Why Are ADHD and Autism Diagnoses Increasing?

May 5

Have you heard this analogy before? Imagine looking up at the night sky and seeing a handful of stars with your eyes.

Now imagine using a powerful telescope. Suddenly, there are thousands of stars you couldn’t see before. Then millions.

Did the stars suddenly appear? No. We just got better at seeing them.

That’s what’s happening with ADHD and autism.

We are starting to understand neurodivergence better than ever. For a long time, autism and ADHD were defined in very narrow, stereotyped ways: Autism = nonverbal, socially withdrawn boys; ADHD = hyperactive young boys who can’t sit still.

But newer research has expanded this understanding significantly: Autism is now recognized as a spectrum with diverse presentations. ADHD includes inattentive types, not just hyperactivity. Internal experiences (sensory sensitivity, executive dysfunction) are now taken more seriously.

The diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (updated in 2013) reflected this shift by: Combining previously separate autism diagnoses into one spectrum and expanding ADHD criteria across lifespan and presentations.

Research is expanding. In Autism brain imaging shows differences in connectivity patterns, not deficits. Research supports the idea of autism as a neurodevelopmental difference, and not a disease. There are also strong genetic components have been identified (hundreds of genes involved).

In ADHD they have studies have found differences in dopamine regulation and executive functioning. There is Increasing evidence of lifelong persistence, and not just a childhood condition as well as ADHD running in families.

Many people were missed or misdiagnosed in the past and we are catching up with that. For example, for decades, many groups were systematically overlooked: Women and girls, adults, people with high masking abilities, and people with co-occurring conditions (anxiety, depression, trauma). Because of our awareness shifting many women are diagnosed in their 30s–50s after years of being misdiagnosed. Quiet ADHD” (inattentive type) is being recognized. Masking is now understood as a major factor in delayed diagnosis.

More people are seeking evaluations because of increased awarbess and several things could be related to this cultural shift with social media increasing awareness and self-recognition and going in to get evaluated; mental health stigma decreasing, and more adults seeking answers to lifelong struggles they have faced. So, it doesn’t mean everyone is “suddenly autistic or ADHD” - it just means more people are being found.

Instead of asking “Why is everyone suddenly ADHD or autistic?” maybe we could be asking “Why did we miss so many people before?”

Citations:

Masking:

https://www.cdc.gov/mmwr/volumes/72/ss/ss7202a1.htm

https://doi.org/10.1177/1362361316671012

https://doi.org/10.1038/s41398-021-01694-6

Autism Brain Connectivity Differences:

https://doi.org/10.1038/s41583-021-00515-1

https://doi.org/10.1016/j.neuron.2022.10.012

Genetics and Autism:

https://doi.org/10.1038/s41588-019-0344-8

https://gene.sfari.org/