Colman Noctor: Not everyone who struggles to focus has ADHD

Colman Noctor: "The spike in ADHD diagnoses has prompted a vigorous debate about the legitimacy of these presentations. Are we finally recognising a condition that has long gone undiagnosed, or are we pathologising normal variations in behaviour and attention?" Picture: iStock.

Once a niche childhood condition, attention deficit hyperactivity disorder (ADHD), has become one of the most common mental health problems. 

The increase in diagnosis is not just in children, but also in adults. The numbers are staggering. In the US, ADHD diagnoses in children increased by 42% between 2003 and 2011, and, according to the US Centres for Disease Control and Prevention (CDC), adult diagnoses have risen even faster in the past decade. 

According to ADHD Ireland, as of October 2024, ADHD affects approximately 5% of children and 3% of adults, amounting to 230,000 people.

The spike in ADHD diagnoses has prompted a vigorous debate about the legitimacy of these presentations. Are we finally recognising a condition that has long gone undiagnosed, or are we pathologising normal variations in behaviour and attention? Is this surge a reflection of increased awareness, or is it a symptom of something deeper?

Much of the polarisation stems from an inability to consider both perspectives. My 25 years of working in the mental health field have taught me that there is rarely one explanation for any condition or presentation, and being open to multiple causes can offer far more insight.

Technology, education, and work have undergone seismic changes in the past two decades, which may be reshaping not just how we live but also how we function and, in turn, how we diagnose dysfunction. 

Mental illness is not a static, universal phenomenon. It is dynamic, context-bound, and shaped by society’s values, expectations, and structures. So, while mental illnesses are ever-present, their presentation may change as society changes.

One of the most significant societal shifts contributing to the rise in ADHD diagnoses is the advent of the ‘attention economy’. In the past two decades, our lives have become saturated with digital technologies designed to capture and monetise our attention.

Social media platforms, video streaming services, gaming apps, and news feed notifications ping throughout the day, demanding our attention.

The result is that we are constantly switching tasks, scanning headlines, and skimming content. This always-on environment does not just cater to a short attention span, it cultivates it.

It’s not hard to see how typical traits associated with ADHD, such as difficulty sustaining attention, impulsivity, and restlessness, could be exacerbated or even produced by the demands and distractions of the modern world. Our brains are neuroplastic; they adapt to the environments they inhabit. And, increasingly, those environments are designed to create hyper-distraction.

Children growing up in this environment face particular challenges. Screen usage has soared, and opportunities for unstructured play and outdoor activity, which were once crucial outlets for youthful energy, have declined or become non-existent. 

Classrooms, meanwhile, are increasingly focused on standardised testing and prepping young people for state examinations, leaving little room for creativity, varied learning styles, or divergent thinking.

Explosion in adult diagnosis

The story of ADHD in the 2020s isn’t just about children. The explosion in adult diagnoses is one of the most remarkable aspects of the recent surge. 

For many adults, an ADHD diagnosis can feel like a revelation that explains years of difficulty with organisation, time management, emotional regulation, or meeting deadlines. 

Online forums and social media communities are awash with stories of people, particularly women, overlooked as children, but who now recognise symptoms in themselves, due to greater public awareness.

I worked in CAMHS (Children and Adolescent Mental Health Services) for years, and ADHD was primarily associated with hyperactive boys. In hindsight, girls, who are more likely to present with inattentive symptoms (daydreaming, disorganisation) rather than hyperactive and disruptive ones, and especially those who were academically functioning, tended to slip through the cracks.

An expanded understanding of ADHD was long overdue. Many parents who bring their child for an ADHD assessment see themselves in the questions being asked, prompting them to seek an evaluation. It’s a legitimate reason, as ADHD can run in families.

However, the speed and scale of the diagnostic surge also raise reasonable questions about whether we are medicalising behaviours, which, in a different era, might have been seen as personality quirks, lifestyle mismatches, or responses to stress. 

So, instead of asking if the diagnosis spike reflects an actual neurological difference, or whether people are seeking a diagnosis to explain their struggles with lifestyle management, why not ask if it is a reflection of an increasingly fragmented and demanding world?

Modern work culture may also significantly shape perceptions of attention and productivity. The rise of remote work and the 24/7 hustle culture have created environments where individuals are expected to be constantly available, responsive, and self-motivated. This flexibility is liberating for some, but overwhelming for others, particularly those who struggle with executive function: The ability to plan, prioritise, and stay on task.

What constitutes ‘normal’ productivity is being unrealistically redefined by cultural, social, economic, and technological standards. Any deviation can feel like failure when the baseline expectation is constant output. For individuals who struggle to focus or stay organised, this pressure can lead to burnout, anxiety, and a search for answers, which could culminate in them suspecting that they might have ADHD.

I see this in the many young people who feel overwhelmed by the demands of life and ask me whether I think they have ADHD. Some young people ask this not because they genuinely believe they have ADHD, but because they desire to belong to an ADHD community as a means of providing identity.

Digital platforms, such as TikTok and Instagram, contribute to this identity-seeking phenomenon as they are hubs for mental health content, including ADHD awareness. 

While these platforms have democratised information and helped to de-stigmatise mental health struggles, the algorithms tend to reward dramatic, relatable content, which can sometimes lead to oversimplification, self-diagnosis, and misinformation. Messaging like, ‘Do you forget where you left your car keys? Then you probably have ADHD’ is deeply problematic.

Consider the recent surge in the diagnosis of gluten intolerance. The awareness of gluten intolerance has led to many people with coeliac disease being identified sooner and receiving treatment. At the same time, we have seen a raft of self-diagnoses of gluten intolerance. 

That doesn’t mean that coeliac disease is not real; it means that some people have taken it upon themselves to align with this group without the testing or clinical assessment.

Cultural causes

Ultimately, we need to consider how the surge in ADHD diagnoses reflects more than just medical or psychological trends. It is a cultural mirror, revealing how our society defines ‘normal’ behaviour, and how that definition is being strained by modern life.

We live in a time of relentless overstimulation and declining downtime. We expect children to sit still for hours, adults to juggle multiple roles, and to be constantly connected and perpetually productive. In such a world, is it any wonder that more and more people feel like their brains are not functioning ‘correctly’?

This is not to say that ADHD doesn’t exist. Of course it does. For many, diagnosis and treatment can be transformative, and going through life without a diagnosis or understanding can be detrimental. But as with all aspects of over-correction, it is also true that we might be diagnosing more people more quickly and broadly than ever before. And instead of only asking what is wrong with individuals, perhaps we should also ask what is wrong with the world they live in.

We need a more nuanced approach to ADHD that balances awareness and compassion with critical thinking and understanding. We need to better distinguish between genuine neurological conditions and socially induced struggles. We must also rethink how schools, workplaces, and digital environments are structured to allow for a broader range of human attention styles and learning modes.

Not everyone who struggles to focus has a disorder. Sometimes, the problem is not the person, it’s the system.

As the conversation around ADHD evolves, let’s make room for complexity. Let’s respect the stories of those who have found clarity and healing through a diagnosis, while remaining vigilant about the forces, such as economics, technology, and culture, that may be shaping our understanding of what it means to be ‘normal’.

The surge in ADHD diagnoses may tell us as much about society as it does about individuals. 

I hope we find the insight needed to regain control over our attention and build a world that demonstrates an understanding of our brain’s limitations, leading to fewer people struggling to keep up with an unattainable pace.