Questions you might be afraid to ask about ADHD: answered.

1)Are more people being diagnosed with ADHD now than before?

When I was diagnosed 5 years ago, I didn't think it was real, and didn't know anybody else - so I wrote ADHD: an A to Z to figure this out by myself. Today, without fail, every single stranger I tell I am an ADHD Coach has a reference point - they or their friends think they might have it, or have recently been diagnosed.

This isn't just me (or you) - the data agrees:

• In the US, diagnosis amongst adults (123.3% increase) are growing 4x faster than amongst children (26.4% increase), from 2007-16.
• As Steven Bartlett noted, 1 in 20 US children were diagnosed in 1980; now it's 1 in 9.
• The ADHD Foundation Neurodiversity Charity suggests there's been a?400% increase in the number of adults seeking a diagnosis since 2020.
• There's been a 40% rise in prescriptions between 2015/16 and 2020/21 - from 1.31 million items to 1.83 million items.

2) Does everybody have ADHD?

I often start talks by counting to 10 and asking people to share what number they lost focus at. Microsoft found the average attention span had dropped from 12 seconds in 2000, to 8 seconds in 2015 - so imagine what it is now. Living in a literal attention economy is definitely contributing to the overall loss of our society's ability to pay attention, as we wake up and immediately plug into screens designed to hook us onto dopamine and distractions.

However, just because someone has a short attention span, doesn't mean they have ADHD. In talks I then explain how I was diagnosed: I almost killed myself. I was constantly hurtling from country to country, couldn't stay in a job longer than a few days, and was lurching from crisis to crisis in all areas of my life.

The diagnostic criteria of ADHD is that someone has 2+ areas of their life significantly and negatively impacted by symptoms of inattention, hyperactivity &/or impulsivity 'pervasively' (i.e throughout their life). In contrast, researchers have identified environmentally induced symptoms of ADHD called 'Variable Attention Stimulus Trait' - which are essentially from living in our modern technological world, which is why I wrote 'the Reality Manifesto' book.?

3) Why are more people being diagnosed with ADHD?

ADHD has only been diagnosable in adults in the UK since 2008. As awareness grows from it being a condition that only impacts hyperactive boys disrupting class, more people are realising that maybe it's not 'normal' to live with a brain that feels like it's constantly on fire. As trailblazers like Abigail Agyei-Jones MBE speak about their experiences as a black woman diagnosed in Ted talks, entire sections of society who may have been previously unable to identify with ADHD because they didn't see anyone who looked like them with it, maybe not realising that support is available.

This shared awareness of lived experience (largely on social media) is expanding past the painfully outdated diagnostic criteria. For example, it doesn't reflect emotional symptoms, which I presented to the World Health Organization on, such as the fact that the suicide risk is 5x higher in people with ADHD. There may also simply be more people who meet the diagnostic criteria than before for a number of reasons, such as our attention constantly being under attack.

The NHS is unable to meet this increase in demand, with 7 year waiting lists, which leaves people vulnerable to exploitation, such as well packaged but low quality 'assessments' that are not recognised by the NHS, but cost almost ￡1000. Privately, medication can cost hundreds of pounds a month - forever - which is often the only 'treatment option' suggested by psychiatrists.

I've met people who have been diagnosed with ADHD after reading an article and making a phone call, all in the same weekend. They didn't have 2+ areas of their life that were 'disordered', they just resonated with the symptoms of not having 'homes' for their belongings. I've also met people who sought out a diagnosis purely under the misguided belief it would help them to keep up with their colleagues. I get messages regularly from people asking if a diagnosis would help them to get extra time in exams. As someone who really did not want this diagnosis and understands how severely it can impact your entire life, it is frustrating to hear these experiences, because they undermine the majority of people who desperately need help.

I've asked medical professionals how many people seeking ADHD assessments from them they don't diagnose, some who have told me: zero. This is a good question to start out any assessment with!

4) Is ADHD caused by a chemical imbalance - is it a disease or illness?

The reason ADHD is a 'Disorder' is because this is the threshold of not everybody having it. Gabor Mate says there's no gene found to cause ADHD specifically (as gene-determined conditions are very rare). There are genes that can cause greater sensitivity to all mental health conditions, which is heritable. The ability to feel can mean we are wonderfully creative, happy, successful people in the right environment, or struggle deeply and naturally tune out to our surroundings in a stressful one.

There is no physical test: no one opens up your brain to find the green splodge identifying ADHD. This doesn't mean it's not real - just like any other condition. As ADHD is linked to a 30% developmental delay in executive functioning skills, I strongly believe these can be strengthened in the right environment, because they are skills - which is why I made the course & became an ADHD coach. If a child is not given the right support it needs to develop in all areas safely (including during pregnancy), a neurodevelopmental delay will emerge in these areas in comparison to the way 'most' people's brains work (i.e neurotypical) - making us neurodiverse. As 82% of people with ADHD have experienced trauma, I believe there is a strong casual link here, as trauma can change the way our brain works.

So, ADHD isn't a disease or an illness: it's a neurodevelopmental condition. This is neither good nor bad: it's just like having a different operating system. However, as society prescribes certain types of standards, legally, ADHD can very much be considered a disability in UK law - even without a 'formal' medical diagnosis. This isn't automatic, as it has to substantially impact a person's ability to do day to day activities in comparison to their colleagues, but it triggers a range of important legal duties for employers, such as to make reasonable adjustments.

6) Why is ADHD treated with medication?

If you meet the diagnostic criteria of ADHD, it's likely that your life has spiralled beyond your control. Medication can help with this, but it is not always necessary, despite unfortunately often being offered as the only treatment option by medical professionals.

Medication can be like putting on glasses so you can finally see mess around you, as in having a neurological impact on your brain, but it doesn't give you any tools to clean it up. So in many cases, things might actually get worse as you become more aware of the mess, which can be very overwhelming. ADHD Coaching taught me the metaphorical tools to clean that mess up. Before I took this medication, I couldn't trust myself to stay alive to the end of a day, but now I do - so I keep taking it!

ADHD medication is regularly given to animals trapped in cages, who are self-harming - because it is not natural for animals to be trapped in cages. Focusing on your environment: your job the people in your life, where you're living, what you're eating, substances you're taking in, exercise, how much nature you're experiencing - has the same impact. The problem isn't with you: it's with your environment.

7) What are the long-term costs of medication?

People haven't been taking ADHD medication long enough for conclusive studies to show the long-term effects. The stimulant medication I take, Elvanse, will lose its exclusive 20yr patent next year - which means we are likely to see a lot more of it around.

Gabor Mate says people should take medication if it helps them, but it treats the symptoms of ADHD, not the root causes of it. I strongly agree with this: it can help, but isn't the answer - and it can be extremely dangerous.

When I first took it, I lost 15kg, my skin went grey and developed acne, it kept me up all night, and I had constant panic attacks. I took a break for a few months and returned via the NHS on the lowest dose, as I could then understand the benefits.

The ongoing costs of this medication having to take medication at all: the crippling anxiety of whether it is 'working' and whether you are functional just because you take this pill in the morning. The painful monthly obstacle course designed by a sadist as you try to remember to jump through the multiple administrative hoops required to fill your 'controlled drug' prescription before it runs out. The stigma of telling people you do indeed take ADHD medication. If you're not on the NHS, it will also literally cost you hundreds of pounds each month.

For the type of medication I take, I also forget to eat, and am so hyper-focused on work that I stop living my life outside of it. I feel like it's having an impact on my heart and circulation, where every so often a finger or toe will go alarmingly white or yellow. I don't know what impact it will have on me in the longer term, but I probably wouldn't be here to find out if I wasn't taking it, so it's a compromise I'm willing to make.

8) Should people take the medication forever?

I don't know if I will take ADHD medication forever, but for now, it seems to be worth it - all things considered. Gabor Mate encouraged people to take it when they need to focus and have breaks, but when I attempted to self-medicate in this way, my life collapsed. Personally, and the way I coach people, is to get a routine in place and stop overthinking it. We don't just need to focus on work - we need to focus on staying alive, cooking, showering, being present with people we care about - our ability to pay attention is crucial to every second of our lives.

It should make you feel 'normal' - but it is not the only answer. I believe for a LOT of people I speak to, it causes more problems than it solves - especially if your life wasn't particularly 'disordered' before taking it.

This is because although ADHD is diagnosed at the level of 'disorder', it doesn't have to stay that way (so it's quite an unhelpful and stigmatizing name in the long term). If you change your environment, you may not experience the symptoms so severely anymore, just like if a plant was moved into the right environment for it to grow. There is no shame in taking medication, and it is a personal choice of whether you want to continue. I think of it a lot in the same way as alcohol, coffee or illegal drugs: we are all consuming something that helps us cope.

If you'd like to join the virtual launch of ADHD: an A to Z on 21st November, head here.

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