Beyond the attention economy: Rethinking rising adult ADHD diagnoses in response to Jesudason et al. (2026)

Objective To argue that current evidence does not justify privileging Jesudason et al.’s attention-economy account of rising adult attention deficit/hyperactivity disorder (ADHD) diagnoses over plausible alternatives, including delayed recognition, historical underdiagnosis and misdiagnosis, and exclusionary diagnostic practices. Conclusions Jesudason et al. appropriately caution against simplistic diagnosis, performance-enhancing stimulant use, and uncritical medicalisation. However, adult diagnosis is not equivalent to adult onset, and increased treatment uptake or prescribing does not establish increased underlying prevalence. Associations between digital use and ADHD characteristics do not resolve causality or directionality. Digital environments may amplify or unmask longstanding ADHD-related difficulties without causing ADHD, while problematic digital use may reflect ADHD-related vulnerabilities. Rising adult diagnoses may also represent diagnostic correction among women, people assigned female at birth, racialised communities, Indigenous and First Nations peoples, and culturally minoritised groups historically missed, misdiagnosed, or routed into punitive frameworks. A balanced account must reject both over-medicalisation and exclusionary diagnostic gatekeeping.