The explosion in diagnoses of ADHD and other similar disorders in students has become notable, and has triggered some controversial and compensatory actions, with the unintentional potential to hobble and handicap large numbers of youngsters, writes Paul Sagar in Unherd.
He writes:
I’ve been teaching in British universities for 15 years, during which time, I’ve watched a few trends unfold. Like when they started needing safe spaces and denying basic facts about human biology. Or wearing hideous footwear, and dressing in androgynous black-and-white clothing. All of it the wrong size.
But probably most noteworthy is the dramatic increase in students entitled to special accommodations because of disability.
Every year, more essays come in after the deadlines, because more students get extensions lasting weeks, even months. On Mondays, I receive automated emails reminding me to be very careful when asking certain students questions in seminars, or expecting them to contribute in any way (apparently, they might not be able to handle it if I do).
Despite the fact that I teach political philosophy – a subject impossible to execute without precise handling of language – the university bureaucracy says that the quality of written language needs to be disregarded when assessing some candidates’ coursework. All of this, and more, is due to accommodations made under the rubric of disability.
Recently, eye-opening statistics were published in this regard. From 2008 to 2023, the proportion of students at UK universities claiming to have a disability doubled from 8% to 16%.
Even more strikingly, at Oxford and Cambridge it went from 5% to 20%. And the UK is not alone.
As recently noted in The Atlantic, 38% of undergraduates at Stanford in the USA are now registered as having a disability. Lagging behind is Harvard, at “only” 21%. (Both were at 5% in 2009.) It’s the same across all developed Western democracies.
This explosion has not been driven by campuses suddenly becoming wheelchair accessible. (I happen to be a wheelchair user myself, so I assure you I take disability very seriously.)
Instead, students are being diagnosed with impairment disorders relating to their ability to learn. And of these, four constitute the bulk: attention deficit and hyperactivity disorder (ADHD), anxiety, depression and non-profound autism spectrum disorder (ASD).
So what is going on? The truth is, it’s complicated. And as a result, two of the most common answers just won’t do.
All a scam?
The first answer is that, as The Atlantic suggests, it’s basically all a scam. Here’s the thing: students with registered disabilities are eligible for deadline extensions, extra time during exams, and a whole raft of entitlements regarding seminar attendance and participation.
Having realised that students with impairment diagnoses get such special consideration, sharp-elbowed middle-class parents reckon it is a sure-fire way to win their offspring competitive advantage. Cue the surge in presentation of the disorders.
It is not that parents are pretending their sons and daughters have these disorders. If their children are presenting as anxious and depressed and socially complicated, then they will really believe their offspring have ADHD and anxiety – these conditions have, after all, been confirmed by the professionals.
Partly the reason they are more readily open to believing this is because the conditions no longer carry the stigma as in the past, when children would be institutionalised rather than sent to university.
Rather than being a straightforward, limiting disability, the diagnosis now represents an opportunity: not just for extra time on exams, but also for handy legitimation and excuse-making if Junior comes up short (never mind bragging rights if he comes out on top).
Way too simplistic
For precisely these sorts of reasons, the other (and largely opposed) popular explanation for the increase in cases is also too simplistic: that rates of diagnosis have massively increased because medical professionals are now better at spotting underlying conditions which previously went unrecognised.
While certainly the case in some instances, this cannot account for such massive increases.
To be clear, studies using consistent criteria of symptoms have found no increase in the incidence of those, even as diagnoses of ADHD and autism have simultaneously risen dramatically.
The threshold has moved. In the past, the level of symptoms required to trigger a diagnosis of something like ADHD or autism were higher than today.
So have doctors, psychiatrists, and other professionals become sloppy? Are they failing to properly apply the right diagnostic criteria? Have the forces of middle-class ambition and medical over-reach manifestly combined, to feed off each other? But again, this is too simple.
To understand the complexity, it is helpful to consider the work of the philosopher of science Ian Hacking, who referred to “looping effects”: that when people receive a label, they respond to it by changing their behaviour accordingly. But because their behaviour has now changed, the label itself must evolve to capture the very thing purportedly being labelled.
Mentally impaired
Hacking’s work on autism helps to illustrate the point. When autism was first established as a diagnostic criteria in the 40s, it applied only to the severely mentally impaired, typically those who were non-verbal and highly socially dysfunctional (unable to live without extensive support from parents and professional carers; many were institutionalised).
Over time, however, the criteria were relaxed, in particular the (controversial) introduction of Asperger’s syndrome in the 80s, which applied to “high functioning” autistic people especially: those who were not only fully verbal, and often living independently, but crucially were diagnosed as adults (previously autism was something identified almost exclusively during childhood, precisely because it was so severe).
Yet this expansion of autistic criteria and the birth of the idea that autism is a spectrum, rather than a single category of psychological impairment, inevitably set off looping effects.
An Asperger’s diagnosis, for example, changed not only how certain kinds of adults (i.e, those receiving the diagnosis) viewed themselves, but how they behaved. Rather than being shamed and shunned for being “weird” (the fate of earlier generations), they could now (justifiably) protest that they were simply different, as validated by science, and deserving of relevant accommodations.
Indeed, many advocated for precisely this distinction, refusing to suppress their non-typical behaviours simply to accommodate “normal” people. (This is one important origin of the modern distinction between the “neurotypical” and the “neurodivergent”.)
Such a development has quite clearly benefited, in real and important ways, many people, by allowing them to access better resources in a world of reduced stigma.
Autism spectrum
Yet, as the criteria was relaxed, more and more adults started to see themselves as possessing features enveloped within the ever-growing “autistic spectrum”. Ever-growing, because the spectrum diagnostics kept changing to incorporate and accommodate the growing range of correlated symptoms. Which led to more people meeting the criteria…
This itself is an oversimplification, but a large part of why we now have an “autism spectrum disorder” so broad I can have students medically diagnosed as autistic, and yet who have rich social lives, romantic partners, and no problem understanding my terrible jokes in lectures.
But there is, also, an interconnected phenomenon, which Hacking called “making up people”. His point is that there are certain ways to be a person that require a pre-existing social infrastructure to first be in place.
Taker skaters, for instance. You might think this is simply somebody who rides around on a skateboard. But there’s more to it. To be a skater is to identify – and be shaped by — a certain subculture.
And what it meant to be a skater evolved: it went mainstream and became socially acceptable, changing what it was. The looping effect kicked in. Now, I see men in their 30s skating alongside schoolchildren. Not a single mohawk in sight, nobody even smoking weed.
Youth counterculture
On Hacking’s account, the same is true of “high functioning autism”. While there have always been people possessed of literal mindedness, a fixation with niche interests, difficulty relating emotionally with other people, finding it hard to read social cues and so on, it was only roughly 40 years ago – when it was diagnosed as a medically recognised thing – that you could identify as a “high functioning autistic”.
It became a social role people could inhabit. And which they could eventually expect others to recognise and accept.
The modern explosion in ADHD diagnoses, then, can be understood in much the same way. When I was an undergraduate in the mid-2000s, ADHD was something the naughty kids who failed at school all had. And back then it was almost impossible to imagine an Oxford graduate with ADHD.
The social infrastructure required to conceive of an academically high-achieving student with such symptoms was not yet in place. Now it is. This in part explains the striking changes of recent years: we have been “making up” new kinds of people.
Hindering or helping?
But the increase in diagnoses has not translated into effective help for those who need it most.
More generally, there is the question of whether widespread special learning accommodations are hindering rather than helping our students. University administrators love to bang on about imparting “transferable skills” to undergraduates. What they normally mean is nebulous guff such as “communication”, “leadership” or “problem-solving”.
By contrast, here are some real transferable skills: turning up on time, meeting deadlines, having to manage multiple tasks at once, dealing with intellectual discomfort, pushing through and completing something even if you find it boring, difficult, or unpleasant. In short: learning when you have to suck it up and grind on, because sometimes that’s just how life goes.
And yet diagnoses like ADHD, anxiety, depression, and ASD allow students to avoid having to learn these difficult life skills. Nor can we lecturers hope to impart the importance of short-term toil for long-term reward: tough love and all that.
Who are we, after all, to contradict medical diagnoses, not least when vast university bureaucracies are now structured to uphold and defer to such things?
There’s no small irony to all this. Measures originally undertaken with the good intention of helping students may be doing the very opposite.
It’s time to loop some different effects, make up some new kinds of people.
Paul Sagar is a Reader in Political Theory at King’s College London. His most recent book is Basic Equality (2024). His Substack is called Diary of a Punter.
Unherd article – Why do so many students have ADHD? (Open access)
See more from MedicalBrief archives:
Global ADHD cases not growing, just more awareness – London review
ADHD scripts in England up by 18% each year since pandemic
Autism and ADHD can co-exist and cases are growing, says expert
Half of adults with ADHD have had a substance use disorder — Canadian study