ADHD – Overdiagnosis or Opportunity?

Heidi Phillips is a neurodevelopmental specialist GP and Associate Professor for Primary Care at Swansea University Medical School. She is Clinical Advisor to the RCGP for Neurodiversity and Chair of the Neurodiversity Special Interest Group. She is also founder and Chair of the British Association for Neurodiversity (www.B4ND.org). She is on LinkedIN

The recent interim report from the independent ADHD Taskforce, commissioned by NHS England, brings to the forefront a critical discussion about Attention Deficit Hyperactivity Disorder (ADHD) in the UK.¹ The argument that neurodevelopmental conditions are socially constructed or over diagnosed² is a diversion, when the real difficulties experienced by individuals whose functioning is significantly impacted are undeniable. With waiting lists for assessment increasing across the UK, the Taskforce compellingly argues that the prevailing issue is, in fact, significant unmet need and underdiagnosis, resulting in serious educational, employment, social, physical, and mental health problems across the lifespan.³  

The current system for ADHD care often relies heavily on limited-capacity secondary and specialist services, creating immense bottlenecks and extremely long waiting lists. Current services are siloed and often offer diagnosis-only services.  A diagnosis without subsequent, integrated support leaves individuals, particularly young people and adults, without the necessary tools and guidance to thrive in education, employment, daily living, and social interactions. Additionally, the arbitrary separation of services depending on age or neurotype is woefully inefficient and inadequate. 

Contrary to outdated perceptions, ADHD and Autism are common and often co-occurring.¹ ADHD and other neurodivergence is not just about mental health, although it is widely acknowledged that the majority of patients with mental health difficulties are managed in primary care.⁴ Associated physical health disorders include dysautonomia, POTS, fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, allergies, atopic conditions, inflammation, and autoimmune conditions.⁵ Furthermore, adults with ADHD are more susceptible to general health conditions such as obesity, type II diabetes, asthma, hypercholesterolaemia, and hypertension.⁶ Emerging research also highlights complex brain-body connections between neurodivergence and common variant connective tissue disorders such as joint hypermobility which are associated with ‘perplexing’ physical symptoms such as chronic pain and fatigue.⁷ Significant overlap exists with other neurodevelopmental disorders, such as dyspraxia (DCD), developmental language disorder (DLD), and dyscalculia.⁸ 

The inherent co-occurrence of multiple physical and mental health disorders associated with neurodivergence underscores the need for a broad, holistic clinical lens in assessment. This presents a crucial opportunity for primary care to transform patient outcomes and broader societal well-being, by the “mainstreaming” of ADHD into primary care⁹.

As holistic practitioners, General Practitioners (GPs) are uniquely positioned to address this huge unmet need. Our comprehensive understanding of mental and physical health, coupled with our role as the first point of contact in the healthcare system, makes us ideally suited to support neurodivergent patients. Indeed, as GPs, we support patients across the lifespan and can recognise patterns within families. Together with our expertise in managing these prevalent physical and mental health issues, we are arguably better placed to identify and support neurodivergent patients presenting with such comorbidities than our increasingly specialist colleagues. The management of ADHD is not inherently more complex or difficult than other common health conditions currently treated within primary care and can be effectively managed by trained GPs, overseeing a team of allied health professionals. Specialist mental health services can then focus on patients with complex or severe mental health difficulties, reflecting the expertise of psychiatrists in navigating challenging psychiatric presentations, especially those with other psychiatric conditions or where medication initiation is complicated. This would involve aligning ADHD care pathways with those for other common health conditions within a community service, rather than leaving diagnosis and management to siloed, highly specialist services.

The current GP model cannot support this.Barriers such as resource limitations and system capacity clearly hinder implementation. The current GP workforce is overwhelmed, GPs are leaving the NHS and those that remain are working longer hours.¹⁰ Counter-intuitively, highly trained GPs are out of work.¹¹ So we have a generalist workforce committed to providing holistic care and a patient population desperate to receive their services, but currently a lack of effective means to connect the two.  

A potential solution to his impasse is the GP with Extended Role Framework. A GP with an extended role (GPwER) is a GP who undertakes a role that is beyond the scope of GP training and the MRCGP, and undertakes further training in assessment, diagnosis and support.¹² The GPwER in ADHD framework was published in March 2024 and a GPwER in Neurodiversity is currently in press. Whilst many GPs have undertaken additional training in neurodiversity in general and ADHD in particular (there were over 2000 sign-ups to the One Day Essentials Conference in October 2024), there is currently no mechanism for them to assess and diagnose neurodivergent patients under the current funding pathways. 

We urgently need top level commitment from policy makers and healthcare leaders. By investing in our primary care infrastructure, recognising the expertise that GPwERs bring, and fostering a culture of understanding and support for neurodiversity, we can unlock the full potential of primary care. 

It is time to put aside the divisive discussions surrounding “overdiagnosis” and recognise the fact that those seeking diagnosis are in need of support, and doing so offers a significant opportunity for primary care in terms of really making a difference to our patients.

References

1. NHS England 2025. Report of the independent ADHD Taskforce: Part 1. [Available from: https://www.england.nhs.uk/publication/report-of-the-independent-adhd-taskforce/ [Accessed 3/7/25]
2. O’Sullivan S. 2025The Age of Diagnosis: How Our Obsession with Medical Labels Is Making Us Sicker. New York: Penguin Random House.
3. Autistica. 2023. What are the personal and economic costs of undiagnosed ADHD and/or autism? [Available from: https://www.autistica.org.uk/our-research/research-projects/undiagnosed-adhd-autism accessed 14th May 2025  [Accessed 3/7/25]
4. RCGP. 2017. Mental Health in  Primary Care. [Available from: https://www.rcgp.org.uk/representing-you/policy-areas/mental-health-in-primary-care Accessed 05/06/25 [Accessed 3/7/25]
5. Du Rietz, E., Brikell, I., et all (2021). Mapping phenotypic and aetiological associations between ADHD and physical conditions in adulthood in Sweden: a genetically informed register study. The Lancet Psychiatry, 8(9), 774-783. doi:10.1016/S2215-0366(21)00222-9.
6. Libutzki B, Neukirch B, Reif A, Hartman CA. 2024Somatic burden of attention-deficit/hyperactivity disorder across the lifecourse. Acta Psychiatr Scand. 150(2):105-117. doi: 10.1111/acps.13694. Epub 2024 May 28. PMID: 38804256.
7. Eccles JA, Cadar D, Quadt L, et al. 2024. Is joint hypermobility linked to self-reported non-recovery from COVID-19? Case-control evidence from the British COVID Symptom Study Biobank. BMJ Public Health;2(1):e000478. doi: 10.1136/bmjph-2023-000478 [published Online First: 20240220]
8. Cleaton M. A. M., Kirby A. (2018). Why do we find it so hard to calculate the burden of neurodevelopmental disorders. Journal of Childhood and Developmental Disorders, 4(10), 1–20. https://doi.org/10.4172/2472-1786.100073 [Accessed 3/7/25]
9. Asherson, P., Leaver, L., Adamou, M. et al. 2022. Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations. BMC Psychiatry 22, 640 (2022). https://doi.org/10.1186/s12888-022-04290-7 [Accessed 3/7/25]
10. Khan, N. 2024. GP workload and patient safety. British Journal of General Practice 2024; 74 (746): 412-413. DOI: https://doi.org/10.3399/bjgp24X739257 [Accessed 3/7/25]
11. British Medical Association 2025. Poor employment opportunities forcing GPs out of the NHS, BMA survey warns, https://www.bma.org.uk/bma-media-centre/poor-employment-opportunities-forcing-gps-out-of-the-nhs-bma-survey-warns. [Accessed 3/7/25]
12. RCGP. 2024. General Practitioners with Extended Roles. https://www.rcgp.org.uk/your-career/gp-extended-roles [Accessed 3/7/25]

Featured photo by Google DeepMind on Unsplash.