A.D.H.D. Is Everywhere

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My story in the New York Times this week describes how A.D.H.D. rates have been rising throughout the world, presenting millions of parents with dilemmas and controversies long-familiar to Americans coping with the disorder.

Certainly part of the reason for the rise has to do with a flood of new information. Back in May, Laurie Kelleher, who recently launched International ADHD Parent from Tbilisi, Georgia, published a list of more than 40 nations that now have Facebook pages and websites for A.D.H.D. support groups.

It's certainly plausible, as some researchers suggest, that global pharmaceutical firms have contributed to the rising rates, lobbying governments and funding conferences and awareness campaigns in recent years. That's a topic I plan to write about soon. For now, however, I want to mention one other major reason for the rising rates, which is that competitive pressures, in school and on the job, appear to be making people ever less tolerant and more concerned about distraction and impulsivity.

The leading A.D.H.D. expert Stephen Hinshaw, a University of California professor and my co-author on "A.D.H.D.: What Everyone Needs to Know," has co-authored a fascinating book on this phenomenon, inside and outside the United States, titled The A.D.H.D. Explosion: Myths, Medication, Money, and Today's Push for Performance.

"This pressure for performance is being felt all over the world — and it's making people look for every available edge," he says.

I heard reports of the consequences of this pressure throughout my weeks of researching the Times story. In Turkey, for instance, Yanki Yazgan, a professor of child psychiatry at the Marmara University Medical School in Istanbul, told me that he thought the rates were rising partly because: "Schools are becoming more demanding, especially private schools. Children are made to sit for 35 to 45 minutes straight, starting in kindergarten. In private schools, they're often learning two foreign languages at once. Parents are also becoming more demanding because they're getting worried about their children's futures."

In recent years, such competition may have increased anxiety about A.D.H.D. even in Brazil's Amazon basin, according to Paulo Verlaine Azevedo, an assistant professor of psychiatry at the Pontifical Catholic University in Goiás, Brazil.

I interviewed Azevedo about his published research on the incidence of A.D.H.D. among a group of Karajá people indigenous to an island on the Araguaia River in central Brazil. Even there, he said, in an email interchange, A.D.H.D. had recently become a "major concern" among parents who've watched their children fail to stay focused in schools that have gradually become more demanding.

Azevedo estimated that more than 10 percent of Karaja parents and other caregivers reported signs of the disorder in their children, although they appeared to have a much higher threshold for concern than a typical U.S. family might display. For instance, he said, the parents he interviewed weren't seriously concerned about children who would leave their classrooms spontaneously for a quick swim in the river. But, as he added, "They did get concerned when the children swam across the river to the city and didn't come back all day."