Image Credit: Scientific Frontline
Scientific Frontline: "At a Glance" Summary: ADHD Diagnosis Trends and Prevalence
- Main Discovery: There is no robust evidence supporting the narrative of ADHD overdiagnosis in the UK; instead, systemic underdiagnosis, undertreatment, and severely delayed clinical assessments are the predominant healthcare challenges.
- Methodology: Researchers analyzed English National Health Service (NHS) administrative records and compared domestic diagnostic rates against internationally standardized diagnostic criteria, while incorporating clinical evaluations and input from individuals with lived experience.
- Key Data: International baseline prevalence for ADHD is approximately 5 percent in children and 3 percent in adults, but English NHS diagnosis rates remain well below these thresholds. Furthermore, 27 percent of diagnosed youth waited one to two years for assessment, and 14 percent waited two to three years.
- Significance: The popular misconception of overdiagnosis misleads policymakers and obscures the critical ethical issue of unmet medical needs, as untreated ADHD severely increases the risks of academic failure, substance abuse, criminality, and suicidal behavior.
- Future Application: Healthcare systems must implement a risk-stratified stepped-care approach, increase funding, and improve multidisciplinary clinical training to efficiently expand access to accurate diagnostic and therapeutic care.
- Branch of Science: Psychiatry, Epidemiology, and Public Health.
- Additional Detail: While systemic overdiagnosis is statistically unsupported, individual misdiagnosis remains a clinical risk, particularly when evaluations rely heavily on self-reporting or when excessive public wait times drive patients toward less rigorous private sector assessments.
Experts are warning that far from being over diagnosed, people with ADHD are waiting too long for assessment, support and treatment.
In a new study, published in the British Journal of Psychiatry, experts say there is no robust evidence that ADHD is over-diagnosed in the UK.
The study was led by experts from the University of Southampton along with colleagues from the University of Cambridge and the University of Nottingham.
The new paper refutes the view that ‘nowadays everyone has ADHD’ which is gaining traction in public discourse and has been amplified by some leading politicians, as demand rises for NHS assessments and services.
Bringing together academics, clinicians, people with lived experience and carers, the group say this narrative risks misleading the public and policymakers and overshadows a more pressing concern - unmet need.
While the incidence of ADHD diagnosis has increased significantly since 2020 - particularly in women and young adults - NHS administrative data in England shows no evidence of overdiagnosis with the rate of ADHD diagnosis remaining below the expected levels of ADHD in the population. The recent rise in ADHD diagnosis reflects a catch-up after many years of under recognition and under diagnosis. Hence, rather than ‘overdiagnosis’ the real concern should be the unacceptably long waiting times, sometimes over years, that people experience in the NHS for diagnosis, support and treatment.”
Professor Samuele Cortese from the University of Southampton, and lead author of the paper, said: “Rather than focusing on increases or decreases in diagnostic rates, attention should be directed toward the extent to which those with ADHD are being adequately diagnosed and treated.
“While misdiagnosis and inappropriate diagnosis do occur, the available evidence indicates that under diagnosis and under treatment remain the predominant challenges.”
When standardized diagnostic criteria are applied, the prevalence of ADHD internationally is around 5 per cent in children and 3 per cent in adults.
While prevalence has increased over time, NHS administrative data in England remains substantially below these expected levels, suggesting that many people with ADHD are living without a diagnosis and adequate support.
The group acknowledges that misdiagnosis can occur in some cases, particularly where assessments rely heavily on self-reporting or where alternative conditions are not fully considered.
Professor Tamsin Ford, Head of the Department of Psychiatry at the University of Cambridge, a co-author on the paper, said: “While many more people with ADHD are being recognized and treated, we are failing to support many more. Overdiagnosis is not a problem, but misdiagnosis may be as people are driven into the private sector by long waits; and sadly, missed diagnoses remain common.”
The researchers stress that the absence of biological diagnostic markers means that thorough, multidisciplinary clinical assessment is essential. Field trials show that when clinicians are properly trained, an ADHD diagnosis is among the most reliable for a mental health condition.
“Similar to physiological traits, such as blood pressure or weight; ADHD symptoms are distributed along a continuum,” says Professor Hollis. “But as with hypertension or obesity, there are diagnostic severity thresholds that determine health risks and what interventions should be used. Similarly, in ADHD a risk-stratified stepped-care approach may be useful.”
The team highlights significant pressure on UK services, with long waiting times and growing demand, especially among adults who were not diagnosed in childhood.
They point to figures showing that around 27 per cent of children and young people diagnosed with ADHD reported waiting one to two years, while 14 per cent waited two to three years.
Evidence shows that untreated ADHD is associated with serious long-term risks, while effective treatments are available, backed by strong evidence, and generally well tolerated.
“The costs of untreated ADHD are often overlooked,” says Professor Cortese. “They include increased risk of academic failure, suicidal behavior, substance abuse, criminality, injury and death. The failure to provide treatments which have been shown to reduce these risks represents a major ethical issue that needs to be urgently addressed.”
The authors call for improved funding, workforce training, and a more balanced, evidence-based conversation to ensure accurate diagnosis while expanding access to care for those who need it.
Funding: The researchers are supported by the National Institute for Health and Care Research (NIHR), UK Research and Innovation (UKRI), and the Office for Life Sciences.
Published in journal: British Journal of Psychiatry
Title: ADHD (over) diagnosis: fiction, fashion and failure
Authors: Samuele Cortese, David Daley , Chris Hollis , Sarah Rae, Cornelius Ani, Philip Asherson, Johnny Downs , Bernadka Dubicka , David Foreman, Jonathan Green, Isobel Heyman , Matthew Hodes, Marinos Kyriakopoulos, Holan Liang , Pallab Majumder, Paul McArdle, Ulrich Müller-Sedgwick , Tamsin Newlove-Delgado , Dasha Nicholls, Dennis Ougrin, Anna Price, Abigail Russell , Gonzalo Salazar-de-Pablo, Paramala Santosh, Kapil Sayal, Stephen Scott , Philip Shaw, Emily Simonoff, Alice Wickersham, Paul Wilkinson, Susan Young, and Tamsin Ford
Source/Credit: University of Nottingham
Reference Number: psyc030626_01