The ADHD Diagnosis Boom: Are We Labeling Normal Struggles as Medical Conditions?

The ADHD Diagnosis Boom: Are We Labeling Normal Struggles as Medical Conditions?

In the 1980s, Attention Deficit Hyperactivity Disorder got its name. By the end of that decade, just forty people in Britain were being treated for it—all of them children. Today, more than 800,000 people are queuing for assessment and diagnosis. Thats a waiting list roughly the size of Leeds.

Something has changed. And its not our biology.

A Staggering Rise in Diagnoses

The numbers tell a story thats hard to ignore. According to statistics reported in The Times last week, 4.7 million people are now claiming disability or incapacity benefits in the UK—a rise of 1.8 million, or 62 percent, since 2019. A Lancet study published last month found that 1.19% of the English population has an ADHD diagnosis recorded in their GP records. The authors werent concerned that this figure was too high; they worried it was still below published estimates.

Meanwhile, a government report is set to recommend changing the system so that ADHD symptoms no longer automatically put people on the uphill road to a formal diagnosis. Health Secretary Wes Streeting ordered the review last December in response to rising diagnoses of ADHD and other mental conditions, set against a backdrop of increasing sickness and incapacity benefit claims.

Professor Peter Fonagy, a psychoanalyst at University College London, is leading the review. Hes made a pointed observation: people are being incentivised to get a diagnosis. “Incapacity and unemployment benefits now harm a great many of the people they are designed to help,” he has said.

The Problem With Diagnosis as a Goal

Heres where things get uncomfortable. Whatever the biological underpinnings of ADHD, they cannot have changed so quickly as to account for the extraordinary rise in diagnosis and referral. Genetics dont work that way. Yet a great many people genuinely have a problem, and their suffering is real.

Suffering doesnt become less real when its cause is uncertain—or when it comes from social circumstances rather than biology. It isnt less valid when its “all in the mind,” like grief. The more useful question isnt what causes ADHD but how we should respond. And the same holds true for many other mental afflictions that have become major blights on society and individual lives.

Medicine worries intensely about overdiagnosis, but usually in conditions like high cholesterol or high blood pressure—things that can be objectively measured and for which drugs have proven long-term benefits. In mental health discussions, the dominant complaint often runs the other way: that diagnoses are made too seldom.

Both concerns can be true simultaneously. Thats what makes this so tricky.

What Is the Virtue of a Diagnosis?

In Aaron Sorkins The West Wing, President Bartlet once asked about American military retaliation: “What is the virtue of a proportional response?” The goal wasnt to kill the same number of people the other side had killed. The goal was to stop them killing again.

Medicine often adopts a similar approach. As a junior doctor, I was trained not to conduct tests that wouldnt change patient management. As a consultant, I repeat that lesson to others. All tests come at a cost—money, side effects, the fact that accuracy is never perfect. Therefore, only order tests whose results bring benefits.

Usually that means tests that trigger a change in treatment. But not always. There are situations in which diagnosis itself is treatment. Knowing whats wrong with you can help, even if the diagnosis is nothing more than a label.

When I was a young athlete, I had knee pain. The doctor diagnosed me with chondromalacia patellae, and I felt better. The pain suddenly seemed subsidiary. I carried on running, rowing, boxing. Friends who were already medically qualified laughed and said the GP had simply told me in Greek what I had told him in English. They were right—but somehow it helped.

The Trap of Illness as Identity

But theres a darker side to this dynamic. A benefits system can damage people by turning illness into the most rewarding explanation for their struggles. More and more of us are trapped without the dignity of work, swallowed up by disease labels and a sense of self built around being the victim of illness or economics or misfortune.

Professor Fonagy holds a sensible view: incentives shape outcomes. Incentivise people to get a diagnosis, and thats what theyll do. His argument isnt that people should be told to develop more moral fibre. Its that help should be available regardless of whether a formal diagnosis exists.

Only those likely to benefit from a diagnosis—perhaps because drugs may help—would be routed through clinics. Others would be directed to non-clinical forms of support, from parenting classes to workplace adjustments.

This approach recognises something important: the label isnt always the solution. Sometimes its a barrier.

Measuring What Actually Works

Theories about why treatments might work can suggest possibilities. But whether an approach works—from a pill to a talking therapy to a government strategy—must be established by reliably measuring its effects, not by working outwards from conjecture.

In 2000, NICE first issued guidance on treatment of childhood ADHD. In 2008, its guidelines covered adults too. The medical establishment has been engaged with this condition for decades. Yet the explosion in diagnoses suggests something has gone awry in how we identify and respond to mental distress.

How we disentangle help from diagnosis is delicate work. One hopes Professor Fonagys report will help more than it harms. But the conversation needs to happen in public, not just in committee rooms.

The question isnt whether ADHD exists. It clearly does. The question is whether our current system—one that creates an 800,000-person queue and incentivises diagnosis as a pathway to support—is actually helping the people it claims to serve.

What would a better system look like? One where help doesnt require a label. One where suffering is addressed regardless of its cause. One where people arent trapped by their diagnoses but empowered despite them.

Thats worth queuing up for.

Related Articles

The ADHD and Autism Diagnosis Shift: Why Todays Diagnosed Kids Look More Like Everyone Else

Zombieing: The Dating Trend That Makes Ghosting Look Like a Warm-Up

The ADHD Misdiagnosis Hiding in Your Childs Bedtime Routine

The Brains Blue Place Isnt a Foghorn — Its a Precision Postal Network, Scientists Discover

When Neurodivergent Becomes a Catch-All, Science Gets Lost in Translation

The Word Neurodivergent Is Everywhere. Science Says We Still Dont Know What It Means.