In this episode of The Diary Of A CEO, Steven Bartlett examines the recent surge in ADHD diagnoses and prescriptions across the UK and US. The discussion delves into the neurological basis of stress responses in children, explaining how the brain's key components—the amygdala and hippocampus—develop during early childhood and how their development affects stress regulation throughout life.
The episode explores how early life experiences and family environment influence a child's stress response system, with data showing that children who experience adverse childhood events are more likely to develop ADHD. The conversation also addresses concerns about the current treatment landscape, including the widespread use of medication, and presents alternative approaches that focus on addressing underlying stressors rather than just managing symptoms.

Sign up for Shortform to access the whole episode summary along with additional materials like counterarguments and context.
Recent statistics reveal a dramatic increase in ADHD diagnoses and medication prescriptions across both the UK and US. In the UK, ADHD diagnoses among boys aged 10-16 have more than tripled to 3.5%, while prescriptions for men aged 18-29 have increased 50-fold. The US shows similar trends, with 15.5 million adults diagnosed with ADHD and 10.5% of children holding a current diagnosis.
The brain's stress response system involves two key components: the amygdala and hippocampus. Research shows that the amygdala, which regulates stress responses, remains offline during the first 1-3 years of life. However, early-life stressors can prematurely activate it, leading to a hypervigilant stress response. In children with ADHD, an underdeveloped hippocampus (the brain's "off switch" for stress) can result in an overactive amygdala, making stress regulation more challenging.
Research indicates that nurturing parenting during the first three years can significantly impact stress regulation, even neutralizing genetic stress sensitivity. Various psychosocial stressors affect child development, including divorce, parental mental illness, and sibling rivalry. Studies show children with high adverse childhood experiences (ACEs) are nearly four times more likely to have ADHD. Even seemingly minor events like moving homes or a sibling's birth can significantly impact a child's stress levels.
Erica Komisar critiques the widespread reliance on medication as a quick fix for ADHD symptoms, warning that stimulant medications can cause severe side effects, including growth issues in adolescents. She advocates for a more comprehensive approach that addresses underlying stressors rather than merely treating symptoms. Komisar emphasizes the importance of parental guidance, emotional regulation, and understanding the root causes of stress in effective ADHD management. She suggests that maintaining structure with empathy and helping children feel heard and understood is crucial for their psychological development.
1-Page Summary
Recent statistics show a stark increase in ADHD diagnosis and prescriptions for medication, raising questions about the trends in how we diagnose and treat this condition.
Between 2000 and 2018, there has been a significant rise in the number of ADHD diagnoses, drawing attention to the potential overdiagnosis or increasing recognition of the disorder.
In the UK, ADHD diagnoses among boys aged 10 to 16 have more than tripled, jumping from roughly 1% to about 3.5% by 2018. This dramatic rise is accompanied by an even more startling increase in prescriptions for ADHD medication among men aged 18 to 29, which saw a nearly 50-fold surge during the same time frame. These figures highlight a growing concern regarding the way ADHD is addressed in male populations.
Turning to the US ...
The Alarming Rise in ADHD Diagnosis and Prescriptions
Understanding the stress response in children involves exploring the neurological and physiological underpinnings that control and mediate their reactions to stressful situations.
The amygdala, a primitive brain part responsible for regulating stress responses, is pivotal in how children respond to stress. Research suggests that for the first 1-3 years of life, the amygdala isn't fully online, which has significant implications for a child's early development.
During the early years, when the amygdala is not yet fully functioning, children are less capable of responding to stress in the hyperaroused 'fight-or-flight' manner typically seen in older children and adults. This developmental window is essential for forming secure attachments and basic trust that can buffer against future stress.
However, when children experience stressors early in life, it can prematurely activate the amygdala. This early activation may lead to a hypervigilant stress response mechanism. A child with a prematurely activated amygdala may be more likely to perceive situations as threatening, which can lead to persistent feelings of anxiety and stress long-term, affecting behavior and health.
The hippocampus, another vital part of the brain, plays a crucial role in the regulation of stress. It's often referred to as the brain's "off switch" for stress because it provides negative feedback to the stress response initiated by the amygdala.
Stress Response in Children: Neurological and Physiological Basis
Understanding how early experiences and family or environmental factors impact a child's ability to regulate stress is critical to fostering healthy development.
Research highlights the powerful role of attentive and nurturing parenting in the formative years of a child's life.
Attentive caregiving and secure attachment can be of immense significance for children born with the sensitivity gene—a short allele on the serotonin receptor—which makes them more sensitive to stress. Although children with this gene are more prone to mental illness due to their increased stress sensitivity, nurturing parenting in the first year can neutralize the expression of this gene. It's revealed that when such children receive emotionally and physically present attachment security, it mitigates the potential negative outcomes, making them just as healthy as those without the gene.
Moreover, the role of epigenetics is crucial as it shows the environment's influence on gene expression. Empathic parenting can supersede genetic dispositions, as research indicates that nurture in early childhood can alter the expression of the gene in sensitive children. Recognizing and reflecting a child's feelings, showing empathy before discipline, and ensuring they feel acknowledged and valued are crucial components of this nurturing approach.
A host of psychosocial factors can influence the development of a child and their ability to manage stress.
Erica Komisar points to various stressors in a child's environment that can trigger a state of fight or flight, indicating an underlying stress condition. Children are particularly susceptible to stresses at home, such as parental divorce, which exacerbates stress even in cases where parents handle the separation deftly.
Sibling rivalry, parental mental illness, or addictions also contribute significantly to stress. For children with an ACE score of four or mo ...
Impact of Early Experiences and Family/Environment on Child's Stress Regulation
In a critical look at how ADHD is currently treated, Erica Komisar argues for a shift towards a more holistic approach that addresses underlying stressors rather than merely silencing symptoms with medication.
Komisar critiques the common practice of quickly resorting to medication as a solution for children with ADHD symptoms. She considers this approach as a form of malpractice, as it may silence the child's pain without addressing the root of their stress. She warns that stimulant medications can cause severe side effects, including panic attacks, anxiety disorders, depression, and growth issues in adolescents. Komisar shares her own clinical experiences where young male patients did not grow physically due to being put on stimulants at a young age, implying that medication can lead to more harm than good.
Komisar emphasizes the importance of understanding and addressing the deep-rooted issues that may cause a child to experience stress. She suggests that effective ADHD management involves parental guidance and a close look at the child's life dynamics and psychosocial stressors. Komisar implies that individuals with ADHD may have brains that are more sensitive to stress rather than fundamentally different.
Komisar discusses the possibility that the heightened sensitivity to stimuli commonly seen in ADHD could be an indicator of underlying stress sensitivities contributing to the condition. She describes ADHD as a "bucket" that often includes individuals with untreated anxiety and argues that society’s reliance on drugs as a quick fix is superficial.
Pointing out that stress can be regulated if parents introspectively consider their part in contributing to their child's stress, Komisar advocates for not yelling at children and being an emotionally regulated parent. She notes that early presence, especially during the first three years of life, is essential in achieving the emoti ...
Limitations of Adhd Treatment and Need For a Holistic Approach
Download the Shortform Chrome extension for your browser
