Overdiagnosis and -treatment of ADHD is more a North American problem
Moynihan et al. make an important point about analysing the impact of missed medical appointments during the COVID-19 lockdown as an opportunity for evidence-based reduction of unnecessary healthcare.
We were not happy to see ADHD on the list of over-diagnosed conditions in the BMJ, which is read primarily by members of the British Medical Association. There is good evidence from pharmaco-epidemiological studies that prescribing of ADHD medication in the US is 5-8 times higher in children and adolescents, and 10-20 times higher in adults with ADHD compared to countries with much lower prescribing rates in Europe (France, UK and Spain) and worldwide (Japan, Australia). Prescribing of ADHD medication in the UK has increased considerably in the last 20 years, especially for 10-14 year-old boys, but 2014 data indicate that less than 0.1% of adults in UK were prescribed ADHD medication, this is by a factor 10-40 lower than the global prevalence of ADHD in adults (1.4-3.6 %). The prevalence of ADHD was stable from 1985-2012 when controlling for study methods. However, in the UK and elsewhere in Europe, ADHD is an under-diagnosed condition and ADHD medication is widely under-prescribed.
Most NHS services have waiting lists of 1-2 years for an adult ADHD assessment and this situation has just got worse with the closing down of many ADHD services that were considered non-essential during the pandemic lockdown. We need more funding and more efficient NHS services (including video-consultations, electronic prescribing and trained doctors & nurse prescribers) to tackle this problem.
1. Moynihan et al., BMJ 2020; 370:m2752
2. Raman et al., Lancet Psychiatry 2018; 5: 824-35
3. Fayyad et al., Atten Def Hyp Disord 201; 9: 47-65
4. Polanczyk et al., Int J Epidemiol 2014; 43: 434-42
Competing interests: UM-S is joint president and JS-M executive committee member of UKAAN (www.ukaan.org), which has received educational funding from Flynn/Medice, Janssen & Shire/Takeda