The number of adolescent girls prescribed ADHD-related medication under NHS England has more than tripled since 2016, but psychiatrists believe diagnosing in girls needs improvement.
NHS BSA data shows 10,198 girls aged 10-19 had NHS prescriptions for Central Nervous System Stimulants (CNS) stimulants and drugs relating to ADHD in 2016, a figure which has increased by 208% over the last decade, reaching 31,392 in 2024.
In the past three years, the figure saw its greatest increase of 26% between 2022 & 2023 and 20% between 2023 and 2024, compared to a 11.8% & 9% over the same period for their male counterparts.
The gender diagnosis gap
However, despite the boom in ADHD-related prescriptions for adolescent girls, young boys still for the majority of prescriptions.
Between 2023 & 2024, nearly three quarters of the 117,792 NHS patients in the age bracket 10-19 were boys.
Experts agree that the reason for this disproportion is not down to a lesser prevalence of ADHD in girls, but a disparity in understanding of how ADHD presents in girls, in the psychiatry field.
Patients are assessed for ADHD based on their presentation of 18 symptoms: nine indicating hyperactivity and impulsivity and nine indicating inattention.
Impulsivity relates to such behaviours as speaking over other people and reckless decision- making while hyperactivity refers to fidgeting and restlessness.
Symptoms of inattention include an umbrella term: executive function deficit, which encomes a broad range of behaviours, such as deficit in working memory and difficulties prioritising tasks and regulating emotions, otherwise known as emotional dysregulation.
Dr Asad Raffi, consultant psychiatrist and founder of private ADHD specialist clinic, Sanctum Healthcare, discussed how emotional dysregulation and alexithymia, a term used to describe a difficulty expressing your emotions, are prominent features of ADHD in girls.
Raffi said: “Females with ADHD are more internal, more emotional. They often have dare I say a more complex presentation.
“If you have external scaffolding, be that the school environment, be that parents compensating for you, ADHD will go undetected.
“What tends to happen is when girls face transitions in life, going from primary into secondary school, secondary school into college, you’re expected to become independent, that’s when you get exposed.
‘“Especially with these transitions and the onset of puberty, it’s often when you will see symptoms emerge catastrophically.”
As the NHS guidelines on ADHD state that symptoms should emerge before the age of 12, this often leads to ADHD going undetected and undiagnosed in girls.
Inadequate tools to diagnose ADHD in girls
Dr Mirza Kah, a consultant child and adolescent psychiatrist at the NHS Hertfordshire Partnership Foundation Trust, argues that some of the tools that have been used for the past few decades in ADHD diagnosis have blind spots when it comes to female diagnosis.
The Conners Rating Scale is a questionnaire commonly used in the initial screening stage of ADHD assessment but was created with the ADHD symptoms, typically hyperactive, in mind.
Emotional dysregulation is not a part of the questionnaire.
As well as working for the NHS, Dr Kah also holds a private clinic one day of the week and has found that using a Development and Wellbeing Assessment, which creates a comprehensive picture of the individual’s emotional and psychological state has been a better tool for diagnosing ADHD in girls.
He said: “Girls with ADHD often have significant levels of emotional dysregulation, along with a lot of difficulties in their social and emotional relationships.
“The Conners Scale was created with young boys in mind. We are misdiagnosing girls because we are not using the right kind of tools.”
He is currently developing a ADHD-symptom scale catering to young girls which he hopes will soon be adopted by the NHS.
Social understanding of ADHD
Beyond the medical field, a social awareness of ADHD which is skewed more towards boys has meant that teachers often don’t spot the learning difficulty in female students.
Auriel, 22, was diagnosed with ADHD in the lead up to her GCSEs.
Even though her teachers had noticed she had been struggling to keep up with the workload and hadn’t completing assignments, they didn’t suggest she might have ADHD.
Auriel said: “I don’t think it was in the forefront of my teachers’ minds. They never suggested it. Their was, your work isn’t getting done, you need to start doing this if you want to get good grades.
“A lot of the teachers had come from teaching at the all boys school next us, so they probably encountered ADHD, but it presents differently in girls and I don’t think they had taken that into .”
Increase in ADHD diagnosis and demand for medication
However, despite dissatisfaction with the tools used to diagnose ADHD in girls, it still remains that the number of people being diagnosed with the condition generally has sky-rocketed in recent years.
The BBC reported that the current waiting list for people seeking an ADHD diagnosis on the NHS would take up to eight years to clear in some parts of the UK and estimated that nearly 200,000 people were on the waiting list for diagnosis in 2024.
In March 2024, NHS England created an ADHD taskforce to tackle the surge in numbers, exacerbated by the backlog from COVID-19.
In London alone, NHS spending on ADHD-related medications has tripled since 2020, increasing from £650,855 in August 2020 to just shy of £2 million in February.
April-June 2024 saw the biggest increase in NHS England prescription spending for CNS stimulants and drugs for ADHD off all the drug groups measured at 6.4% to £36 million, according to NHS BSA.
The explosion in demand for ADHD medication has partially caused a UK-wide shortage of methylphenidate, one of the main CNS stimulants prescribed to treat ADHD.
Jordan, 23, who has been taking ADHD medication since she was 16 has had to half her dosage recently due to the medication shortage.
She said: “It’s great more people are finally getting diagnosed. Not only has ADHD become easier to diagnose because there’s more awareness about it but also because of social media and attention spans going down because of it, ADHD does exist more.
“I think now with everyone saying ‘oh everyone’s a little ADHD, it becomes a lot more difficult to spot.”
TikTok in particular has become a double-edged sword as a platform, simultaneously compounding short-attention spans characteristic of ADHD while also raising social awareness on the condition.
However, Dr Raffi believes the proliferation of ADHD-related content has confused further what constitutes ADHD.
He said: “There is a lot of misinformation online.
“We live in a stressful society and we are faced with more information, whether that is misinformation or the right information on ADHD, which is driving people’s awareness and knowledge, and therefore it’s driving that demand.
“The NHS, sadly, is not equipped to either understand or deliver on that demand.”
In a study published in The Public Library of Science ONE (PLOS) journal in March this year, psychiatrists reviewed the 100 highest-viewed TikTok videos with the ADHD hashtag.
They found more than half of the videos were misleading and do not contain information on ADHD symptoms that could be ed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)*.
*DSM- 5 is not used in clinical practice in the UK
