Summary: The rapid rise in ADHD diagnoses reflects expanding diagnostic criteria and financial incentives as much as any increase in impairment. Traits such as distractibility, high activity, and shifting attention often represent ordinary developmental or cognitive variation, especially among children expected to conform to rigid classroom routines. Digital media reshapes attention rather than simply damaging it, strengthening some abilities while weakening others. More reliable diagnoses require tighter criteria, independent assessments, and systems that do not create perverse financial incentives.

The sharp increase in attention-deficit/hyperactivity disorder (ADHD) diagnoses—nearly doubling among American children between 1997 and 2022, and more than tripling among adults from 2012 to 2023—has been chalked up to better screening, increased awareness, and the corrosive effects of smartphones and social media on developing brains. None of these factors holds up well under scrutiny.

The diagnostic category itself has been steadily widened by the institutions that define it and the financial structure that rewards every participant for applying the ADHD label. As we have argued in our Cato Institute analysis of how the American healthcare system rewards psychiatric overdiagnosis, subjective diagnostic criteria interact with a payment system that rewards diagnosis to produce predictable inflation across psychiatric categories. The result is labeling ordinary behavior as pathological. ADHD is among the cleanest case studies of that pattern.

Foraging minds in an industrial classroom.

Human cognition was shaped over hundreds of thousands of years in small foraging bands, where attentional flexibility was an asset rather than a liability. A child who scanned the horizon, registered novel stimuli, and shifted focus rapidly between threats and opportunities was a child more likely to survive. Sustained, narrowly channeled attention to a single abstract task for hours at a time was simply not part of the ancestral environment, and the cognitive machinery to produce such concentration on demand was never uniformly selected for. What we now call distractibility is, in another light, vigilance. Most animals, including ancestral humans, evolved to be constantly on the lookout for novelty and threat.

Mass schooling, which emerged in the 19^th century in part to prepare children for industrial labor, asks something quite different. It asks 6- and 7‑year-olds to sit still in rows, suppress physical movement, attend to a single voice for extended stretches, and produce written output on a fixed schedule. Most children adapt. The variance in how easily they do so is enormous, and the children at the lower tail of conformity to that demand have come to define the diagnostic category.

Boys end up there more often than girls, for reasons that are not mysterious. Boys, on average, are more physically active, take longer to develop self-control, and are more drawn to rough play. The same pattern shows up in other mammals and tracks the effects of testosterone on brain development. Put boys in a room and tell them to sit still for six hours, and a predictable share of them will fail, not because they are mentally ill but because they are boys. The youngest children in any classroom are also more likely to be diagnosed with ADHD than their older peers, a finding so robust across studies and countries that it points to ordinary developmental variation rather than disease.

The evolutionary frame also provides a more nuanced understanding of the fear that screen time in childhood harms brain development and attention span. The brain is plastic, especially in childhood, and it adapts to the environment it is given. That plasticity is precisely what allowed generations raised under modern industrialized education systems to develop the sustained attention style that schools reward, despite it being so far from our environment of evolutionary adaptedness. But a generation that grows up navigating fast-moving feeds, switching between applications, and processing rapid streams of visual information will predictably develop a different attentional profile than one raised on books and chalkboards.

That does not mean the learning or attention span of youth raised on digital technology is impaired. Heavy media multitaskers and habitual users of touchscreen devices do tend to perform worse on tasks that demand sustained, narrowly focused attention and inhibitory control. But they also tend to perform better on tasks that demand rapid visual search, parallel processing of multiple objects, and flexible reallocation of attention. Action video game play, in particular, has been shown to enhance visual selective attention, processing speed, and the spatial resolution of vision. These effects transfer beyond the trained task, improving general abilities to track several moving things at once, spot relevant objects in a crowded scene, and pick out a target faster when surrounded by distractions.

These cognitive trade-offs elucidate how neural plasticity gives rise to different forms of intelligence. The brain has a finite budget of computational and metabolic resources, and the cortex reallocates them in response to the demands placed on it. The clearest demonstrations come from sensory deprivation: In people who lose their sight, the visual cortex does not simply lie fallow but is recruited for auditory and tactile processing, including Braille reading, with measurable gains in those domains. Congenitally deaf individuals show analogous repurposing of the auditory cortex for vision and smell. Every brain is continuously specializing toward whatever it does most, and different cognitive skillsets have different trade-offs.

A brain trained on rapid feeds and parallel streams gets better at rapid visual search, switching, and parallel processing while getting worse at slow, serial, endogenous focus. A brain trained on long books and chalkboards makes the opposite trade. The picture is not simply that screens damage children’s brains or lower their intelligence. Claims of generalized cognitive harm typically rest on measures of a single attentional style, the one schools happen to demand, and ignore the capacities that grow on the other side of the ledger. Calling the resulting attentional profile ADHD, treating it as a chronic illness, and medicating it accordingly is a category error. The trade-offs are real, but the diagnostic system measures only the deficits because only the deficits are reimbursable.

From hyperkinetic boys to inattentive adults.

The diagnostic category we now call ADHD has been progressively widened almost from the moment it entered the Diagnostic and Statistical Manual of Mental Disorders, the reference text published by the American Psychiatric Association that defines the criteria for every recognized psychiatric condition in the United States. The DSM-II, published in 1968, listed the condition as “hyperkinetic reaction of childhood” and described it in a single sentence, focused on the restless, disruptive child, almost always identified as a boy, who would supposedly grow out of the condition by adolescence. The DSM-III, in 1980, renamed it attention deficit disorder, with or without hyperactivity, and for the first time treated inattention as a stand-alone presentation rather than a symptom of restlessness. That single revision opened the category to a far larger population of children, especially girls, whose attentional patterns had previously been invisible to the diagnostic system.

The DSM-III‑R, in 1987, folded the subtypes back together and introduced the current acronym, ADHD. The DSM-IV, in 1994, separated the disorder again into three presentations—predominantly inattentive, predominantly hyperactive-impulsive, and combined—and explicitly extended the diagnosis into social, academic, and vocational contexts beyond childhood. Studies comparing the DSM-III‑R and DSM-IV criteria directly found that prevalence rose from 9.6 to 17.8 percent under one set of comparisons and from 7.3 to 11.4 percent under another, almost entirely on the strength of newly identified inattentive cases. The DSM‑5, in 2013, raised the age-of-onset requirement from 7 to 12 and lowered the symptom threshold for adults.

Each revision expanded the population eligible for diagnosis, and, with it, the population eligible for stimulant prescriptions, academic accommodations, and disability protections. The trajectory runs in one direction. There is no edition of the DSM in which the criteria for ADHD became more restrictive.

The incentive problem.

Layered atop the definitional and developmental story is a set of economic incentives that quietly lower the threshold for diagnosis. A growing share of these diagnoses now comes from primary care clinicians rather than specialists, reflecting how rapidly ADHD treatment has migrated into routine primary care, and how the expansion of telehealth lowered the friction of obtaining a prescription.

One of the clearest examples of incentives for overdiagnosis comes from how we finance education. When special-education funding is tied to specific diagnoses, schools have a built-in reason to identify more students with ADHD, because the label unlocks additional resources. Researchers have documented systematic differences in diagnosis and treatment that align with funding formulas rather than with underlying disease rates, a pattern consistent with third-party financial incentives shaping who gets labeled. Clinicians do not work in isolation; they respond to expectations from schools, families, and the broader system. Once stakeholders recognize that a diagnosis unlocks services, pressure to apply the label tends to grow.

Primary care clinicians typically practice in fee-for-service systems, where assigning a diagnosis makes the encounter billable and enables reimbursement for follow-up visits and medication management. Patients have their own incentives to seek the diagnosis, including academic accommodations, workplace protections, and access to performance-enhancing stimulants such as Adderall. In an environment where the condition is defined by subjective criteria rather than objective tests, it is unsurprising that some individuals exaggerate or feign symptoms to obtain those benefits.

The pattern is by now familiar. As we documented in our analysis of Medicaid-funded autism therapy, the broadening of autism criteria, combined with open-ended reimbursement, produced an explosion in spending on applied behavior analysis that far outpaced any plausible change in the prevalence of disabling autism. The broadening of ADHD criteria has produced a parallel surge in stimulant prescriptions, and our recent piece against the campaign to formalize “social media addiction” anticipates the same trajectory if that diagnosis is formalized. In each case, subjective diagnosis and financial incentives that reward diagnosis push the boundaries of illness outward.

What this should teach us.

The growth in diagnoses is best understood as the cumulative output of several systems, each behaving in a way its incentives reward. Definitions expand because there is little institutional pressure to keep them tight. Clinicians diagnose because diagnosis is what the system pays for. Schools refer because referrals bring resources. Patients seek labels because labels bring access to special accommodations. The aggregate effect is a steady erosion of the line between ordinary human variation and clinical disease.

That erosion has costs. Children whose ordinary inattentiveness is medicated as a chronic condition, adults who organize their identities around a label, and patients with severely impairing ADHD whose treatment resources are diluted across an ever-larger pool all bear those costs. The path to more reliable diagnoses runs through more reliable incentives: tighter criteria, independent assessments, and payment structures that do not reward expanding the definition of illness. Policymakers should stop structuring schools, insurers, and healthcare systems so that people must acquire a medical diagnosis to receive help, accommodations, or reimbursement.

Children today have greater safety, resource availability, and tools for education than any cohort in human history. It is the schoolroom that asks kids to sit still for hours and the diagnostic system that pathologizes the ones who cannot that are the more unusual and pathological features of modernity. A more honest accounting would distinguish severely impairing attentional disorders from the wider band of ordinary human variation. It would recognize that the temperaments now most likely to be medicalized are, in a different setting, the temperaments that helped aid survival and human progress.

This article originally appeared in The Dispatch on 5/13/2026.

Summary: Psychiatric diagnoses and medication use have risen sharply in the United States, raising concerns about overdiagnosis and overprescription. Expanded diagnostic criteria and reimbursement incentives are likely contributing to these trends. A recent US Department of Health and Human Services (HHS) initiative—which promotes informed consent, regular reassessment of psychiatric medications, and support for tapering patients off unnecessary drugs—is a step in the right direction, but reducing unnecessary medication use may require broader reforms to the policies and financial structures that shape mental-health care.

Health Secretary Robert F. Kennedy Jr. announced an initiative last week to reduce the overprescribing of psychiatric medications, especially among children. In what’s being called a national mental-health crisis, psychiatric diagnoses in almost every category are reaching all-time highs. The Centers for Disease Control and Prevention reports that autism now appears in 1 in 31 children, a 381% increase since 2000. Childhood attention-deficit/hyperactivity disorder diagnoses nearly doubled between 1997 and 2022. Childhood anxiety diagnoses rose 54% between 2016 and 2022. Past-year prevalence of any mental illness among adults reached 23.1% in 2022, with young adults at 36.2%.

But much of the supposed surge in mental illness can be explained by a broadening of the American Psychiatric Association’s diagnostic criteria in recent decades and financial incentives for diagnosing more. The Mental Health Parity and Addiction Equity Act of 2008, extended by the Affordable Care Act in 2010, required health plans to cover mental-health services at parity with medical and surgical care. That addressed a genuine inequity in coverage, but made it so clinicians are paid more when they diagnose more cases.

The result is what economists call supplier-induced demand. Ideally, increased spending on mental-health care would yield better mental-health outcomes. Instead we have seen the opposite. Between 2000 and 2021, mental-health care spending in the U.S. more than tripled, from $40 billion to $140 billion, while mental-illness rates grew almost as dramatically.

Defenders of mental-health parity argue that spending and diagnoses are rising to meet previously unmet needs. But psychiatry is more subjective than other branches of medicine. No objective cutoff distinguishes ordinary worry from clinical anxiety, or grief from clinical depression. Findings are prone to distortion under the influence of nonpsychiatric factors.

When the National Institute of Mental Health says that half of all American adolescents have experienced mental illness, that isn’t psychiatry advancing as a field. It’s the result of various incentives for pathologizing ordinary struggle.

Wasteful spending and panic over a possibly nonexistent mental-health crisis would be bad enough. But psychiatric overdiagnosis creates an even more serious problem: overmedication. Roughly 1 in 6 American adults, an estimated 44 million people, are now on antidepressants. In young adults, those numbers are even higher. Thirty percent of college students take psychiatric medication, up from 9% in 2007.

For adults with mental conditions resistant to therapy, psychiatric medication can be effective. But we don’t understand the long-term consequences of many psychiatric drugs, particularly on young brains. We are running a large uncontrolled experiment on the developing brains of millions of young people, and we won’t know the full results for decades.

Meanwhile, the reimbursement architecture makes overmedication practically inevitable. Once a patient is on a drug, side effects are often addressed with a second drug rather than with a reassessment of the first. Clinicians call this the “prescribing cascade”: An antidepressant causes insomnia, so a sleep aid is added; a stimulant causes irritability, so a mood stabilizer follows. Each new prescription generates a billable visit, while tapering a patient off an ineffective drug takes time, monitoring and follow-up, which the billing system frequently doesn’t reimburse. Adding a prescription is the fastest, most reimbursable response at every stage of care.

The new HHS initiative rightly recognizes the harms of overprescription and the potential for negative side effects from long-term psychiatric medication in young people. It includes new reimbursement for clinicians who help patients taper off drugs, a “Dear Colleague” letter urging informed consent and regular reassessment, and a technical expert panel to develop formal tapering guidelines this summer.

These are sensible steps, but they don’t address the root cause. The fundamental problem is that federal law created an incentive structure that makes psychiatric medication the default for tens of millions of Americans who might be better served by therapy, lifestyle intervention or no clinical intervention at all.

To get physicians to stop overprescribing, the institutions that shape their choices should offer a greater reward for prescribing sparingly. In addition to new billing codes for deprescribing, what’s needed is a serious examination of whether the coverage mandates and reimbursement structures the ACA put in place are producing the outcomes they promised.

The mental-health system has improved over the past half-century. Effective treatments are more widely available, and people are more willing than ever to seek help. But the same mandates that have increased access to mental-health care have made overdiagnosis and overmedication the path of least resistance for a generation of clinicians and patients.

This article was originally published at the Wall Street Journal on 5/10/2026.

Summary: The GUARD Act would require age verification for AI chatbots and ban minors from using companion chatbots. Evidence that these restrictions would reduce youth suicide is limited, while AI tools may provide mental health support for some users who lack other options. The proposal could restrict privacy, speech, and innovation. More targeted policies may offer a better way to protect vulnerable users.

The Senate Judiciary Committee advanced Senator Josh Hawley’s Guidelines for User Age-verification and Responsible Dialogue (GUARD) Act. The bill would require every American to verify their age before using a generative AI chatbot and would bar anyone under eighteen from using a “companion” chatbot at all. In the room during the markup were the parents of children who died by suicide after conversations with AI products. Their grief is unimaginable, and their motives are beyond reproach. But concerningly, such a policy might quietly cost rather than save lives.

The strongest claim animating this bill is the belief that restricting minors’ access to AI chatbots will prevent suicide. On the available evidence, that claim is closer to a hypothesis than a finding—and a hypothesis that runs against several decades of data on how young people die. 

According to the Centers for Disease Control and Prevention, the American suicide rate began climbing around the year 2000—before ChatGPT, smartphones, or social media even existed. It accelerated through the 2010s, then, contrary to popular narrative, plateaued and modestly declined after 2018—even as generative AI moved from research labs into the pockets of nearly every teenager in the country. If chatbots were a meaningful driver of adolescent suicide, the curves should have moved together. They have not, and, importantly, suicide rates among young Americans remain the lowest among any age group. 

While any loss of a young life to suicide is a tragedy, whatever is killing young Americans predates the technology that lawmakers now propose to ban them from using. 

What the GUARD Act’s sponsors do not seriously consider is the other side of the ledger. There are cases where AI could help Americans of all ages when it comes to mental health. Roughly half of Americans with a diagnosable mental health condition never seek professional help; stigma, cost, and fear of involuntary intervention keep them silent. For some of them—especially adolescents in households where therapy is unaffordable, unavailable, or unsafe to disclose—a chatbot is their most reliable form of emotional support. 

In a survey of over 1,000 adolescents and young adults, 13 percent had used a chatbot for mental health support, and more than 90 percent of those found it helpful. In another study of over 1,000 users of Replika, a popular AI chatbot, 30 reported without solicitation that their artificial companion saved them from suicide. 

We do not know how many lives generative AI has saved by improving access to mental health care. But for every incidence of AI psychosis or suicide, there may be dozens of unobserved positive outcomes. Policy that presumes only the worst outcomes also prevents the best.

The consequences of the proposal could also dissuade investment or chill speech that would make better options available. Faced with $100,000 per-violation penalties, providers will not invest in better suicide-detection models and instead likely remove any content that could be related to such a topic, thus limiting resources to crisis hotlines for those who are struggling. It would also limit the availability of information for those seeking to understand a deeply traumatic event or help a friend who may be struggling. Clinicians have known for decades that abrupt treatment referrals without first building rapport can deepen shame and shut down disclosure. The best science suggests suicide-prevention frameworks place trust-building before resource provision precisely because the order matters. A regulatory regime that punishes providers for nuance will produce less of it.

Beyond being bad policy, such laws are almost certainly unconstitutional. The underlying policy is not based on a compelling government interest nor is it narrowly tailored. It impacts the speech rights and anonymity of all users of online tools, not just minors, on the basis of justifications that are far from accepted. The compliance regime is broad enough to capture homework helpers, customer-service chatbots, and search engines that produce conversational responses, placing a “papers, please” approach to a broad and growing swath of the internet. To enforce it, every American adult would have to upload a government ID or submit to biometric scanning to ask a question, complete a customer service interaction, or practice a foreign language.

More measured and better policy responses are available if policymakers want to support parents and teens who may encounter difficulties with AI chatbots or generative AI. That includes training and providing appropriate resources for law enforcement to go after the bad actors who abuse technology to create or solicit sexual content from minors. Investment in AI literacy, of the kind Idaho recently codified into its public schools, equips young people to use these tools the way they will inevitably need to use them as adults and can include information on what to do if they encounter problems. 

Far from being a problem, liability shields modeled on Section 230, paired with safe-harbor incentives for providers that invest in better mental-health detection, would reward the kind of careful development the current bill punishes. None of those would deliver the cathartic clarity of a ban, but all of them are more likely to save lives. Importantly, they also empower parents and other trusted adults, not policymakers, to be the ones who determine what makes sense when it comes to kids and teens’ AI use.

The bill’s sponsors are not acting in bad faith. The cases motivating them are real, and the impulse to protect the vulnerable is one of the more honorable features of our political instincts. But the pattern is familiar from earlier moral panics over comic books, rock music, and video games. Each was sincerely felt. Each rested on weak social science amplified by strong public emotion. Each produced a policy that aged poorly.

The GUARD Act asks us to trade a measurable loss of liberty and privacy for an unmeasured, and possibly negative, impact on safety. The forces that drive people toward suicide—isolation, family conflict, untreated illness, loss of meaning—operate on timescales and through mechanisms that no technology policy will address. To pretend otherwise is to offer grieving families a consolation that policy cannot honestly deliver while quietly closing a door through which other young people, less visible to us, are still walking toward help.

This article was originally published at Cato at Liberty on 5/5/2026.

Summary: Growing concern over smartphones and social media has fueled claims that screens are driving an epidemic of adolescent mental illness. But the scientific evidence for this narrative remains mixed and often overstated, with many studies failing to distinguish correlation from causation or account for underlying social and psychological factors. Loneliness, family instability, social support and resilience appear to be far stronger predictors of youth well-being than screen time alone.

As a member of Gen Z, I have studied the effects of social media on adolescent mental health from a perspective most psychology researchers lack: I grew up under its influence.

Between ages 12 and 17, I was obese, socially isolated and addicted to the fantasy video game RuneScape. I was home-schooled, lived with just my mother and rarely went outside. I logged over 10,000 hours in that game alone, nearly a third of my waking life during those years.

That doesn’t include countless additional hours I spent on other video games, television and, of course, social media. I made friends through online chatrooms and pen pal websites because I had none in real life. I averaged well over 10 hours a day on devices.

If ever there were a case study for the claim that screens destroy young minds, I would seem to fit it. And yet here I am as a 26-year-old developmental psychologist with a doctorate from Harvard. I am in good mental and physical health, with deep friendships online and off.

Maybe I’m the exception. Or maybe the harms are overblown.

Jonathan Haidt’s best-selling book “The Anxious Generation” argues that smartphones and social media have “rewired” childhood and caused an epidemic of mental illness. The book has helped inspire social media restrictions in Australia and several American states, and shaped how a generation of parents thinks about technology.

Restricting screen time and social media access are reasonable aspirations for child-rearing. But as a matter of public policy, the case for regulation rests on a scientific foundation far weaker than its proponents claim.

Haidt’s argument relies on the observation that adolescent mental health indicators worsened around 2010, when smartphones and social media apps popular with young people — such as Instagram and Snapchat — started becoming widespread. But correlation is not causation, and research suggests that some of the supposed mental health crisis is an epidemic of overdiagnosis. Wealthy Western democracies with the highest smartphone adoption rates have also seen expanded access to psychiatric services and a cultural shift toward identifying and labeling psychological distress, as Abigail Shrier argues in her 2024 book “Bad Therapy.”

Meanwhile, youth have been doing better on many other outcomes: less crime, less smoking, less drug use, fewer teen pregnancies and fewer high school dropouts. If social media were truly “rewiring” the adolescent brain, we would expect the damage to be more consistent than a selective worsening on some measures and improvement on others.

Many studies have reported on how social media use is associated with mental health problems among the young. However, a 2024 analysis in JAMA Pediatricsof 143 studies featuring data from over 1 million adolescents worldwide found that links between social media use and poor mental health among youth were small, inconsistent across studies and drawn mostly from nonclinical community samples.

One reason studies report mixed findings is that many fail to account for factors such as personality traits and social support that independently predict heavy screen use and mental distress. For example, social media use may be associated with anxiety and loneliness, not because it causes them, but because socially anxious individuals are more likely to seek out connections online. Statistically controlling for such factors often accounts for the relationship between social media and mental health.

I am not dismissing the possibility that some children are harmed by some content in some contexts. Many in my generation have had online exposure to graphic, violent and sexual imagery that no child should encounter.But the blanket claim that social media use drives generational mental illness does not align with the evidence.

Screens didn’t cause my problems. They were coping mechanisms for preexisting problems: loneliness, family instability, social anxiety, an absent father. The variables that predict youth mental health are not hours spent on social media but social support, resilience and a sense of belonging. To help struggling adolescents, the evidence points toward strengthening those capacities, not confiscating phones.

During my most isolated years, online connections were the only positive relationships I had. Internet forums helped me navigate college applications and taught me about calorie-counting, which sparked a weight-loss journey that changed my life. Even in RuneScape, I built discipline and goal-setting habits that I later transferred to academics and research.

Concerns about social media are well-intentioned. But sincerity is not proof. The dramatic assertions that children’s lives would be transformed by reducing social media exposure are more akin to moral panics over past technologies and obsessions — from radio to comic books to video games — fueled by weak social science and strong public emotion. In the United States, according to data from the Centers for Disease Control and Prevention, youth mental health has been improving recently, despite no change in access to social media. The simplest explanation might be that social media is not as harmful as people think.

This article was originally published at the Washington Post on 4/12/2026.