If you read the diagnostic criteria that is used, it’s so broad it could easily apply to most of the world’s population…as long as they declare they have trouble focusing.

I disagree. I think that 6 months or more of 5/9 symptoms of inattentiveness or 5/9 symptoms of hyperactivity, persistently, does not represent most of the world. (And excluding: "The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions." 6/9 symptoms are required to diagnose children) [0]

Indeed, surveys show that it's probably under 10% [1]. Mind you, these are surveys of symptoms, not surveys of diagnoses.

0. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t3/

1. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...

If you look into how the criteria is chosen its very arbitrary. And this descriptive diagnosis where you pick from list A and B is extremely bizarre from a common sense standpoint. And there is no brain imaging or genetic markers available.

> The number of criteria required for a diagnosis of ADHD has been set arbitrarily in DSM-5. No scientific justification has been presented nor method used for deciding how many criteria should be required

> https://www.frontiersin.org/articles/10.3389/fsoc.2022.81476...

and...

> For the case of ADHD specifically, this is translated to: “if an individual has attention deficit hyperactivity disorder it is because he is inattentive, disorganized and hyperactive-impulsive, and if an individual is inattentive, disorganized and hyperactive-impulsive it is because he has ADHD.

> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9871920/

It's important to be aware that each percentage point is hundreds of millions of dollars.

The set of symptoms are not arbitrary, but are connected logically, by each being the result of a deficit in some type of executive function. ADHD is broadly a disability of executive function.

Executive function is historically entirely a psychological concept, although there is starting to be some biological understanding which came later (e.g. which brain regions are involved, etc.).

> The number of criteria required for a diagnosis of ADHD has been set arbitrarily in DSM-5. No scientific justification has been presented nor method used for deciding how many criteria should be required.

Erm.. welcome to psychiatry ?

There is nothing bizarre (or unique to ADHD) about picking from a list of precise, agreed-upon criteria to form a mental health diagnosis. It's how the entire field works, and it's actually a huge step forward from the times when each therapist made up their own definitions.

In the absence of definite imaging or genetic markers for most illnesses, building consensus on criteria and thresholds in a reference manual (the DSM) is the next best possible way to end up with objective, useful and standardized definitions.

Not having a blood test for an illness doesn't mean it isn't real.

> It's important to be aware that each percentage point is hundreds of millions of dollars.

You don't need to resort to conspiracy theories once you understand the above.

Many people probably do have the same brain wiring, or maybe it's a low level of background dopamine, or whatever it turns out to be once science figures it out.

The reason most of the worlds population isn't diagnosed[0] is that second D: Disorder.

No disorder, no problem, no diagnosis.

[0] outside of lack of access to mental health resources, not knowing what they're looking for so never getting referred to a place to diagnose it, not believing in treating mental health issues, self-medicating, avoiding stigma, etc

I liken it to forgetfulness in old age.

A majority of elderly people see a decline in memory as they age. Not every elderly person who is forgetful necessarily has dementia.

Yeah it’s hard to write specific criteria for some mental disorders.

They’re not all uniform in presentation or affect.

It’d really be up to the therapist.

Thankfully, it doesn’t seem like most of the ADHD meds usually have long lasting adverse effects.

This is true about most diagnostic criteria, which is why medical students think they have all the illnesses before they get experience with people who actually have them. Its just very difficult to use words with sufficient precision to capture the bits that are, somehow, more obvious once experienced.