Global ADHD Epidemic or Not?

Is ADHD an essential or universal psychiatric disorder? In other words, is ADHD found in all human populations across time and space? Or has ADHD been experienced, understood, diagnosed, and treated differently in different countries?

A number of scholars have written about how a range of psychiatric disorders that emerged in the United States after the Second World War have spread to other countries in recent years. One of these disorders has been ADHD. ADHD was first diagnosed (using different terminology) in the U.S. during the late 1950s, was diagnosed in Canada a decade later and, during the 1970s, became a commonly diagnosed condition in countries like Australia and New Zealand. Following the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders in 1980 and the coining of the term Attention Deficit Disorder, the disorder spread further, into Europe, Asia, and beyond.

Psychiatrist Sami Timimi has described this globalization process with respect to ADHD as the "McDonaldization of childhood," and has pointed to the role of pharmaceutical companies in marketing the disorder (and the drugs that treat it) to different global markets. Although I am very sympathetic to Timimi's analysis and concerns, a closer look at the history reveals a more complex picture. Specifically, while ADHD has spread to most parts of the globe, different countries have engaged with the concept in very different ways. While some have accepted the American model of ADHD, diagnosing large percentages of children and adults and treating them with stimulant medication, many others have contested how the disorder is presented or rejected the idea altogether. In other words, ADHD is not a universal nor essential condition; it changes (and sometimes disappears) when it migrates from country to country.

For example, while ADHD is a commonly diagnosed disorder in the UK, British psychiatrists and parents have long been more sympathetic to different explanations for it and have been more skeptical to drug treatment than their cousins in the U.S. While Iceland has the highest per capita consumption of Ritalin, even surpassing that of the U.S., other Nordic countries, such as Finland (where children don't start school until age seven) have low rates of diagnosis. The other Nordic countries have substantial regional differences in terms of diagnosis and treatment (as does the U.S. and other countries). Although ADHD has been diagnosed in China since the 1980s, it has taken longer to take off in India, where there are considerable regional and class differences in terms of diagnosis and treatment.

Although it is tempting (and informative) to focus solely on local and national factors, it is possible to draw out some generalizations about why countries do and do not accept ADHD. One stands out: ADHD tends to be diagnosed in countries where children are seen as means to the end of creating a more competitive, prosperous, and powerful society, rather than as ends in themselves. Who benefits from seeing in children this way? Another question worth asking.

For more information, please read this open-access article in Social History of Medicine. https://academic.oup.com/shm/advance-article/doi/10.1093/shm/hkw127/2919401