Think of cases where someone has asthma, diabetes, a heart disease, or physical injury. No one can deny that something is wrong with the person, and help should be given immediately.

Unfortunately, the same is not true for ADHD.

ADHD can feel as painful as having asthma, osteoporosis, and many other illnesses, but this is not reflected in the diagnosis and treatment rates. In general, mental health disorders are diagnosed and recognized less than physiological ones.

Mental health disorders are less visible because everything happens inside the person's head, which leaves room for interpretation. This opportunity for subjectivity leads to misconceptions about the condition being made up so the person feels unique and interesting, avoids responsibility, and excuses problems in their behavior.

This article will debunk common misconceptions about the origins of ADHD, how common diagnosis is, and the current challenges preventing people from getting officially recognized with the condition.

The Origins of ADHD

There are multiple scientific theories on the reason why ADHD exists, covering genetic defects, differences in brain function, and even outdated evolutionary advantages.

Prefrontal Cortex Impairments

The first theory on the origins of ADHD points toward differences in the prefrontal cortex, especially the right hemisphere (1)

The prefrontal cortex (PFC) is responsible for many skills that make a person rational and emotionally intelligent, including thought analysis, regulation of behavior, long-term decision-making, the ability to pay attention and stick with goals, and many others.

The theory suggests that people with ADHD have an altered or weaker structure of their PFC circuits. It could develop more slowly, have less gray matter, or be less receptive to signals from brain chemicals in the right hemisphere.

One of the most common side effects of this PFC difference is a cluster of symptoms collectively named executive dysfunction. This leads to an impairment in important mental skills related to goal setting, self-control, time management, motivation, channeling of emotions in the right direction, etc.

Disruptions in Neurotransmitter Production

The second theory on the origins of ADHD focuses on the role of neurotransmitters in optimal brain function.

Think of brain chemicals, such as dopamine and norepinephrine, as messengers. They bounce between brain circuits, telling them when to activate and shut down so everyday life can flow smoothly and effectively.

Issues with neurotransmitters can lead to executive dysfunction symptoms because brain circuits, like the PFC, are not activating properly. When they are not working at full capacity, you are more likely to experience procrastination, distractability, and faltering motivation (2)

According to that theory, your brain likely has all the potential and capacity to function well, but the brain chemicals required to supervise the process are causing trouble. Much like a talented work team that needs a manager or a sports team that needs a leader, it's not an individual failing of any brain circuit but the collective inability to synchronize and work together.

What precisely is the issue with neurotransmitters remains unknown. Some theories suggest brain chemicals, like dopamine, are not produced sufficiently. Others hypothesize that certain brain circuits are not sensitive to them or that the chemicals are disrupted while sending the messages.

The neurotransmitters theory makes a lot of sense if you consider how ADHD plays out.

People with ADHD work best when doing something intellectually stimulating, intrinsically enjoyable, emotionally engaging, challenging, or urgent.

This is why video games feel so much better than doing your homework, and working on a passion project feels effortless compared to the assignments at work you’ve been delaying for weeks. It's those moments of being in "the zone" that ramp up the production of neurotransmitters, making you feel fully functional for a short time.

The Hunter Versus Farmer Hypothesis

There is a third and highly controversial theory on the origins of ADHD. It’s not based on any scientific literature that has stood the test of time or a rigorous reference to sociological and anthropological data. However, its simplicity makes it very popular in pop psychology circles and social media.

This hypothesis claims that the symptoms of ADHD were useful in hunter-gatherer societies, which is why a small part of the population, hunters or warriors, kept successfully surviving and reproducing with those genes. Essentially, ADHD isn't a defect in cognition but a different brain structure that strategically evolved due to the environment in the past (3)

The hunter-gatherer theory was pioneered by Thom Hartmann, with very speculative personal anecdotes and currently no robust scientific backing. According to Hartmann, the symptoms of ADHD may not be useful in our post-industrial society, but they were crucial in the resource-scarce hunter-gatherer society of the past.

Adaptability and crisis response were much more important in a chaotic and dynamic world than long-term habits and routines. The world was changing too often for them to have an evolutionary advantage.

Impulsivity and risk-taking were required to ensure there was always a way to accumulate resources. Remaining cool and composed in highly stressful environments allowed us to successfully defeat predators.

Being able to hyper-focus on a single task based on urgency, even at the expense of eating, resting, and sleeping, could have been beneficial when hunting.

Currently, this theory has no scientific backing. Furthermore, it has been comprehensively refuted by experts in the field, like Russell Barkley. Doctor Barkley and other academics like Matthew Keller claim that genes for mental health syndromes and neurodevelopment disorders can survive in the population even if they cause harm to the person carrying them.

Essentially, the genes for ADHD are a maladaptive mutation. More often than not, they cause harm and a reduction in the standard of living, no matter the cultural context.

However, this harm isn’t severe enough to stop most children with inherited ADHD genes from surviving into adulthood and reproducing. Furthermore, new mutations causing the cluster of ADHD symptoms continue to happen, making it unlikely that the set of genes associated with ADHD will be removed completely from the gene pool.

Finally, the last nail in the coffin is a comprehensive genomic analysis in 2020, which examined the amount of ADHD risk genes across different generations in the past. It concluded that natural selection has been acting against those genes for a very long time, even if at a slow pace. This means that there is unlikely to be a time in the past when ADHD would have been a clear evolutionary advantage.

The Origins of ADHD - Bottom Line

Theories trying to explain the origin of ADHD are not mutually exclusive.

For example, the prefrontal cortex could be underdeveloped, thus requiring more neurotransmitters to become fully active. Hunter-gatherers were risk-takers and impulsive hotheads because they craved stimulation due to low baseline levels of neurotransmitter production.

Those are the current theories that seek to explain why ADHD happens. It's important to recognize that they are plausible but not confirmed as the definitive underlying reason for the condition due to a lack of scientific consensus.

Fortunately, even if the origin of ADHD remains unknown, the symptoms list remains the same (4).

The condition has a list of official symptoms that will not change no matter which of the theories ends up being the most accurate. As a result, successful treatment with therapy, coaching, and support networks can effectively tackle each individual symptom, even if the origin is somewhat disputed.

How Common Is ADHD?

ADHD is surprisingly common. Between 6% to 9% of US children are officially diagnosed with ADHD. The worldwide population of adults with ADHD is around 6,7% (5)

The data applies only to cases where an official diagnosis was given and the person was registered on the list. The actual number may be much higher because many factors actively prevent people from being diagnosed with ADHD.

Some of the factors leading to under-diagnosis include:

Lack of Recognition for Mental Health Issues

Many countries across the world are socially conservative, and as a result, they don't recognize mental health issues or severely undermine the legitimacy of an ADHD diagnosis.

In a lot of places, expressing symptoms of ADHD is seen as anything but a problem with brain chemistry and cognitive function. As a result, medical professionals deny the condition exists, or people who wish to get diagnosed get rejected because the bar is set excessively high.

A mental health culture based on ignorance and excessive skepticism not only denies diagnosis but discourages people from trying altogether. Even if a diagnosis can be life-changing, having to go through hell just to potentially get denied in the end is a significant investment of time, money, and mental energy. As a consequence, many people don't even bother trying.

This is not just an issue for developing countries but a grim reality for many people, even in the Western world. In 2023, the UK government's negligence led to a massive 10-year waiting list for diagnosis with ADHD. If the same wait list had been given for people with diabetes, there would be riots and outrage on the streets.

Outdated Views on ADHD

ADHD is seen by many as a mental health disorder that predominantly affects children and will eventually go away once a person reaches adulthood.

According to the theory, symptoms like hyperactivity and impulsivity are typical of children with prefrontal cortex development issues. Eventually, no matter if they have more challenges or at a slower pace, they will grow out of it.

As a result, many assessments of ADHD are heavily biased toward an early diagnosis. They may also emphasize more visible symptoms, like hyperactivity and impulsivity, without accounting for how coping mechanisms and masking in adults could make them much harder to identify.

By the time you are 40, you likely have a significant other who helps with tasks where you struggle, you've shifted toward a more suitable ADHD-friendly career after many trainwrecks, and you've developed many systems to keep the boat together after an excruciatingly painful trial and error period in your 20s and 30s.

When you go to get assessed, it can be very difficult to convince a mental health specialist that a smart and relatively successful person with two degrees, a stable job, and a normal life could have ADHD. Even if your life has structure and stability, what remains left out is the immense amount of sacrifices, personal struggle, and chronic stress required to build and maintain that fine balance.

Add to that the current aversion to ADHD diagnosis due to the rising stigma against stimulants, and you have a recipe for under-diagnosis disaster.

Many conservative doctors are suspicious of what they perceive to be “junkies” looking to abuse amphetamines and get "smart drugs”. Even after diagnosis, struggle to get your dosage and stressful negotiations when there is a shortage in nearby pharmacies are a monthly struggle due to the stigma.

Gender Biases in Diagnosis

The medical institutions that diagnose people with ADHD can be full of engraved biases and prejudices. For the longest time in clinical practices, boys are twice as likely to be diagnosed with ADHD than girls (6)

Dr. Ellen Littman, the author of "Understanding Girls with ADHD," notes that the early clinical research conducted in the 1970s was primarily focused on hyperactive boys. Focusing mostly on one gender made those symptoms dominate the field for decades. After all, if the groundwork for ADHD relied on restless male subjects, then subsequent clinical trials would also look for impulsive boys as test subjects.

The issue is that ADHD shows itself in very different ways depending on your gender. Boys, on average, tend to be more hyperactive and impulsive. Gender norms encourage, normalize, and offer them forgiveness if they are risk-takers, adventurers, or even impulsive and reckless imps. Boys will be boys, right?

Quick reality check - When you go back memory lane, what was the gender of the class jesters, troublemakers, and bullies? For most people, the answer is more likely to be boys.

On the other hand, gender norms encourage girls to be polite, peaceful, and docile. While men can externalize frustration, anger, and other emotions, women tend to focus more on suppressing struggles or expressing them in less visible ways.

Of course, just because society shuts off expression doesn't mean that girls aren't hyperactive in their own ways: quietly fidgeting with their legs, chewing on their nails, fingers, or hair, clicking their pen, or tapping their fingers.

You have most likely found a way to pour some of that energy out. The symptoms are all there, just more subtle and largely ignored by others.

Girls also deal with an internal battle - disorganization, forgetfulness, impaired time management, anxiety, etc. While that's happening, the private anguish is attributed to a personality trait. Struggling with attention is attributed to a lack of discipline and not caring. Zoning out and daydreaming are seen as being more shy, reserved, and introverted.

The struggle doesn't disappear. It just remains hidden and masked from the world.

At worst, women are denied an ADHD diagnosis because they don't fit the male-centered perception of ADHD and have become very capable of masking and coping with symptoms just enough to pass the bar.

At best, they experience immense struggle, but since it can't possibly be ADHD, they get misdiagnosed with bipolar, depression, or anxiety. Unfortunately, even if they also have this co-occurring condition, in many cases, the symptoms happen and are magnified due to their untreated ADHD.

Debunking Four Common Lies, Myths, And Misconceptions About ADHD

Let’s get started one by one.

Myth I - ADHD Is Not Real

This is the most common myth you will find online.

Purely looking at the science makes this claim collapse very quickly because multiple scientific studies analyzing data from millions of people across different countries have reported a similar set of symptoms that all fit the label of ADHD.

The very large data collected on people with "ADHD symptoms" shows that even when accounting for age, gender, ethnicity, socio-economic status, environment, culture, and other miscellaneous factors, people still report experiences that align with the label of ADHD.7,8,9

At this point, many people make a common logical error in mistaking contributing factors for underlying causes. Technically, a malnourished person or someone who's chronically sleep-deprived will experience ADHD symptoms, like impulsivity, inattention, and worse motivation. However, those symptoms will go away once those huge gaps in their health are corrected.

This happens because many lifestyle and environmental factors can make ADHD symptoms worse/better, but they are not the origin (underlying cause) of ADHD. So, ADHD is a real label because there is no other way to explain away the symptoms that millions of people are having throughout the world.

All those factors increase or reduce the intensity of ADHD symptoms, but they are not responsible for their existence. Instead, the underlying cause is due to a brain injury (especially before birth) in a minority of cases or genetic inheritance from parents in the majority of cases. Studies show a genetic component as strong as 80% in twin studies.

Of course, even if the origins are primarily genetic, two people with the same diagnosis will not experience ADHD in the same way. This is because ADHD diagnosis is a cluster of symptoms, so one person will experience more challenges from one set of symptoms compared to another. To account for this, medical professionals have created categories/presentations within the ADHD medical label that are given when a person is more inattentive than impulsive and hyperactive, or vice versa.

The difference between factors contributing to worse ADHD symptoms and the actual underlying cause for ADHD also explains why many similar myths are not true, including:

Modern life causes ADHD through the school system, capitalism and industrialization, Western culture, the internet, and social media.
Nutrient deficiencies cause ADHD.
Bad parenting causes ADHD.
Depression causes ADHD.
Trauma causes ADHD.

All those factors can make someone's ADHD way worse, but they are not the original reason for the existence of ADHD symptoms.

Myth II - ADHD Is Not A Serious Condition

A large group of people concede that ADHD is real but don't think it is serious enough for us to pay so much attention. If this myth had to be described with a quote, it'd be, "Everyone has a bit of ADHD, don't they?"

Such phrases and sentiments come from the person's inability to account for differences in the frequency and intensity of ADHD-like symptoms across different people.

For instance, we wouldn't say depression is not real simply because we all feel sad sometimes. Obviously, depression means the sadness lasts much longer, and the intensity of emotions a depressed person feels turns simple sadness into deep melancholy and unbearable hopelessness and sorrow.

The same logic applies to ADHD.

We all zone out during conversations sometimes, get distracted by social media, struggle to do the work that needs to be done before the last moment or forget something at home. However, for most people, those experiences don't count as symptoms because they don't happen often enough or don't happen in a highly intrusive way that prevents them from normally functioning day-to-day.

ADHD symptoms exist on a spectrum, and we choose to apply a label because ADHD symptoms start to significantly interfere with everyday life after a specific point has been passed. The most widely accepted criteria for ADHD, like the DSM-5's list, account for that by asking about the frequency of symptoms and their intensity instead of just casually questioning whether you had ever felt procrastination or impulsivity.

Finally, the scientific data we currently have very clearly points out that people diagnosed with ADHD have worse lives than the rest of the population.

If you want to do a fun little game to prove this point, go into Google and combine the phrase "Studies on ADHD and" with any scary-sounding phrase, like anxiety, depression, bipolar, substance abuse, road accidents, lifespan reduction, worse relationships, unemployment, career difficulties, sleep disruptions, obesity, or anything else that comes to mind.

You will very quickly see the undeniably strong connection between ADHD and dozens of negative life outcomes.

Myth III - ADHD Is A Nice Way of Saying Someone Is Lazy, Irresponsible, And Lacks Discipline

Similar to ADHD not being taken seriously, many people think the ADHD label is an excuse for character flaws and personality deficits.

Unfortunately, many people fall into common cognitive fallacies, like the fundamental attribution error that leads to the myth of laziness.

This means they attribute another person's actions to their character or personality while attributing their behavior to external situational factors outside of their control. So, if they procrastinate, there is an obvious excuse, but if someone else is slacking, it means they are lazy and irresponsible. If you focus on a person's character, then everything distracting you from their lack of discipline is an unacceptable excuse.

The fundamental attribution error grows even stronger as a fallacy because modern society is highly individualistic. Since many norms and narratives promote radical self-responsibility, we are encouraged to connect a person's actions and consequences to their character in almost all circumstances.

So, it's much easier to think of someone as stupid, irrational, undisciplined, and irresponsible when they spend hundreds of dollars on items they don't need instead of looking at ADHD symptoms, like impaired impulse control and cravings for stimulation as the primary drivers of harmful financial spending.

The logical difference can be subtle, but it's a night-and-day contrast.

Laziness is a conscious act of not doing anything or not doing enough because you simply don't want to or don't care enough. Having ADHD is not a choice but a condition that significantly influences a person's behavior, decisions, and actions, no matter if they like it or not.

Ironically, the opposite of intending to be lazy is often true for people with ADHD. They want to prove to themselves and the world what they are capable of but struggle to turn this intention into consistent actions. The gap between motivation and what actually happens is due to executive dysfunction, which is a core ADHD symptom that leads to impairments in attention, impulse control, organization, time awareness, and long-term motivation.

Myth IV - ADHD Is Over-Diagnosed

There has been an explosion in the rates of ADHD diagnoses in recent years. This naturally leads to claims that ADHD is overdiagnosed.

The silliest reason for such a belief has to do with the increased awareness about ADHD, which leads many people to self-diagnose, create content around ADHD, or comment about their experiences with ADHD symptoms on social media and online forums. The sudden explosion of ADHD content in social media creates the perception that ADHD is everywhere thus too many people must be getting diagnosed.

It should go without saying that what you see online is far from what happens in real life.

More realistically, for an "over-diagnosis to happen," the clinicians who give out the diagnosis must become more lenient in handing out the label to anyone who comes across the door. Considering how sudden the shift was in recent years, it is unlikely that the same generation of clinicians is suddenly lowering their standards for diagnosis.

Furthermore, clinicians receive extensive training that makes them generally averse to over-diagnosis because giving a label to a person changes their self-perception massively. Most doctors would prefer to be cautious due to the massive impact a few words from them can have on someone's life. So, risk-averseness and avoidance of giving an ADHD diagnosis without comprehensive testing are much more likely to be the default clinical practices.

Finally, there hasn't been a significant reduction in the criteria set by reputable institutions. For instance, the DSM-5's criteria are almost entirely the same as the DSM-5's, except for additional examples and illustrations and the reduction of the minimum symptom count required from 6 to 5. Such minor changes are not enough to justify the huge increase in ADHD diagnoses.

Without a huge shift in the behavior of clinicians or the diagnostic criteria for ADHD, it's highly unlikely that ADHD is being overdiagnosed. On the contrary, ADHD is very likely to have been underdiagnosed until very recently, which is why the increased awareness of the condition leads to a higher interest in an official diagnosis.

Key Takeaways

Getting an official ADHD diagnosis can be challenging due to outdated and unscientific social norms and systematic biases in medical institutions. If any of the symptoms resonate with your lived experiences, it's worth fighting tooth and nail until you get taken seriously.

Before and after the diagnosis, it's crucial to remember that ADHD is real. Let that fully sink in, and try never to doubt your diagnosis after you receive it. Someone saying otherwise should be treated with the same look we'd give to a person who claims 2+2 equals 5.

It's only through absolute acceptance that the path of healing, effective treatment, and management of ADHD can begin.

Origins of ADHD, Common Misconceptions, and Challenges in Diagnosis