Can GPs help the ADHD generation?
Dr David Turner questions the mental health epidemic in young people, and ponders how to build resilience in an over-medicalised generation
We are in the middle of a new epidemic – mental health in young people. Requests for ADHD assessments, referrals for anxiety, depression, OCD, and every shade of neurodiversity have spiked and far exceed the capacity of state-funded mental health services to cope.
Why has this occurred and what can we as GPs do to improve things?
You have to wonder what has driven this. Has modern society become so toxic that the current mental health crisis was inevitable? Or are the younger generation just not being equipped with the appropriate coping mechanisms to help them deal with the multi-pronged assault on their mental well-being that living in the 21st century entails?
There’s been many a discussion and theory on what the factors may be regarding the current levels of mental health problems in the younger generation: Covid, climate change, Brexit, wars, social media and more. But is this oversimplifying the problem?
All societies throughout human history have experienced the stress of armed conflict, famines, disease, poverty, and unemployment. Are we over-medicalising normal reactions of sadness, grief, and anxiety, which most people will experience at some point or other in their lives? Improving resilience, both physical and mental, as one reinforces the other, would I feel, go a long way to improving the mental health of our young.
A couple of years ago, I received a complaint from some medical students I was teaching, when I had asked them to walk to visit an elderly person in a retirement home 0.9 miles away (I know the distance as I checked it). Some of the students complained they had never walked so far in their lives. I pointed out that some of the residents, in their nineties, walk the same distance for appointments at the surgery.
Another group of students complained that I made them feel uncomfortable when I pointed out during the first Covid vaccination clinics, that it was people of their generation fainting at the thought of a needle. The older generation took their jabs without blinking an eye.
I present these examples not to highlight the behaviour of what some call the ‘snowflake generation’ but as examples of how physical and mental resilience have reduced in just three generations.
We must learn to distinguish between the vast range of ‘normal’ human and particularly adolescent human behaviour and pervasive maladaptive psychological pathology. We could start by not wrapping children up in cotton wool so much. Let them out to play on their bicycles and in parks. Electronic devices have off buttons for a reason – use them!
It seems that universities are beginning to understand this. I heard Professor Arif Ahmed, director for Freedom of Speech and Academic Freedom at the Office for Students, speaking on Radio 4 earlier this summer. He said that future university students need to ‘prepare to be shocked’ and should ‘expect to be exposed to views they may find offensive’. It certainly rang true for me, and is a first step in removing the cotton wool.
There is no doubt that we were underdiagnosing mental illness in young people in the past, but I do think that the pendulum has swung too far the other way now. Not every child who is inattentive in class has ADHD. Not every teenager who has a meltdown when asked to help with the housework has a personality disorder. Not every young person who chooses to lock themselves in their bedroom for the weekend has clinical depression. There must be a middle ground we can find.
Dr David Turner is a GP in Hertfordshire
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READERS' COMMENTS [13]
Please note, only GPs are permitted to add comments to articles
Aye up mi old duck, thee should bring back national service for these young idlers…..nowt wrong wi’ that.
@David
The “fainting” thing is a poor example. This is an age effect, not a cohort effect. When previous generations were young they were also prone to fainting at blood tests. Now they are older they are not so prone. See for instance, https://www.sciencedirect.com/science/article/abs/pii/S0020748907000272
Furthermore, I think your analysis misses the key role of digital communications such as social media in “promoting” conditions such as ADHD and autism. I for instance, am one of the least ADHD-ish people I know – I have read “War and Peace” twice for fun – yet my browser home page still tells me I might be missing features of ADHD in myself and I should take the linked online test. Would any of these screening tests pass the Wilson criteria for a screening test? I presume not.
Agree with the bird.
National Service, or proper Voltary Service (perhaps instead), would give them life-experience and maturity – though not if they are too much allowed to pick what they will and will not do.
@dylan.summers – “I have read “War and Peace” twice for fun” – presumably, next for a really good laugh, you’re tackling Ulysses….😉 Good luck.
A certain cure for ADHD.
Cue ‘The Four Yorkshire Men’ sketch from Monty Python.
The UK government spends / controls 44% of GDP. In such a society the emphasis – for employment protection, university application consideration, housing / PIP / universal credit benefits – is for individuals to continually declare how incapable they are in order to optimise their access to these resources.
This is a poisonous psychological burden that is in opposition to the mindset of ‘how can I improve the value I offer to the world’ (to friends, families, partners, employers, educational establishments, in public spaces and in other secular and religious spaces) – the mindset that is actually needed for ongoing growth, success and fulfillment.
There is no corollary between Govt spending (as %age of GDP) and a political opinion on how we should behave towards the poor and weak (who may include a few shirkers) in society.
The USA spends around 40% of their GDP, France 58%, Germany 48% etc – so what’s the pattern?
Most people think the USA is low spending…it’s not, it’s high spending but with rubbish political decisions handing tax takes to private businesses hence shaping poor health and social outcomes – that’s the American way!
Also, it’s important to remember that in the Victorian (or Dickensian) era, UK spending was lower (apparently 10% of GDP) – but do we really want to time-travel back to the terribly Bleak and Hard Times of Oliver Twist?
Our spending is in the bottom half of the Western bloc (just above Estonia and Romania)…
Would just be great if GPs actually spent their CPD time learning about a disorder which affects at least 1 in 20 of their patient population, has an effective treatment which is just not complicated or difficult to prescribe rather than shirking responsibility by allowing the outsourcing to variable quality and expensive private companies. Patients get stuck between said companies, GPs and pharmacists.
If GPs identified and treated these patients, I would guarantee that they would see the patients less overall for other associated presentations.
As a baby boomer I feel we have been the ‘golden generation’ with no conflict, lots of work and rising house prices. The newer generations may have all the electronic toys but compared to our luck they are cursed by economics falling living standards and a society that does not expect them to do well. They have learnt that its the ‘victims’ who get let off and gain perks and compensations. Their desire to be labelled inadequate is understandable, but unfortunately just makes them miserable.
Hi Vicky,
5% is quite a lot of patients. I note you do not mention resource. Perhaps you meant to. Without resource which part of our current daily work should we not do?
Without diminishing the effect of this condition on certain group of patients (often the ones who can’t afford private in any case) suggesting that it is simple and easy to identify and treat these patients is at complete odds with our own local psychiatry advice.
I wonder what the long term effects of these medications will turn out to be?
Wish it was only the younger generation requesting ADHD diagnoses. We appear to have many adults now requesting this. With no preparation or training on how to decipher whether we should refer or not, this has turned us in to a “see and refer” service. Still feels in many cases like lack of resilience.
The vast amounts of poor quality social media and negative news stories young people consume means they must cope with both their own issues but also a heightened awareness of all the problems facing the world including politics, war, perceived social injustice, their own insecure financial futures in their own countries and all over the world. The algorithms feed anxiety and overthinking. Our brains evolved and were designed to coexist in small simple communities and have not had chance to adapt to 21st century life and technology. Over-medicalisation is real.
Rates of diagnosis of ADHD are still well below the population prevalence- there is more under-diagnosis than over-diagnosis. Please be careful not to gaslight patients who have a serious problem (ADHD reduces estimated life expectancy by 12.7 years, and costs society approx £20k per patient per annum if untreated) by lumping them together with self-diagnosed tiktokkers- its not some snowflake lifestyle choice that some people portray it as! and there is no evidence that the rates are increasing, only that it is better recognised; I share some concerns that the more severe cases are less likely to receive a correct diagnosis, because there is diagnostic overshadowing (eg focus is on eating disorder, substance misuse, PTSD or anxiety rather than the underlying ADHD) and those with poorer executive function (and less capable/assertive families) are worse at filing in questionnaires, complying with online appointments etc. which are the only way to get an assessment for most people. there is some evidence that those who are already discriminated against in other ways (poor, BME, women etc.) are subject to an inverse care law for ADHD assessment too.