A debate on the Jeremy Vine show has reopened a question that seems to come up every time ADHD is discussed: are too many children now being diagnosed?
During the discussion, concerns were raised that behaviours associated with lack of sleep, trauma, anxiety or depression could sometimes be mistaken for ADHD, leading to children being unnecessarily “medicalised”.
The opposing argument was equally important: diagnosis can be life-changing, ADHD has historically been missed in many people, and girls in particular may not present in the stereotypical way people expect.
So what does the evidence actually tell us?
The answer is considerably more complicated than either “ADHD is being overdiagnosed” or “everyone being referred has ADHD.”
ADHD referrals have increased enormously
There is no question that demand for ADHD assessment has risen.
The Government’s independent review into mental health conditions, ADHD and autism reported that the number of children and young people waiting for an ADHD assessment in NHS mental health services increased from around 21,000 in April 2019 to approximately 270,000 by December 2025.
That’s an extraordinary increase.
But here’s the important distinction:
A referral is not a diagnosis.
And an increase in recorded diagnoses does not, by itself, prove that children are being incorrectly diagnosed.
The Government review itself warns against overly simplistic interpretations of these figures. It says several factors are likely contributing, including improved recognition, changes in help-seeking, changing pathways and pressures within services.
Could anxiety, trauma or sleep problems look like ADHD?
There is an important point within the criticism.
Children are complicated.
Anxiety can affect concentration. Poor sleep can affect attention and behaviour. Trauma can affect emotional regulation. Depression and other mental-health difficulties can affect motivation, executive functioning and everyday life.
These things therefore need to be considered during an assessment.
But that’s precisely why ADHD isn’t supposed to be diagnosed from a TikTok checklist, a questionnaire alone, or because a child won’t sit still in class.
NICE says ADHD should be diagnosed by an appropriately trained specialist following a full clinical and psychosocial assessment, developmental and psychiatric history, information about the person’s experiences across different settings and observer reports. A diagnosis should not be based solely on a rating scale or observation.
ADHD symptoms must also cause meaningful impairment and occur across multiple important settings.
So yes:
We absolutely should make sure children are assessed properly.
But that’s very different from concluding that children with anxiety, trauma or sleep difficulties are routinely being incorrectly labelled with ADHD.
What about girls?
This is where the discussion becomes particularly important.
For generations, the image many people had of ADHD was the disruptive little boy who couldn’t sit still.
But ADHD doesn’t always look like that.
A child can struggle profoundly with attention, organisation, working memory, emotional regulation or executive functioning without disrupting a classroom.
NICE specifically warns that ADHD is thought to be under-recognised in girls and women. Girls are less likely to be referred for assessment, may be more likely to have undiagnosed ADHD, and may sometimes receive another diagnosis instead.
So when we talk about rising diagnoses, we also need to ask:
How many people were previously being missed?
Are ADHD rates actually exploding?
Here’s another interesting part of the Government’s review.
While referrals, waiting lists and recorded diagnoses have increased substantially, population surveys suggest the underlying prevalence of ADHD symptoms has been far more stable.
The review says the best available estimates remain around 5% for children and young people and 2–3% for adults, without evidence of a dramatic population-level increase over recent decades.
That doesn’t automatically prove either overdiagnosis or underdiagnosis.
It tells us that what we’re seeing in healthcare data isn’t necessarily the same thing as a sudden explosion in the underlying condition.
Recognition has changed.
People’s willingness to seek help has changed.
Knowledge of ADHD has changed.
And the system responsible for assessing people is struggling to keep up.
Diagnosis doesn’t automatically mean medication
Another misconception worth addressing is that an ADHD diagnosis inevitably means immediately putting a child on medication.
It doesn’t.
NICE describes both non-pharmacological and pharmacological approaches to ADHD, and medication should be initiated by appropriately trained healthcare professionals following assessment.
Interestingly, the Government review found that although ADHD diagnoses among children and young people have increased, the proportion progressing from diagnosis to medication prescribing appears to have roughly halved in the post-pandemic period.
Again, the reality is considerably more nuanced than “more diagnoses = more children being medicated”.
Perhaps we’re asking the wrong question
There is a legitimate debate to have about diagnostic accuracy.
Nobody should want a child diagnosed with something they don’t have.
A good assessment should consider alternative explanations, coexisting conditions, the child’s developmental history and how their difficulties affect everyday life.
But there is another risk we shouldn’t ignore.
If the public conversation becomes:
“Everyone has ADHD now.”
“It’s just normal childhood behaviour.”
“They’re diagnosing naughty children.”
then children who genuinely are struggling may once again become easier to dismiss.
And we’ve already seen what happens when certain presentations don’t fit society’s stereotype of ADHD.
They get missed.
The question should be different
Instead of asking:
“Are we diagnosing too many children with ADHD?”
perhaps we should be asking:
“Are we assessing children properly, understanding what is actually causing their difficulties, and giving them appropriate support?”
Because the answer for one child might be ADHD.
For another it might be anxiety.
For another it might involve trauma, sleep, autism, learning difficulties or several overlapping needs.
And sometimes ADHD and those other difficulties can coexist rather than one automatically explaining away the other. NICE’s guidance explicitly recognises ADHD alongside conditions including anxiety, depression and autism.
Ultimately, this shouldn’t become a battle between people who believe ADHD is “overdiagnosed” and parents desperately trying to get their children assessed.
It should be about getting the right child, the right assessment, the right understanding and the right support.
Because whether a child eventually receives a diagnosis or not, if they’re struggling badly enough for their family or school to seek help, that struggle deserves to be taken seriously.
What do you think? Are we diagnosing too many children — or are we finally recognising people who would previously have been missed?
AskEllie provides information and support for SEND families. We are not medical professionals and our content should not replace individual clinical advice.
Leave a Reply