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The recent surge in diagnoses and prescriptions for attention deficit hyperactivity disorder reflects more public awareness of the condition rather than a real increase in prevalence, according to a research review.
Researchers at the Institute of Psychiatry, Psychology & Neuroscience at King’s College London analysed 40 studies undertaken since January 2020 in the first systematic review of global ADHD research since the Covid-19 pandemic.
“We found that ADHD prevalence in adults and children has remained largely stable since 2020 . . . but most of the research is too biased to draw conclusions from,” said Alex Martin, lead author of the review published on Thursday in the Journal of Affective Disorders.
Demand for ADHD medication in the UK and the US has surged in recent years. The neuro-developmental condition can be characterised by persistent inattention, hyperactivity or impulsivity, but symptoms often present differently depending on the individual.
In the UK, the proportion of boys diagnosed with ADHD rose from 1.4 per cent in 2000 to 3.5 per cent in 2018. The number in England waiting for an ADHD assessment rose from 17,400 in April 2019 to 172,000 in December 2023.
There is wide variation in the diagnosis rate of ADHD between countries, analysis of higher quality data showed. In the US around 10 per cent of children aged 3 to 17 have been diagnosed, compared with just 3.2 per cent up to 17 years old in Sweden.
The best estimate of the true prevalence rate in the UK — diagnosed and undiagnosed — is around 5 per cent in children and 3 per cent in adults according to current criteria, said Philip Shaw of King’s.
In England, NHS estimates released last week put the number of adults and children with ADHD at 2.5mn, mostly undiagnosed. As many as 549,000 people are waiting for ADHD assessments.
“This study presents us with a puzzle. How can the ‘true’ rate of ADHD not be increasing despite rising demand for ADHD assessments?” Shaw asked. “I think the most likely explanation is that we’re playing catch-up. There’s now increased recognition and less stigma around ADHD, which means that people are increasingly coming forward for assessment.”
In addition, extensive publicity about ADHD means that “it is often used as a language of distress,” Shaw said. Some children use ADHD “to express that they are struggling, particularly at school, and need help.”
Neuroscientists are investigating whether obsessive use of social media is increasing the incidence of ADHD, through constant dividing of attention and multitasking online. There is evidence of a link between social media use and some ADHD symptoms, Shaw said, but research has not demonstrated that one is causing the other.
The study did not support the frequently floated idea that the disruption caused by Covid had caused significantly more ADHD in children and young people. “Although we found that incidence showed some variability across the pandemic, that variability was not statistically significant,” said Martin.
ADHD diagnosis rates are about twice as high in the US as the UK and other European countries, but the difference probably represents different cultural contexts and diagnostic criteria on opposite sides of the Atlantic, said Edmund Sonuga-Barke, professor developmental psychology at King’s: “I think the real prevalence of ADHD is very similar in the US and UK.”
Chart by Amy Borrett