Why Do Americans Have So Much ADHD?

Chances are you know someone with ADHD. Maybe you have it yourself.

Diagnoses are soaring. The CDC’s 2023 National Survey of Children’s Health found that 11.4 % of U.S. children aged 3–18, about seven million kids, carry an ADHD diagnosis. Adults show the same pattern: 8.7 million adults, roughly one in twelve Americans. These rates significantly exceed those in most European countries, where prevalence typically ranges from 3-7%, the United States is a clear statistical outlier.

The pandemic was gasoline on an already blazing fire. Kids stuck at screens all day at school, telemedicine doctors doling out Adderall like candy. But this was happening way before lockdown. Even now, schools reopened, the prescriptions just keep coming.

Why are so many people in the United States diagnosed with ADHD? It’s an interesting question. There are two dominant explanations, and one controversial new theory that I want to propose in this newsletter that might explain America’s outlier status.

1.The Over Diagnosis Problem

Some people don’t even think ADHD is a real disease. The argument goes that ADHD is purely a result of over diagnosis.

Their case is straightforward, if you're struggling to focus, experience stress, chronic sleep-deprivation, or are overwhelmed from modern life, doctors will prescribe stimulants after a laughably brief consultation

The diagnosis is a joke. Forty-five minutes with a doctor who's checking his Rolex. Two behavior checklists filled out by parents who want their kid fixed. People confuse sleep deprivation and TikTok addiction with neurological difference. One video call on your iPhone and you're walking out with a prescription.

Structural incentives reinforce this trend. U.S. public schools often tie special-education funding and classroom accommodations to an official diagnosis, while insurers demand a DSM code before covering treatment. Bureaucracy pushes borderline cases over the diagnostic threshold. Pharmaceutical companies spend obscene sums advertising stimulants directly to consumers, an 800% spike since the 1990s, turning patients into eager customers.

What they call ADHD could just be a personality type that doesn't fit. Energetic. Disruptive. Creative. Uncomfortable. Easier to pathologize than accommodate. Fix the person, not the system. Label them. Medicate them. Move on.

Modern Life vs. Ancient Brains

Connected to the overdiagnosis argument is the idea of an evolutionary mismatch.

Humans evolved in an environment that required constant movement, tactile problem solving, and immediate feedback, activities dramatically different from today's sedentary lifestyles.

Consider our ancestral environments where:

• Constant scanning of surroundings for threats and opportunities was survival critical

• Physical movement was integrated throughout daily activities

• Tasks varied continuously with immediate natural feedback

• Focus shifted frequently based on environmental demands

Compare this to today's requirements:

• Sitting still for hours while maintaining attention on abstract concepts

• Delaying gratification for distant rewards

• Processing enormous amounts of low-priority information

• Sustaining focus despite minimal physical movement

Consequently, many individuals seek ADHD diagnoses not because their brains are dysfunctional but because they require chemical assistance to cope with unnatural demands. Some even use it to become super workers at high stakes corporate white collar jobs

Legitimate Neurological Differences

The first two explanations help us understand why so many people receive ADHD labels but fail to address why some genuinely struggle without assistance. For a significant minority, ADHD represents a legitimate neurodevelopmental condition rooted in brain chemistry, specifically, dopamine regulation, not simply a product of modern stresses.

Individuals with ADHD maintain lower baseline dopamine levels, a neurotransmitter essential for reward processing, motivation, and mood regulation. When stimulation occurs, their brains react intensely, creating a distinctive all-or-nothing attention pattern commonly called hyperfocus.

Neuroimaging studies have identified structural differences in ADHD brains, particularly in regions responsible for executive function and impulse control. Researchers at Massachusetts General Hospital discovered that certain brain regions mature an average of three years later in children with ADHD compared to their neurotypical peers.

@docamen

Reply to @maekomei My friend @chalenejohnson came to get her brain scanned awhile back and here’s what we found. #adhd #adhdinwomen

Historically, these individuals were misunderstood as lazy or troublemakers, akin to how left-handedness was once stigmatized rather than recognized as natural variation.

Their struggle feels undeniably real, undeniable suffering embedded in biology, revealed clearly in brain scans even if not officially diagnostic. I’ve seen people transform completely after they were diagnosed. I understand many people are using the system to get pills without ADHD, but from personal experience, there does seem to be something to ADHD that is real. Here’s one very personal blog excerpt:

A New Theory: The American Selection Hypothesis

Consider the American selection hypothesis. People with ADHD tendencies were more likely to leave familiar surroundings. They packed their belongings, boarded ships, traveled thousands of miles on promises and possibilities. Self-selection in action.

First-generation immigrants, driven and entrepreneurial, pass ADHD-linked genes to their children. These subsequent generations, who seek safer, more stable lifestyles, experience a neurological mismatch, wired for novelty but confined to monotonous environments. The genetic impulse remains while you attend meetings in office parks. While you answer emails at your desk.

Here is evidence supporting this theory:

• ADHD's heritability approaches 75%, comparable to physical traits like height.

• Adults with ADHD moved residences 2.7 times more frequently than control groups. They change jobs more readily. Start ventures. Abandon projects. They seek novelty when familiarity becomes overwhelming. Apartment to apartment. City to city. The pattern repeats.

• The DRD4-7R allele. Scientific terminology for a genetic marker linked to ADHD behaviors. It correlates with historical migration distance. The frequency increases in populations that traveled farther from their origins. Higher concentrations appear in Australia. In Canada. In America. The same countries with elevated ADHD diagnosis rates. Correlation that suggests causation.

America represents a large scale experiment in self-selection for novelty seeking traits. Those who tolerated stability remained in their homelands. Those who craved change, who required stimulation, who couldn't remain still, they came here. Their descendants inherit the neurochemistry but inhabit environments demanding opposite behaviors. Office buildings. Standardized classrooms. Eight-hour workdays. The mismatch manifests as disorder. The solution becomes medication.

Is this argument correct? Maybe or maybe not. People immigrate for different reasons, some are refugees who had to emigrate against their will, others to join their families, whereas some others chose it voluntarily.

But the selection argument is something to consider in many cases.

Selection Effects

Selection effects are the hidden forces shaping the data we trust. Before measurement even begins, unseen filters sort people and events, leaving behind only those who survived the cut. We tally ADHD diagnoses in American classrooms without asking what drove those children's ancestors across oceans generations ago. Patterns appear clear, but they're shadows cast by invisible selection, stories incomplete unless we recognize who's missing from the numbers.

Take the popular meme of selection bias, you may have seen it online. What does it mean? It’s an airplane with holes? What happened was, engineers in World War 2 studied bullet holes in returning planes and concluded they should armor those areas, but they initially overlooked the fact that planes hit elsewhere didn't make it back at all. The solution was to reinforce parts of planes that were not damaged on the survivors.

Here are a few other examples of Selection Effects

Marriage and Happiness

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