ADHD remains under-recognised and under-diagnosed in England despite recent increases in diagnosis and better understanding of the condition, according to a new study.
The research, carried out by academics at UCL, University of Liverpool and King’s College London, found that while 1.19% of people in England had an ADHD diagnosis in their primary care record, recorded diagnosis rates were lower across all age groups compared with the international estimates, which typically range between 3% and 5%.
This gap was especially large in older adults, with just 0.05% of men and women over the age of 65 diagnosed with ADHD.
The researchers say their findings show that while diagnosis rates for ADHD have increased substantially over the past decade for both children and adults, recorded diagnoses of ADHD in England are still lower than the best available estimates of ADHD prevalence.
ADHD is being under-recognised, challenging increasingly common narratives about overdiagnosis
Rates of new ADHD diagnoses increased markedly after 2020 across most age groups, with the highest rates observed in boys under 18 years old, while increases among adults were particularly notable in women.
In contrast, diagnosis rates among adults aged 65 and over remained consistently low throughout the study period.
Better recognition
Dr Amber John, psychology lecturer and lead researcher, who began the research at UCL before moving to the University of Liverpool, said: “The low rates observed in older adults don’t necessarily mean that ADHD is uncommon in older age.
“Instead, they may reflect historical differences in recognition and access to diagnosis, particularly among generations who grew up before ADHD was widely recognised.”
A major benefit to accurately understanding the incidence of ADHD across the population is in ensuring that appropriate services are in place, the study said.
The authors of the research, funded by the Medical Research Foundation and the British Academy, used data from more than 3.5 million people registered with GP practices in England in 2025 to estimate the proportion of people with a recorded ADHD diagnosis at this time.
They then compared this with published estimates of ADHD prevalence in the general population from international studies, pulling together research to estimate how common ADHD really is, and used data from more than 42 million patients in England to examine diagnostic trends in ADHD from 2000 to 2024.
Dr Gavin Stewart, British Academy research fellow at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London and another of the authors, said: “When we compared recorded ADHD diagnoses with published estimates of how common ADHD is in the population, we found a substantial gap across every age group.
“This gap was especially large in older adults, suggesting that many people may have gone unrecognised.”
Life expectancy
A previous UCL-led study comparing 30,029 adults across the UK with diagnosed ADHD and 300,390 participants without ADHD found that adults with ADHD have reduced life expectancies because of increased rates of physical and mental health problems.
It called for better services and for clinicians to be aware that many sections of the population – including older people, women and those from minority ethnic communities – may not have a diagnosis but needed support for their needs.
Dr Georgia Pavlopoulou, associate professor at UCL and neurodiversity programmes lead at Anna Freud, added: “Our findings suggest that ADHD is being under-recognised, challenging increasingly common narratives about overdiagnosis.
“The results also indicate that some groups who do not fit traditional stereotypes about ADHD. To turn this evidence into action, we want to see services better resourced to provide culturally responsive, gender-informed and equitable support.”
The paper, Attention-Deficit/Hyperactivity Disorder in Children and Adults in England, 2000–2025: Recorded Prevalence and Diagnostic Trends in a Population-Based Observational Study Using Routinely Collected Primary Care Data was published in The Lancet Regional Health – Europe
