During a talk in Belgium last week, I was asked a question by a school leader that I seem to hear more and more often: Why are we seeing so many more diagnoses, such as ADHD, than before? Is there really an explosive increase? Have children changed? Or are we looking differently?

Not coincidentally, shortly afterwards, I came across a new sociological study in Social Forces via Dan Willingham that tries to answer exactly that question. Not from neurology or psychiatry, but from a macro-sociological perspective. I certainly do not agree with everything in it, and you will probably notice it quickly. Still, I found it particularly interesting because Tuncer-Ebetürk and colleagues attempt something I do not often see: examining ADHD worldwide as both a cultural and an institutional phenomenon.

The researchers analysed data from 135 countries between 1996 and 2019. Their starting point is straightforward: ADHD diagnoses have been increasing globally for decades. Not only in the United States, but across very different countries and regions. At the same time, ADHD remains scientifically a complicated diagnosis. There is still no objective biological test. Diagnoses continue to rely mainly on behavioural criteria and observations. The authors then make an interesting argument: perhaps rising diagnoses do not only tell us something about children themselves, but also about how societies look at children.

Their explanation revolves around two major societal developments. Important to note: this remains a macro-sociological correlational study. It shows associations at the societal level, not direct causal mechanisms at the individual child level.

The first development is what they call “child-centeredness”. According to the authors, children are increasingly viewed worldwide as unique individuals with their own rights, needs, and developmental potential. They argue this can be seen in several broader trends:

• more attention to wellbeing,
• stronger focus on development,
• more intensive parental involvement,
• smaller families,
• more educational reforms targeting young children,
• and greater sensitivity to possible difficulties or developmental delays.

Their analysis suggests that countries with more educational reforms aimed at young children, combined with lower fertility rates, also tend to report more ADHD diagnoses.

That obviously does not mean that smaller families cause ADHD. Rather, the authors point to a cultural shift in which each individual child receives more attention. And the more attention societies pay to development and behaviour, the greater the likelihood that differences or difficulties are noticed, named, and diagnosed.

The second factor they emphasise is the role of international organisations and health networks. According to the authors, organisations such as the WHO, UNICEF, and various health and advocacy groups have increasingly positioned ADHD worldwide as a legitimate neurodevelopmental condition deserving support and treatment. Through international guidelines, campaigns, and medical networks, this way of thinking spreads globally.

Interestingly, the researchers found little support for more traditional explanations such as wealth, democracy, or the overall quality of healthcare systems. The cultural variables remained much more strongly associated with rising diagnosis rates.

Now, I do think we need to be very careful here. This is not evidence that ADHD is “not real”. That is absolutely not what this study claims. The authors explicitly acknowledge that ADHD may be a neurodevelopmental condition with biological components. Their point is rather that the social visibility and interpretation of ADHD are also culturally shaped.

And honestly, that’s hard to deny.

Anyone teaching or working with children today operates in a very different cultural context from forty years ago. We view behaviour, wellbeing, participation, emotions, and development differently. Parents, schools, and support services monitor children far more intensively. At the same time, our expectations about functioning may also have increased.

That has advantages. Difficulties that were once ignored may now finally receive recognition and support. But it also means that the boundary between “difference”, “difficulty”, and “disorder” constantly shifts culturally.

That is precisely why I found this paper interesting. Not because it gives “the answer”, but because it broadens the discussion beyond the classic opposition between “ADHD is purely biological” and “ADHD is just a social trend”. As is often the case, reality is probably more complicated.

And so, rising diagnosis rates probably do not only tell us something about children. They also tell us something about ourselves, about how we look at children today, what we value, and which forms of behaviour we increasingly experience as problematic.