Study shows that ADHD awareness may lead to increase in false self-diagnosis, but intervention can help

Growing awareness of ADHD may be leading some young adults to mistakenly believe they have the disorder, according to new U of T Scarborough research. 

The study, published in Psychological Medicine, found that while mental health awareness programs are designed to help people recognize symptoms and seek support, they can trigger false self-diagnosis. 

But the researchers also found that a short educational session on the nocebo effect – a phenomenon in which negative expectations about having a disorder can make someone’s symptoms 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 without the risk of unintended harms,” says Dasha Sandra, a PhD student in the Department of Psychology who led the study. 

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 then 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 the 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 information 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 that this may happen because a diagnosis can feel like 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.”

This is the first study to examine how false self-diagnosis from ADHD awareness can occur and persist over time. The study is also the first to show that mental health awareness can be taught safely by including a brief intervention explaining the nocebo effect.

The nocebo effect has long been seen in medicine. Patients in drug trials often report side effects from placebo pills simply because they believe they’re taking real medication. Teaching patients about the nocebo effect has been shown to reduce such responses.

Sandra’s team applied this approach to mental health, creating a 10-minute lesson with techniques to reduce the nocebo effect. These included explaining the nocebo effect through relatable examples, including how issues like irritability, fatigue and poor concentration are common among undergraduates, helping them view these as normal rather than signs of ADHD. She says a short session like the one used in the study could easily be added to awareness programs or online resources.

Sandra emphasized that people should not be discouraged from seeking help and that mental health awareness remains vital. What matters most, she says, is helping people interpret their experiences accurately.

The findings come amid a surge in ADHD awareness and diagnoses. “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,” she says.

While awareness is essential, Sandra cautioned 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. 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.”

As mental health conversations become increasingly common on campuses and online, she says the findings show awareness alone isn’t always enough and that adding a few minutes of context could make those programs far more effective.

The research was supported by funding from the Social Sciences and Humanities Research Council,  Fonds de Recherche du Quebec Société et Culture and an Ontario Graduate Scholarship.