ADHD diagnosis, which largely originated in the United States, began to spread to the rest of the globe in the late 1990s, and has continued ever since. In a 2023 article, an international team found that ADHD “is highly prevalent in children and adolescents with boys twice more likely to experience the disorder than girls.” The researchers concluded that their findings “underpin that priority should be given to preventing, early identifying, and treating ADHD in children and adolescents.”
This is a narrative that tells of medical progress, of the spread of a diagnostic practice that can lead to helpful medical treatment, which typically includes a prescription for a stimulant.
A new study published in Social Forces explores the global export of this diagnosis through a different lens, as a phenomenon driven by institutional and cultural forces. Moreover, if the evidence regarding the benefits and risks of diagnosis and treatment is carefully parsed, the spread of this diagnosis—arising from institutional and cultural forces– tells of harm done on a global scale.
Risks and Benefits
On the benefit side of the risk-benefit equation for ADHD drugs, there is a lack of evidence showing that stimulants provide a long-term benefit in any domain of functioning. This was the bottom-line result from the NIMH-funded MTA study, and similar findings from the Raine ADHD Study of long-term stimulant use. The Australian researchers found no improvement of ADHD symptoms, academic performance, depression, self-perception, or social functioning in children treated with ADHD drugs.
At the same time, the potential harms from stimulants are well documented. ADHD drugs alter developing brains in ways that are not fully understood and have been linked to reduced cognitive functioning, increased risk of depression, mania, growth suppression, cardiomyopathy, high blood pressure, arterial disease, poor academic performance, psychosis, and earlier onset of psychosis. Stimulants are also addictive and can result in withdrawal symptoms when attempting to quit using them.
In addition to the harms associated with ADHD drug use, the diagnosis itself, which is based on subjective observations and a questionable medicalization of common childhood behaviors, exposes service users to stigma and social exclusion. One study found that the ADHD label, not the behavioral symptoms, was linked to self-harm and lower quality of life.
The Cultural Forces Driving a Diagnosis
While the spread of the ADHD diagnosis is often seen by critics as a marketing story, the global export of a product, the Social Forces article found that the presence of health focused international non-governmental organizations (INGOs) and western-style “child-centeredness” predicts higher rates of ADHD diagnosis globally. This research, authored by IremTuncer-Ebetürk and Yasemin Nuhoglu Soysal from the Berlin Social Science Center, and Jessica Kim from the University of Pittsburgh, also finds indirect evidence that global market forces have contributed to the rise of ADHD diagnosis worldwide. The authors write:
“Our analysis suggests that the global rise in ADHD diagnoses reflects broader cultural shifts, particularly the prioritization of children’s needs and the dissemination of global health norms by health INGOs. Together, these factors create an environment where ADHD is more readily recognized, diagnosed, and treated, reflecting the profound impact of global cultural norms and institutional practices on children’s health and behavior.”
Methodology
The goal of the current work was to examine the link between ADHD diagnosis and the presence of INGOs. The authors also wanted to investigate the relationship between ADHD diagnosis and child-centeredness, “the presence of cultural values,beliefs,and practices prioritizing children’s needs and well-being within society,” as measured by children’s educational reforms and declining fertility rates.
The authors argue that both educational reforms and declining fertility rates are indicative of a country moving towards greater child-centeredness, as they reflect a centering of children’s needs at both societal and familial levels. These factors also demand and allow for more attention to be paid to the behaviors of individual children. This individualized focus can then lead to behaviors being marked as “pathological”, as is the case with ADHD.
The authors used data from the Global Burden of Disease, Injuries, and Risk Factors (GBD) to examine ADHD prevalence in children and adolescents across 135 nations from 1996 to 2019. These rates were compared to the number of educational reforms passed, the fertility rate, and the number of active INGOs in each country. Together, the authors call these three factors global cultures and institutions.
The current work also examined other likely contributors to ADHD prevalence rates including: health expenditures, a measure of univerlistic welfare, the country’s score on the Liberal Democracy Index, tertiary education, and poverty rate. These factors allowed the authors to control for internal country characteristics’ influence on ADHD prevalence.
Results
Global cultures and institutions were the driving factors in ADHD diagnosis, with substantial effects on prevalence rates. High rates of educational reform and INGO presence were each linked to an increase from 2,100 to 2,500 ADHD diagnoses per 10,000 children/adolescents. Low fertility rates were associated with an increase from 1,500 to 2,500 ADHD diagnoses per 10,000 children/adolescents.
According to the authors, educational reforms and INGO presence each predict a 25% increase in ADHD diagnoses, while fertility rates predict a 35% increase. The authors note that ADHD diagnoses both increase alongside global cultural and institutional influence, and remain elevated in countries where these factors have been consistently high.
None of the other factors measured as controls represented significant predictors of ADHD prevalence. This finding is counter to previous research. The authors note that this may be related to the over-representation of industrialized, well-educated countries in other studies. While much of the data on ADHD in the academic literature comes from countries like the United States, Australia, and Canada, 70% of the data used in the current work came from the global south. They write:
“Global variations in ADHD prevalence are not predominantly explained by the domestic factors examined here, but rather by the broader global cultural context in which they are embedded and prioritized.”
The authors also considered several other factors as possible explanations for rising ADHD prevalence rates. GDP, internet use, and children as a higher percentage of the population were not significant predictors of ADHD. Pharmaceutical sales showed marginal significance in rising ADHD rates. Overall mental “Illness” could also not account for the effects of global cultures and institutions on ADHD prevalence.
Limitations
This research had several limitations. The design limited the authors ability to examine individual level factors of ADHD prevalence. The GBD database relies on DSM and ICD diagnostic criteria of ADHD. This limits the ability of researchers to track changes in ADHD prevalence between countries over time. INGO power and focus were not examined. This means the authors don’t know how much influence INGOs had, or how focused on ADHD they may have been.
Industry Influence on the Spread of ADHD Diagnosis
Recent research in Harvard’s Health and Human Rights journal has explored the pharmaceutical industry’s role in the global export of the biomedical model of mental “illness.” This model situates certain behaviors, like those seen in ADHD diagnosis, as medical conditions. In the case of ADHD, industry in collaboration with the American Psychiatric Association, essentially rebranded childhood restlessness as a disease.
Once this type of behavior was rebranded as a medical condition, industry could market its drugs as a helpful treatment. Industry has recruited teachers as quasi-diagnosticians, applied cultural pressure through the funding of ADHD awareness campaigns and patient advocacy groups, and increased sales by marketing stimulants directly to physicians. Industry also makes payments directly to physicians to increase sales of their products.
After ADHD took hold in the U.S., the joining of these two forces—the psychiatric guild and industry—promoted the diagnosis and treatment to nations in Western Europe and other English speaking countries. According to this study in Social Forces, international non-governmental organizations then contributed to its global spread, by promoting Western “child-centeredness” ideas and practices.
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Tuncer-Ebetürk, I., Kim, J., & Soysal, Y. N. (2025). The global rise in children’s attention-deficit/hyperactivity disorder prevalence: A macro-sociological explanation. Social Forces. (Link)
Referencing: According to this study in Social Forces, international non-governmental organizations then contributed to its global spread, by promoting Western “child-centeredness” ideas and practices.
Unfortunately, it’s not common knowledge that NGOs often are simply extensions of the very same (pharmaceutical) industry and, when they’re not, are still constrained in what they can do, given certain legal mandates often engendered by pharmaceutical companies and other industrial complexes.
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Yes. The pharmaceutical octopus reaches far and wide.
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There’s something about the role of NGO’s in global capitalism here. They get their money from governments and philanthropy. They cannot afford to rock the boat too much.
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The issue is that 1. government effectively has surrendered control to a global market predominated by banks, hedgefunds and syndicates and that 2. much of the structure we associate as sound functioning of a capitalist society are in fact its most corrupt aspects.
For that matter, philanthropy is a euphemism for often very overt manipulation of public opinion or institutions by means of funnelling a lot of money, often in the range of billions, through set-up organizations and lobby groups, many of which only exist as an mail box somewhere in Delaware or London. That’s the preferred way for most of our philanthropes because it helps them obfuscate their own steps and also lets them operate in, what some call, a legally grey area. Their “interventions” are also much easier to sell to the public. You can look into Bill Gates, for that matter. A guy who had no problem driving potential competitors to the point of their founders killing themselves or becoming homeless is now the public face of philanthropic action.
If you want to know to what extent some industrial complexes go to perpetuate their own interests and expand their market, a notorious example would be “autism speaks” which, among other things, propagated anti-vax ideology despite its board being stuffed full with pharma executives.
This was (probably) done in order to derail genuine criticism of the pharmaceutical industrial complex by needlessly polarizing such issues along party lines, think of RFK Jr. as part of the Trump gang, in addition to capturing potential hostile groups and have them “sterilized” that way. In essence, another form of institutional capturing. Since then, autism speaks and similarly have moved on, now propagating other autism narratives primarily targeting adolescents and adults (masking, civil rights, finding your true self) as opposed to parents. If this sounds like what you hear in ADHD spaces, it’s hardly accidental. The point, obviously, isn’t just that this creates profits but that these diagnoses also function as convenient political tools, be that by means of exerting pressure on parents so that their kids develop alongside “standardized” trajectories, be that by means of selling such diagnoses as identity markers so as to further promote identity politics.
There’s a reason psychiatric diagnoses are medically useless and scientifically meaningless. If they were scientific valid, there would be a hard, empirically determined, limit to what such diagnoses can entail. But because we live in dynamic times, we need to have dynamic labels so whatever e.g. ADHD, is effectively has to change every other year. For example, if more people get unemployed because the economy sucks, it’s probably because of undiagnosed ADHD that now presents differently for some made up reason etc. Again proven by the fact that this exact narrative surged shortly after COVID took off.
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Just a couple of quick notes:
Gates’ principal philanthropy is global ‘vaccination’, by which he’s doubled his wealth (ca. 50 to ca. 100 billion); the covid operation was the launch into the new normal of worldwide rollout and regulatory population control. You might find the following doc worthwhile if you’re not already familiar:
Who Is Bill Gates? (Full Documentary, 2020)
https://corbettreport.com/who-is-bill-gates-full-documentary-2020/
Wikipedia, fwiw, identifies Autism Speaks as pro-vax, historical nuances notwithstanding; the mainstream position is to continue to deny overwhelming correlation – indicative of causation – between vaccines and autism, among a mind-boggling proliferation of other ‘diseases’.
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