The Whitewashed Increase In The Diagnosis of ADHD

It was in seventh grade that I first encountered the term ‘ADHD’. This introduction was not through a textbook but rather through my friend who had recently been diagnosed with the disorder. Her parents had furtively tried to keep the diagnosis under wraps due to the scorn with which mental health and its constructs were viewed in India. Their attempts were thwarted, of course, when the prying teachers marked her out as ‘different’ from the regular students. This ‘difference’ became evident in the altered treatment she received thereafter.

The discourse around mental health has evolved greatly since, evident in the hashtag #ADHD boasting a total of 4.1 million posts on Instagram. Accessible mental health resources donning prescriptions on how to identify symptoms of disorders are just an Instagram reel away. This shift in approach from stigma to social acceptance is reflected in the trend in the increase in the prevalence of mental disorders, ADHD being one of the most popular ones. The prevalence of diagnosis of ADHD among children and adolescents in the United States observed an increase from 6.1% during 1997-1998 to 10.2% in 2015-2016 (Xu et al 2018).

Read More: ADHD: Diagnosis, Types and Treatment

During and post the pandemic, these numbers have only accelerated further to 10.47% (Li et al 2023). However, research conducted in India concluded that only 5.7% of primary school children in India had ADHD in 2018 (Suthar et al.). Even today, the prevalent cases of ADHD in India are 619.6, as compared to the US which has 1675.64 prevalent cases, with the US holding the title of having the largest percentage of adolescents with ADHD (ADHD Rates by Country, 2024).

The diagnostic criteria for ADHD according to the DSM-5-TR includes symptoms that fall under one of two broad categories – inattention and hyperactivity-impulsivity. For a diagnosis, five or more symptoms must be present for six months or longer and the daily functioning of an individual must be impacted due to these symptoms (American Psychiatric Association, 2022).

However, even the mildest symptoms portrayed by white children have become a basis for a diagnosis. This is a pathologization of normal variations in attention and behaviour. Not only is there an overdiagnosis of ADHD in white children, but there is also a risk of misdiagnosis. Since ADHD has a high rate of comorbidity, several other disorders may be clubbed into the umbrella diagnosis of ADHD (Abdelnour, 2022). There is evidence that therapists may have a bias towards diagnosing children with ADHD if they seem like a quintessential case of ADHD without keeping in mind certain exclusionary criteria (Bruchmüller et al., 2012).

But this is a whitewashed problem. This is a problem of racial disparity. Both Black and Latino children in the US are less likely than white children to be diagnosed with ADHD (Marks, 2022). The structure of the US healthcare system which discriminates in its diagnosis is the cause for the overdiagnosis of white children and the underdiagnosis of others. This is also what causes resources to be taken away from individuals who need them (Marks, 2022) to those who portray even the mildest symptoms of ADHD.

Read More: Understanding ADHD in Women: Symptoms and Recognition

The after-effects of the pandemic – the digitization of everyday routines across all spheres of life, be it education, work, or entertainment have exacerbated the narrative of the prevalence of ADHD. An alarming new trend on TikTok and Instagram reels varnished with captions like ‘10 signs you have ADHD’ took over most social media. Under the pretences of wanting to destigmatize mental health disorders and spread awareness, these reels propagated often misleading and subjective experiences which led to further demands on the healthcare industry for an ADHD diagnosis (Yeung et al., 2022). A simple search on Instagram proves that the individuals creating these reels are overwhelmingly white. This often creates a snowball effect wherein more people begin relating to ADHD symptoms which puts pressure on the already lacking healthcare system in the US (Green, 2023).

Of course, this is not to say that India is doing better than the US in any regard. The reason for the lower rate of ADHD diagnosis in India may be because less than 1% of mental health disorders are self-reported in India (Ghai, 2024). There is also limited research in India surrounding ADHD. Until recently, the prevalence rate of ADHD in Indian children varied from 1.6 to 14% in various studies (Suthar et al., 2018).

Furthermore, simply because the discourse around ADHD has become more prominent due to globalization, there is no evidence that India has been any more accepting of the disorder. Lastly, India still has a massive population living below the poverty line. Financial barriers and a lack of awareness force a huge populace to continue to suffer in silence.

While India is lacking in destigmatising mental health disorders and providing resources to its entire population, the trend of unnecessarily steep rise in the diagnosis of ADHD is skewed towards white people, white children in particular and this narrative has been wrongly generalized to the overall population of not just India but most countries. The most obvious step towards a more comprehensive understanding of the prevalence of ADHD in India and among other minority groups is accessibility. This can be achieved through better funding for mental health resources.

Read More: Benefits, Risks, and Controversies of ADHD Medication Management

Several minority groups often come from lower socio-economic backgrounds and thus lack the means to get a diagnosis and treatment. Once mental healthcare has been made more accessible and through the use of better diagnostic tools, a less biased vision of ADHD is created, there can be better research with a diverse sample. This research will clear up whether the increase in ADHD diagnosis is a whitewashed baseless mass hysteria or if there truly is a cause for concern that is simply being ignored when it comes to the marginalized sectors of society.