Why Are So Many More People Being Diagnosed With ADHD?
It can sometimes feel as though ADHD is suddenly everywhere.
More children are being referred for assessment, increasing numbers of adults are discovering that difficulties they have experienced throughout their lives may be related to ADHD, and the condition is discussed far more openly on social media and in the wider media than it was even ten years ago.
A major area of increase, is women identifying and being assessed for ADHD as well.
This has inevitably led to questions such as: Why are so many more people being diagnosed with ADHD? Are we simply getting better at recognising it, or is ADHD being over diagnosed?
The answer is more complicated than either of these explanations alone.
ADHD itself may not actually be becoming more common.
One of the most important distinctions is between the prevalence of ADHD and the number of people receiving an ADHD diagnosis.
Current research does not suggest that there has been a dramatic increase in the proportion of the population who actually meet the criteria for ADHD. The 2025 NHS England ADHD Taskforce concluded that there is no evidence of an increase over time in the number of children in the population meeting diagnostic criteria for ADHD.
Instead, what has changed considerably is our recognition of ADHD.
For many years, large numbers of people with ADHD appear simply to have gone undiagnosed. During Covid, numbers of assessment requests increased considerably.
This is particularly relevant to adults. ADHD was historically regarded primarily as a childhood condition, often associated with the stereotypical image of a highly active, disruptive schoolboy. We now understand that ADHD frequently persists into adulthood and can present in much more subtle ways, and this has been included in the diagnostic manuals, both American (DSM-5) and European (ICD-11).
As a result, there is effectively a substantial population of adults who may have had ADHD throughout childhood but were never identified.
We understand ADHD differently now.
Our understanding of ADHD has developed significantly.
ADHD involves difficulties with attention regulation, impulsivity and/or hyperactivity, but these characteristics do not necessarily look the way people might expect.
For example, someone with ADHD may be capable of concentrating intensely on something that interests them while finding it extremely difficult to sustain attention on routine or less stimulating tasks.
Others may experience difficulties with:
- Organisation and time management
- Procrastination and task initiation
- Forgetfulness
- Maintaining attention during conversations or meetings
- Regulating impulses
- Restlessness
- Completing tasks
- Managing competing demands
- Maintaining routines.
Some people develop sophisticated strategies to compensate for these difficulties, and they may also be ‘scaffolded’ by others around them. This certainly happens a lot with younger people, and the support they receive from parents and in school. They may therefore appear outwardly successful while privately experiencing considerable stress, exhaustion or feelings that everyday life seems inexplicably harder for them than for other people.
Greater understanding of these presentations means that people who might previously have been described as lazy, disorganised, unmotivated, careless or not reaching their potential may now be considered from a neurodevelopmental perspective.
Girls and women have historically been overlooked.
Another significant change has been increasing recognition of ADHD in girls and women.
NICE guidance specifically acknowledges that ADHD is thought to be under-recognised in girls and women, who may be less likely to be referred for assessment and more likely to receive another mental health or neurodevelopmental diagnosis instead.
One reason may be that ADHD does not always involve obvious hyperactivity, in fact, for the people I personally see in clinic, marked restlessness and fidgeting is less commonly present than not.
A girl who is quiet, daydreamy, forgetful or chronically disorganised may attract much less attention than a child whose impulsivity and hyperactivity disrupt the classroom.
Some girls also become particularly skilled at compensating for or masking their difficulties.
These children may subsequently become adults who have spent decades wondering why organisation, concentration, emotional regulation or simply keeping on top of everyday life seems to require so much effort.
Increasing awareness means that many of these women are now seeking assessment for the first time.
Social media has undoubtedly played a part, and this became especially notable during the Covid pandemic when certain social media platforms took off.
It would also be unrealistic to discuss the increase in ADHD referrals without considering social media.
TikTok, Instagram, YouTube, podcasts, and online communities have dramatically increased public awareness of neurodivergence. For some people, encountering somebody describing their experience of ADHD can be the first time that their own lifelong difficulties begin to make sense.
This can be genuinely helpful.
However, social media also has significant limitations.
Many experiences commonly presented online as signs of ADHD — procrastination, distraction, forgetfulness, poor motivation or difficulty concentrating — are not unique to ADHD. A study [Yeung, A., Ng, E., & Abi-Jaoude, E. (2022)] following Covid found that of all social media they examined, only around 21% was classified as useful. 52% was classified as misleading, and 27% described personal experience only.
They can also occur with anxiety, depression, trauma, chronic stress, sleep problems, autism, physical health conditions and many other difficulties. They can also occur, to some degree, in people who have no clinical disorder at all.
Recognising yourself in an online description of ADHD can therefore be a useful reason to explore the possibility further. It is not the same thing as receiving a diagnosis.
The COVID-19 pandemic may also have revealed previously hidden difficulties
The NHS ADHD Taskforce has identified the COVID-19 pandemic as another possible contributor to increased demand for assessment.
For some people, established coping mechanisms suddenly disappeared.
Changes to education, working from home, disrupted routines and reduced external structure meant that difficulties with organisation, motivation and self-regulation became much more apparent.
For others, returning to work, university or education afterwards highlighted just how much effort they had previously been putting into maintaining everyday functioning.
The pandemic did not necessarily cause ADHD, but it may have exposed difficulties that had previously been compensated for.
Autism and ADHD can now be recognised together
Diagnostic practice has also changed.
Historically, diagnostic systems made it difficult to diagnose someone with both Autism and ADHD. It is now more generally known that the two conditions frequently occur together. This is something the team I previously worked in when in the NHS was acutely aware of over 20 years ago, but it has taken a long time for this to become something more widely known.
This has important consequences.
Some people previously diagnosed as autistic may also have significant ADHD characteristics that were never recognised. Conversely, somebody diagnosed with ADHD may subsequently recognise autistic characteristics that require further exploration.
The ability to recognise both conditions therefore contributes to increasing diagnostic numbers while providing a more accurate understanding of an individual’s neurodevelopmental profile.
Does this mean ADHD is never over diagnosed?
No.
It is possible to hold two ideas simultaneously:
ADHD has historically been under-recognised in many people, while individual ADHD diagnoses still need to be made carefully, and must be comprehensively assessed.
The dramatic increase in demand for assessment has created significant pressure on ADHD services. NHS England has reported that referral volumes are considerably exceeding service capacity, with extremely long waiting times developing in some areas.
Alongside this, considerable variation has developed in how assessments are provided.
A diagnosis of ADHD should not simply be based upon completing a questionnaire or identifying with a list of ADHD characteristics.
NICE states that ADHD diagnosis should involve a full clinical and psychosocial assessment, a full developmental and psychiatric history, consideration of symptoms across different areas of everyday life, and appropriate additional information.
Importantly, ADHD is developmental.
This means an assessment should explore whether relevant characteristics were present during childhood, even if they were not recognised as ADHD at the time.
It should also consider whether another explanation, or an additional condition, might better account for some of the person’s difficulties.
A good ADHD assessment asks more than “Do you have these symptoms?”
At Clear Sky Therapies, we believe that neurodevelopmental assessment must be comprehensive rather than simply focused on reaching a diagnostic decision as quickly as possible.
The purpose of assessment is not to prove that somebody has ADHD, nor to find reasons why they do not.
It is to develop the most accurate understanding possible of the person.
That means considering their developmental history, education, relationships, work, mental health, everyday functioning and the different environments in which difficulties occur.
It can also mean considering other neurodevelopmental differences, including Autism, as well as psychological factors that can sometimes resemble or coexist with ADHD.
Ultimately, a good assessment should answer a broader question than simply:
“Do I have ADHD?”
It should help answer:
“Why do I experience the difficulties I do, and what might help me?”
So why are diagnoses increasing?
There probably isn’t one single explanation.
Increasing ADHD diagnoses appear to reflect a combination of greater public and professional awareness, recognition of ADHD across the lifespan, improved understanding of ADHD in women and girls, changes in diagnostic practice, recognition of co-occurring Autism and ADHD, social media awareness, the effects of the pandemic, and a substantial backlog of people whose ADHD may previously have been missed.
The rise in diagnoses therefore should not automatically be interpreted as evidence that ADHD has suddenly become more common.
Nor should every increase in diagnosis be accepted uncritically.
The challenge for ADHD services is to improve access to assessment while maintaining the quality and thoroughness required to distinguish ADHD from the many other factors that can affect attention, organisation, motivation and self-regulation.
For the individual seeking answers, receiving an accurate diagnosis can be enormously valuable. It can provide a framework for understanding difficulties that may have existed for decades and open the door to appropriate treatment, adjustments and support.
But the value lies not simply in receiving a diagnosis.
It lies in receiving the right understanding of the person.
ADHD Assessment at Clear Sky Therapies
Clear Sky Therapies provides comprehensive ADHD and neurodevelopmental assessments for young people and adults.
Our approach considers the whole person rather than relying solely upon questionnaires or brief symptom screening. Where appropriate, assessment can also explore whether Autism or other factors may contribute to an individual’s experiences.
If you are considering an ADHD assessment for yourself or a young person, you can contact Clear Sky Therapies to find out more about the assessment process.
