An increasing number of people are being diagnosed with ADHD, without researchers knowing exactly why. Greater awareness of ADHD and changes in diagnostic criteria may be one reason. Some people are probably misdiagnosed, while others remain underdiagnosed, according to an expert in the field.

Merete Glenne Øie is a professor of psychology at the University of Oslo and has been researching and working clinically with ADHD for over thirty years.

She is calling for more thorough diagnostic assessments and a stronger focus on non medication interventions for people with ADHD. Medication should not, in her view, be the only solution.

Easier to get a diagnosis than before

According to the ADHD researcher, there may be many reasons why more and more of us are being diagnosed with ADHD.

– We have had a change in the diagnostic criteria, which may have contributed. Put simply, it takes a bit “less” to receive an ADHD diagnosis now than it did before, says Øie.

A society with a faster pace, greater demands and a wide range of opportunities and choices, may also play a role:

ADHD is considered as a neurodevelopmental disorder, not something that society in itself “creates”. But a society with ever increasing demands for concentration and success in achieving one’s goals can, according to Øie, have an impact.

– Together with a digital reality that involves far more distractions than before, these factors may mean that people who already have a vulnerability to attention difficulties more easily cross the threshold for a diagnosis than they would have done previously, says the psychology professor.

Both overdiagnosis and underdiagnosis

Merete Glenne Øie also believes that the great deal of attention around ADHD, including many celebrities coming forward with the diagnosis, may have helped to reduce shame and stigma. And this may in turn have led to more people daring to undergo assessment than before.

– Has there been an inflation in the ADHD diagnosis?

– I don’t think I would use that term. We only know that there has been an increase. But the picture may be twofold: – We probably have both underdiagnosis and overdiagnosis, she says.

She nevertheless warns against relying on medication as the only answer.
Varying levels of knowledge

Merete Glenne Øie explains that ADHD cannot be detected with a single test, but is diagnosed on the basis of a thorough assessment.

– In the end, however, it is still a clinician who makes the diagnosis, and each clinician assesses whether the criteria are met through their own lens and their own perspective.

Øie refers to studies that have identified weaknesses in assessments. When reviewing the medical records of people who had received the diagnosis, it was found that there were shortcomings in around half of the cases.

– It is probably fair to say that both knowledge and practice can vary somewhat, she concludes.

Recently, Norwegian media reported on online diagnosis of ADHD. One case referred to an assessment in which over 90 per cent received a diagnosis.

– Diagnosing over the internet is not necessarily a problem in itself. But if it is done too quickly and with too little thoroughness, where you only fill in a questionnaire, then that is not enough. A fairly extensive assessment is required in order to make the diagnosis, says Øie.
pity there is a battle for and against medication

Disagreements about the use of medication for people with ADHD regularly arise among both professionals and relatives.

– I think it is a pity that it often turns into a battle, where people take to the barricades and are either for or against medication. It must not become an either–or issue. The question is more nuanced than that, says Øie.

– With medication, many people become, at least in the short term, more focused and less restless. We must remember that with this diagnosis, if untreated, things can go quite badly for some individuals. We know, for example, that ADHD is associated with an increased risk of substance misuse problems and suicidal behaviour, says Øie.

She nevertheless warns against medication as the only response.

– The guidelines recommend a holistic treatment of ADHD, where non medication interventions and practical accommodations are often included, and where medication is considered when there is an indication for it, the ADHD researcher emphasises.

Training to concentrate, plan and avoid distraction

A research project that Merete Glenne Øie and her research group are now finalising represents a non medication alternative or supplement to standard treatment in BUP (Child and Adolescent Mental Health Services).

It is a method in which young people with ADHD are trained in strategic thinking, so that they are better able to achieve the goals they set for themselves. A total of 116 adolescents are taking part in the project. Half receive standard treatment in BUP. The other half also receive group training in strategic thinking.

– The aim is for the young people to improve their executive functions: their ability to plan, to hold back impulses, and to concentrate, explains Øie.

The training is concrete and closely linked to everyday life.

The ADHD researcher explains:

– Say to yourself: «Now I’m going to do that task. Stop when you notice that you are starting to fade out. Think. What is the goal? Go back. Try again. Take a deep breath.» Above all, it is important to recognise when you “zone out” and to learn how to get back on track, she says.

Similar studies have been carried out with adults with ADHD, with good effect.

Great variation

Merete Glenne Øie stresses that there is great variation among people with ADHD. For some, the main problem is getting started on boring tasks, especially when there is no immediate reward. For others, the main problem may be concentrating or regulating their emotions.

– Treatment must be tailored and adapted to the individual. The most important thing is to focus on everyday functioning, not just the diagnosis, says Øie.

She notes that long term studies show that ADHD most often does not last a lifetime.

– In one of the studies I have been involved in, it turned out that 60 per cent of children and adolescents with ADHD no longer met the criteria for the diagnosis after ten years.

– What is the reason for that?

– Research shows that many simply grow out of the diagnosis. ADHD is, after all, called a developmental disorder, so for some it is a question of delayed maturation. For others, it may be that they have learned to live with their difficulties: they know what they need in order to cope with everyday life and therefore no longer have a sufficient level of impairment to meet the criteria for the diagnosis.

Ask yourself: have I always struggled with this?

For anyone wondering whether they themselves or someone close to them has ADHD, Øie has one piece of advice:

– Remember that most people can recognise many of the symptoms in themselves. If you are tired, have slept badly, are anxious, or have another mental disorder or developmental condition, you will have many of the same symptoms, says Øie.

Before seeking an assessment, she believes you should ask yourself the following questions: «Have I always struggled with this? Has it been a consistent pattern throughout my life? Have I tried to do something about it and to make adjustments around me, and it still doesn’t work?»

– If the answer is yes and you have clear functional impairments, my advice is: «Go to your GP, raise the issue there, and get an evaluation», says psychology professor Merete Glenne Øie.