TikTok trends or the pandemic? What’s behind the rise in ADHD diagnoses | Attention deficit hyperactivity disorder

Dani Donovan almost didn’t post the illustration that changed her life: a deadpan visual gag that translated her ADHD-added storytelling style into a 12-point flowchart.

When she released her drawing into the Twittersphere in December 2018, she figured that few people would see it. Instead the post went viral “almost immediately”, amassing more than 100m views across social media channels. Just over a year later, she quit her corporate graphic design job to make ADHD comics full-time.

Donovan, now 31, has become something of a grand doyenne in the widening arena of ADHD influencers, a niche that virtually didn’t exist when she shared her inaugural post just three and a half years ago.

ADHD, or attention deficit and hyperactivity disorder, is having a moment. On TikTok, videos tagged #ADHD have been viewed more than 11bn times. Most of the creators are twenty- and thirtysomethings who identify as having the executive function disorder, whose symptoms commonly include difficulties in concentrating and regulating emotions. Some are practicing clinicians who use their platforms to correct misconceptions (and discourage self-diagnosis). Altogether, they post to ever-expanding audiences.

The trend nods at a surge in adult ADHD diagnoses more than a decade in the making. The steady climb of juvenile ADHD was already a source of concern (and eye-rolls). But between 2007 and 2016, the reported incidence of adult ADHD shot up by 123% in the US, far outpacing the rate of increase in child and adolescent cases. In the mid-2010s, adults replaced children as the primary market for ADHD medication.

The comic that launched Kelli Donovan's career.
Photograph: Kelli Donovan

There is some anecdotal indication that the phenomenon has at least held pace during the pandemic and, more likely, accelerated. In a survey published in March by ADDitude magazine, more than a quarter of 2,365 adult readers of the ADHD-focused publication reported that they were given a formal ADHD diagnosis within the past year. The online pharmacy SingleCare saw a 16% increase in prescriptions for generic Adderall, a popular ADHD stimulant medication, from the start of last year to the beginning of 2022.

Some attribute the pattern to social media. Donovan attests to this first-hand, that she’s gotten more than 1,000 messages from people who pursued clinical assessments and received diagnoses thanks to her content. The decade-old Reddit page r/ADHD grew from 643,000 subscribers in March 2020 to more than 1.4 million today, neatly charting an increase in ADHD curiosity (if not necessarily diagnoses) that coincides with the pandemic. But the rising prevalence of the disorder isn’t so much a fad fueled by social media overexposure as the entanglement of distinct cultural and diagnostic threads, each of them knotty in their own right. The age of ADHD is a clash of science and society, and the discontents of each.

It helps to break things down. There’s ADHD as a neurodevelopmental impairment with known anatomical correlates (think smaller amygdalas and hippocampuses in the brain) , and ADHD as a clinical diagnosis with hefty profit potential for the pharmaceutical industry. Then there’s #ADHD as an algorithmic content incentive and affirmation of experience.

“One thing that makes ADHD a unique diagnosis, in some ways, is that there are social benefits to having the diagnosis that you don’t always see for other mental health difficulties,” says Dr Margaret Sibley, a clinical psychologist and researcher who specializes in ADHD. “People are able to take an ADHD diagnosis to a school or a workplace and have reduced responsibilities because of it, or accommodation for testing, et cetera. When there are benefits like that in place, you have different kinds of consumers.”

In other words, ADHD can grant people a measure of grace for falling short of productivity expectations that would strain most human beings’ baseline capacity. To that end, the pandemic may have provided an even greater incentive to seek out ADHD diagnoses. With the onset of Covid-19, many people found themselves suddenly unable to read books or maintain basic email correspondence, their focus completely and uncharacteristically shot. The phenomenon has been so pronounced and widespread that it’s fed a media subgenre of psychological reassurance-explainers, assuaging readers that reduced cognitive horsepower is to be expected, given the “unprecedented” challenges of the times.

The striking overlap between ADHD symptoms and garden variety “pandemic brain” only compounds common misunderstandings of the former. Simply, ADHD symptoms can look and sound a whole lot like the struggles that define many people’s everyday workflows, which are so often fragmented by push notifications and digital dopamine hits. Who does not have trouble multitasking or following through with tasks? And who isn’t fighting the urge to impulse-scroll social media during the particularly dull moments of any given afternoon? In the past two years, these difficulties have only become more pronounced.

But whether or not ADHD is actively overdiagnosed is a separate question, and one without simple answers. Two things are certain. For one, research suggests that ADHD isn’t a clearcut disorder that a person either totally does or does not have, but a combination of challenges that present on a spectrum of impairment. According to Sibley, rigorous standards of psychiatric assessment should be able to determine between a clinical presentation of disorder and the mere presence of certain ADHD traits.

The second certainty is that the stimulant medications often prescribed to treat ADHD are extremely contentious. Skeptics are quick to point out that drugs such as Adderall and Vyvanse are, effectively, industry-regulated dosages of speed. Whether or not everyone diagnosed with ADHD has the disorder, it is a statement of uneasy fact that most people’s productivity would see improvement from the drugs prescribed to treat it.

The result is what Sibley characterizes as a “philosophical debate”, albeit one often cloaked in the language of safety.

“You could ask yourself a similar question about people using steroids in sports,” says Sibley. “People can raise pros and cons, but ultimately it comes down to what people value more than it does a safety issue, because you can safely manage stimulants in anyone, even a person without ADHD.”

Debates aside, ADHD diagnoses – and the medications that treat the condition – have become much easier to obtain during the pandemic. Social distancing measures removed legislative barriers that previously restricted remote providers from prescribing controlled substances, a class of drugs that includes many ADHD medications. This allowed a number of venture-backed telehealth startups to expand their provisions, and led some to redirect focus to diagnosing ADHD and prescribing medications to treat it.

The shift has not gone unnoticed. The same algorithmic mechanisms that boost the visibility of #ADHD TikToks and Instagram memes also promote ADHD treatment offerings from startups with take-control names such as Klarity, Done and Cerebral. Promoted ads for these companies have become the inescapable window dressing of many people’s social media feeds.

But pushback is under way. At the end of April, a former Cerebral executive launched a labor lawsuit against his former employer, alleging that he was fired for voicing concern that the company had “egregiously put profits and growth before patient safety” by overprescribing medications for ADHD. In recent weeks, a growing number of online pharmacies and brick-and-mortar drugstore chains have stopped filling prescriptions for controlled substances such as Adderall placed by telehealth providers.

A dish of white tablets is bathed in a bluish light.
The pandemic removed legislative barriers that previously restricted remote providers from prescribing controlled substances, such as Adderall. Photograph: JB Reed/Bloomberg News

Outsize concussion over stimulant medications paints a misleading picture of what some patients actually want or need. “The thing is that meds are not a panacea,” says Joy Hui Lin, a southern California-based freelance journalist in her early 40s. “You need structure.”

Hui Lin was diagnosed roughly five years ago, after recognizing her own struggles in an article about ADHD in women. She soon learned that because of gendered social expectations and societal bias, ADHD is often misdiagnosed or overlooked in girls and women, especially girls and women of color.

What she’d internalized as shortcomings of character turned out to be textbook traits of the disorder. She also realized that, while medications provided a helpful assist, she benefited most from the implementation of routines and processes to help stay on top of her daily responsibilities.

A similar vantage is echoed by “Cindy Noir”, the online persona of a 26-year-old social media content creator based in Dallas. Last summer, a licensed psychotherapist got in touch with Noir after seeing a TikTok live stream in which Noir vented about her difficulty completing household tasks and communicating ideas in pace with her rapid-fire brain. The therapist was unable to give Noir an official ADHD diagnosis from a single phone call and email exchanges, but expressed the opinion that Noir probably meets diagnostic criteria for the disorder and recommended that she seek assessment.

“Unfortunately, she said as a woman and as a minority, actually being diagnosed with ADHD is one of the biggest uphill battles because they will diagnose your symptoms as other things and not as ADHD,” says Noir, who is Black. She ultimately opted against pursuing a formal ADHD evaluation or pharmaceutical treatment path because of a lack of health insurance coverage, but says that her life has improved from adopting organizational strategies recommended to ADHD patients, such as making to-do lists and setting electronic reminders. She feels in control, empowered.

What mainstream debate often overlooks is that most people are trying the best that they can with the resources at their disposal. Companies’ cynical exploitation of individuals’ deepest vulnerabilities, amid the amoral landscape of a for-profit health care system, merits scrutiny. But it seems unfair to dismiss the relief people find in an ADHD diagnosis, or from social media content that validates and supports their efforts to live their fullest lives.

“I see the relief and the belonging that has started to occur from people who have felt like they didn’t fit anywhere,” says Donovan, the ADHD comics artist. “They found this space to be, like, ‘Oh OK, these are my people’. These are my people.”

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