May 19, 2021
Myth: ADHD is an American disorder.
Those who claim ADHD is an American disorder believe that ADHD is due to the pressures of living in a fast-paced, competitive American society. Some argue that if we lived in a simpler world, ADHD would not exist.
Fact: ADHD occurs throughout the world.
Wherever scientists have searched for ADHD, they have found it. They have done this by going to different countries, and speaking to people in the community to diagnose them with or without ADHD. These studies show that ADHD occurs throughout the world and that the percentage of people having ADHD does not differ between the United States and the rest of the world. Examples of where ADHD has been found include Australia, Brazil, Canada, China, Colombia, Finland, Germany, Iceland, Israel, Italy, Japan, New Zealand, Spain, Sweden, Taiwan, The Netherlands, and Ukraine. ADHD is not an American disorder.
Myth: A child who sits still to watch TV or play video games cannot have ADHD.
Many parents are puzzled that their child can sit still to watch TV or play video games for hours, but that same child cannot sit still for dinner or stay at their desk for long to do homework. Are these children faking ADHD symptoms to get out of homework?
Fact: ADHD does not necessarily interfere with playing video games or watching TV.
Because children cannot turn their ADHD on and off to suit their needs, it does seem odd that a child who is typically hyperactive and inattentive can sit for hours playing a video game. But this ability of ADHD children fits in very well with scientific facts about ADHD. First, you probably understand the effects of rewards and punishment on behavior. If your behavior is rewarded, you are likely to do it again. If it is punished, you will avoid that behavior in the future. Rewards that have the strongest effect on our behavior are large and will occur soon. For example, consider these two choices:
a) if you listen to a boring one-hour lecture, I will pay you $100 immediately after the lecture
b) if you listen to a boring one-hour lecture, I will pay you $110 one year after the lecture
Choice (a) is more appealing than choice (b). Most people will not think it is worthwhile to wait one year for $10. We say they have 'discounted' the $10 to $0.
Now consider the choices:
c) if you listen to a boring one-hour lecture, I will pay you $100 immediately after the lecture
d) if you listen to a boring one-hour lecture, I will pay you $2,000 one year after the lecture
Choice (d) is more appealing than choice (c). Most people will wait one year for$2,000. It is obvious here is that if I want the best chance of having you watch a lecture, I should offer you a large sum of money immediately after the lecture. What is not so obvious is that people vary a great deal in the degree to which they are affected by rewards that are either small or distant in the future. For some people, getting $2,000in one year is almost like getting nothing at all. We say that such people are not sensitive to distant rewards.
What does this have to do with ADHD and video games? Well, people with ADHD are usually not very sensitive to weak or distant rewards. To affect the behavior of a person with ADHD, the reward needs to be immediate and fairly large. When a child with ADHD sits down to do homework, the potential reward is getting a good grade on their report card, but they won't receive that grade for weeks or months, so it is very distant. Thus, it is not surprising that the possibility of that reward cannot control the child's behavior. In contrast, video games are created so that players are rewarded very frequently by winning points or completing one of the many levels one must pass to finally complete the game. Because playing well is also rewarded by friends, the video game rewards are strong and immediate, which makes it easy for people with ADHD to sit still and play for long periods.
Myth: ADHD disappears in adulthood.
Until the 1990s, it was commonly believed that children grew out of ADHD. The reason for this is not clear. Some theories about ADHD suggested that ADHD children had a lag in brain development, and that they would make up for that lag during adolescence. So ADHD was seen as a delay in brain development that could be overcome. The idea that children routinely recovered from ADHD was so strong that many insurance companies would not pay for the ADHD treatment of adults.
Fact: In the majority of cases, ADHD persists into adulthood.
This myth about ADHD has been proven wrong by studies that diagnosed ADHD in children and then examined it many years later than in adults. These studies showed that, although there was some recovery from ADHD, about two-thirds of cases persisted into adulthood. The studies also taught us that ADHD symptoms tend to change with age. The extreme and disruptive hyperactivity of many ADHD children gets somewhat better by adulthood, as do some symptoms of impulsivity. In contrast, inattentive symptoms do not decrease much with age.
Myth: People with ADHD cannot do well in school or succeed in life.
This myth is based on several facts: 1) ADHD affects many aspects of life; 2) ADHD impairs thinking and behavior and 3) for most people, ADHD is a lifelong disorder. Altogether, doesn't this mean that people with ADHD won't succeed in life?
Fact: People with ADHD can succeed and live productive lives.
There are two reasons why people with ADHD can succeed in life. The first is obvious. Although treatments for ADHD are not perfect, they can eliminate many of the obstacles that would otherwise make it difficult for ADHD patients to do well in school or on the job. But, more importantly, having ADHD is only one of many facts about a person's life. Some ADHD people have other skills or traits that help them compensate for their ADHD. For example, if you have a high level of intelligence, an engaging personality, or excellent athletic skills, you can do well despite having ADHD. Consider Michael Phelps, who broke so many Olympic swimming records. He was diagnosed with ADHD at age 9 and took Ritalin to help his hyperactivity. James Carville has ADHD, but he completed law school and helped Bill Clinton become President of the United States. Cammi Granato's ADHD did not stop her from becoming captain of the United States Olympic ice hockey team, and Ty Pennington's ADHD did not stop him from becoming a star on TV.
Myth: ADHD does not affect highly intelligent people
The mistake behind this myth is that it assumes that being very intelligent protects people from having ADHD. It's true that if you are highly intelligent, you can use that intelligence to compensate for some ADHD' effects, but does high intelligence completely protect a person from ADHD?
Fact: People with ADHD can succeed and live productive lives.
When my colleagues and I studied this question, we found clear evidence that high intelligence does not completely protect people from ADHD. Like people who don't have ADHD, having high intelligence will help Alderpeople do better than ADHD people who are not smart. But when we compared highly intelligent Alderpeople with highly intelligent non-ADHD people, we found that the highly intelligent ADHD people had many of the impairing problems that are known to be associated with ADHD. For details about these problems, see Complications of ADHD. In another study, we compared ADHD adults who had received straight A grades in high school, with non-ADHD people who had achieved the same grades. Despite their good grades, these ADHD adults were not doing as well in their jobs and not earning as much income as the non-ADHD adults. And ADHD also has an impact at every level of education. As you can see from the figure, even for people with college degrees, having ADHD lowers your chances of being employed.
Faraone, S. V., Sergeant, J.,Gillberg, C. &Biederman, J. (2003). The Worldwide Prevalence of ADHD: Is it an American condition? World Psychiatry2, 104-113.Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J. &Rohde, L. A. (2007). The Worldwide Prevalence of ADHD: a systematic Review and Meta-regression Analysis. Am J Psychiatry164,942-8.
Scheres, A., Lee, A. &Sumiya,M. (2008). Temporal reward discounting and ADHD: task and symptom-specific effects. J Neurol Transm115, 221-6.
Faraone, S., Biederman, J. &Mick, E. (2006). the Dependent Decline Of Attention-Deficit/Hyperactivity Disorder: Aneta-Analysis Of Follow-Up Studies. Psychological Medicine36,159-165.
The National Health Interview Survey (NHIS) is conducted annually by the National Center for Health Statistics at the Centers for Disease Control and Prevention. The NHIS is done primarily through face-to-face computer-assisted interviews in the homes of respondents. But telephone interviews are substituted on request, or where travel distances make in-home visits impractical.
For each interviewed family, only one sample child is randomly selected by a computer program.
The total number of households with a child or adolescent aged 3-17 for the years 2018 through 2021 was 26,422.
Based on responses from family members, 9.5% of the children and adolescents randomly surveyed throughout the United States had ADHD.
This proportion varied significantly based on age, rising from 1.5% for ages 3-5 to 9.6% for ages 6-11 and to 13.4% for ages 12-17.
There was an almost two-to-one gap between the 12.4% prevalence among males and the 6.6% prevalence among females.
There was significant variation by race/ethnicity. While rates among non-Hispanic whites (11.1%) and non-Hispanic blacks (10.5%) did not differ significantly, these two groups differed significantly from Hispanics (7.2%) and Others (6.6%).
There were no significant variations in ADHD prevalence based on highest education level of family members.
But family income had a significant relationship with ADHD prevalence, especially at lower incomes. For family incomes under the poverty line, the prevalence was 12.7%. That dropped to 10.3% for family incomes above the poverty level but less than twice that level. For all others it dropped further to about 8.5%. Although that might seem like poverty causes ADHD, we cannot draw that conclusion. Other data indicate that adults with ADHD have lower incomes. That would lead to more ADHD in kids from lower income families.
There was also significant geographic variation in reported prevalence rates. It was highest in the South, at 11.3%, then the Midwest at 10%, the Northeast at 9.1%, with a jump down to 6.9% in the West.
Overall ADHD prevalence did not vary significantly by year over the four years covered by this study.
This study highlights a consistently high prevalence of developmental disabilities among U.S. children and adolescents, with notable increases in other developmental delays and co-occurring learning and intellectual disabilities from 2018 to 2021. While the overall prevalence remained stable, these findings emphasize the need for continued research into potential risk factors and targeted interventions to address developmental challenges in youth.
It is also important to note that this study assessed the prevalence of ADHD being diagnosed by healthcare professionals. Due to variations in healthcare accessibility across the country, the true prevalence of ADHD may differ still.
...
.png)
Background:
An international research team used the nationally representative 2020–2021 U.S. Survey of Children’s Health to explore associations between ADHD, weeknight sleep insufficiency, and bedtime irregularity.
"Sleep sufficiency" refers to the recommended amount of sleep for an individual. Sleep recommendations vary by age and other factors, such as health and lifestyle. For example, 7-9 hours is typically considered sufficient sleep for most adults, but an active teen may require closer to 10 hours of sleep per day.
Previous studies have shown that issues with both falling and staying asleep are common in individuals with ADHD.
The Study:
The team matched 7,671 children and adolescents with ADHD aged 3-17 to 51,572 controls.
Noting that “The few available population-based studies examining sleep in children with ADHD have focused on circumscribed age ranges, limiting generalizability across childhood, and have seldom included controls,” and “bedtime irregularity has received limited empirical attention in children with ADHD,” this study focused on these aspects of sleep impairment.
The study group excluded children and adolescents with ADHD with Down syndrome, current or lifetime cerebral palsy, and current or lifetime intellectual disability. In the control group, it excluded individuals with Down syndrome, cerebral palsy, intellectual disability, speech and language disorder, autism spectrum disorder, ADHD, anxiety, depression, behavioral or conduct problems, Tourette syndrome, and use of mental health services in the preceding 12 months. These groups were excluded to limit potential confounding factors.
After adjustment for covariates, parents of children and adolescents with ADHD reported weekday sleep insufficiency 65% more frequently than parents of controls.
However, when comparing matched controls with children and adolescents with ADHD who were being treated with ADHD medication, there was no significant difference.
Similarly, there was a small but significant effect size increase in bedtime irregularity among children and adolescents with ADHD relative to their matched controls.
Yet there was also a small but significant effect size decrease in bedtime irregularity among those taking medication for ADHD relative to those who were unmedicated.
The team noted, “Interestingly, here, ADHD medication use was linked to less bedtime irregularity across full and age-stratified samples, and not related to sleep insufficiency. However, research indicates the association between stimulant use and sleep problems is attenuated with longer duration of use, and also suggests the potential for stimulants to produce positive effects on sleep through reduced bedtime resistance. Further, ADHD medication type, not specified, may have influenced outcomes.”
The Take-Away:
The study concluded that ADHD in children was linked to insufficient sleep and irregular bedtimes in a nationally representative sample, reinforcing and expanding previous research. The findings emphasize the influence of various factors on sleep insufficiency and bedtime irregularity, including race, screen time, poverty, ADHD severity, and depression.
Noting that “the association between adult ADHD and dementia risk remains a topic of interest because of inconsistent results,” an Israeli study team tracked 109,218 members of a nonprofit Israeli health maintenance organization born between 1933 and 1952 who entered the cohort on January 1, 2003, without an ADHD or dementia diagnosis and were followed up to February 28, 2020.
Israeli law forbids nonprofit HMOs from turning anyone away based on demographic factors, health conditions, or medication needs, thereby limiting sample selection bias.
The estimated prevalence of dementia in this HMO, as diagnosed by geriatricians, neurologists, or psychiatrists, is 6.6%. This closely matches estimates in Western Europe (6.9%) and the United States (6.5%).
The team considered, and adjusted for, numerous covariates: age, sex, socioeconomic status, smoking, depression, obesity, chronic obstructive pulmonary disease, hypertension, atrial fibrillation, heart failure, ischemic heart disease, cerebrovascular disease, diabetes, Parkinson’s disease, traumatic brain injury, migraine, mild cognitive impairment, psychostimulants.
With these adjustments, individuals diagnosed with ADHD were almost three times as likely to be subsequently diagnosed with dementia as those without ADHD. Men with ADHD were two and a half times more likely to be diagnosed with dementia, whereas women with ADHD were over three times more likely, than non-ADHD peers.
More concerning still, persons with ADHD were 5.5 times more likely to be subsequently diagnosed with early onset dementia, as opposed to 2.4 times more likely to be diagnosed with late onset dementia.
On the other hand, the team found no significant difference in rates of dementia between individuals with ADHD who were being treated with stimulant medications and individuals without ADHD. Those with untreated ADHD had three times the rate of dementia. The team nevertheless cautioned, “Due to the underdiagnosis of dementia as well as bidirectional misdiagnosis, this association requires further study before causal inference is plausible.”
Conclusions and Relevance:
This study reinforces existing evidence that adult ADHD is associated with an increased risk of dementia. Notably, the increased risk was not observed in individuals receiving psychostimulant medication, however the mechanism behind this association is not clear.
These findings underscore the importance of reliable ADHD assessment and management in adulthood. They also highlight the need for further study into the link between stimulant medications and the decreased risk of dementia.
...
Struggling to get the care you need to manage your ADHD? Support The ADHD Evidence Project and get this step-by-step guide to getting the treatment you deserve: https://bit.ly/41gIQE9
_logo%201.svg)
