During her school years, Mara (pseudonym) did not encounter any major difficulties. She did well in class and exams were no problem. Things only started to get complicated when he entered college. “While my classmates were studying diligently in the library, I was easily distracted by my cell phone.”
For a while, she managed to handle the situation well, but as her co-workers began to train and Mara still struggled to stay focused and organized, the silver lining came down: “Okay, something’s wrong here.”
The diagnosis came indirectly. After a depressive episode and several unsuccessful treatments with different medications, his psychiatrist suggested that he also undergo a screening test for ADHD (attention deficit hyperactivity disorder). Bingo. “It was like someone had opened my eyes,” Mara said. She was then in her early twenties.
Mara finally understood that much of what she saw as a personal failure was not her fault. “I realized it wasn’t because I hadn’t tried hard enough, but because my mind was working differently. And I was facing obstacles that others didn’t have to overcome.”
Mara is not alone. More and more people are not diagnosed until adulthood.
ADHD in adults: are the numbers increasing?
Epidemiological studies carried out in different countries estimate that between 2 and 3% of adults suffer from ADHD. In Germany, however, health insurance data shows a significantly lower incidence, of 0.2% to 0.4%.
But new data published by the specialist journal Ärzteblatt International have reignited the debate: between 2015 and 2024, the rate of new ADHD diagnoses among adults insured by the public system increased from 8.6 to 25.7 per 10,000 people, or almost triple what we call the incidence, that is to say the number of new diagnoses over a given period.
This trend is not an exclusively German phenomenon. Internationally, the numbers are also on the rise. In the United States, for example, the number of adults diagnosed with ADHD has more than doubled over the past two decades.
This seems like a lot, but how can we interpret this data?
“It can be stated quite objectively that ADHD in adulthood has been diagnosed much more frequently over the past ten years,” says Swantje Matthies, psychiatrist and behavioral therapist at the Department of Psychiatry and Psychotherapy at the University Hospital Freiburg, Germany.
“Probably because many adults with ADHD had not yet been diagnosed.”
The myth as a childhood illness
For a long time, ADHD was seen primarily as a disorder of childhood and adolescence – that classic image of the restless child who can’t sit still or concentrate.
Today, we know that the disease is 80% genetic and that it is present from birth. The fact that many adults are diagnosed late is also due to sex-specific differences. While boys tend to exhibit more hyperactivity and impulsivity, girls exhibit less noticeable symptoms, such as inattention and daydreaming behavior.
“These symptoms are harder to identify and are often confused with depression,” says Matthies.
This is also reflected in the current analysis: young women are diagnosed much more frequently, while as adults their diagnosis rates become comparable to men. Additionally, symptoms may change. Hyperactivity often later turns into internal agitation and attention problems persist.
How is the diagnosis carried out in adults?
The diagnosis of ADHD in adults is complex and relies mainly on detailed interviews, questionnaires and a reconstruction of the patient’s life history. This also implies a fundamental point: checking if the symptoms were already present before the age of 12 and continue to cause limitations today.
“Looking back, it’s not easy,” says Matthies. “Who really remembers what it was like when they were eight?” Therefore, old documents, such as school report cards, can be useful.
In addition, other causes must be excluded, because several psychological disorders are also accompanied by difficulty concentrating.
Why are diagnoses increasing?
The study authors cite several reasons for the high number of diagnoses. Among them, there is greater awareness in society on the subject. Additionally, changes have been made to the classification system used to establish criteria for various disorders.
Researchers have also highlighted the impact of the Covid pandemic on mental health as a driving factor, with increasing numbers of people seeking help for mental health problems in recent years.
Therefore, an increase in new diagnoses does not automatically mean that ADHD is becoming more common. Above all, it reflects the improvement in diagnostic methods.
Matthies emphasizes that any explanation of why remains speculative. Further studies and research will be needed in the coming years to clarify the causes. The figures are expected to stabilize in the long term – similar to the available data on ADHD in children.
Social networks: information or excess diagnostics?
Social media also helps make ADHD more visible, often in simplified ways. This likely also contributes to more people seeking a diagnosis.
For Matthies, even if the positive effect is undeniable, caution is required. “I think it’s good that information and personal stories are shared, that there is clarification and reduction of stigma. But there is also a lot of inaccurate and exaggerated content,” he warns.
For many, the diagnosis is a turning point – a relief, because it explains why certain strategies don’t work and indicates which ones can help. In Mara’s case, behavioral therapy and medication were crucial. “It’s like the level of difficulty in my life has decreased.”
At the same time, she learns to adopt her own working methods, including hyperfocus, that is to say phases of intense concentration – a typical characteristic of ADHD. “I can write an academic article in a week. Just because others don’t do it doesn’t mean it’s bad.”
Mara acknowledges that ADHD also gives her strengths, such as enthusiasm and the ability to make connections. “I wouldn’t want to miss it,” she said. The negatives, like difficulty concentrating even on the things she loves, are the price she has to pay, she laments.
“There are people who benefit a lot from their ADHD – for them it is a huge resource,” says Swantje Matthies. “At the same time, we must not forget that many people have difficulty carrying out daily tasks and need support.” Indeed, ADHD exists on a spectrum and does not manifest itself in the same way in everyone.
How can we make society more inclusive for people with ADHD?
ADHD continues to pose a challenge, not only to those who have it, but also to society as a whole. For Swantje Matthies, in many areas there is still a lack of preparation for caring for people with ADHD.
“For many people with mental health issues, it would be good to find niches where they can use their strengths and where their unique qualities are valued.” At the same time, however, she acknowledges that this can be difficult, as many jobs require compliance.
Mara believes everyone would benefit from a more inclusive society for people with ADHD. “Not sitting in a big open office, but in less stimulating environments and with the possibility of more flexible working hours,” she says. “It helps a lot of people, not just those with ADHD.”
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