Is ADHD on the Rise Worldwide?

The Globalization of a Diagnosis

Posted Jan 12, 2015

In the United States, the number of children diagnosed with attention deficit hyperactivity disorder, typically abbreviated as ADHD, has exploded since 1987. That year, the authors of the third revised edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) first introduced the ADHD diagnosis. The DSM, often called the “psychiatrist’s bible,” is the book psychiatrists use to diagnose mental health problems in children and adults.

The previous edition of the manual, the DSM-III, published in 1980, had introduced the precursor of ADHD, a diagnosis the authors called attention deficit disorder or ADD. DSM-III-R authors believed that 3 percent of children in the United States were afflicted with ADHD. By 2011, the number of children diagnosed with ADHD increased to 11 percent of our child population (according to data published by the Centers for Disease Control and Prevention).

Whether or not ADHD is an actual medical condition is a question that I have discussed quite a lot in my previous blogs. To briefly summarize, my research and my clinical experience have led me to conclude that ADHD is a name for certain behaviors of children that are (except in rare instances) normal childhood behaviors or normal childhood reactions to stressful situations.

The word “ADHD” is much like the word “unicorn.” Everyone knows what the word means, but the thing named does not exist in nature.

That is not to say that some children are not more active, fidgety, disruptive, impulsive, and inattentive in school than their peers. There’s no doubt about that. But for the most part these children are not suffering from a medical condition--although there are a few actual medical conditions which can produce these behaviors in children. DSM-III-R authors identified these medical conditions as central nervous system abnormalities, the presence of neurotoxins, cerebral palsy, and epilepsy. These medical conditions—along with encephalitis and brain tumors--had long been known to produce hyperactive, impulsive and/or inattentive behaviors in children.

The doctors who authored the DSM-III-R also identified certain psychosocial situations that could predispose a child to become hyperactive, inattentive, impulsive or fidgety. They stated that these  situations were “disorganized or chaotic environments and child abuse or neglect.” However, the authors did not distinguish between inattentiveness and hyperactive behaviors originating in a medical condition, on the one hand, and behaviors originating from psychosocial causes, on the other. Since the DSM-III-R defined mental disorders by symptoms alone, the two types of situations were combined into one disorder. This combining of biological and psychosocial causes into one diagnosis has led to enormous confusion.

To address the question that I pose in the title: Is ADHD spreading from its origins in an American psychiatric manual in 1987 to the rest of the world? The short answer is “yes.” As psychiatrists in more countries use the American DSM to diagnose children, the number of children diagnosed with ADHD worldwide is certainly on the rise. One particularly startling figure comes from the South American country Chile, where the number of children diagnosed with ADHD in urban areas is 12 percent—even higher than in the United States. In Chile, psychiatrists primarily use the American DSM-IV or DSM-5 to make their diagnoses.

In countries like France and Italy, where child psychiatrists have traditionally relied on alternative manuals to make diagnoses—manuals such as The International classification of Diseases (ICD) abd the French Classification Française des Troubles Mentaux de L'Enfant et de L'Adolescent (CFTMEA)--the number of children diagnosed with ADHD is far less. I discuss this topic in detail  in my forthcoming book, A Disease called Childhood.

As the influence of American psychiatry and the DSM''s increase across the globe, so do the number of children diagnosed with ADHD. What is proliferating, however, is not a medical disease but a word that purports to name a medical disease. And many words that have purported to name psychiatric diseases (such as the infamous diagnoses of "draeptomania" and "dysaesthesia aethiopica") have lost credibility over time, despite their backing by powerful interest groups.

As long as American psychiatry retains its influence and credibility, the ADHD diagnosis will survive and spread throughout the world. If American psychiatry loses its influence, ADHD will join draeptomania and dysaesthesia aethiopica on the rubbish heap of history.

Copyright © Marilyn Wedge, Ph.D.

Marilyn Wedge is the author of A Disease Called Childhood: Why ADHD became an American Epidemic

Image: Wikimedia Commons: public domain