The Overdiagnosis of ADHD
Obvious explanations for the rise in demand for ADHD services
Hi ADHDers!
Over the past few years, we have increasingly seen articles on the supposed overdiagnosis of ADHD. These articles, well, rants, also promote the notion of ADHD being a fad, a trend, and claim that ADHD ‘never existed’ back in their day.
👉 Rarely do these articles show understanding or concern for those struggling with ADHD.
The use of the term ‘overdiagnosis’ implies that people who are diagnosed with ADHD or seeking an ADHD assessment would be fine without an ADHD diagnosis.
📰 This week, it was reported that the UK Health Minister is “launching an independent review into rising demand for mental health, ADHD and autism services in England.”
📰 The BBC reports that this review will also look into the overdiagnosis of ADHD, which I find slightly concerning.
Shall we begin?
The incorrect framing of ADHD overdiagnosis
➡️ The use of the term ‘overdiagnosis’ implies that people who are diagnosed with ADHD or seeking an ADHD assessment would be fine without an ADHD diagnosis.
⤵️
💡What is overdiagnosis?
The National Library of Medicine defines overdiagnosis as:
“the diagnosis of a medical condition that would never have caused any symptoms or problems. This kind of diagnosis can be harmful if it leads to psychological stress and unnecessary treatments.”
👉 ADHD is a Neurodevelopmental disorder where symptoms usually start before the age of 12.
There is a misconception by the media and many people that individuals who require ADHD services have magically developed ADHD symptoms in adulthood.
They fail to consider that:
➡️ People’s symptoms can worsen over time due to a lack of support and treatment
➡️ Many people develop co-occurring health conditions as a result of unidentified or untreated ADHD
➡️ Many people groups are underdiagnosed and undertreated
➡️ People who have struggled for years now feel empowered to seek out an ADHD assessment
Isn’t this obvious to us all?
The obvious reasons for the rise in demand for ADHD services 📝
The rising demand for ADHD services can be attributed to many things, and it shouldn’t be entirely boiled down to an overdiagnosis of ADHD.
1️⃣ The underdiagnosis of girls, women, in particular, women of colour
2️⃣ An increase in ADHD Awareness and greater visibility
3️⃣ Increase in ADHD assessments
The underdiagnosis of girls, women, in particular, women of colour
👩🏫 In 1997, a meta-analysis on gender differences and ADHD results showed that ADHD among girls went undetected by teachers and those seeking care had greater difficulties compared to boys.
🐠 As a pre-teen and a teen, I ticked every box for ADHD. My teacher had told my parents that I had the attention span of a goldfish; I was outwardly hyperactive to the point where it became disruptive in classes.
🧑💼I was referred to a counsellor by my school, whom I had to see between classes, and she taught me techniques to manage my hyperactive traits.
I was so embarrassed, omg.
The possibility that I could have ADHD never came up. However, I did attend an all-girls catholic school.
| “A 2013 study categorized Black girls as one of the most historically overlooked demographics of all” - Jess Joho
An article I was featured in on Mashable titled, How social inequities feed into the under-diagnosis of ADHD details how ‘marginalised and underprivileged people are left chronically underdiagnosed and undertreated.’
I am begging you all to find time to read the article.
📣 An increase in ADHD Awareness and greater visibility
👉 In 1994, a conference on gender differences in ADHD demonstrated that girls had been virtually excluded in the comprehensive field of ADHD research.
👉 There were questions on whether ADHD was a valid diagnosis for girls, which we are now seeing the impacts of today.
In addition, earlier beliefs suggested that kids outgrow ADHD. These beliefs have since been challenged, with some studies revealing that not all kids outgrow ADHD symptoms.
🎯 These long-held beliefs are presumably why many people slipped through the cracks and are only now being diagnosed in their 20s, 30s, 40s, 50s and 60s!
| The “maybe I’m developing early onset dementia” to “Oh, I have ADHD” pipeline
👩⚕️ My ADHD Diagnosis came as a result of thinking that I had early-onset dementia in my 20s.
There I was, in my early 20s, sitting in my GP’s office, taking a brief memory test, which proved that I did not have early-onset dementia.
What happened next?
🎬 Two years later, a Netflix documentary showcasing adults with ADHD hit very close to home.
Watching the documentary and doing additional research was the beginning of my 1-year and 6 months long ADHD assessment process before I was eventually diagnosed after seeing two psychiatrists via the UK NHS.
🎯 The increase in ADHD awareness online has been a positive contributing factor in people identifying that what they have been struggling with for many years could be ADHD or another form of Neurodivergence.
🎯 If people only knew what it felt like to wonder what is “wrong with my brain” and finally have the answers and the support to live a full and meaningful life.
Increase in ADHD assessments 🧑⚕️👨⚕️
There is a possibility that the increase in ADHD assessments correlates with an increase in ADHD diagnoses. I don’t know this to be a fact, but it’s not outside of the realm of possibilities.
As you have all read throughout this post, many people with ADHD have spent years of their lives undiagnosed. Undiagnosed does not mean an absence of ADHD symptoms or challenges.
I should say that I welcome any efforts by the review to prioritise the expansion of ADHD services and the reduction of the ADHD assessment waiting list period.
If you have been paying attention, you’ll understand why the framing of ADHD overdiagnosis is not only wrong but incorrect.
That’s all from me.
Rach, with ADHD.
I endorse this summary (which is both reasoned and supported) as a fellow -HD person and a scientist who studied neurodevelopmental disorders. This should not prevent us from studying eg the exposome and quantifying which environmental exposures increase the risk, but adults with ADHD and kids alike stand to gain nothing from the misguided treatment of existing evidence as highly suggestive of some widespread over diagnosis problem. There is a rise in diagnoses, and there is likely eg an overprescription problem, because most systems get abused. That cannot be used as an argument to deny services to people who qualify for those services and support legally and who have a legitimate medical need. The need is rooted in complex neuroscience and there are arguments for and against over-medicalization of neurodivergence, but at the core we must all recognize what it is (a neurodevelopmental disorder, biological in origin, involving a departure from a typical neuro dev trajectory, that is highly familial, highly genetic - and also can be treated).
I am a strong believer in science for the good of the people. The entire point of the research in XX century was to accelerate our understanding of the breadth of the problem, its continuity, and IMPROVE ways to conceptualize and quantify it. We always expected this may lead to an increase in the services provided - which is why we always called neurodevelopmental disorders under-diagnosed, under-funded (they still are), under-served, and frequently misrepresented in the public narratives as well as policy discussions.
So - yeah, none of this is "shocking" or "surprising" to people who are actually familiar with the literature. It is complex and suggests many things but primarily it suggests that we got better at helping a greatly underserved population - a testatement to our progress that we cannot afford to twist into some admission of guilt or reframing as deep uncertainty.
I am a teacher who works with adolescent children, many who are neurodivergent. Also, I missed my daughter's ADHD symptoms until she was 13. Her younger twin brothers were diagnosed at age 5. Yes, girls are underdiagnosed, even by the best of us. The important thing is to give them access to systems and supports that will make life easier and allow them to be successful!