Increased rates of diagnosis of ADHD in the news

There have been numerous media articles over the last while referring to increased prevalence rates and related issues such as lengthy NHS waiting lists for diagnostic assessment for ADHD. Indeed, over the last few months we have written several blogs on the topic. A recently published study that has reported on rates of prevalence and prescriptions in the UK from 2000 to 2018 has attracted media attention. The study reported increases in rates of diagnosis during that 18 year period with the greatest increase in young adults (aged 18-29).

Most of the media article that covered this research study was generally accurate with wording that kept close to the researchers own words and indeed included quotes from them. However, a highly sensational headline, and a narrow focus on the interpretation of this increased prevalence, leads overall to a very biased article.

Let’s look at the headline first. It reads: ‘ADHD timebomb fear as diagnoses rocket in the UK among adult and boys over the past two decades’. This headline is completely out of context with the researcher’s interpretation of the findings, who compare the community prevalence of ADHD (5%) and the highest rates reported from this data (2.3%) and conclude that the much lower rate revealed in this data shows that “ADHD is therefore likely under-diagnosed rather than over-diagnosed in the UK”. So how does a ‘timebomb fear’ fit with this interpretation? And the negative connotation that comes from the reference to ‘diagnoses rocket in the UK’? Both of these sets of wording (and remember one is the headline!) lead the reader to arrive at a very different interpretation of the study findings than that of the researchers who carried out the study.

Some key findings of the study were left out of the media reporting. For example, rates of diagnosis of ADHD in under 5s were reported to have dropped substantially. This is an important finding but clearly would not have fitted with a headline of ‘ADHD timebomb fear as diagnoses rocket’ and was left out.

The media article picked up on the increased prevalence in adults. They were accurate in reporting that over the 18 year time period, there was approximately a 20-fold rise in ADHD diagnoses and nearly 50-fold in ADHD prescriptions in men aged between 18 to 29, from 0.01 per cent to 0.56 per cent.  It is good to see they referred to the baseline rate of 0.01 but unfortunate that they did not add an extra sentence to highlight that an extremely low starting rate such as 0.01 means that even 20-fold or 50-fold rises are still overall small. If your child eats one piece of chocolate per year and then has a 20-fold increase it means they are now having 20 pieces within a year – which is still a small overall rate of consumption. It would be very different if the starting point had been higher and one chocolate piece a day becomes 20!

It is always really important to contextualise any increase in something that may be related to a potential health concern. Here, there were numerous interpretations made by the researchers in the paper that could have been used to identify if increased rates of diagnosis or prescriptions were a health concern – but these were ignored. Examples include the variety of reasons that underlie the increased prevalence of ADHD diagnosis in the UK. The researchers identify drivers such as increased awareness among patients, caregivers and medical professionals as well as changing attitudes toward ADHD. And they refer to the possibility of over- or mis-diagnosis but conclude that ADHD is not over-diagnosed in the UK. What is the health concern here then? Well as the researchers themselves mention – waiting times for diagnosis are lengthy in the UK and adult ADHD services in particular are in dire need of appropriate resourcing. This is why media articles like this are not helpful and indeed potentially harmful.