Growing awareness of attention deficit hyperactivity disorder (ADHD) may be leading some young adults to mistakenly believe they have the disorder, University of Toronto researchers have found.
In a study published in the journal Psychological Medicine , the researchers show that mental health awareness programs that are designed to help people recognize symptoms and seek support may also trigger false self-diagnosis.
However, a short educational session on the so-called "nocebo" effect - a phenomenon in which expectations about having a disorder can make symptoms seem worse - can lower the likelihood of mistaken diagnosis.
"We wanted to identify whether there are negative effects of awareness efforts and find a way to raise awareness in a more balanced way, so that people can learn about a disorder without the risk of unintended harms," says the study's lead author Dasha Sandra, a PhD student in U of T Scarborough's department of psychology.
Sandra's team conducted a randomized controlled trial with 215 young adults (ages 18-25) who did not meet clinical criteria for ADHD and had no prior ADHD diagnosis. Participants were assigned to attend one of three workshops: one on ADHD, one on ADHD that included a 10-minute lesson about the nocebo effect and a control group that learned about sleep.
Those who only received ADHD awareness information had a stronger belief they had ADHD immediately after the session and one week later even though their actual symptoms did not change. In that group, the share of people who rated themselves highly in self-diagnosis rose from 30 to 60 per cent immediately after that workshop and remained at 50 per cent a week later.
For the group who also received the nocebo education intervention, false self-diagnosis rates were cut in half right away and disappeared entirely after one week.
Sandra says the findings show how mental health awareness can reframe normal experiences as hidden signs of mental health problems, causing people to falsely identify with a disorder they don't have. She adds this may happen because a diagnosis can make for a comforting explanation for random, unexpected challenges.
"Believing you have a disorder can help make sense of confusing or messy experiences that are actually completely normal," says Sandra, whose past research has examined the placebo effect. "This could be especially true for young adults."
The study is the first to examine how false self-diagnosis from ADHD awareness can occur and persist over time - and the first to show the benefits of incorporating explanations of the nocebo effect into mental health education.
The nocebo effect has long been observed in medicine. While patients in drug trials often report side effects from placebo pills simply because they believe they're taking real medication, teaching them about the nocebo effect has been shown to reduce those responses.
Sandra's team applied this approach to mental health by creating a 10-minute lesson with information and techniques to curb the nocebo effect. These included explaining, for example, that issues like irritability, fatigue and poor concentration are common among undergraduates (and not necessarily a sign of mental illness).
Such insights could help young people view these as normal experiences rather than signs of ADHD, Sandra says, and can easily be integrated into awareness programs and online resources.
She emphasizes that people should not be discouraged from seeking help, but should rather be helped to interpret their experiences accurately as part of a balanced approach to mental health awareness.
"It's documented that there is currently an overdiagnosis of ADHD. At the same time, awareness is growing because ADHD remains underdiagnosed in some populations, particularly women and adults," says Sandra.
While awareness is essential, Sandra cautions that its unintended consequences should not be ignored. "A false self-diagnosis might prevent someone from getting an accurate diagnosis or addressing the real challenges in their life," she says. "It also diverts scarce resources from those who need help due to an underlying neurodevelopmental condition that needs proper assessment."
She adds the solution isn't to scale back mental health education, but to refine it.
"We're not saying that mental health awareness is uniformly bad. The positive benefits are well documented. The key thing is how much awareness and what kind people should get."
The research was supported by an Insight Grant from the Social Sciences and Humanities Research Council, funding from Fonds de Recherche du Quebec Société et Culture and an Ontario Graduate Scholarship.
