Adults in BC now account for the majority of new ADHD diagnoses despite a steep rise in cases among all ages since 2020, according to BC government statistics.

(LEVI LANDRY / iNFOnews.ca)

Leanne Gallant was suspicious when she found herself repeatedly relating to the children she worked with describe their ADHD. She knew what it was, read about it and knew people from school who took Ritalin when she was young, so the disorder wasn't novel.

What was new was the realization that she, a social worker in her mid-20s, had the same symptoms as the children she was helping.

"It was never just one thing," she said. "It just kept happening, where I was reflecting on my own childhood and seeing those characteristics."

At 30, Gallant was diagnosed with attention deficit hyperactivity disorder. A year later, she has settled on a treatment routine.

"It was like wearing glasses for the first time," she said. "I still need something, I still have a challenge with things others maybe don't struggle as much with, but wow, this feels a lot better."

Chances are, more of your friends and family are taking Ritalin or Adderall than ever before. New cases in BC are skyrocketing, especially among adults.

Psychiatrist and ADHD researcher at UBC, Dr. Elisabeth Hall, said it's only since the 1990s that the medical community started to recognize the disorder's prevalence among adults, no longer only a childhood condition.

"It's taken a while for this to catch on in the general public for sure, but also in the medical and psychological communities," she said.

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THE NUMBERS

The BC Ministry of Health provided figures going back 15 years, showing 5,288 new cases in 2009 among children and adults. Childhood diagnoses roughly doubled those among adults at the time, but the rates closed in over time. The total new cases would also grow by around another thousand each year until 2020.

New cases jumped by around 3,000 to 16,515 that year, followed by a jump by nearly 10,000 in 2021 and growing. More than 40,600 people in BC were diagnosed with ADHD in 2023. Adults 19 years of age or older made up 57% of them.

Annual new cases among youth and adults both grew in the past four years, but the diagnosis rate for a disorder once thought to only affect children is now skewed toward adults.

It's a trend that's consistent across all of BC's health regions.

People in the Interior Health region accounted for around 8,150 of the new cases in 2023, with 5,346 of them adults, according to ministry statistics.

More than 60% of the nearly 20,000 people with ADHD in the region are adults, which is similar across BC. As of 2023, just over 100,000 people in BC are diagnosed with ADHD and less than 40% are under 19. Until 2020, even the total amount of cases in the province was skewed toward youth.

So what happened?

Hall said a growing understanding of ADHD, first in academic and medical circles, then expanding to the general public, has been ongoing for some years, but the COVID-19 pandemic seemed to shift it to the next gear.

"Definitely what we saw was an increase in people identifying a problem," she said.

Lockdowns kept people indoors, routines were disrupted and many started working from home.

Those thousands of adults would have been living with ADHD for their entire lives. While it can happen, Hall said it is extremely rare for anyone to acquire ADHD later in life. 

THE PANDEMIC

Whether they knew or not, many undiagnosed people create workarounds or routines that keep them on track. It might be constant reminder notes, a dozen alarms or even an exercise routine. The pandemic poked holes in their routines and workarounds.

"People didn't exercise, they were cooped up, they had no novelty whatsoever and they were scared," Hall said, adding that anxiety is closely associated with ADHD. "So during COVID what we saw was an increase in people identifying a problem."

For Gallant, who now works as a therapist, lockdowns and working from home brought a shift that she long struggled to adjust to.

"I never experienced that before, I was always on the go. I switched jobs a lot because I got bored," she said. "I found a job that I really loved, but everything just changed. It wasn't that fast-paced, crisis-driven experience that I grew to love and do really well in."

The shift changed from a job that was response-focused and out in the world to not only one that was in a home office more often, but also tested her time management and ability to plan her work schedule, something people with ADHD struggle with regularly.

"I seriously crashed," Gallant said. "I had such a hard time."

She spoke with friends and her mother, then checked her report cards for notes from her teachers as a child. If the results were those of a child she helped at work, featuring notes like she "just needed to apply herself" and many late attendance records over the years, she said it would have raised the flag that an assessment was needed.

Though she wasn't hyperactive, Gallant's attention was fleeting from one thing to the next. Teachers and parents sometimes miss those signs, especially among girls, because rather than bouncing off the walls, they are often inattentive and ruminating into worry or anxiety, according to Hall.

"I made the decision to get an assessment, but it took a couple years after that to actually get it done," Gallant laughed. "It was a combination of forgetfulness, distraction, not wanting to make a phone call that wasn't work related."

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It was historically thought to be only an issue for children, but more recent research shows symptoms can persist into adulthood. Odds are high those people take more risks than neurotypical people, leading sometimes to serious consequences and destructive behaviour, especially if unmanaged.

Researchers have found people with ADHD are twice as likely to develop addictions than the general population. They often change jobs, whether on their own accord or not, and tend to have lower incomes and higher debt. They're also more likely to engage in criminal behaviour. In 2015, a study found a third of Canada's incarcerated population had ADHD, while it only affects about five per cent of the population.

Caught and treated in childhood, Hall said studies suggest the risk for substance use disorder in particular is reduced almost entirely.

Hall, whose career has been focused on ADHD for years, said stereotypes tend to downplay the ways the disorder can deeply affect a person's life. It's common for people without the disorder to suggest everyone has "a bit of ADHD," something she said is "disrespectful for people who have spent a lot of time managing it."

"Of course others have trouble with attention, but they don't necessarily have ADHD," she said.

One persistent stereotype is that people who are successful or intelligent wouldn't have it. They have often avoided suspicion because they have tools to work around the disorder.

"I work with a lot of physicians and I've had some who are obviously very intelligent and did well in school. They come to me and say, 'I can't possibly have ADHD, but I can't figure out why I can't organize myself and my colleagues seem to work so much better than me,'" she said. "You can hear the symptoms and the impairment, but what you also hear is these really brilliant and creative workarounds they've developed over the years."

As Hall described the way people with ADHD "mask" or cover up their symptoms and how it may seem like peers manage organization or tedious tasks with ease, I realized that not only do I have ADHD but it affects me in more ways than simply being easily distracted.

I am wary of self-diagnoses, but between interviewing Hall and writing this story, I came to learn that some of my tendencies are rooted in a disorder that's been documented for at least two centuries.

This fall I became one of thousands in the province now taking a prescribed stimulant for the first time, but the path to diagnosis varies for many.

'IT ISN'T YOUR FAULT'

Gallant said she was "privileged" to have reliable primary care, but she took the typical route to get assessed through the public system. Despite her strong suspicion, she was careful not to presuppose what her assessment would end with, whether it be ADHD or something else.

She was referred to a psychologist who, after a nine-month wait, took her through an hours-long assessment.  It drew on a lengthy one-on-one interview, another with her mother and a review of past records to show her tendencies as a child. A specific focus, as is common, was placed on report cards. Gallant said it was a "full day experience" and a "rollercoaster."

In the end, it was confirmed.

"She said to me, 'I want you to know, it isn't your fault,'" Gallant said. "She said that and I started to shake my leg. It wasn't a nervous shake, it was like, OK, I can do this. It's OK for me to move, I don't have to contain my body in a way that somebody's expecting me to do.

She drove back to work, parked her car and cried. Not because of sadness or grief, but it was "validating." Although it took years into adulthood to hear that confirmation, she didn't blame parents or teachers for perhaps not catching it earlier.

"I think throughout this there was a lot of reflection and compassion for others, so I could have compassion for myself," she said. "For me it was about how I feel about this now and what I'm going to do in the future. And, now I know I don't have to mask as much."

Robin Dunn, a 78-year-old man in Kamloops, was only diagnosed a year ago. Reflecting on his life, Dunn said it all made sense, but the decision came because of his own child.

"I've always been classified as different. I heard 'he can't concentrate' and 'if only he could apply himself,'" Dunn said. "In the end, my son prompted me to get diagnosed."

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GENERATIONAL

It was a chain reaction as his son's diagnosis was done in response to Dunn's grandson's assessment. Without a family doctor, he sought a private assessment to streamline the process. An ADHD-focused clinic in Vancouver went through a similar assessment process to Gallant's for $300. He needed a second opinion from another doctor, but his ADHD was then confirmed last fall.

It's a common approach for people without primary care and there are few clinics that do it.

"I'm still a work in progress. (The medication) is working partially for me. I'm content with that because it's an improvement," he said. "And also the fact that somebody has agreed that I have ADHD, we can put a label on it. That counts for something, it's an explanation."

I was unsure how long my assessment would take, but I felt it was important to take the public healthcare route. A call to 8-1-1 erroneously directed me to Interior Health's Mental Health and Substance Use clinic, which takes on patients with more acute mental health issues, like those that might land a patient in the psychiatric ward at Royal Inland Hospital.

While looking at options and considering the private route, I learned my childhood family doctor in another province diagnosed me at a young age. It merely took two appointments at an Urgent and Primary Care Centre. Within weeks I had a prescription and after a brief trial with differing doses, I settled on a pill that helps.

I knew I was assessed, but I didn't know its results and never took medication. The structure my parents put in my life went a long way, doing what they thought was best amid ADHD stereotypes from the 1990s and stigma against medication.

Hall sees the increase in diagnoses across the province as a "correction." She noted that a proper diagnosis should take hours of assessment and dig deep into childhood behaviour, and sometimes it's "a little quick and not careful enough." Even if there are some misdiagnoses, she isn't overly concerned, but there are some who are.

A UBC research group, The Therapeutics Initiative, raised concerns about quick, cursory assessments leading to an "epidemic" of stimulant prescriptions in BC. It's a concern, the group notes, that has been raised since the late 1990s. Stimulants sold under brand names like Vyvanse and Ritalin, the most common drugs to manage ADHD, have had a massive increase in use since 2020, alongside the rise in diagnoses.

Adults have been quicker to take medication with their diagnosis since 2011, according to ministry of health statistics. Adults have also seen a far faster upsurge in new medications since the pandemic compared to youth up to age 18.

According to The Therapeutics Initiative, just one adult per every 1,000 British Columbians was taking medication in 2004. By 2011 it was still only around three adults per 1,000, but the steep rise in diagnoses the next decade saw more than 16 adults per 1,000 British Columbians prescribed ADHD medication. By 2022, the total spent on those drugs was estimated to cost $46.5 million through public and private funds combined.

The Therapeutics Initiative casts doubt over the efficacy of prescription drugs available for ADHD, concluding there remains "uncertainty" and calling the evidence about their use "controversial."

The group also said quick assessments that rely more heavily on self-reporting are generally not reliable for a diagnosis, but it's made worse by the burgeoning creation of ADHD-related social media content.

Social media platforms, especially TikTok, have become rife with ADHD and mental health-related content. A 2022 study, also done by UBC researchers, examined ADHD-related content on TikTok, finding half of the videos were misleading. The vast majority were not made by a health care worker.

Hall said it's encouraging that it's more commonly discussed, but users should be wary of what they trust online.

"This is probably people who are reflecting and they're seeing a trend, and to know that a person has had a significant impact in their life because of ADHD can be very liberating for people because it helps them develop skills or seek appropriate help," Hall said.

There are many reasons why someone with ADHD might never have been diagnosed. Even for Gallant, there were likely multiple factors, like the fact she was generally a good student with high marks or that she wasn't obviously or outwardly hyperactive, along with the simple fact she's female.

Hall said in childhood, three boys are diagnosed for every girl, sometimes followed by a diagnosis of another mental illness later in life when missed, like clinical depression or borderline personality disorder.

Despite the challenges the disorder brings, Hall said there are strengths some might draw from their ADHD.

"For example, ADHD is overrepresented among entrepreneurs. Why is that? Well, they're super creative people, thinking outside the box," she said. "We tend to get so focused in the problems, but I would like to see more of a balance."

The strengths are something Dunn, newly diagnosed and approaching 80, keeps in mind, too. To him it's "an asset."

"The way we think actually gives us a strong advantage in some industries," Dunn said. "If you have a crisis, put me in the crisis because my brain works so fast in multiple directions, I can multitask for hours."

Go here for more information on ADHD and resources in Canada.

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