IT'S ABOUT TIME WE PAY ATTENTION TO ADHD

Yes, the wordplay is intentional. And yes, we need to talk about this seriously.

Over the past few years, Attention Deficit Hyperactivity Disorder — ADHD — has become one of the most searched topics in mental health. It shows up in social media feeds, parent groups, teachers' lounges, conversations between friends, and, inevitably, in consulting rooms.

Rarely a week goes by without someone walking into my office saying, "I think I have ADHD" or "I'm almost certain my child does." And there is something genuinely positive about that. For a long time — perhaps for entire generations — people spent years, sometimes their whole lives, without understanding why they struggled so much to concentrate, organise themselves, meet deadlines, finish what they started, or control their impulses. Many were called lazy, indifferent, undisciplined, or "spacey." The consequences could be severe: dropping out of school, punishment, stigma, labels that wouldn't even be considered acceptable to repeat today.

A better understanding of ADHD has allowed many of those people to finally find an explanation for difficulties that followed them throughout their lives. But the larger problem, from where I stand as a psychiatrist, is what happens when a suspicion becomes a "certainty" before a careful — and therefore accurate — evaluation has taken place.

I keep coming back to something that bears repeating: we have never had access to so much information as we do today, and yet we may never have had more difficulty telling information apart from knowledge.

A fifteen-second video can present "ten signs you have ADHD." Someone recognises eight of them, and within minutes, what began as recognition turns into diagnosis. Recognising yourself in a description is not irrelevant — it can be exactly the first step that leads someone to seek help. The mistake is treating it as the last one.

Likewise, a parent may correctly sense that something isn't right with their child. A teacher may observe difficulties that no one at home had noticed. An adult may finally begin to make sense of a lifetime of forgetfulness, disorganisation, and missed opportunities. All of this deserves to be heard and brought to a qualified professional. What it does not deserve is a shortcut.

Inattention is not the same as ADHD

This may be the most important point in this entire conversation: inattention is a symptom, not a diagnosis. And symptoms can have many different causes.

Anxiety, for instance, can fill a person's mind with so many worries that little room remains for concentration. Depression can drain energy, motivation, processing speed, and the capacity for organisation. Significant sleep disturbances can compromise memory and attention. Mood fluctuations, traumatic experiences, alcohol or substance use, and certain medical conditions can all interfere with cognitive functioning — mimicking ADHD without actually being it.

In children and adolescents, the picture can be even more complex. Specific learning disorders, intellectual disability, emotional difficulties, family conflict, inadequate or understimulating school environments, and other neurodevelopmental factors can all show up as falling grades, restlessness, difficulty concentrating, or what looks like a general lack of interest in school or homework.

The way we currently use screens, digital games, and social media also deserves a place in this conversation. Problematic technology use can compete with other important areas of life — sleep, physical activity, studying, social interaction, and anything that requires sustained mental effort. At the same time, people who already struggle with impulsivity or emotional self-regulation may be especially vulnerable to the pull of unlimited access to these platforms. The relationship between inattention and digital habits is not straightforward, and very likely runs in both directions.

All of this, as I said, can produce a picture that — when assessed too quickly — looks like ADHD. And to complicate things further, some of these conditions can coexist with ADHD.

This is precisely why a diagnosis should not begin with a simple checklist of inattention or hyperactivity symptoms. It should begin with a more open question: what is actually going on with this person, taking their life as a whole into account? Even when that question is asked of a child or a teenager, the answers can be surprisingly revealing.

What ADHD actually is

ADHD is one of several neurodevelopmental disorders. It has a well-established genetic component and involves differences in the functioning of the brain networks responsible for attention, what we call executive control, motivation, and behavioural regulation.

Symptoms begin during childhood, with some needing to be present before the age of twelve — even if the diagnosis only comes years or decades later. This is why someone can discover they have ADHD at thirty, forty, or fifty. The diagnosis may be late; the disorder is not.

There are predominantly inattentive, predominantly hyperactive-impulsive, and combined presentations. ADHD, in other words, is not synonymous with the classic image of a child who simply cannot sit still in class. Some children are quietly inattentive. Some girls go undiagnosed throughout their entire school years. Some adults build years of compensatory strategies until life's demands eventually outpace what those strategies can handle.

The diagnosis is essentially clinical. There is no blood test, CT scan, MRI, EEG, or biomarker that can confirm ADHD. What is required is a careful reconstruction of a person's history — from early childhood to the present. When did the difficulties begin? Do they appear in more than one setting — at school, at home, at work, in social situations? Is there real functional impairment? If the patient is an adult, what were they like as a child? What do parents remember? What did teachers observe? How is sleep currently? Are there symptoms of anxiety, depression, or mood changes? What do the people around them notice?

And what about neuropsychological testing?

It is extremely useful — I would even say indispensable in many cases — but it is important to be clear about what it is for. On its own, it does not "officially" establish the diagnosis. What it does is add important layers of information. It helps clarify how attention, memory, executive functions, intelligence, and learning are functioning; it contributes to identifying specific learning disorders or intellectual disability; and it reveals not only the difficulties but also the preserved abilities that can inform treatment strategies. Together with the person's family, academic, professional, and emotional history, it provides essential elements for the clinical assessment. And it is that clinical assessment that arrives at the diagnosis.

How is it treated?

When the diagnosis is correct, pharmacological treatment for ADHD can be highly effective. Psychostimulants are among the first-line pharmacological options and carry decades of evidence supporting their benefits for the core symptoms of the disorder. Non-stimulant medications also exist, used depending on the person's age, clinical profile, therapeutic response, side effects, and individual circumstances.

But notice the important qualifier I used: when the diagnosis is correct. The diagnostic process matters precisely because the therapeutic approach changes entirely when the attention difficulties are part of a different condition. Someone whose concentration is impaired by depression may need an antidepressant. Someone whose inattention occurs in the context of intense anxiety may need a different kind of intervention altogether. In someone with an unrecognised or unstabilised bipolar disorder, certain approaches require particular caution due to the risk of destabilising mood.

This is why the goal of seeking professional help should not simply be to "concentrate better" — it should be to understand why this is happening, since, as we have seen, the causes can be very different.

It also needs to be said that medications capable of producing benefits can also produce side effects. In ADHD treatment, it may be necessary to monitor appetite, weight, and growth, as well as sleep, blood pressure, heart rate, and mood changes — in both children and adults. The response to treatment also needs to be regularly reassessed. Continuing to take a medication simply because it was prescribed at some point is not the same as follow-up care.

There is another problem worth naming: the use of psychostimulants by people without a diagnosis — particularly adolescents and young adults — with the aim of studying longer, performing better, or enduring excessive workloads. Medications designed to treat a disorder should not become tools for adapting to ever-increasing productivity demands. Inattention may be a significant symptom of a disorder with a name and a proper treatment; being unable to exceed human limits in a system that asks for more and more in less and less time is not a disease — at least not in any individual sense. In a social sense, perhaps.

Treatment neither begins nor ends with medication

Even when the diagnosis is genuinely ADHD, the concept of "treatment" extends well beyond a prescription. The approach should be individualised and may or may not include medication. It can draw from a range of tools: psychotherapeutic interventions, guidance for parents and family members, adaptations at school or in the workplace, and changes to how daily routines are structured.

Therapy, particularly when it works on cognitive and behavioural strategies, can help with organisation, planning, time management, procrastination, and emotional regulation.

Psychoeducation also makes an enormous difference. Understanding that a particular behaviour stems from a self-regulation difficulty does not mean abandoning limits or responsibilities — quite the opposite. It means replacing oversimplified explanations like "laziness," "lack of willpower," or "poor upbringing" with more accurate ones, and looking for more effective ways to help that person live better.

Adequate sleep, regular physical activity, and a reasonably predictable routine are all part of treatment. And what we in medicine call comorbidities — anxiety, depression, learning disorders, emotional dysregulation, behavioural difficulties — also need to be identified and addressed. They are common in ADHD, and they can significantly affect both how the disorder presents and how it should be treated.

Perhaps the real problem is our hurry

There are two mistakes we must avoid at all costs: diagnosing ADHD where it does not exist, and failing to recognise it where it genuinely does. The answer to the epidemic of rushed diagnoses is not to discredit ADHD as a real condition — it is to stop flattening every concentration difficulty into a single diagnosis whilst ignoring causes that need to be handled differently.

What is needed is what mental health has always asked of us: listen to the story, observe the context, form hypotheses, explore alternatives, and follow the person over time. Before reaching for a quick answer, it may be necessary to ask some slow questions.

What this subject requires is attention. This time, without the wordplay.

Image created by AI from a prompt by the author.