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Is ADHD under- or over-diagnosed?

Is ADHD under- or over-diagnosed?

The number of ADHD diagnoses has risen significantly in recent decades. However, this says nothing about whether ADHD is under- or overdiagnosed.

ADHD has become much better known in recent years. The fact that ADHD also affects adults became apparent in research at around the turn of the millennium. Naturally, it took several years for this realization to reach clinical practice, i.e. doctors and psychologists.
Since 2022, social media (Instagram, TikTok, Facebook) have brought the issue to the public’s attention in an entertaining way.

Our impression is that many adult people with ADHD only realize through such media what has burdened them throughout their lives and that this burden does not necessarily have to be simply accepted. This leads to an increasing demand for diagnostics.
In German-speaking countries, many doctors and psychologists are not yet familiar with ADHD in adults to the extent that would be appropriate for a disorder that affects 8 to 12% of all children1 and 5 to 8% of all adults. However, we are seeing that more and more doctors and psychologists are recognizing the problem and that there are now a growing number of doctors and psychologists beyond the big, renowned specialist names who are excellently informed about ADHD and are also very good at solving difficult problems.

A meta-analysis of 135 studies found no evidence that the prevalence of ADHD has changed in the last three decades. Differences in prevalence are rather the result of different study methods.2
Differences naturally arise if one looks at the diagnostic prevalence (how often ADHD is present in the population when a representative group of specialists is examined) instead of the field prevalence (how often ADHD has been diagnosed). The diagnostic prevalence depends firstly on the awareness of people with ADHD (which prompts them to ask for a diagnosis) and secondly on the knowledge of the medical profession (the ability to recognize ADHD). Both have increased significantly in recent years.

Furthermore, the relevant data do not indicate that ADHD is diagnosed too frequently or too rarely.3

The fact that the consumption of methylphenidate (the most important ADHD medication) is measured in tons is certainly not an indication. At best, this is a sign of a lack of knowledge of basic mathematical operations - or a lack of will to use them adequately
In Germany, around 1.8 tons of methylphenidate were prescribed and consumed in 2013.
1 ton is 1000 kg is 1000 x 1000 = 1 million grams.
The average daily dose is 40 mg.
The annual requirement is therefore 365 x 40 = 14,600 milligrams = 14.6 grams
1 million / 14.6 results in 68,493 annual doses, i.e. people with ADHD who have been medicated for one year.
1.8 tons / year is enough for around 123,000 people with ADHD / year.

In 2019, a total of around 56 million daily doses of methylphenidate were prescribed by German doctors.4
This corresponds to around 153,000 annual doses, an increase of around 25 % compared to 2013.

Of Germany’s 82 million inhabitants, 46 million are adults of working age.
If 6% of these are affected, this results in 4.92 million people with ADHD.
The 1.8 tons mentioned are therefore sufficient for 2.51% of the people with ADHD in employment.
But then no child has received even a single milligram of methylphenidate.

This shows that there is very severe under-treatment.

One study showed that around 3/4 of all children with ADHD receive no treatment.5

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