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!
Thanks for sharing! Yes I agree, early identification/diagnosis is really helpful in finding a path for kids to thrive and struggle less as they progress into adulthood. Sounds like you have a busy but fun household
Really appreciated how you handled the “overdiagnosis” narrative without slipping into blame or panic. It often feels like people argue about labels instead of lived impact. I see so many adults whose real challenge is years of feeling unseen, not their score on a checklist. What kind of response do you most hope this piece will spark in clinicians and policymakers who read it?
Hi Dr KB thanks for reading and the comment - sorry for the late reply!
I appreciate this response especially the point you make about people ‘arguing about labels instead of lived impact’.
I actually wrote this to try and bring a perspective to policy makers who tend to be so far removed from the reality and facts about adults with ADHD. Firstly, I want their focus to be more on how can we better support those who probably should’ve gotten diagnosed or received support in childhood based on what studies show on underdiagnosis of certain groups.
They should also be thinking how can we make sure children of today aren’t being missed or overlooked given there’s already a long waitlist for pre-teens and kids for an ADHD assessment.
Secondly, for them to stop using the term ‘overdiagnosis ’ as the term simply cannot apply to people with ADHD because symptoms are present since childhood.
For clinicians, understanding that ADHD in adulthood can be more complex due to years of masking, the development of other conditions due to lack of ADHD support and there’s also the matter of misdiagnosis which I have previously written about
100% agree with this. The diagnosis confirms the label. That’s it. It’s what happens after that that really matters. Finding the symbiosis between changing your environment to suit your strengths vs adapting your approach by leveraging your unique skillset is far more important.
I really felt the frustration in it. Long ago has been needed more awareness, more assessments, and more people understanding what has been happening to them for years instead of having being twisted into proof that the problem was not real. Luckily this is changing today a bit.
The underdiagnosis of girls piece hit hard. As a family physician, I see this pattern constantly—especially women who've spent 20+ years managing symptoms they never had language for. Your point about the dementia-to-ADHD pipeline resonates deeply; I've had conversations with patients following almost exactly that arc. Recently its been in the form of relationship struggles as a result of the cognitive struggles.
This isn't overdiagnosis; it's diagnosis finally catching up to reality. The waiting lists exist because people are finally getting answers and we didn't have the infrastructure in place beforehand. Awesome read!
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!
Thanks for sharing! Yes I agree, early identification/diagnosis is really helpful in finding a path for kids to thrive and struggle less as they progress into adulthood. Sounds like you have a busy but fun household
This is so important! I just wrote a similar piece—
https://substack.com/home/post/p-181082879
Really appreciated how you handled the “overdiagnosis” narrative without slipping into blame or panic. It often feels like people argue about labels instead of lived impact. I see so many adults whose real challenge is years of feeling unseen, not their score on a checklist. What kind of response do you most hope this piece will spark in clinicians and policymakers who read it?
Hi Dr KB thanks for reading and the comment - sorry for the late reply!
I appreciate this response especially the point you make about people ‘arguing about labels instead of lived impact’.
I actually wrote this to try and bring a perspective to policy makers who tend to be so far removed from the reality and facts about adults with ADHD. Firstly, I want their focus to be more on how can we better support those who probably should’ve gotten diagnosed or received support in childhood based on what studies show on underdiagnosis of certain groups.
They should also be thinking how can we make sure children of today aren’t being missed or overlooked given there’s already a long waitlist for pre-teens and kids for an ADHD assessment.
Secondly, for them to stop using the term ‘overdiagnosis ’ as the term simply cannot apply to people with ADHD because symptoms are present since childhood.
For clinicians, understanding that ADHD in adulthood can be more complex due to years of masking, the development of other conditions due to lack of ADHD support and there’s also the matter of misdiagnosis which I have previously written about
100% agree with this. The diagnosis confirms the label. That’s it. It’s what happens after that that really matters. Finding the symbiosis between changing your environment to suit your strengths vs adapting your approach by leveraging your unique skillset is far more important.
I really felt the frustration in it. Long ago has been needed more awareness, more assessments, and more people understanding what has been happening to them for years instead of having being twisted into proof that the problem was not real. Luckily this is changing today a bit.
The underdiagnosis of girls piece hit hard. As a family physician, I see this pattern constantly—especially women who've spent 20+ years managing symptoms they never had language for. Your point about the dementia-to-ADHD pipeline resonates deeply; I've had conversations with patients following almost exactly that arc. Recently its been in the form of relationship struggles as a result of the cognitive struggles.
This isn't overdiagnosis; it's diagnosis finally catching up to reality. The waiting lists exist because people are finally getting answers and we didn't have the infrastructure in place beforehand. Awesome read!