Updating ADHD

Twenty years ago, Jeff Strong wrote ADHD for Dummies to help more people understand the condition, and to provide information on medical and alternative therapies.

Strong, who founded and directs the Strong Institute—which creates brain simulation programs intended to treat children with developmental disabilities—says the book needed an update. The new edition, published this year, is now available for purchase. Strong and co-author Santa Fe-based licensed social worker Carol MacHendrie will read from and discuss the book at 6 pm, Wednesday, March 27 at Collected Works Bookstore.

“I started my research in 1992, and I thought I knew quite a bit by 2004. I realized how little I know now, even 20 years later,” he tells SFR. “I’d talked about it years ago, because things really shifted. The Diagnostic and Statistical Manual (DSM) for these conditions was changing, and then the DSM-5 (published in 2013) changed everything.”

The DSM-5′s revisions to the definition of ADHD, while subtle, include modifications to diagnostic criteria and new terminology to reflect that symptoms often change over time in individuals. Between 1997 and 2017, ADHD diagnosis rates among children aged 3-17 rose from less than 6% to 10% and, according to MacHendrie, the understanding of the disorder has changed significantly.

“The concept of what it is, that it’s a neurodevelopmental brain difference, and the whole concept of neurodiversity…when I was in graduate school, we called ADHD ‘minimum brain syndrome.’ It was terrible,” MacHendrie says.

Both Strong and MacHendrie received ADHD diagnoses in adulthood, in contrast to early misconceptions of ADHD as a condition that only affected young boys.

“When I wrote the first book, we introduced the idea of ‘it’s not just boys,’ but we didn’t dig in as deep as we did now,” Strong says.

One section of the new edition of the book titled “Facing ADHD in Different Populations” highlights differences in symptom presentations and experiences in children, adolescents, adults, women, people of color and members of the LGBTQ community.

MacHendrie and Strong say this section of the book is important because it recognizes populations often underdiagnosed with ADHD, especially given that ADHD diagnosis rates continue to rise in the aftermath of the COVID-19 pandemic.

According to a recent survey from the National Center for Health Statistics, 11.3% of children and adolescents aged 5–17 years have received a diagnosis of ADHD. A study from JAMA Psychiatry also found that between 2018 and 2022, prescriptions for stimulant and non-stimulant ADHD drugs for people aged 20 to 39 increased by 30% and 81%, respectively.

Strong said when the pandemic hit, his team at Strong Institute expected to take a break.

“We’ve never been so busy,” he recalls. “And it’s gotten busier since school’s gotten back in—that’s when we really got busy.”

MacHendrie, who primarily works with couples and adults with ADHD, says the influx of ADHD-related referrals she received during the pandemic deterred her plans to retire.

“I would have between 65 and 80 referrals in three months,” she says. “A full mental health practice is 20 clients a week, and I was always full. But the amount of referrals was insane. Before, I’d have three or four a week.”

Increased demand for referrals has also impacted K-12 schools. In Santa Fe Public Schools, for example, Executive Director of Special Education Jeff Pinkerton says parents’ requests for ADHD testing for their children has gone up “at least 50%.”

“Coming out of COVID, we have a tremendous amount of anxiety with kids, and ADHD and anxiety go hand in hand. Or depression,” Pinkerton says.” WIth ADHD and anxiety, for instance, we’re not identifying more kids than in the past with ADHD, we’re getting more parent requests for having their students tested for ADHD…several years ago, autism became the word, and then it was ADHD.”

As a response to rising behavioral issues in students such as hyperactivity and inattentiveness, SFPS has set procedures in place for entry into the district’s behavioral health program, according to Pinkerton, which prioritize having teachers use de-escalation strategies with students exhibiting behavioral issues in the regular classroom before even considering enrolling the student in a behavioral health program.

“In a lot of kids that used to be in a pipeline to a behavior program, [teachers] figured out some of the strategies that are de-escalating for a student with behavioral or ADHD issues,” Pinkerton says. “We have not seen an influx into the behavioral program by using these strategies.”

Pinkerton says that in his opinion, the lack of structure that accompanied online learning during the pandemic may have contributed to students presenting inattentive and hyperactive behaviors when returning from the classroom.

“I think from an educational standpoint, we’re going to have to adapt to five- to 10-minute bursts of teaching versus the traditional ways,” Pinkerton says.

MacHendrie, however, says one of the biggest misconceptions about ADHD is that the condition is overdiagnosed.

“I was at a doctor’s office the other day, and I told him I wrote this book, and he said, ‘Oh, everybody thinks they have ADHD.’ I said, ‘You need some education,’” MacHendrie says. “No, it is not a fad diagnosis. If anything, it’s underdiagnosed.”

Strong says he believes ADHD students’ symptoms may not have been recognized during the pandemic’s remote learning period, noting that he “would’ve done really well with remote learning, because I could get up and move around, whatever I need to do to get myself going, whereas in a classroom, no.”

Join ADHD for Dummies co-authors Jeff Strong and Carol MacHendrie for a discussion about and signing of the book, which provides simplified explanations of symptoms, treatment and living with ADHD, at 6 pm, March 27 at Collected Works Bookstore & Coffeehouse (202 Galisteo St.,) or online via Zoom; register here.