UK ADHD diagnoses remain underestimated as calls grow for holistic support

Despite debates over over- diagnosis, recent analyses suggest that ADHD remains under-recognised in the UK, with long waiting times and uneven access highlighting the need for more holistic and supportive approaches.

Attention-deficit/hyperactivity disorder remains one of the most discussed child mental health conditions, but, as Kathryn Bates argues in a piece for Bold Science, the louder the debate becomes, the easier it is to lose sight of what matters most: whether a young person is getting the right help. The key issue is not simply how many children are being diagnosed, but whether services can respond properly to need.

ADHD is identified through behaviour rather than a blood test or brain scan. The Centers for Disease Control and Prevention says clinicians look for at least six symptoms of inattention and/or hyperactivity-impulsivity lasting for six months or more, appearing in more than one setting and causing genuine impairment. Cleveland Clinic similarly notes that diagnosis depends on symptoms beginning in childhood and affecting daily life, which helps explain why assessments often require reports from parents, teachers and health professionals rather than a single appointment.

That complexity has fuelled arguments about self-diagnosis and supposed over-diagnosis. Yet several recent analyses suggest the more pressing problem is under-recognition. A UCL study published in June found recorded ADHD diagnoses in English primary care were well below international prevalence estimates, while a separate expert article in The British Journal of Psychiatry said there is no good evidence of over-diagnosis in the UK. The neurodiversity charity Neurobetter says the NHS-commissioned Independent ADHD Taskforce also concluded that most people with ADHD in the UK remain undiagnosed and untreated.

The picture is especially uneven for girls and women, who are more likely to be missed, and for some minority ethnic groups, who are less likely to be referred or treated, according to Bates and the supporting commentary she cites. That matters because the overlap between ADHD and other conditions can make assessment more complicated, not less. Some clinicians and advocates now argue that services should look more holistically at a child’s wider needs, rather than forcing families through separate routes for ADHD, autism or obsessive compulsive disorder.

Bates also points to a practical reality familiar to many families: long waits. In the UK and in parts of Europe, children and teenagers can wait months or even years for an assessment, which leaves many to improvise coping strategies in the meantime. Her argument is that schools and clinicians should stop treating ADHD as a label to be debated and start treating it as part of a wider conversation about support.

That means recognising strengths as well as difficulties. Many children with ADHD can hyperfocus, think creatively and respond well to flexible, engaging teaching. Simple classroom adjustments, clear routines and regular check-ins can help, and often benefit other pupils too. The broader lesson, according to Bates, is that young people should not have to prove they are struggling before adults start taking them seriously.