I’m a doctor and this is what I think about GPs ‘over-diagnosing’ ADHD

“What we are now seeing is lots of young women having the courage to step forward and get a diagnosis of ADHD.”

It's no secret that ADHD cases are on the rise. According to the National Institute for Health and Care Research, ADHD cases rose by 20 times in the UK between 2000 and 2018. And it seems the NHS can't keep up with the rise in cases — in fact, they recently announced their intention to pay for thousands of new ADHD patients to receive treatment at private clinics to keep up with the growing demand.

The rise of ADHD in the UK has been so steep, it has left some people concerned that young people are getting their information about the condition from TikTok and are self-diagnosing. “Many young people are self-diagnosing ADHD after viewing TikTok videos,” wrote researchers from the University of East Anglia in a 2022 study published by the Cambridge University Press. “This may improve mental health stigma, however the expertise of the video creators should be scrutinised.” A 2021 report even suggested that the condition may be over-diagnosed in young people who do not, in fact, have the condition.

However, while it may seem like ADHD is on rise due to TikTok misinformation and young people jumping on social media trends, the reality may be a little more complex. According to Dr Aarthi Sinha, the rise of ADHD diagnoses in the UK is, in fact, a sign of increased awareness around the condition — particularly for women who are typically much better at masking their symptoms. In the past, she claims, ADHD has been woefully under-diagnosed in women — the new rise in cases, she says, is merely bringing the levels closer to where they ought to be.

Below is our full conversation with Sinha on the rise of ADHD in the UK, why it's happening, and what it means for young women.

Have you seen an increase in patients coming to you asking about ADHD?

As an NHS and Private GP, I have seen a marked increase in patients seeking clarification on whether they may have a diagnosis of ADHD or Autism in the last few years – this is now a weekly occurrence – if not several a times a week – which is starkly different to about 5 years ago. As GPs, we are often a person’s first port of call and I always promote an open, supportive and non-judgemental approach. It can often take a person a few visits to the GP before they feel they can open up about how they are feeling.

What do you think has fuelled this increase?

I think that the rise in people seeking to clarify a possible ADHD, Autism or other neurodivergent diagnosis, has been fuelled by an increasing societal awareness of neurodiversity with the gradual breaking down of traditional attitudes, taboos and stigmas around mental health diagnoses and disabilities. This has therefore led to more people seeking help from their doctor to see if any difficulties they have been experiencing are due to this, just like we would any other physical or mental health condition. I also find that people are more willing to share their lived experiences to promote awareness and help others. All these things are positive moves in the right direction, although we still have a long way to go.

“I do not believe from my experience that there is an over-diagnosis of ADHD at all.”

What do you think about claims doctors are 'over-diagnosing' ADHD?

The prevalence of ADHD in adults is thought to be 3% to 4% with a male to female ratio of 3:1 although this is changing. I do not believe from my experience that there is an over-diagnosis of ADHD at all. There is simply a higher rate of truly existent ADHD, Autism and other Neurodivergent conditions (such as Dyscalculia and Dyslexia) through increased awareness both in the general population and amongst healthcare and allied professionals eg within the education system and workplace.

Is it even possible to 'over-diagnose' a condition? 

I was previously an NHS GP Partner in Camden and Islington, an area with a large proportion of the population aged between 18 and 35. I was responsible for overseeing the Autism and Neurodivergent conditions long term care delivery. I can honestly say that you cannot ‘over-diagnose’ a condition – rather you may misdiagnose it (e.g. other conditions such as mood regulation disorders may mimic ADHD, or mood disorders may be misdiagnosed as the primary diagnosis when it is secondary to an underlying neurodivergent condition).

If a patient presents with certain symptoms – and more importantly concerns that their emotional and mental wellbeing could be being affected by an underlying neurodivergent condition such as ADHD or Autism – GPs should not turn them away. The GP has a moral and professional obligation to fully take a history of all the symptoms that patient is experiencing, what their ideas, concerns and expectations are, and then make a management plan to help that person. It is not up to the GP whether they believe that the patient has ADHD or not – it is their responsibility to signpost or refer the patient onwards where they can get the appropriate support or diagnosis they need.

The first time that patient comes to the GP with their concerns is absolutely critical; they have finally mustered the courage to seek help, which would definitely have been all the more difficult to do if they have ADHD, Autism or other neurodivergent conditions. This effort should be recognised, respected and the experience made a positive and re-affirming one for the patient. This isn't ‘misdiagnosis’, in many cases it may be a case of ‘ADHD sufferers finally asking for, and receiving the help they need’.

What about the strain on the NHS?

As a result of increased awareness and a higher rate of diagnosis, there are more referrals being made by GPs to secondary Adult ADHD Clinics. This has led to an increased waiting list time to be seen – currently I have seen waiting lists on the NHS of at least 2 years. This must be incredibly difficult for those patients who are waiting for the right support. We really need more investment, more structuring of services and even more awareness to tackle this problem in the long run – it would be ideal if ADHD was picked up when individuals were much younger.

How does undiagnosed ADHD impact a person's life? Why is diagnosis and subsequent treatment so important?

Undiagnosed ADHD, Autism and other neurodivergent conditions can have an incredibly detrimental effect on a person’s life. Without a diagnosis there can be a lack of recognition of difficulties that these individuals can face, which may not resolve until they get a proper diagnosis with an appropriate treatment and support plan.

In the workplace, undiagnosed ADHD means that there will be a lack of support to help with focusing, organisation, meeting deadlines and time management. This can cause significant under achievement in academic settings and in the workplace, denying individuals the correct role or resulting in unemployment.

“We really need more investment, more structuring of services and even more awareness to tackle this problem in the long run.”

An individual with an undiagnosed neurodivergent condition such as ADHD will often mask, which can be harmful to their mental health. Masking is the term where neurodivergent individuals ‘mask’ or ‘camouflage’ certain traits (or replace them with other ones) to attempt to fit in with societal (often neurotypical) expectations around them; for example suppressing the urge to stim or move around in a particular situation. Whilst we may all do some element of masking (like at a job interview) this can often become ingrained into a neurodivergent individual’s daily life. I can only imagine how incredibly stressful it must be to have to pretend to be someone you are not on a minute-by-minute basis! This often leads to high levels of stress and depression, low self-esteem, and even suicidal thoughts. Physical health can also be adversely affected as these individuals often have sensory needs, which if not diagnosed and managed (often by an occupational therapist) can lead to higher rates of accidents and injuries as well as poor nutrition.

One of the biggest challenges for those with ADHD, Autism and other neurodivergent conditions is navigating the complexities and social demands of relationships. This can often affect young women more, as they tend to be better at masking and hence their underlying diagnosis may be more likely to be missed. Without a diagnosis, difficulties in reading social cues, forgetfulness, challenges in managing emotional regulation and impulsivity can all lead to conflicts and frustration with family members and partners, without the young person even understanding what is going on or why this is happening.

Most of my young female adult patients tell me that finally getting a diagnosis of ADHD or other neurodivergent conditions in young adulthood has suddenly given them much needed clarity about why they always perhaps felt they did not fit in, or were ‘naughty’ at school amongst other challenges. I have not come across any young adults who regretted receiving a diagnosis, and my experience is that the right diagnosis in the right individual only serves to improve their quality of life and emotional and mental wellbeing.

Dr Aarthi Sinha

How do you think a lack of awareness about neurodivergence has held women with ADHD back? Is there an element of medical misogyny?

I think that an overall lower rate of diagnosis of ADHD in women, caused by a traditional lack of awareness about neurodivergence in women, has had a role in holding back women with ADHD.  Again, this lack of awareness stems from the ability of young women to be better at masking, therefore resulting in a higher rate of ADHD and other neurodivergent diagnoses in men, and therefore perhaps a stereotypical association of ADHD with men rather than young women. This then ends up being a self-perpetuating cycle. However, I have clearly seen this changing markedly in the last few years in both my NHS and private practice as young women are rightfully advocating for themselves more powerfully, with positive impacts on their jobs, relationships and self-confidence. We do see more and more women being diagnosed, but from my experience this is just a higher rate of diagnosis of pre-existing ADHD brought about by the above factors rather than misogyny or mocking of women’s symptoms. I think sharing lived experiences has a key role to play in fuelling this further and in breaking away from traditional stereotypes.

Do you think the increase in diagnoses is, in part, a result in breaking down these barriers?

Absolutely! Instead of the negative self-perpetuating cycle I described above, what we are now seeing is lots of young women having the courage to step forward and get a diagnosis of ADHD. They are then sharing these experiences with family and friends, which then encourages them to seek help if they feel they need it. This is a lovely positive cycle to see, and the more of us talking openly about ADHD and neurodiversity there are, the closer we get to finally breaking down all those barriers and stigmas.

Do you worry that young women are increasingly relying on social media as a diagnostic tool?

Yes, I do worry that young women are increasingly relying on social media as a diagnostic tool. Social media is a great way of spreading  accurate information to large numbers of individuals to provide education about different aspects of healthcare. I use my social media account for this purpose. This is particularly relevant to those with ADHD, Autism and other neurodivergent conditions, some of whom may be more comfortable with accessing information from social media and websites, rather than through interactions with others. As individuals with undiagnosed ADHD can often have low self-esteem and anxiety, (as they try to understand why they are feeling the way they are), they can be particularly vulnerable to misinformation. I would not stop anyone from seeking out such information, but I would suggest that it is always then best to take any information you find to your GP to discuss – please do not hesitate or worry about doing this, that is what we are here for. It is also important to understand that no two individuals with ADHD, Autism or other neurodivergent conditions will be the same – so any advice, tips of lived experiences shared on TikTok or other platforms, need to be interpreted in context to avoid young women causing harm to themselves.

“We are not over diagnosing these conditions. We are simply breaking down traditional barriers, improving awareness and correctly increasing the rate of diagnosis.”

Do you think this is inadvertently caused by the medical profession not taking young women's symptoms seriously?

I think that the medical profession does take young women’s symptoms seriously, but on the NHS there are often simply not enough staff, clinics or other resources to meet the demands of young women in a timely manner. They may therefore turn to social media for this support in times of great need. Some individuals choose to go privately for a diagnosis and treatment plan, but this can cost thousands of pounds. Patients on the NHS can also be referred on the ‘right to choose’ pathway — so they can be referred to an ADHD Clinic outside of their geographical area if a shorter waiting time is available, but the waiting lists are often very long across the country.

What would you say to people who think GPs are over-diagnosing these conditions?

We are not over diagnosing these conditions. We are simply breaking down traditional barriers, improving awareness and correctly increasing the rate of diagnosis – particularly in young women so they do not have to undergo the chronic stress of having to mask to the same extent every day without any support. This approach should be welcomed by everyone as it ultimately improves the quality of people’s lives.

What would be your advice to any women who think they might have ADHD?

Go and see your GP first to explore your health concerns holistically. They should work together with you to make a plan going forward as you may have several other physical or mental health issues that may need addressing first or at the same time as the ADHD. This holistic approach is key and what I provide my patients with. Understanding the interplay between the physical, mental and emotional aspects of your ADHD and other health concerns is the key to improving your well being and self-confidence.

What would your advice be to those who think they might have ADHD, but don't want to contribute to the strain on the NHS?

Please prioritise yourself first! Yes the NHS is under strain but this should not stop you from seeking help. I would always advise you to come and speak to your GP about these concerns of yours so that we can work through what is best for you together. Open conversations are key to making progress for you on an individual level with your ADHD, but also in helping society move forward as a whole and helping the NHS to responsively adapt to your needs.

You have personal experience with ADHD diagnosis, too. Was it difficult for your daughter to get her autism and ADHD diagnosis?

My daughter, Aneeta, got her diagnosis very early on before she was in school. I think it may have been easier for her as being a GP, I was aware of the signs to look out for and exactly where to seek help from. This is why I am passionate about using my combined personal and professional experience as a platform to help other young women.

Her diagnosis has been important, as it helps her to understand who she is, helps her to understand why she may not feel or respond the same as others and most importantly that this is perfectly acceptable. I think that having a diagnosis has only empowered her sense of self-worth.