In some parts of the world, record numbers of people are being diagnosed with attention deficit hyperactivity disorder (ADHD). In the United States, for example, government researchers last year reported that more than 11% of children had received an ADHD diagnosis at some point in their lives.

One thing that’s clear is that several factors — including improved detection and greater awareness of ADHD — are causing people with symptoms to receive a diagnosis and treatment, whereas they wouldn’t have years earlier. Clinicians say this is especially true for women and girls, whose pattern of symptoms was often missed in the past. Although some specialists are concerned about the risks of overdiagnosis, many are more worried that too many people go undiagnosed and untreated.

At the same time, the rise in awareness and diagnoses of ADHD has fueled a public debate about how it should be viewed and how best to provide support, including when medication is required. The emergence of the neurodiversity movement is challenging the view of ADHD as a disorder that should be ‘treated’, and instead proposes that it’s a difference that should be better understood and supported — with more focus on adapting schools and workplaces, for instance.

A slew of studies suggests that diagnoses of ADHD have gone up in many high-income countries in the past two to three decades — similar to a rise in autism diagnoses (see ‘ADHD on the rise’). The rate of new ADHD diagnoses in the United Kingdom, for example, doubled in boys and quadrupled in girls between 2000 and 2018, according to one study². In adults, the rate shot up even more. “We have numbers suggesting that we’re seeing a rise,” says Max Wiznitzer, a paediatric neurologist at Rainbow Babies and Children’s Hospital in Cleveland, Ohio.

One thing that’s clear is that several factors — including improved detection and greater awareness of ADHD — are causing people with symptoms to receive a diagnosis and treatment, whereas they wouldn’t have years earlier.

Researchers and specialists highlight other factors that are likely to be driving up the number of diagnoses. One is a change in diagnostic criteria in The Diagnostic and Statistical Manual of Mental Disorders (DSM). In the fourth edition of this widely used manual, introduced in 1994, a child or adult ADHD diagnosis required the presence of at least six of a list of nine inattention symptoms and/or six or more of nine hyperactivity symptoms, and stipulated that these had to be present before the age of seven. (This reflects the idea that ADHD is a neurodevelopmental condition that arises during childhood brain development.)

When the fifth edition, DSM-V, arrived in 2013, the criteria were slightly relaxed. Symptoms had to be present before age 12, and adult diagnosis required a minimum of five symptoms. (Children still had to have at least six.) “So when we expand the criteria, obviously you increase a little bit the prevalence,” says Rohde, who was involved in those revisions.

Today, a thorough ADHD assessment involves collecting a detailed history and completing behaviour questionnaires, including input from family members and, for children, from schools. In the United States, the condition can be diagnosed by a range of health professionals, including psychiatrists, other mental-health specialists and primary-care physicians such as paediatricians, who might not have dedicated training in ADHD.

A diagnosis requires that symptoms are present for at least six months and in two or more settings (such as school, home, work); are not explained by another condition such as anxiety; and cause an impairment, such as struggling with schoolwork, losing a job or having relationship problems.

The impairment requirement is key, clinicians say. These traits vary across the population: some individuals are very hyperactive or inattentive, and some not at all. But people tend to be diagnosed with ADHD when their symptoms significantly interfere with their lives.

But working out when someone crosses the impairment line involves a subjective and sometimes tricky judgement, say specialists. And there is an ongoing debate about whether a person’s level of impairment should be defined relative to their own potential or to a population average.

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Another reason why diagnoses have surged is an increase in public awareness of ADHD — fueled by an explosion of discussion on TikTok and other social media.

The surge in ADHD has led to concerns, particularly in the United States, about questionable diagnoses being given without a thorough clinical evaluation — through online services, for example, or by medical professionals without ADHD training.

“They’ve got a visit for 15 or 20 minutes, and the diagnosis is made,” says Stephen Hinshaw, a specialist in child and adolescent mental health and ADHD at the University of California, Berkeley. But Jeremy Didier, a clinician specializing in ADHD who is president of Children and Adults with Attention Deficit–Hyperactivity Disorder (CHADD) says that a bigger problem is the number of people with ADHD who are undiagnosed or untreated. She emphasizes how important it is for people to have access to a thorough, accurate assessment from a trained professional who specializes in ADHD.

Excerpted from “ADHD diagnoses are growing. What’s going on?” in Nature.com. Read the full article online.

Source: Nature.com | ADHD diagnoses are growing. What’s going on?, https://www.nature.com/articles/d41586-025-03855-2 | © 2025 Springer Nature Limited. Retrieved November 2025