Is ADHD really being overdiagnosed – or finally just understood?

an artistic concept to illustrate a piece on whether adhd is being overdiagnosed or is just finally understood, it shows a woman with her face blocked out with a computer pop up saying condition appears to be misunderstood
ADHD: Over-diagnosed or finally understood?Florence Ogram - Getty Images

For Olivia, life was a cycle of never-ending chaos. Each morning began in the same unsettling way; she'd frantically turn her flat upside down in search of her keys. Running out to her car, already late for work, she'd often discover yet another parking ticket stuck to the windscreen. A further blow to her mammoth overdraft - that she seemed to live in at all times.

It wasn't a coincidence that Olivia's world was characterised by chaos. She was unknowingly living with the neurodevelopmental condition attention deficit hyperactivity disorder (ADHD).

The condition is categorised into two main behaviour types by the NHS: inattentiveness (difficulty concentrating and focusing) and hyperactivity and impulsiveness. On the surface, it may appear to be organisational disarray, restlessness or constant oversharing, but it's so much more than that. An estimated 2.6 million people in the UK live with ADHD. Many are now being diagnosed later in life, partly thanks to greater awareness in recent years.

Conversations about the condition began getting louder during the pandemic - when experts suggested that lockdown stripped those of us with ADHD of our coping mechanisms, from daily structures to support circles and exercise, leading to a potential exacerbation of milder symptoms for some - particularly children.

As we found ourselves increasingly online, the discussion rose to the fore on social media. The hashtag #ADHD has now garnered 26.7bn views on TikTok, allowing people a safe space to share their stories. Celebrities including Paris Hilton, Zooey Deschanel and Mel B have begun to publicly discuss how they live with the condition as well.

I certainly understand Olivia's pain. Lockdown changed everything for me: after discovering communities online, I realised the issues I'd dealt with for years (emotional sensitivity, time blindness and debilitating insomnia) aligned with the traits of ADHD. But it wasn't just one viral TikTok that led me towards seeking a diagnosis: it was a gradual process of slow realisation.

After the best part of a year umming and ahing, I finally referred myself for a private assessment through Psychiatry UK in April 2021. I was diagnosed that November and cried at the news.

Diagnoses are on the up; the ADHD Foundation estimates a 400% increase in adult referrals since 2020. Prescription data from ADHD UK also shows that between 2015 to 2016 and 2021 to 2022. the number of patients prescribed with medication to treat their ADHD increased from 105,889 to 190.730 - an 80% leap. But there's also been a backlash bubbling. Certain corners of the internet and some media commentators are suggesting this uptick in people seeking help is a sign that the condition is simply being 'overdiagnosed', rather than being better understood.

Meanwhile, a lack of information and understanding around what causes ADHD has led to speculation around where the boom has come from, from suggestions that phone usage and even diet could have an impact. This week, fitness guru Joe Wicks, known as The Body Coach, ruffled feathers when he suggested that a diet of Ultra Processed Foods (UPFs) could have been the cause of his own childhood behaviour. Speaking on BBC Radio 5 podcast Live Headliners, Wicks said: “Looking back now, there’s no doubt the food I was eating was directly linked to my behaviour. I was never diagnosed with ADHD but I think nowadays it’s this common thing that every child seems to be being diagnosed. And I think a lot of it can stem back to the diet and the foods that we’re eating.” So which is it? Over-diagnosis or a greater awareness?

medicine bottle
Florence Ogram

Overdiagnosis vs struggling ADHD services

'It's being overdiagnosed.' 'People with ADHD iust need to take a break from technology.' 'These dangerous stimulants shouldn't keep being prescribed.' These are just a handful of the 'concerns' that have been published in the media recently, all of which seem to disregard just how difficult it is to get a diagnosis or prescription, and suggest that ADHD is some kind of quirky trend.

According to this line of thinking, everyone has ADHD now. At the time of my diagnosis, my TikTok was an amalgamation of information and memes - 'Having ADHD is like seeing a glass door, but you still accidentally walk into it' has always been a favourite of mine. Some might see these jokes as dangerous territory - perpetuating the 'I'm so ADHD' narrative that can feel all too similar to tidiness being off handedly referred to as 'being OCD' - but for me, they were an escape mechanism. They offered a comforting reminder that I wasn't alone.

Of course, realising and identifying with the symptoms is just the first hurdle. The NHS pathway to a diagnosis usually involves a GP referral to a specialist psychiatrist - but the process takes an average of seven years. Even then, the criteria used to diagnose ADHD, known as the DSM-5, specifies that adults must display five or more symptoms of inattention and five or more of hyperactivity and impulsivity to warrant a diagnosis.

But with neurodiversity being an umbrella that comprises ADHD, autism spectrumdisorder (ASD), dyspraxia, dyslexia, Tourette's syndrome and dyscalculia, the overlapping of these conditions can also lead to a difficulty securing a clear diagnosis. As a result of this, it's estimated that between 50% and 70% of people with autism also have ADHD.

Going down the private route can drop this process to approximately six months, but an hour-long assessment can range anywhere from £360 to over £ 800 (which doesn't include the cost of any medication afterwards). While Olivia was in a financial position to refer herself to a private psychiatrist in September 2021 and received her ADHD diagnosis that December, others are adopting the label without a formal medical diagnosis.

Charli (they/she), 22, who was diagnosed with autism at the age of 15, had spent years telling doctors that they struggled with task paralysis, emotional dysregulation, anger and suicidality. They had been repeatedly told this was 'autism-associated mixed anxiety and depression', before eventually putting the puzzle pieces together. They used a rent rebate to self-fund a private assessment and circumvent lengthy NHS waits. 'The diagnostic process is full of gatekeeping and endless admin,' Charli tells Cosmopolitan UK. 'No one is walking straight into a doctor's office and getting an instant diagnosis.'

There's a gender diagnosis gap to consider, too. While men and boys often present more physically, for example with hyperactivity - the behaviour most historically associated with ADHD - women and girls are more likely to experience internalised symptoms, which can make it easier to go undetected.

Hester Grainger, an ADHD coach, co-founder of Perfectly Autistic and neurodiversity consultant, says women are 'often missed due to masking [when someone tries to hide their ADHD to mimic neurotypical behaviours], or are misdiagnosed with other conditions ranging from borderline personality disorder to anxiety'.

Race further exacerbates this diagnosis gap, with Black children diagnosed with ADHD at two-thirds the rate of their white counterparts, despite displaying more symptoms. Services are so far in decline that in February this year, parliament was forced to debate the current state of ADHD and autism assessments. The government went on to confirm that it was investing £13m into the latter and made a vague commitment towards 'supporting' children through ADHD diagnoses, but offered no mention of adult care.

a clock with the words time is ticking on
Florence Ogram

Awareness is everything

It's pretty clear that an ADHD diagnosis isn't an easy, quick-fix journey, nor should the condition be used to label someone who's a bit scatty. Debilitating symptoms mean many have to develop coping mechanisms just to get through the day. And in too many cases, those 'days' have lasted years.

'We've had to work out how to hack our environment in order to function,' explains Samantha Hiew, founder of ADHD Girls, a social impact company that empowers girls and women with ADHD to thrive. 'It's society that's catching up with the awareness and women are finally feeling like they have a space to ask for help.'

Dissenters may dismiss those who have self-labelled, but after waiting years for clinical confirmation, all while dealing with medical misogyny, can we blame anyone for finding an answer themselves?

Communities on social media, meanwhile, are offering respite and support tothose who have spent decades feeling othered', struggling with a neurotypical approach to life and adopting masking behaviours.

There's no clear evidence that the rise in ADHD discussions on platforms such a s TikTok is leading to overdiagnosis, but simply higher rates of diagnosis, which, for those struggling to secure treatment, can provide the validation and comfort they urgently need. It's an acknowledgement that they're not just 'hyper' or 'forgetful, but that their brains are wired differently – and that's a beautiful thing.

Where to get help with ADHD

Seek out a charity

ADHD UK is campaigning to reduce NHS ADHD assessment waiting lists. It offers free information about the condition and the diagnostic process on its website, as well as access to support groups.

Look at other pathways

If waiting lists in your area are looking too long, patients in England can choose to be seen by an NHS mental health provider outside of their geographic NHS area, explains Henry Shelford, CEO of ADHD UK.

Advocate for yourself

If you're struggling to cope whilst waiting for a diagnosis, connect with a community. 'Joining support groups is a great way to understand ADHD and build successful strategies,' explains Shelford.

Useful websites

Helpful online resources include ADHD UK, The ADHD Foundation, ADHD Adult UK, ADDISS, ADHD and Autism, ADHD Babes and Staring Back At Me.

You Might Also Like