There’s a fascinating new study out of Denmark — which can easily do these kinds of analyses because they have a national healthcare system that leaves nobody out — on kids and teens who were diagnosed with ADHD or autism between 2012 and 2022, a ten-year period, comparing them to those kids who avoided either diagnosis. They looked overall at 2.1 million Danish kids, with roughly 71,000 having gotten a diagnosis.
For decades, kids with an ADHD or autism diagnosis were more likely to have been preemies, have low-income and/or low-education parents, a parent with a psychiatric history, and were frequent visitors to the doctor (often for accidents).
What’s fascinating is that the Danish team found that this “classic” profile is disintegrating. At the start of the decade, a child born at low birth weight was 54 percent more likely to end up with an ADHD or autism diagnosis than a child born at normal weight. But by the end of the decade, that gap had shrunk to 17 percent. The same collapse showed up for premature birth and for nearly every measure of family disadvantage they checked. The first author, Magnus Elias Tarp, put it plainly:
“What we found is that people diagnosed in recent years resemble the general population more closely than those who received the same diagnoses a decade ago.”
And this isn’t just a weird one-off. In June, a companion study from the same Danish research network, also in JAMA Psychiatry, examined the polygenic risk scores of more than 20,000 people diagnosed with ADHD between 1994 and 2016. The more recently someone was diagnosed, the lower their genetic loading for ADHD, and for autism, bipolar disorder, and schizophrenia as well.
The authors concluded that their data “support broadening diagnostic criteria as an explanation for increasing rates.”
I read both of these and thought about the kids I knew decades ago.
In the late 1970s, Louise and I were running a residential treatment and educational program for abused children. Instead of ADHD, the word was “hyperkinesis,” and the children who carried that label were generally the same ones that old risk profile would have predicted.
Many of these children had been born prematurely or at low birthweight to mothers who’d had no access to affordable prenatal care. The vast majority came from families where poverty, mental illness, and violence had been passed down for generations. They arrived with files an inch thick, and every single one of the kids we saw in the 5 years we ran that program were labeled as “suffering from hyperactivity” or the “hyperkinetic syndrome.”
I spent a week with Dr. Ben Feingold in his San Francisco apartment learning about his diet, ran a study with our kids, and published the results in 1981. It was my first published work on what we now call ADHD, and every child in it fit the profile the Danish researchers say is now somehow magically going away.
I didn’t get all this until almost a decade later — when my son and I were both diagnosed with ADHD — helping me realize that the wounds those abused kids carried weren’t the things that made them into hyperactive Hunters, or what “caused” their “hyperkinetic” diagnoses.
Instead, because they’d been both the victims of poverty and abuse (and the way they were treated in school because of their ADHD), their “Hunter-ness” was far more visible. A Hunter kid born into a broken home who can’t sit still in a classroom gets a file and sometimes a criminal record or beaten up by a short-tempered parent. A Hunter kid born into a stable, wealthy home gets called “spirited,” has a tutor and private college-prep class, and after doing his or her homework is simply sent outside to play.
For roughly three decades I’ve been arguing that what we call ADHD is a set of traits that were essential in hunting and gathering societies but became a liability when the Agricultural Revolution moved most of us humans into the Farmer’s world of fields, factories, and classrooms.
In this way of looking at ADHD, it becomes part of a distribution rather than some random disease that hits some kids and misses others. It’s like height or weight; there’s a bell-curve that it falls on the ends of, and that’s what these two Danish studies are pointing out.
When you think of ADHD kids as damaged or incompetent, that throws them into the far edges of that bell-curve, but was the threshold for diagnosing ADHD moves closer to the middle of that bell-curve you’ll suddenly start noticing the “ordinary Hunters,” the ones who’ve never been seriously injured by birth or life circumstances.
The result is that ADHD starts to look less like an illness and more like a normal part of the curve distribution of humanity overall.
The American numbers are increasingly telling the same story. Parent-reported ADHD diagnoses in this country rose to 10.5 percent of children by 2023, but the increase came almost entirely among kids who were rated as having “mild” or “moderate” ADHD. Most came from families with the means to carry private health insurance that covered mental issues.
The “severe” cases weren’t going up in number here in the US any more than in Denmark; in fact, the opposite was happening. More and more Hunter kids are being diagnosed yet also falling closer and closer to the “normal” middle of that curve’s distribution.
In other words, the entire notion of what is or isn’t ADHD and who does or doesn’t have it started, years ago, with the wrong assumption. It asserted that the classroom and cubicle are just fine for all of us, and the variable that made Hunters pop out was that they were broken or defective.
But what if it’s the classroom or the cubicle that’s the problem, not the Hunter? That’s the essence of my argument, and over and over again I’ve seen (and documented, and seen in my own life and family) cases where when you change the environment for the ADHD child or adult, suddenly the ADHD is no longer a problem.
The label describes your wiring, in other words, but not your worth. Hunters do fine when they can make use of their scanning and free thinking and energy; they crash and burn when they’re told to sit down and shut up for hours at a time.
That’s the conversation I want to be having as ADHD Awareness Month begins this week. Not about how many of us there are, but let’s discuss what kind of a world we’re going to build for the Hunters among us who we’ve finally learned to see.
If this resonates with you, forward it to the parent who just got the diagnosis and is wondering what they did wrong and let them know that they didn’t do anything wrong, they just gave birth to a noble Hunter.
These articles are just what is needed today. We are not exactly alike but we all have the same value.
I am telling all that I have ADHD and am proud of it.
75 years old and never diagnosed when a child. I was smart and bold enough to push through.
Now I’m grateful that I am aware of how capable I truly am.
Thom: Thank you again for spotlighting these types of study results that look at "prevalence" statistics over time. And, thank you for noting me in one of your past posts where I wrote about lactose intolerance being a great metaphor for understanding the increasing diagnoses of ADHD.
It seems very problematic if you are going to attribute the "increasing" prevalence of symptomatic ADHD primarily to "broader" criteria. Yep. There are broader criteria and more mainstream understanding, but . . .To me, that is a lazy explanation, and although it is intuitive and seems rational and logical, it is likely not the best explanation for the phenomena. Just because it seems logical does not make it correct.
There are real problems with official ADHD diagnostic criteria since they are mostly highly subjective. Corollary substantive, less subjective measures, such as working memory capacity and the bell curve related to that would be a better measure of the population's distribution of the major variable underlying the manifestations of most of the upside and downside of the ADHD brainset, poor working memory.
The idea that the diagnosis (the "net") is being thrown wider and catching more fish is okay, and easily understood. But, it is also misleading and dangerous. When you start attributing a widespread, expanding diagnosis to a wider net, you can deny the possibility for a more accurate and meaningful understanding. If all we have to do is make the net smaller, we are underestimating the power of data load in this ADHD scenario.
The fact is that the characteristics we use to diagnose ADHD can be produced even with folks who have great working memory. Overwhelm them enough with data (sensory, emotional, controversy, doubt, unpredictability, survival needs, walking next to cliffs (financial insecurity), constant intrusive noise of all types (entertainment, gaming, advertising, influencers who live by "kill or be killed" value systems, exploitation for profiteering (and the list could go on). and what do you get?
It really is a wonder we aren't all agoraphobic.
It is not the net. It's what drives more people in to the same size net. It is the increasing per hour data loads that have skyrocketed to the extent that such loads are producing the overwhelm that can happen with even high working memory. The same WM in 1950 or so will not be enough to prevent your expression of the typical ADHD characteristics 50 years later.
The net does not need to be smaller, the data load (the sharks) that drive folks into the diagnostic net needs to be looked at.
I used the lactose intolerance challenge (a clearly genetically influenced scenario) as a metaphor for what is taking place with the "expanding" population of ADHDers.
The terms asymptomatic and symptomatic apply. Although those terms are somewhat misleading in that they imply "disease or disorder" they are still useful. With lactose intolerance, the question is, do you have it if you don't have symptoms? How do the symptoms come about? What can prevent symptoms? I think everyone knows that you can prevent symptoms by avoiding lactose ingestion. Right?
If you have that baseline vulnerability (created by genes) and if you avoid the consequences of lactose use, you won't experience the typical characteristics of lactose intolerance. Do you have lactose intolerance without symptoms created by challenging it? Yep.
The same scenario is taking place with ADHD, whose major vulnerability is created by processes that affect working memory capacity (comparable to RAM in a computer). The more you challenge the prevalence of low working memory in a population, the more ADHD will show up.
By not appreciating that, we do a disservice to everyone. Our major reigning cultural values, styles, and behaviors fit the criteria for the diagnosis of ADHD. That is no accident.
The more we challenge the prevalent low working memory capacity found in Western populations, the more the "symptoms" show up. So, it is not so much about a so-called wider net, as it is about a bunch of sharks driving us into the same old nets. Tone the sharks down, less prevalence of symptoms, "less" caught up in the net.
Not less prevalence of vulnerabilities. Vulnerabilities are constant. Environments are not, unless we make them so.
I hope that makes sense. Similar to Mr. Hartmann, I have been gathering data from my 15 years of work as a dedicated (embedded?) psychiatrist specializing in evaluation, diagnosis, and treatment protocols for those seeking to figure out whether they fit the criteria for ADHD and what to do about it.
I used more than 50 pages in my 2013 Book (still relevant) to scientifically show how there is both an upside and a downside to the so-called ADHD brainset. It is not a disorder. I also document and discuss what the downside is of the non-ADHD brain. Unllike hunter/farmer or hunter/gatherer, I use terms like defender/planner. The literature was clear before 2013 and it is still clear in 2026 that "different "does not mean "disorder." I hope that makes sense.
Take care. Ron