Why adult ADHD diagnoses are rising, and what comes after the label

The headlines keep saying everyone has ADHD now. If you were assessed last year, you have probably felt your shoulders rise when you read one.

One recent piece of evidence is a review by Professor Barbara Sahakian and Dr Christelle Langley at Cambridge, published in the Journal of Psychopharmacology and written up in The Conversation this August.

It looks at diagnoses and prescriptions around the world.

In the UK between 2000 and 2018, diagnoses and prescriptions rose in every age group. For men aged 18 to 29, the review reports roughly a 20-fold increase in diagnoses and almost a 50-fold increase in prescriptions.

Later, in England, prescriptions of stimulant medication to adults rose 32% in 2021-22, and for the first time more adults than children were being prescribed it.

A separate study covering 13 countries and over 154 million people also found medication use rising.

The authors give several reasons: greater public awareness, a better clinical understanding of how ADHD presents, newer medications, and better recognition of women, girls and people whose ADHD is mainly inattentive, who were missed before. The causes are still being argued over.

The review also acknowledges a debate about over-identification and over-prescribing, and says awareness may only tell part of the story. Other researchers dispute that over-diagnosis is happening in the UK at all.

A lot of it is catch-up

Here is what I see from my side of it. In childhood the ratio is about four boys to every girl. In adulthood it is close to one to one.

Those girls grew up. My reading is that most of the rise is catch-up: a generation of women who spent decades being called scatty, too sensitive or not trying, and who are finally being recognised.

Many of the women who come to see me are in their thirties and forties, and a good number say the same thing. It was their child's assessment that made it click. They heard their child described and recognised themselves.

I start by asking for an ordinary Wednesday, from the alarm to bedtime, and I listen for the point where it starts to cost you. It is usually earlier in the day than people expect. Most people apologise for how long the answer is.

Much of the rise looks like people who were missed for decades finally being recognised.

Whatever the argument over the numbers, the Wednesday sounds the same. The dread before the first task. A big feeling at a small thing, and the crash an hour later. A look at the school gate, carried round all day and replayed at midnight.

Underneath it is a fast mind, and that is a strength. It notices the child about to cry before the child does, stays calm when the room goes wrong, and will hold a job for three hours and make the best thing in the building. I call ADHD a superpower, and I mean it.

Most of what gets called the downside is that same engine pointed at the wrong job, or left running with no off switch.

If the headlines left you feeling defensive, that makes sense. Your assessment is yours, and the argument over national figures can carry on without you.

What is still there after the label

The argument about whether everyone has ADHD now keeps people looking at the front door. The risk sits further in, in what happens after the label.

Most people tell me the assessment day felt like relief, and that the relief lasted about a week. Then the dread before the first task came back, and the evenings went the way they always had. Medication helps plenty of people, and whatever you take, the patterns are still there to work on.

This is the work.

Dread before starting, flooding and the crash after it, rejection sensitivity, boom and bust, sleep: these are behaviour patterns, and behaviour pattern reprogramming with clinical hypnotherapy changes them at the level beneath conscious thinking. I find where each one started, change what it does automatically, and then you and I make the change hold in an ordinary week.

Years of "try harder" leave their own mark. Many women tell me they still hear it in an old teacher's voice when they miss a deadline.

Where the shame sits in one specific memory, I use EMDR, which settles a memory through eye movements. You hold the memory in mind and follow my hand as it moves from side to side, and it stops landing as if it were happening today.

Mothers tell me the hardest part is the five minutes after they snap at their child, when the flood has passed and the shame arrives. That five minutes is a pattern too, and it can change.

The label explains the Wednesday. The dread, the flooding and the crash are still waiting on Thursday.

A flat reply to a message can ruin an afternoon. You know it is out of proportion, and the knowing adds shame on top. I work on the automatic reaction itself, below the part of you that already knows better.

Each pattern gets the tool that fits it: hypnotherapy for the habit or the fear that runs below choice, EMDR for the memory that still fires in the present.

The other half of the work is the strengths. Hyperfocus is brilliant until it takes the whole evening you needed for your daughter, and the bad night that follows. In hypnotherapy I work on the switch, so you decide when the focus starts and when it stops.

Sleep gets its own attention. A mind that races at bedtime pays for it by seven the next morning, and most people have been paying for years.

The changes I look for are the ones that show up in the day you already have: the first task, the morning rush, the row at tea. In my room the first thing to shift is usually the gap between deciding to start and starting.