Why Does It Seem Like There Is So Much ADHD in the World?
Updated: Sep 15
It’s a question I hear all the time.
Why does everyone seem to have ADHD now?
Sometimes it’s asked with genuine curiosity. Sometimes with skepticism.
We didn’t have all these kids with ADHD when I was growing up.
Everybody has ADHD now.
Is there really that much more ADHD—or are we just diagnosing everything?
There are several legitimate answers to that question.
We understand ADHD better than we once did. We recognize presentations that were historically missed, particularly in girls and women. Parents, teachers, clinicians, and adults themselves have greater access to information about ADHD. People who once would have been described as lazy, unmotivated, difficult, scattered, overly emotional, or simply “not living up to their potential” are more likely to be understood through a different lens.
All of that matters. But I think there is another question we should be asking.
What has changed about the world we are asking our brains to function in?
Because perhaps part of the story isn't simply that we're identifying more ADHD. Perhaps we're also creating environments in which certain kinds of neurocognitive differences are harder to miss.
The ADHD Brain Didn't Suddenly Appear
ADHD is a neurodevelopmental disorder. The neurobiological variations associated with it didn't suddenly emerge with smartphones, school portals, standardized testing, or modern parenting. Human brains have always varied.
Some of us are more active than others. Some are more responsive to novelty. Some become intensely engaged when something is interesting and have enormous difficulty sustaining effort when it isn't. Some think sequentially; others make rapid and unexpected associations. Some plan naturally. Some improvise beautifully. Some are more affected by movement, sensory input, emotion, urgency, immediate feedback, or what is happening right now.
Those differences don't automatically tell us how well someone will function. Because brains don't operate in isolation.
They operate somewhere.
And that somewhere matters.
The Airport Has to Be Located Somewhere
I use the Control Tower Model™ to help explain the different systems that influence how we function. The model has four parts.
The Power Supply represents the underlying neurobiology—the physical system we're working with.
The Control Tower represents executive functioning: the skills that help us plan, organize, initiate, inhibit, manage time, regulate ourselves, and turn intentions into action.
Thinking Style, which I describe through Wagon Wheels and Ladders™, reflects how we tend to organize ideas and approach problems.
And the Switch represents the factors that influence when our attention and engagement come online—things such as interest, emotion, sensory experience, movement, novelty, and other features of what we're experiencing.
Together, those four pieces help us understand something about the individual. But lately I've been thinking more and more about something that sits outside the model. Because an airport doesn't exist in isolation. It has to be located somewhere.
What is the terrain like?
What is the weather?
How much traffic is coming in?
What kinds of planes are expected to land?
How quickly do they arrive?
What resources are available?
What does this particular airport have to manage every day?
The airport itself matters enormously. But so does where we've put it. That's the environment. And it changes the question.
Instead of asking only, How well is this person's Control Tower working?, perhaps we also need to ask:
What is this environment asking this particular brain to do?
We Have Built a World That Asks a Lot of the Control Tower
Think about what we ask a child to manage during an ordinary week.
Pay attention. Ignore distractions. Sit when sitting is expected. Move when movement is permitted. Follow multi-step directions. Transition according to a schedule. Keep track of assignments. Remember what needs to come home and what needs to go back. Manage a Chromebook. Check a portal. Monitor deadlines. Start work that isn't particularly interesting. Finish it. Turn it in. Prepare for tomorrow while remembering what is due next Thursday.
Those aren't simply academic demands. They are Control Tower demands.
And adults aren't exactly getting off easily. We manage calendars, passwords, email, text messages, appointments, forms, bills, portals, deadlines, schedules, notifications, long-term projects, competing priorities, and an almost endless collection of small administrative responsibilities.
Modern life places tremendous value on our ability to anticipate, plan, sequence, organize, remember, inhibit, manage time, tolerate delayed rewards, and execute consistently. Those are valuable skills. We need them. But they aren't the only valuable ways a human brain can work.
Wagon Wheels and Ladders
More than a decade ago, I began using Wagon Wheels and Ladders™ to describe another kind of difference I kept seeing.
Some people naturally organize their thinking more like a Ladder. They tend to move sequentially- first this. Then this. Then this. They often appreciate order, structure, predictability, and a clear path from beginning to end.
Other people think more like Wagon Wheels. An idea travels in one direction, connects with something else, circles back, sparks another possibility, and suddenly lands somewhere nobody expected.
Wagon Wheel thinkers often see possibilities before they see sequences. They make connections. They approach problems from different directions. They improvise. They can generate multiple possibilities before settling on one.
Wagon Wheel thinking is often creative thinking, although not necessarily in the way we usually use that word. Creativity isn't limited to art, music, writing, or design. It can be seeing a connection other people missed. Finding another route when the obvious one doesn't work. Generating possibilities. Adapting quickly. Combining ideas in an unexpected way. Coming up with an answer that wasn't apparent at the beginning.
Sometimes Wagon Wheel thinking looks messy from the outside—right up until the person sees something nobody else saw.
Wagon Wheels generate possibilities. Ladders create order.
We need both.
And this distinction is important: Wagon Wheel thinking is not ADHD. Not every Wagon Wheel has ADHD. Not everyone with ADHD is a Wagon Wheel. In my clinical experience, however, the two frequently travel together.
Thinking style is only one piece of the airport.
The Creativity of the Moment
There is another kind of creativity I think we often overlook: The creativity of the moment.
The plan falls apart.
Now what?
Something unexpected happens.
What do we do?
Everyone else is approaching the problem from one direction.
Is there another?
There isn't a clear path.
Can I make one?
This kind of creativity is responsive. It involves noticing, connecting, adapting, improvising, and generating possibilities in real time.
And I think that's particularly interesting when we consider the kinds of functioning our environments reward. Much of modern life depends heavily on what we could call prospective functioning.
Anticipate what will happen.
Plan for it.
Sequence the steps.
Organize what you'll need.
Remember when to do it.
Then execute the plan consistently.
But some situations call for something very different. Something is happening right now.
Notice it.
Respond.
Adapt.
Improvise.
Figure it out.
I've known individuals who struggle tremendously to organize something three weeks from now and are astonishingly effective when something unexpected happens right in front of them. Someone can have difficulty following the established procedure and be exceptionally good when there is no established procedure. That's not necessarily a contradiction. It tells us something about that particular airport.
The Switch Changes the Picture Again
Now add another component.
The Switch.
For all of us, attention and engagement are influenced by the conditions surrounding what we're doing.
Interest matters.
Emotion matters.
Movement matters.
Sensory experience matters.
Novelty matters.
Urgency can matter.
With ADHD, the regulation of attention and engagement can be particularly inconsistent. Give someone a repetitive, low-interest task with a distant deadline and little immediate feedback, and getting the Switch on can be extraordinarily difficult. Change the conditions—make something interesting, active, novel, urgent, challenging, or immediately meaningful—and the same person can look completely different.
This is one reason ADHD can be so confusing to the people watching it.
If you can pay attention to that for three hours, why can't you pay attention to this for twenty minutes?
Because the issue isn't simply whether someone has attention. It's how consistently that attention can be allocated and regulated. And once again, context matters.
Same Airport. Different Location.
Imagine a highly energetic child who learns by doing. Put her at a desk with repetitive work requiring sustained attention, inhibition, sequencing, little movement, and delayed gratification, and you may see substantial difficulty.
Now put the same child into an active group challenge in which something has gone wrong and the kids have to figure out how to solve it.
You may suddenly see leadership.
Persistence.
Negotiation.
Energy.
Creative problem-solving.
Engagement.
Same child. Same airport. Different environment.
Or think about the adult who is phenomenal in a crisis.
He rapidly takes in what is happening. Sees the big picture. Notices what other people miss. Improvises. Makes decisions. Finds a solution.
Then ask him to submit his reimbursement paperwork.
Three weeks later, it's still sitting on his desk.
Again:
Same airport. Different environment. Different demands.
One environment asks heavily for the things that are difficult. Another creates an opportunity to use things that come naturally. And that distinction matters.
Maybe We Used to Have More Niches
This is where I think the ADHD question becomes particularly interesting.
I want to be careful not to romanticize the past. People with ADHD struggled generations ago, too. Impulsivity could be dangerous. Inattention had consequences. Difficulty regulating emotion affected relationships. Executive-functioning weaknesses interfered with everyday life. Many people undoubtedly struggled tremendously without ever understanding why. The past was not an ADHD paradise.
But I do wonder whether there were more varied niches in which different kinds of functioning could find a place.
Children historically had more opportunities for routine movement, independent activity, unstructured time, learning by doing, experimenting, building, negotiating, exploring, and solving problems without adults determining every step.
There were also more common routes into adult life that did not require years of academic and administrative success before someone had an opportunity to demonstrate actual competence.
There have always been environments in which being energetic, responsive, hands-on, intuitive, entrepreneurial, socially perceptive, willing to take a risk, or unusually good at solving the problem directly in front of you carries real value.
Those environments still exist. But increasingly, even getting to them can require navigating a very Ladder-shaped path.
Complete the application.
Meet the prerequisite.
Track the deadline.
Follow the sequence.
Manage the portal.
Earn the credential.
Complete the paperwork.
Plan ahead.
Stay organized.
All before you get the opportunity to show what you can actually do.
Perhaps we haven't simply changed the demands. Perhaps, in some areas of life, we've narrowed the range of environments in which people are first asked to demonstrate that they are capable.
ADHD Is Still ADHD
None of this means ADHD is simply a difference that society has decided to call a disorder.
It isn't.
ADHD can create significant and sometimes profound impairment.
Medication can be enormously helpful. Accommodations matter. Explicitly teaching executive-functioning skills matters. Systems for organization and time management matter. Strategies for emotional regulation, inhibition, initiation, and follow-through matter.
We don't help someone by pretending genuine struggles are really secret strengths. But I don't think we help by doing the opposite either.
Because if we look only at how well an individual meets the demands of a particular environment, we risk confusing performance in that environment with the totality of what that person is capable of.
And perhaps that is one reason the question Why is there so much ADHD now? deserves a more complicated answer.
We are better at recognizing ADHD.
We are recognizing people who were historically missed.
And we may also be living in a world that places increasingly heavy demands on precisely the systems that are most difficult for many people with ADHD to regulate consistently.
The neurobiological variation isn't new. The environment has changed.
And environment influences whether—and where—a particular constellation of human characteristics becomes advantageous, neutral, difficult, or disabling.
We Need Different Kinds of Airports
We need people who sequence.
We need people who organize.
We need people who plan carefully, anticipate what comes next, create systems, and make sure the details get done.
And we need people who generate possibilities.
Who make unexpected connections.
Who respond when the plan doesn't work.
Who improvise.
Who bring energy to a problem.
Who see another route.
Who ask the question nobody else thought to ask.
The answer isn't to pretend executive functioning doesn't matter. It matters enormously.
So we strengthen the Control Tower. We create systems. We make time visible. We use medication when appropriate. We understand the Switch. We teach strategies. We help people develop the skills they need to function successfully in the world as it exists.
But perhaps we should also become more curious about the world we're asking them to function in. Because sometimes we need to strengthen the airport. And sometimes we need to think more carefully about where we've put it.
The goal isn't to build a world in which every Wagon Wheel learns to look like a Ladder.
It is to help people develop the skills they need while preserving—and finding places to use—the way of thinking that may be one of their greatest strengths.
Because when we understand the person and the environment, we can begin asking better questions about the fit between them.
And better questions can lead to very different answers.
Understanding changes everything.
The Control Tower Model™
See their strengths.
Understand their brain.
Strengthen the Control Tower.
If you would like to learn more about how to build an external brain or the Control Tower Model, check out my book ADHD: The Comprehensive Parent's Guide,
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