ADHD IS being “underdiagnosed” in the UK leaving millions without support, a major review concluded today.
Doctors have repeatedly raised concerns in recent years about a surge in diagnoses.
It comes amid a growing number of celebrities and social media influencers sharing their own battles with the condition.
But, according to a team of 32 experts, including clinicians, academics, there is “no evidence that ADHD is overdiagnosed in the UK” and it could even be “underdiagnosed”.
“Alarmist” rhetoric around the condition could “deny” people care, they also found.
The team conceded, however, that some people may have been misdiagnosed with the condition.
In the new paper, published in the British Journal of Psychiatry, they found that around one in 20 children (5.4 per cent) and 3.3 per cent of adults are estimated to have ADHD.
Health records show a rise in the rate of actual diagnosis of the condition in clinical services between 2000 and 2018.
But they point out that while this has increased, the data suggests it is still “substantially below the ADHD population prevalence in the UK, providing no evidence at present that ADHD is overdiagnosed at a population level”.
They said this increase in diagnoses made in clinical services may be linked to heightened awareness of the condition.
“There is no evidence that ADHD is over-diagnosed in the UK. Indeed, available data point to under-diagnosis,” they wrote.
“The main issue is that UK clinical services cannot adequately support individuals with ADHD who need help.
“There is a risk that the narrative claiming ‘ADHD is over-diagnosed’ could be used to deny people with properly-diagnosed ADHD the care they deserve.”
However, they add: “Some cases may be misdiagnosed due to low-quality assessment, poor adherence to national guidance, or inappropriate differential diagnosis.”
Lead author Professor Samuele Cortese, from the University of Southampton, said: “Every time there is a discussion around the prevalence of ADHD and how it is diagnosed, the focus of the conversation most of the time is around the fact that the diagnosis rate has increased over time.
“Sometimes it’s described in an alarmistic tone.
“What we wanted to highlight in this piece is that after reviewing all the evidence we were aware of – in the UK in particular, but also comparing to international estimates – the conclusion is that it is true that the diagnosis rates have increased.
“So we are diagnosing more ADHD in the past decade, but there are still many with ADHD who are out there but despite this they’re not diagnosed.
“So certainly this increase means that there is more awareness now. But the problem is that we are not yet meeting the need of these people.”
He added: “Certainly we acknowledge, of course, that another issue is that probably some who have received a diagnosis of ADHD, probably they don’t have ADHD – they are misdiagnosed with other things.
“But overall, the situation is such that still there is an unmet need for these people.
How to get help for ADHD
Unfortunately, a GP cannot formally diagnose ADHD but they can refer you for a specialist assessment.
Be warned, the wait can be long. Data suggests there are around 200,000 adults on waiting lists across the UK.
And a recent BBC investigation found in many areas it would take at least eight years to clear the backlog.
For an adult to be diagnosed with ADHD, the NHS says their symptoms should have a moderate effect on different areas of their life, such as underachieving at work or having difficulties in relationships, and the person has been displaying symptoms continuously for at least six months.
There must also be evidence symptoms have been present since childhood – it’s thought that the condition cannot develop for the first time in adults.
After a diagnosis, treatment can include psychological therapies, psychotherapy, social skills training and medication.
For many, a diagnosis can be a relief, but also unravel mixed emotions and feelings of ‘being different’.
ADHD UK has information on considering diagnostic pathways and can offer support
“And this is quite concerning, of course, because if not treated properly, ADHD exposes to significant risk for the individual and their family.”
Professor Cortese said these risks include accidental injuries, traumatic injuries, car accidents, suicide, substance misuse and increased risk of death.
Professor Tamsin Ford, study co-author and head of the department of psychiatry at the University of Cambridge, added: “While many more people with ADHD are being recognised 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.”
According to ADHD UK, there are over two million Brits with ADHD who haven’t been diagnosed.
In December last year, Health Secretary Wes Streeting announced he had launched an independent review into the rising demand for mental health, ADHD and autism services.
The review will look at rates of diagnosis and the support offered to people.
Speaking at the time, Health Secretary Wes Streeting said: “We must look at this through a strictly clinical lens to get an evidence-based understanding of what we know, what we don’t know, and what these patterns tell us about our mental health system, autism and ADHD services.
“That’s the only way we can ensure everyone gets timely access to accurate diagnosis and effective support.”
The 9 ‘hidden’ signs of ADHD in adults
ADHD has long been associated with naughty schoolkids who cannot sit still in class.
And that is part of it. Fidgeting, daydreaming and getting easily distracted are all symptoms of the behavioural condition, which is why it is often spotted in children.
However, attention deficit hyperactivity disorder is far more complex than simply having trouble focusing.
Henry Shelford, CEO and co-founder of ADHD UK, says: “If it isn’t debilitating, it isn’t ADHD.”
In recent years, social media has given rise to trends which conflate specific personality traits or single behaviours with ADHD.
You might be thinking, ‘I’m always losing my keys, forgetting birthdays and I can never concentrate at work — I must have ADHD’. But it’s not as simple as that.
Though these may all point to the condition, Dr Elena Touroni, a consultant psychologist and co-founder of The Chelsea Psychology Clinic, says: “The key distinction lies in how much a behaviour impacts a person’s daily life.
“Genuine ADHD symptoms affect multiple areas of life – work, relationships and emotional wellbeing – whereas personality traits are typically context-dependent and less disruptive.”
ADHD UK’s Henry, who has the condition himself, adds: “Having ADHD is hard. One in ten men with ADHD and one in four women with ADHD will at some point try to take their own lives.”
So how can ADHD manifest in someone’s life? While hyperactivity is a common indicator, here are nine other subtle signs:
- Time blindness – losing track of time, underestimating how long tasks will take, regularly being late or excessively early
- Lack of organisation – a messy home, frequently misplacing items, forgetting deadlines
- Hyperfocus – becoming deeply engrossed in activities for hours
- Procrastination – feeling overwhelmed by to-do lists and struggling to determine what needs your attention first so focusing on less important tasks
- Heightened emotions – emotional struggles can manifest in angry outbursts, feeling flooded with joy or shutting down because you feel too much at once
- Being a ‘yes man’ – agreeing to new projects at work or dinner dates with friends when you’re already busy (a desire to please)
- Impatience – interrupting people mid-conversation, finding it painful to stand in a queue, being overly-chatty
- Restlessness – tapping, pacing, fidgeting or feeling restless on the inside
- Easily distracted – by external things, like noises, or internal things like thoughts
