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The latest episode of our podcast where our virtual hosts Adie and Haidee discuss late diagnosis of ADHD and the argument around overdiagnosis versus under diagnosis.

The ‘Explosion’ in Diagnoses Is Actually a Reckoning with a Massive Treatment Gap

The dramatic growth in ADHD diagnoses is not evidence of over-diagnosis but rather a long-overdue correction for decades of profound under-recognition. The increase seems so enormous primarily because, as the founder of a national ADHD charity explained in a recent interview, “the base is so low.” The starting point for diagnosed individuals was a fraction of the true number of people living with the condition.

Data from a recent study of 8 million GP records paints a stark picture. It found that only 0.32% of individuals had a record of ADHD. This figure is estimated to represent just 10%, or one in 10, of the people who actually have the condition. The gap between need and care becomes even clearer when looking at treatment: only one in 15 people with ADHD is receiving medication. This means that for every person getting medicated support, “14 out of 15 [are] unaddressed.”

When viewed through this lens, the narrative shifts entirely. The real crisis isn’t one of over-diagnosis; it is the existence of an “enormous treatment gap” that has left the vast majority of people with ADHD without recognition or support.

ADHD Isn’t a New Trend; Its Formal Recognition Is

Contrary to the belief that ADHD is a modern phenomenon, detailed clinical descriptions of its characteristic behaviors are centuries old. Physicians documented ADHD-like behaviors as early as 1775 and 1798. The condition received its first formal recognition from Sir George Still in 1902, when his lectures describing children with an “abnormal incapacity for sustained attention” were published in the prestigious medical journal the Lancet.

The perception of ADHD as “new” stems from the incredibly recent timeline of its official acceptance by healthcare systems. As the same charity founder noted, in the UK, the NHS only formally recognized ADHD in children in the year 2000 and, remarkably, did not recognize it in adults until 2008. This timeline explains why so many “middle-aged people” are now coming forward for assessment; they simply had “no hope of getting picked up as a kid.” As our collective medical knowledge evolves, conditions that were once dismissed are now understood with greater accuracy and compassion.

…as a healthcare society we we we learned things you know PTSD uh used to be considered a weakness that people were broken we now understand that completely differently… dementia was old people getting befuddled and is now understood to be a disease… our understanding does change.

You Don’t Suddenly “Get” ADHD as an Adult—You Finally See It

A common point of confusion is whether ADHD can develop in adulthood. The clinical answer is clear: ADHD is a neurodevelopmental condition, meaning its origins are rooted in childhood. It does not suddenly develop later in life, but it is often first recognised or diagnosed in adulthood when life’s demands expose previously hidden struggles.

There are three primary reasons why an ADHD diagnosis is often delayed until adulthood:

• Milder childhood symptoms: Not every child with ADHD is disruptive or visibly hyperactive. Many experience inattentive symptoms—like daydreaming, forgetfulness, or disorganisation—which were historically overlooked by teachers and parents.

• Masking and coping strategies: The structures of school and parental guidance can act as a “safety net,” helping a child manage. As they grow, individuals often develop complex coping mechanisms, such as perfectionism or working longer hours, to mask their difficulties. These strategies can be effective for years but often lead to exhaustion and burnout.

• Increased adult pressures: Major life transitions—like starting a demanding job, entering a serious relationship, or becoming a parent—can stretch coping mechanisms past their breaking point. The increased responsibilities make symptoms that were once manageable impossible to ignore, prompting the individual to finally seek help.

The Real Crisis Might Be in How We Diagnose, Not How Many

While the evidence points to widespread under-diagnosis, this does not mean the system is without serious problems. In fact, a parallel crisis is emerging around the quality and regulation of the diagnostic process itself. This unregulated landscape is a direct consequence of the enormous unmet need; the pressure from millions seeking help has created a market for fast, unreliable solutions that can ultimately harm the very people they claim to serve.

Recognizing this systemic issue, the UK’s Health Secretary has ordered a major review into “mental health, ADHD and autism services,” a move that Clinical Director Dr. Lisa Williams called “overdue.” Dr. Williams identifies several critical problems in the current diagnostic landscape, including a “dilution in the level of qualification and experience” among some assessors. Furthermore, the rise of online assessments is problematic, as ADHD is “notoriously difficult to assess reliably online.” This environment has overwhelmed services, making it even harder for individuals with “genuine, debilitating ADHD or autism” to access the high-quality care they need.

Dr. Williams notes that by launching the review, the Health Secretary is addressing a sensitive dilemma that many have avoided:

He’s naming the elephant in the room people haven’t spoken about for fear of judgement.

Shifting the Conversation

The conversation around ADHD is undergoing a necessary and profound shift. We are moving away from a simplistic fear of over-diagnosis and toward a more mature understanding of a complex reality defined by systemic failure. This reality includes decades of historical under-recognition, deep-seated flaws in the quality of our diagnostic systems, and a massive, unaddressed treatment gap affecting millions.

The data shows that we are not over-diagnosing ADHD; we are just beginning to acknowledge its true prevalence. With the scale of this historical gap now clear, the question is no longer whether we are diagnosing too many, but how we can build a system capable of finding and supporting the millions we have failed for so long.

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