Are too many children being diagnosed with ADHD?
Young people need support based on their individual needs, regardless of diagnosis
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Attention-deficit/hyperactivity disorder (ADHD) is one of the most talked-about conditions right now. It’s also one of the most misunderstood. How is ADHD defined and diagnosed? Why are there debates about self-diagnosis, over-diagnosis, and waiting lists? And most importantly, how can adults better support young people?
How is ADHD diagnosed?
ADHD is a ‘behavioural disorder’, meaning it is diagnosed based on behavioural symptoms; there is no single biological or clinical marker. The diagnostic manual used globally to diagnose psychiatric conditions states that an individual must experience six or more symptoms for at least six months and in multiple settings (at school and at home, for example) to receive a diagnosis. Those symptoms, which include difficulty sustaining attention on a task and talking excessively, must be judged to negatively impact the young person’s daily life. This can be difficult to determine and often requires input from multiple adults who know the young person, such as a family doctor or teacher.
ADHD often overlaps with other issues. Around 50% of people with ADHD are autistic. And those with ADHD are more likely to experience other conditions, such as obsessive compulsive disorder (OCD), than individuals without ADHD. This overlap of ADHD with other conditions has contributed to confusion around misdiagnosis, self-diagnosis, and over-diagnosis.
Former emergency room doctor and mental health advocate Alex George tells me he thinks multiple assessments should be offered: “It doesn’t make sense to screen separately for conditions like ADHD, autism and OCD. It is a burden on the individual and the NHS if individuals are required to repeatedly advocate for themselves to different people. If someone is being assessed for ADHD, they should have the option to enquire about their other concerns.” Yet this is often not the case. Leading experts argue that treatment of different conditions should be based on individual needs and characteristics, rather than relying on systems that are designed to step in at the point of crisis.
“This overlap of ADHD with other conditions has contributed to confusion around misdiagnosis, self-diagnosis, and over-diagnosis.”
Self-diagnosis and over-diagnosis of ADHD
Older children might self-diagnose ADHD, identifying that something is not quite right. Ellie Dommett, Professor of Neuroscience and expert in ADHD, explains: “Self-diagnosis is essential… you won’t go forward to a healthcare professional for a diagnosis unless you think you have something to be diagnosed for.” For older children, part of self-diagnosis is identifying a problem and turning to a trusted adult to seek help. There is no harm in this, and instead of blaming a young person who voices concern, we need clearer pathways to help young people, including information on assessment and where to go for support.
Some critics argue that an increase in self-diagnosis triggered by greater awareness has led to over-diagnosis of ADHD. But the number of people with ADHD has not substantially changed in recent years. In the UK, for example, rates have remained stable over the past decade. The number of referrals for ADHD assessments has increased in recent years, but this doesn’t necessarily mean that the condition is over-diagnosed. ADHD may even be under-diagnosed. This is partly due to misconceptions around symptoms, as well as to the systemic marginalisation of some groups of people. For example, girls with ADHD are less likely to be diagnosed, and young people of colour are less likely to be referred for a diagnosis and to receive treatment than their white peers.
When I asked a youth advisory group of 13- to 17-year-olds about their experiences, they said that ADHD is talked about too often casually, and rarely in depth. Those with ADHD said that talking about ADHD helped them to get the right support and understand themselves better. On the other hand, they noted that it can be frustrating when people who do not themselves have ADHD make comments about traits associated with the condition. In a recent preprint that has not yet been peer-reviewed, adolescents were interviewed about self-diagnosis. The young people said that self-diagnosis is the only option for many because of a lack of access to healthcare. Waiting lists for children and teenagers to receive an assessment currently range from several months to several years in countries like the UK and Denmark.
While over-diagnosis can’t be fully ruled out, focusing on it is not helpful. Young people need accessible healthcare systems, more in-depth understanding of ADHD in public discourse, and a holistic approach to reducing risk and supporting individual needs, including prevention and social support.
“By recognising strengths alongside challenges and ensuring that young people have the space and opportunities to seek help, we can support all young people to thrive.”
How to support children with ADHD
The public focus needs to shift away from barriers to learning and towards the strengths of young people with ADHD. Many people with ADHD can hyperfocus, which allows them to become very absorbed in hobbies, tasks and learning. Individuals with ADHD can also be highly creative and flexible in their thinking.
We can harness these strengths in learning. Practices in the classroom that benefit learners with ADHD – such as managing expectations, explaining changes to routines, and providing multisensory aids to make learning more engaging – likely benefit all students. Some young people may find their own ways to cope with difficulties, for example listening to music to help them focus on revision. That can make it difficult to spot when they’re struggling, because they’re managing symptoms on their own. Educators and caregivers need to check in regularly with young people to see how they’re coping at school and at home.
Stigmatising young people for raising their concerns does not help. Learning strategies should be adapted to support young people according to their needs. Assessments should more accessible and have space to address other concerns a young person may be experiencing. By recognising strengths alongside challenges and ensuring that young people have the space and opportunities to seek help, we can support all young people to thrive.
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