May 19, 2021

OTHER MYTHS ABOUT ADHD

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.

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Undiagnosed ADHD May Be Undermining Diabetes Control in Adults with Type 1 Diabetes

Our recent study, published in the Journal of Clinical Medicine, aims to shed light on an under-recognized challenge faced by many adults with Type 1 diabetes (T1D): attention-deficit/hyperactivity disorder (ADHD) symptoms.

We surveyed over 2,000 adults with T1D using the Adult Self-Report Scale (ASRS) for ADHD and analyzed their medical records. Of those who responded, nearly one-third met the criteria for ADHD symptoms—far higher than the general population average. Notably, only about 15% had a formal diagnosis or were receiving treatment.

The findings are striking: individuals with higher ADHD symptom scores had significantly worse blood sugar control, as indicated by higher HbA1c levels. Those flagged as "ASRS positive" were more than twice as likely to have poor glycemic control (HbA1c ≥ 8.0%). They also reported higher levels of depressive symptoms.

As expected, ADHD symptoms decreased with age but remained more common than in the general public. No strong links were found between ADHD symptoms and other cardiometabolic issues.

This study highlights a previously overlooked yet highly significant factor in diabetes management. ADHD-related difficulties—such as forgetfulness, inattention, or impulsivity—can make managing a complex condition like T1D more difficult. The researchers call for more screening and awareness of ADHD in adults with diabetes, which could lead to better mental health and improved blood sugar outcomes.

Takeaway: If you or a loved one with T1D struggles with focus, organization, or consistent self-care, it may be worth exploring whether ADHD could be part of the picture. Early identification and support are crucial to managing this common comorbidity. 

July 10, 2025

Norwegian Population Study Finds ADHD Associated with Much Higher Odds of Contact with Child Welfare Services

Background:

This nationwide population study by a Norwegian team aimed to evaluate the relationship between ADHD and various types of child welfare services contacts over a long-term period of up to 18 years among children and adolescents aged 5 to 18 years diagnosed with ADHD, in comparison to the general population within the same age group. 

Norway has a single-payer national health insurance system that fully covers virtually the entirety of its population. In combination with a system of national population and health registers, this facilitates nationwide population studies, overcoming the limitations of relying on population sampling. 

Study:

The study population included all 8,051 children and adolescents aged 5 to 18 who were diagnosed with ADHD for the first time in the Norwegian Patient Registry between 2009 and 2011. 

The study also included a comparison sample of 75,184 children and adolescents aged 5–18 with no child welfare services contact during 2009–2011. 

The interventions delivered by child welfare services in Norway are largely divided into two primary categories: supportive intervention and out-of-home placement. 

Supportive interventions include improving parenting skills, promoting child development, providing supervision and control, facilitating cooperation with other services, assessments and treatments by other institutions, and offering housing support. 

Norway uses foster homes or child welfare institutions as a last resort. When supportive interventions fail to meet the child’s needs, the child welfare services can temporarily place the child in these facilities. If parents disagree, the county social welfare board decides based on a municipal request. 

The team adjusted for potential confounders: sex, age, parental socioeconomic status (father’s and mother’s education and income level), and marital status. 

Results:

With these adjustments, children and adolescents diagnosed with ADHD were over six times more likely to have any contact with child welfare services than their general population peers. This was equally true for males and females.  

Children and adolescents diagnosed with ADHD were also over six times more likely to receive supportive interventions from child welfare services. Again, there were no differences between males and females. 

Finally, children and adolescents diagnosed with ADHD were roughly seven times more likely to have an out-of-home placement than their general population peers. For males this rose to eight times more likely. 

Conclusion:

The team concluded, “This population-based study provides robust evidence of a higher rate and strong association between ADHD and contact with CWS [Child Welfare Service] compared to the general population in Norway.” 

July 8, 2025

Swedish nationwide population study identifies top predictors of ADHD diagnoses among preschoolers

Most preschool-aged children diagnosed with ADHD also exhibit comorbid mental or developmental conditions. Long-term studies following these children into adulthood have demonstrated that higher severity of ADHD symptoms in early childhood is associated with a more persistent course of ADHD. 

The Study: 

Sweden has a single-payer national health insurance system that covers virtually all residents, facilitating nationwide population studies. An international study team (US, Brazil, Sweden) searched national registers for predictors of ADHD diagnoses among all 631,695 surviving and non-emigrating preschoolers born from 2001 through 2007.  

Preschool ADHD was defined by diagnosis or prescription of ADHD medications issued to toddlers aged three through five years old.  

Predictors were conditions diagnosed prior to the ADHD diagnosis. 

A total of 1,686 (2.7%) preschoolers were diagnosed with ADHD, with the mean age at diagnosis being 4.6 years. 

The Numbers:

Adjusting for sex and birth year, the team reported the following predictors, in order of magnitude: 

  • Previous diagnosis of autism spectrum disorder increased subsequent likelihood of ADHD diagnosis twentyfold. 
  • Previous diagnosis of intellectual disability increased subsequent likelihood of ADHD diagnosis fifteenfold. 
  • Previous diagnosis of speech/language developmental disorders and learning disorders, as well as motor and tic disorders, increased subsequent likelihood of ADHD diagnosis thirteen-fold. 
  • Previous diagnosis of sleep disorders increased subsequent likelihood of ADHD diagnosis fivefold. 
  • Previous diagnosis of feeding and eating disorders increased subsequent likelihood of ADHD diagnosis almost fourfold. 
  • Previous diagnosis of gastroesophageal reflux disease (GERD) increased subsequent likelihood of ADHD diagnosis 3.5-fold. 
  • Previous diagnosis of asthma increased subsequent likelihood of ADHD diagnosis 2.4-fold. 
  • Previous diagnosis of allergic rhinitis increased subsequent likelihood of ADHD diagnosis by 70%. 
  • Previous diagnosis of atopic dermatitis or unintentional injuries increased subsequent likelihood of ADHD diagnosis by 50%. 

The Conclusion: 

This large population study underscores that many conditions present in early childhood can help predict an ADHD diagnosis in preschoolers. Recognizing these risk factors early may aid in identifying and addressing ADHD sooner, hopefully improving outcomes for children as they grow

July 2, 2025