of pocket to get diagnosed. I fit the diagnosis for inattentive ADHD almost completely, but I think it was missed because I never caused any problems at school as a kid, and my parents didn't know enough or

care. I'm not on any medications at the moment, but I'm hoping to within the next couple of months. We've had this huge problem for decades where certain groups have simply been ignored by medicine effectively. One of those groups is just women in general who are more likely to have the inattentive kind of ADHD. The education system is really bad at spotting inattentive ADHD or ADHD in people who are more intelligent because it's less likely to be a problem when they're younger and much more likely to be a problem once they're older. And we have a similar problem when we look at ethnic differences. So, for example, black children in the US are historically 70% less likely to get a diagnosis even though they seem to show symptoms at at least a similar rate, if not more frequently. But there's also been some changes in our definition of ADHD, and it's been able to capture a lot of people who would have been otherwise missed out by doctors. So, in 1994, the

DSM 4 was published, and this was the guidebook for psychologists for almost 20 years. One of the key conditions for being diagnosed is that symptoms needed to appear first before the age of 7 years old. There were a few problems with this. Well, first of all, if symptoms need to appear before the age of seven, then it almost certainly needs to be a parent or a caregiver that first notices. Because I think the average person can't really remember how they behaved that well before the age of seven. This meant that people who didn't have strong support systems at home or retentive teachers would be completely ignored. They physically couldn't be diagnosed with it. However, in 2013, almost 20 years later, this diagnostic manual was updated. The threshold for when symptoms need to first appear was increased to 12 years old. This is a really good change because it means that people who might not have a stronger support system could still be diagnosed with ADHD. Because a lot more of us remember our lives before the age of 12 than we do before the age

of 7. This DSM-5 also acknowledged the fact that ADHD could continue into adulthood for a long time. It was simply believed that it was something you could grow out of, and the diagnostic manuals seemed to kind of reinforce this idea. Some people learn coping strategies, some people learn masking techniques, but adult ADHD rates are rising much more quickly than childhood ADHD. Importantly, before 2013, it was actually impossible to be diagnosed with both autism and ADHD; you had to have one or the other. Autism and ADHD have a strong tendency to co-occur, so a lot of people who have one have the other as well. There's a really strong chance that this rise in diagnosis is something similar to the rise in the rate of left-handedness between the early and mid-1900s. Nothing changed in human genetics, but there were simply some huge societal changes. It could be very possible that we're just actually bridging the gap between the actual percentage and the under-reported percentage that we've had for all of

human history thus far, but we do have to talk about the internet as well because it is clearly affecting our minds, and it's clearly affecting our attention spans, even anecdotally. But yeah, is the internet giving us ADHD? Well, there is a link between ADHD and internet addiction. This is not a causal link, right? It doesn't say that ADHD causes internet addiction or that internet addiction causes ADHD, simply that if you have one, you're more likely to have the other. It seems like there's very little evidence to suggest that the internet is inducing ADHD. One of the problems with the internet, though, is that it can induce symptoms which can appear in anyone. If we go back to some of the symptoms, we can see that these are things that, to some extent, everyone struggles with, right? Everyone struggles at some point with attention, focus, yapping. But to suggest that the internet is giving people ADHD is different than suggesting that it's exacerbating the symptoms which appear in everyone. The real question we're asking here is: will people get better if they just stop

using the internet, whereas if you are a person who has ADHD, even not engaging with the internet will still not cure all of those symptoms. What ADHD shows is that the definitions are constantly changing, and so this feeling that everyone has ADHD is, I mean, categorically not true because there are huge groups of the population that are still being left behind today and that don't have access to the treatment that they need. And where I personally have concern is in the fact that we are letting technology companies fulfill the role that healthcare companies should be doing. I'm not anti-medication or anything; I just think that people should have access to the full spectrum of possible treatments that a qualified doctor who can give them the time and attention that they deserve would provide. In general, we have to accept that ADHD has been adopted into our vocabulary at large, and the difficulty is really you can't control how and when people use words. But more generally, I'm always going to pick the path that leads to more people talking about mental health because that path is more

inclusive and more likely to get people to actually investigate. [Music]

Why Does Everyone Suddenly Have ADHD?

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