How ADHD Proliferates

Your eyes don't deceive you - ADHD is getting more common.

Before you read this, please understand that I have ADHD myself. This is not a beatdown on ADHD and you are not a better or worse person for having it - however, I sincerely dislike my own ADHD, and it can colour the way I talk about it. Because of that this may not be written completely sensitively. Please use discretion.

If you see your ADHD as an asset even though I do not see mine that way - power to you. If not:

You have worth as a human being and you are more than this disorder. I promise.

Where the hell is all this ADHD coming from?

Very frequently I hear it whinged, "All of these children getting diagnosed and labelled with this disorder! Why does everyone seem to have it? Is it society? Is it food additives? Is it pretenders?! No, it must be because psychology wants to pathologise everyone!"

I hear it so often, in fact, that it makes me tired.

Truth be told, I think the answer to all of those questions is a resounding no. Although I do plenty of my own side-eyeing of psychology and psychiatry, I don't think the recently much wider diagnostic criteria for ADHD is the core "problem" here. These criteria desperately needed to be widened and benefitted many of us because so many people were struggling with common problems associated with ADHD, but due to atypical presentation, had no recourse or help.

I was one of those people. Stimulants changed my life. Now instead of being a complete fail of a human being, I am only a partial fail, and even have the audacity to be aiming at med school. Many others have been saved from actions that would have sent them to prison by treatment for ADHD, or accidents that would have crippled or killed them. Many more suicides have also been prevented, because when people stop failing at life, they stop wanting to die. Shocker, that.

So to be honest, if you think the widened diagnostic criteria are a problem, I've got a problem with you.

But then I suppose we have to give some attention to the other "causes" thrown around in the blame game. Food colourings and additives, sugar. Okay sure, parents frequently point at these making ADHD behaviour worse (particularly in kids), and I'm sure as adults you'll know that if you eat better, you'll probably feel better mentally as well. But if you give an ADHDer the healthiest ADHD friendly diet in the world (and they actually stick to it, lol), they'll still have core ADHD problems. So that's probably not it.

What if it's society, then? After all, cPTSD looks a lot like ADHD and the two can easily be confused in diagnosis. Does that mean parents are worse on average than they used to be? Yikes, I hope not. Of course, cPTSDers are rarely helped by stimulants, whereas ADHDers (in fact 80-90% of us) greatly benefit from them. If there were a bunch of people with cPTSD misdiagnosed with ADHD in our dataset, we would expect stimulant effectiveness to drop through the floor. That hasn't happened.

So then, why are there so damn many of us these days? Because you're not wrong, there are literally more of us, a lot more of us. Where are we all coming from? I don't think there's always been the same rate of ADHD within society, even if you applied today's diagnostic standards to previous generations, and even if we actually caught and diagnosed every single person with it. If not the usual suspects of society, or food, or overzealous psychiatrists, then what?

... Did you ever consider evolutionary genetics and pathology?

Excess Mortality

Let's step on the brakes a little. First, I want you to consider that ADHD causes early mortality. Actually, if you have untreated ADHD you're statistically expected to live 10-20 years shorter than your non-ADHD peers due to death of all causes. That's everything from preventable car accidents to eating nothing but McDonald's for 20 years until the golden arches turn your arteries into solid gold. If you have ADHD, I'm sorry you have to learn that (please get treatment, it helps mitigate these stats!). But it's important.

Why do I mention it? Because medically speaking this excess mortality is pretty fucking extreme. That's a lot of people dead a lot quicker than they're supposed to be. Shouldn't ADHD be getting less common (or at least not increasing so quickly) given that we seem to be so good at dying?

Well... not quite.

Meet Sam

Sam is going to be our plaything to demonstrate how this situation happened. Before we play with Sam, we have to consider two specific aspects of ADHD: that is, the hyperactivity and impulsivity associated with ADHD (including dopamine-seeking behaviour), and the fact that ADHD is highly heritable.

Sam is a 37 year old undiagnosed ADHD dingbat. We love him, he's fun to be around, but he has the IQ of a pumpkin and the restraint of a ten year old told they can have anything they want in the sweets shop. ADHD of course doesn't make anyone as dumb as literal bricks, but Sam rolled very badly on his character sheet and so here we are.

Sam has three sets of kids.

What? That's not normal! Actually, sorry to say it, but it's more likely than you might want to think. The hyperactivity and impulsivity in ADHD means that people who have it are more likely to cheat on their spouses, have marriage breakdowns, or just flitter from relationship to relationship. And then the dopamine-seeking behaviour tends to result in having a sex drive like a Polish rabbit. That's a lot of potential partners and an awful lot of sex.

So, given Sam's personality, do you think he used protection every time? Or do you think sometimes he just went for it because that's what he felt like in the moment? I'm gonna go with option B.

And now sure, Kimmie might just have one kid with Sam, but what about Sam's three other kids with Haylee and his two newborns with Danielle? Because ADHD is highly heritable, let's say that half of those have ADHD (3). One dies in a preventable car accident (2) but not before they've managed to get their teenage girlfriend pregnant (3). Whoops!

You now have three separate families that have ADHD in them and even the non-ADHD siblings are likely still carriers. Four families if you include the dead kid's pregnant teenage girlfriend. And that's all just from Sam!

One guy!

The Merry-Go-Round

Of course, the non-afflicted carrier children are far less likely to die than their ADHD siblings and continue to be very good at not dying until they have nice little families of their own. The families they have are probably a little smaller on average than their ADHD siblings (less accidents). However, because they're carriers, a few of their kids have ADHD like their grandfather.

Fortunately, these kids probably don't live in the same level of instability due to their neurotypical parents (although if their parents are traumatised by Sam's actions as a father, that's up in the air). This means that the children are more likely to be brought up well, live in a more economically secure environment, and generally be looked after. They might even get diagnosed and treated. However, this all means they are even more likely to live long enough to... reproduce even more ADHD.

And then there's Sam's kids who do have ADHD. Their children (Sam's other gradndchildren) are more likely to live in a dysfunctional household. Perhaps their parents will understand them better, but have less ability to actually look after them. And then there is the further instability caused by the higher frequency of ADHD among the kids themselves, and the behaviour problems that ensue. Their parents might get them diagnosed and treated out of frustration, or be economically prevented from doing so.

However, for all the dysfunction in these families, these kids will too likely survive long enough at least to have one more kid. In modern times of course people are less likely to choose to have children, but ADHDers are also more likely to have accidents. Can't forget that.

Is it really that extreme?

This of course is a highly simplified model created to demonstrate my point. It doesn't take into account a lot of socio-economic factors, and assumes a Western society - something I would like to account for in later versions.

But if, like some, you are more inclined to argue that the example of Sam and his three different sets of kids is a very extreme one? I'd like you to keep in mind that it only takes a few Sams to inflict the ADHD genepool on hundreds of people in just two-to-three generations. And whether you want to believe it or not, there are quite a few Sams out there.

Some of them aren't even aware they have kids.

Of course, for every Sam there are a few people like me who are asexual, or who have reproductive disorders and will not reproduce. There are also plenty of more normal ADHD people with a more normal number of kids (like Sam's offspring). But as long as the replacement rate for each ADHDer is greater than the replacement rate for the regular population (and due to more sex and more accidents happening, even without the presence of Sams, it is), ADHD will continue to get more common.

Food additives my ass.