ADHD in adults: overdiagnosed or underdiagnosed?

Visual series

6 slides, in Turkish · Instagram

Diagnosis rates are rising. What does this rise reflect?

Catching up: People missed in childhood are seeking help as adults, and more girls and women are being diagnosed.
Growing clinical experience: The neurodevelopmental framework has broadened and the idea of co-occurring conditions is now established.
Public awareness: Information and health services are easier to reach, and more people want to access support.
Scientific progress: Strong evidence on executive functions, ADHD and its lifelong course keeps growing.
Social media: It can raise awareness and help-seeking, but misinformation is also common.

Some factors make the thought “I might have ADHD” more likely.

An awareness workshop: When young adults at low risk of ADHD attended an awareness workshop, the thought “I might have ADHD” rose markedly. Self-diagnosis increased without any increase in symptoms.
Information, expectation, interpretation: Learning about ADHD symptoms made people more likely to read everyday attention lapses as “ADHD”.
The nocebo effect: Negative expectations can make ordinary experiences feel like symptoms of a disorder. A brief “nocebo education” reduced this effect.
Popularity: Greater visibility makes services easier to reach, but it can also raise the risk of mistaken self-diagnosis.

Modifiable factors also play a part in attention problems.

Undiagnosed university students: Current symptoms, childhood history and objective tests were assessed together.
An attention complaint ≠ neurodevelopmental ADHD: There may be an ADHD-like “adaptation pattern” that is independent of childhood symptoms. Objective attention tests did not differ between groups.
Lifestyle and psychosocial factors: Sleep quality, screen time, stress and anxiety contributed to ADHD symptoms.

Two large cohort studies in JAMA Network journals

The most common neurodevelopmental disorder: Genetic factors are strong, and it involves difficulties with executive functions. It more often comes with mental, physical and social problems.
Treatment lowers real-life risks: Substance use, self-harm, traffic crashes and criminal behaviour decrease.
Treatment lowers mortality: Over two years of follow-up, all-cause mortality was lower, especially deaths from unnatural causes such as suicide, accidents and poisoning.

The debate about diagnosis offers a narrow frame.

Diagnosis helps clinical decisions: But a diagnostic threshold alone does not meet the needs of young people and adults.
Symptoms lie on a continuum: A sharp cut-off is hard to set; risk and impairment rise as symptoms increase.
Downplaying ADHD is dangerous: It is linked to mental and physical illness and to losses in education, work and social life.
Overdiagnosis debates are not unique to ADHD: Thresholds and treatment limits are debated for conditions such as hypertension and obesity too. Modern medicine aims to extend life and improve its quality through early intervention.

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Adapted from an Instagram series (in Turkish). General information only; it does not replace a medical assessment.

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