ADHD Diagnoses Are Soaring Across Europe, But the Condition Itself Is Not

Attention deficit hyperactivity disorder seems to be everywhere at the moment. Social media feeds are full of self-assessment checklists, waiting lists for assessment have lengthened dramatically, and prescriptions have climbed year after year in country after country. For clinicians and researchers, however, a crucial question sits underneath the headlines: are more people actually developing ADHD, or are health systems simply getting better at recognising a condition that has always been there? That question will take centre stage at the 39th ECNP Congress in Munich, Europe’s main clinical neuroscience conference, where Professor Anita Thapar of Cardiff University will present a synthesis of the evidence. Her conclusion is striking in its clarity: the rise in cases of ADHD across Europe appears to be driven mainly by changes in awareness and diagnosis rather than by any genuine epidemic of the condition, and in some countries ADHD remains substantially under-diagnosed.

Professor Thapar brings considerable authority to this assessment. She chaired the NHS England ADHD taskforce and co-chaired the Welsh Government Neurodivergence Ministerial Advisory Group, placing her at the heart of the policy debate about why referrals and treatment for ADHD are increasing across the United Kingdom and Europe even as the underlying prevalence in the population appears stable. Her session in Munich will focus primarily on UK data and evidence while drawing on findings relevant to other European countries, and it is designed as an open discussion about what is driving the surge in referrals and how healthcare systems can respond to rising demand while ensuring that people who may have ADHD receive appropriate assessment and support. The framing matters, because the answer shapes how governments allocate resources, how clinicians triage assessments, and how the public understands what is happening around them.

The technical distinction at the heart of the argument is between diagnosed prevalence and population prevalence. Diagnosed prevalence refers to the total number of clinically recognised cases recorded within health systems, while population prevalence describes the expected rate of the condition in the community, estimated through epidemiological research. Evidence cited in the presentation confirms that diagnosed prevalence of ADHD has increased significantly in recent years, yet the population rate itself is estimated at approximately five to seven per cent of children and two to three per cent of adults across Europe, figures that have remained broadly consistent across European countries. In some nations, the proportion of people with a recognised ADHD diagnosis now matches that population rate. In others, including the United Kingdom, diagnosed rates sit well below the expected population figure, which is precisely why researchers argue that the condition is still under-recognised and under-treated rather than over-diagnosed.

Professor Thapar argues that several converging factors explain the diagnostic surge. Diagnostic criteria for ADHD have changed over time, which means the threshold at which a diagnosis is made and treatment is indicated has also moved. Public and professional awareness has improved markedly, and research evidence on ADHD and its associated risks has accumulated to the point where the condition is now being recognised where in the past it was not. She draws a deliberate parallel with other medical conditions: high lipid levels and hypertension and their health risks were not widely recognised in the 1960s, yet nobody today interprets the routine identification and treatment of those conditions as evidence of an epidemic. The same logic, she contends, applies to ADHD. As she puts it, the rise in diagnoses seems to be due to changes in diagnostic criteria, improved awareness and research evidence on ADHD and its risks, rather than to an epidemic of ADHD itself.

Two groups whose ADHD was historically overlooked deserve particular attention. There is now much greater awareness that ADHD can affect adults, not only children, and far stronger evidence that the condition develops in women and girls, something that was neglected in the past because the classic hyperactive presentation seen in young boys dominated both research and clinical expectations. This shift has visible consequences in prescribing data. A recent publication reported increased ADHD medication use in Belgium, Germany, the Netherlands, Spain and the United Kingdom between 2010 and 2023. In the UK, the prevalence of medication use rose more than threefold over that period, from 0.12 per cent to 0.39 per cent of the population, with adult use increasing particularly sharply among women. That pattern is exactly what would be expected if long-missed cases in women and adults were finally being identified, rather than what would be expected from a sudden new environmental cause.

Another important technical point concerns the nature of the condition itself. Having ADHD is not a simple yes-or-no state. As with high blood pressure or high cholesterol, the degree of the condition varies along a spectrum within the population, and the point at which doctors intervene, meaning the diagnostic threshold at which treatment is indicated, can change over time in line with research evidence. Guidelines typically suggest starting with non-pharmacological support and then moving to ADHD medication if those other strategies prove insufficient. This spectrum model explains why small shifts in clinical guidance or public understanding can produce large shifts in recorded case numbers without any change in the underlying biology of the population. It also explains why different countries, applying the same broad diagnostic concept within different service structures, can report very different diagnosed rates.

Indeed, that international variation is one of the most telling pieces of evidence. Population prevalence estimates for ADHD are broadly consistent across European countries, but the number of people formally recognised or treated within health systems varies considerably depending on service provision, access to assessment and local clinical practice. In the United Kingdom, the rate at which ADHD is seen in clinics is lower than the true rate of ADHD in the population, which researchers interpret as a clear signal that the condition is under-recognised and under-treated rather than over-diagnosed. While some observers raise concerns about potential misdiagnosis as assessments multiply, Professor Thapar notes that the research evidence on that question is limited, and she cautions against drawing firm conclusions in either direction from the limited data available.

The stakes of getting this right extend beyond statistics. There is now evidence that treatment can reduce known risks associated with ADHD, including premature mortality and suicide, which reframes the diagnostic surge not as a fashionable trend but as the identification of a genuine health risk that carries real consequences when missed. Untreated ADHD is associated with substantial impairment across education, employment and relationships, and the accumulating evidence base on those risks is itself one of the drivers of improved recognition, as clinicians and policymakers take the condition more seriously. From this perspective, the rising number of referrals reflects a health system slowly catching up with the evidence rather than chasing a fad, even if the pace of that catch-up is straining assessment services.

The wider research community has welcomed the growing recognition while sounding a note of frustration about resources. Commenting on the presentation, Professor Barbara Franke of Radboud University in Nijmegen, the Netherlands, an independent commentator who was not involved in the work, said that for years ADHD researchers have done their best to raise awareness that ADHD is underdiagnosed in females and in adults in general, and that over recent years this knowledge has finally taken hold in the population, but with such speed that it feels like an epidemic. Despite the relatively high prevalence and the burden associated with the condition, however, she noted that funding for research into ADHD, from its causes to its treatment, is surprisingly hard to find, and that ADHD unfortunately remains one of the most under-researched conditions in medicine, a situation she sincerely hopes will change.

For the public, the message from Munich is likely to be one of reassurance tempered with realism. The explosion in ADHD diagnoses across the UK and Europe tells a story about medicine catching up, about women and adults finally being seen, and about diagnostic thresholds moving in line with better evidence, not about a mysterious new epidemic sweeping a generation. At the same time, the gap between the estimated five to seven per cent of children and two to three per cent of adults who have the condition and the far smaller numbers actually diagnosed and treated in countries like the UK means that demand for assessment will likely continue to grow as awareness spreads. The challenge for healthcare systems, as the ECNP discussion will explore, is to meet that rising demand with adequate services and funding, ensuring that people who may have ADHD receive timely and appropriate assessment and support, while sustaining the research effort needed to answer the questions that still remain about this long-overlooked condition.

Subject of Research: Rising ADHD diagnosis rates and population prevalence in the UK and Europe

Article Title: Is ADHD on the rise in children and adults in the UK and Europe?

Article References: Is ADHD on the rise in children and adults in the UK and Europe?. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: ADHD, diagnosis, prevalence, ECNP Congress, Anita Thapar, United Kingdom, Europe, medication use, under-diagnosis, women and girls, adult ADHD, Cardiff University