"I always felt that I was just procrastinating a little." Lin Ling (pseudonym), 25, works in Internet-related work in Beijing. At work, she often had difficulty concentrating and often forgot to-do items. At first, she didn't pay much attention until she saw ADHD-related content in some online posts and found that the symptoms described there were quite similar to her own daily performance. Suspicious, she found a scale and started to measure herself. "Scores of 16 to 23 are considered moderate symptoms, and I actually got 21 points."
ADHD, or attention deficit hyperactivity disorder, is a neurodevelopmental disorder characterized by attention deficit, hyperactivity, and impulse control difficulties. In recent years, the topic of ADHD has attracted attention on some platforms. Some content links common manifestations in people's daily lives with ADHD. Some merchants will include purchase links for ADHD self-measurement scales in relevant posts, and some merchants combine ADHD with paid services and products.
How did ADHD become a business? "Rule of Law Daily" reporters launched an investigation into this.
Anxiety caused by self-assessment
Lin Ling's experience is not unique. Chen Jingyu, a psychological counselor who has done more than a hundred cases of emotional and behavioral guidance for children with ADHD, found that in the past six months, there have been significantly more parents coming for consultation with the results of the ADHD self-measurement scale. She told reporters that some scales directly classify test results into mild, moderate, and severe, and some self-measurement scales delete questions. But in fact, once the title is changed, the original verification is no longer valid.
The reporter searched with the keyword "ADHD" on some platforms and found that there are many topics about ADHD, most of which are popular science posts about ADHD characteristics and other topics. There are also many posts sharing experience in alleviating related symptoms such as "ADHD focus methods". Some of the posts include links to purchase self-measurement meters, most of which sell for between 0.99 yuan and 5 yuan. The reporter randomly purchased several self-assessment questionnaires and found that some of the questionnaire questions were more life-oriented, and most of them focused on daily performance such as "do you often lose things", "do you find it difficult to concentrate for a long time", and "do you often interrupt others when talking". One of the scales gives an assessment result of "You are very likely to have ADHD-C (attention deficit and hyperactivity/impulsivity disorder mixed)", and the other scale shows that the reporter is "very likely to have ADHD-H (hyperactivity/impulsivity disorder mainly)" based on the score. The reporter noticed that almost all the test result pages of the scale were marked with words like "This scale is only for screening and does not represent a diagnosis or serve as a basis for diagnosis."
"Relevant scales developed by the World Health Organization have officially published reliability and validity data, norms and scoring rules. However, some self-measurement scales circulated on the Internet delete questions at will, ignore reliability and validity, and have no standardized scoring. They are entertainment adaptations and are no longer the same thing as the original tools." Zhang Hui, associate professor of the Department of Medical Psychology at Capital Medical University, told reporters that the diagnosis of ADHD is a comprehensive clinical judgment, and a diagnosis needs to meet multiple conditions at the same time. Most of the self-measurement scales circulated on the Internet are neither diagnostics nor, strictly speaking, meet the standards of standardized screening tools. There are many causes of inattention, procrastination, and forgetfulness. Anxiety, depression, lack of sleep, stress, etc. can all produce similar symptoms. Some self-measurement forms circulated on the Internet cannot complete any identification, but give labels of mild, moderate, and severe. They secretly replace "symptom experience" with "disease conclusion."
"Irregular self-measurement scales will cause anxiety in test subjects. The more they compare, the more they feel 'sick', thereby attributing problems that could have been solved by adjusting work and rest and improving task management abilities to the disease, weakening the motivation for self-change," Zhang Hui added.
Chen Jingyu pointed out that even a qualified and standard screening can only do one thing: prompt the person being tested to need further examination. For further diagnosis, you should go to a regular hospital and have a professional psychiatrist perform a diagnostic evaluation.
The reporter noted that the Mental Health Law clearly stipulates the conditions for the diagnosis and treatment of mental disorders and the practice boundaries of psychological counseling personnel. Psychological counseling personnel are not allowed to engage in the diagnosis and treatment of mental disorders. If it is found that a patient may have a mental disorder, he or she should be advised to seek treatment at a medical institution; violators will be ordered to make corrections, be warned and fined. If serious consequences are caused, they will be ordered to suspend their practice activities for more than six months and not more than one year, or until their practice certificate or business license is revoked.
In this regard, Zhang Hui told reporters that non-medical institutions and non-professionals have actually crossed this line by giving disease conclusions such as "diagnosis" and "high tendency" and promoting courses and services accordingly.
The business behind the disease name
The reporter noticed that around ADHD, different forms of services and products have appeared on the market.
Li Ping (pseudonym) from Guangzhou City, Guangdong Province once purchased related services for her children. Previously, she came into contact with ADHD-related content on the short video platform, and then followed the guidance of one of the video comment areas to add the customer service of an organization called "×Dad Focus". After asking about the child's age, learning status and attention performance, the customer service recommended a concentration training course to Li Ping, saying it was suitable for children with ADHD-related symptoms.
Subsequently, Li Ping paid a course fee of 1,680 yuan and purchased a "concentration assessment package" worth 300 yuan. The "assessment package" included hundreds of multiple-choice questions. After the answers were completed, a dedicated person would interpret the results one by one. In addition, it also came with a box of decompression toys. "Actually, the so-called 'focus assessment' is similar to the free test online." Li Ping said that no agency staff came to confirm to her whether the child had ADHD.
According to Li Ping, the course cycle she purchased lasts for three months and includes a total of 12 family intervention courses. They are all small class classes for parents and include emotion recognition training, behavioral problem intervention and social ability development. After studying for a period of time, Li Ping felt that the child's related symptoms had not improved significantly, so she proposed a refund. The institution refused a full refund on the grounds that the service had already begun, and proposed a plan to deduct the fees for courses used. Because the two parties failed to reach an agreement on the refund amount, as of press time, Li Ping was still negotiating refunds with the agency.
In addition to courses for parents of children, there are also paid services such as "ADHD Structured Supervision Services." Pan Lele (pseudonym), a university student in Beijing, spent more than 80 yuan online last year to purchase a "structured supervision" service that was claimed to be specially designed for ADHD people. She bought an experience package with a service cycle of 4 days. After placing the order, a companion contacted her to remind and encourage her every day.
"The help is real, but it has nothing to do with ADHD. It's more like paying someone to supervise you," Pan Lele said.
In addition to courses and services, toys such as "Sensory Stones" and "Twisters" have also been linked to ADHD by some merchants. The merchants also used phrases such as "ADHD essentials" and "ADHD concentration training" to promote them.
"This type of propaganda is obviously exaggerated and misleading." Zhang Hui told reporters that there are currently a small number of studies on this type of toys, and the results are inconsistent. Some studies have even observed a decrease in attention when using them. Domestic and foreign mainstream diagnosis and treatment guidelines do not include similar toys as recommended intervention methods. “In other words, promotions such as ‘ADHD concentration training’ are marketing based on the concept of a disease without any evidence to support it.”
Xu Ying, a senior partner at Kyoto Law Firm who has conducted many discussions with professionals on adolescent psychological issues, believes that ADHD belongs to the category of mental disorders. Linking the functions of ordinary toys directly to recovery training is tantamount to giving the product a "quasi-medical" effect without being qualified as a medical device.
Related services should be regulated
Experts interviewed said that on the one hand, "ADHD" should not be labeled or popularized, but should be left to professional assessment; on the other hand, relevant online science content, self-measurement scales and market services should be standardized.
In Xu Ying’s view, from a regulatory perspective, the available tools are already available. The Advertising Law solves the problem of qualitative propaganda, the Mental Health Law and the "Measures for the Administration of Physician Registration and Registration" solve the problem of cross-border qualifications, the Consumer Rights Protection Law and the judicial interpretations related to prepaid consumption solve the problem of refunds and compensation, and the Personal Information Protection Law solves the problem of data collection.
The interviewed experts suggested that to standardize ADHD-related online content, self-measurement forms and market services, the following professional boundaries should be drawn: First, the professional threshold for disease popularization content should be raised. Popular science content involving the interpretation of ADHD and other diseases should be produced by medical institutions and personnel with professional status as much as possible; platforms should also comply with the "Notice on Regulating "We-Media" Medical Science Popularization Behavior" and implement a qualification verification mechanism for medical science popularization accounts.
Second, prevent products from “misleading” the name of the disease. The Advertising Law clearly stipulates that with the exception of advertisements for medical treatment, drugs, and medical devices, any other advertisements involving disease treatment functions are prohibited, and medical terms or terms that are likely to confuse the products being promoted with drugs or medical devices are prohibited. Market supervision departments and platforms should establish an advertising early warning screening mechanism and include relevant medical terms in the risk vocabulary.
In addition, Xu Ying suggested that the health department should strengthen the supervision of the professional activities of medical institutions and related practitioners, and investigate and deal with non-medical institutions and non-professionals who carry out mental disorder diagnosis and treatment activities in violation of regulations in accordance with the law; the platform should strengthen inspections against illegal dissemination and sales of non-standard assessment scales and products, and promptly hand over clues to relevant departments when discovering suspected violations of laws and regulations.
