Is ADHD really on the rise in schools?

“Diagnosis has definitely skyrocketed. In my school, in the past five years, it has doubled.”

This headteacher, who works in the West Midlands, is talking about the incidence of attention deficit hyperactivity disorder (ADHD).

She has been surprised by the increasing number of pupils at her school presenting with patterns of behaviour that fit with the condition - and she is not alone in noticing a recent uptick.

“There’s been a significant increase in the number of students who are presenting with ADHD symptoms,” says one teacher in Suffolk. “And with boys, especially, there’s been a rise in formal diagnoses.” 

Sarah Finch, an assistant head at The Tiffin Girls’ School in Kingston upon Thames, says she is seeing a similar pattern and adds that the challenges brought about by the increase - whether a student has a formal diagnosis or not - are “complex”.

But beyond this anecdotal evidence, is the number of young people with ADHD really going up across the country? And if so, what might that mean for schools?

ADHD cases on the increase

According to NHS data, the diagnosis rate for ADHD has remained steady for much of the past two decades. In 2017, around 1.6 per cent of five- to 19-year-olds were diagnosed with the condition - a very marginal increase on the proportion diagnosed in 2004 and 1999, when the figure was 1.5 per cent.

There hasn’t been an official update on those numbers since, but there are other signs of a recent increase. For example, NHS prescribing data, released last year, shows a 35 per cent increase in prescriptions between 2015-16 and 2020-21 for children and young people for drugs used to treat the symptoms of ADHD.  

Clinical practitioners, too, say that they are seeing more young people presenting with ADHD than in previous years. Educational and child psychologist Hannah Abrahams, who works at mental health and wellness clinic The Soke, says there has definitely been an increase in ADHD referrals, particularly for younger teenagers.

So, why is it that many more children and young people are being referred and treated for ADHD? Many argue that increased awareness about the condition, along with growing recognition of the symptoms, is driving the shift.

According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, “ADHD is characterised by a pattern of behaviour present in multiple settings (for example, school and home) that can result in performance issues in social, educational or work settings”.

That’s a pretty broad definition, so to narrow it down, DSM-5 offers a list of diagnostic symptoms, divided into two categories: inattention and hyperactive-impulsive.

Behaviours can include failure to pay close attention to details, difficulty organising tasks and activities, excessive talking, fidgeting or an inability to remain seated in appropriate situations. In schools, all of these behaviours can make it more difficult for a child to take part in learning.

To be diagnosed with ADHD, children must have six or more symptoms of inattentiveness, or six or more symptoms of hyperactivity and impulsiveness - and must have been displaying these symptoms for at least six months, in at least two different settings (at home and at school, for example).

That’s the official criteria used by clinical practitioners. However, according to Jane Gilmour, a consultant clinical psychologist at Great Ormond Street Hospital and the course director of infancy and early childhood development at University College London, making the call on an ADHD diagnosis isn’t quite so straightforward.

We now know that ADHD is not a “yes” or “no” condition, she explains, but a “continuum of inattention, hyperactivity and overactivity”. 

In other words, a person can struggle with inattention and hyperactivity without quite meeting the requirements for a formal diagnosis - and even if someone has a diagnosis, they might not present with the same profile as the next person with one.

“The science has moved forward significantly in the last decade or so”

This more nuanced understanding runs parallel to a broader change in how we think about special educational needs in general, says Margaret Mulholland, SEND and inclusion policy specialist at the Association of School and College Leaders (ASCL) and a Tes columnist.

“Historically, when young people have been diagnosed with dyslexia or dyspraxia, we didn’t look beyond that,” she says. “[But] today, there’s a recognition that each profile is unique, and some children may have co-occurring conditions, like both ADHD and autism. There’s much more effort to go beyond the initial diagnosis.”

When it comes to ADHD, for instance, there has been a huge movement in recent years in understanding how symptoms differ between girls and boys. This has led to more girls being diagnosed, whereas previously the condition might have been missed.

“The science has moved forward significantly in the last decade or so,” says Gilmour. And that science has been communicated to the public through the mainstream media and on social media - where ADHD content is booming. 

According to a report by BBC South in February, there have been 20 billion views of #ADHD videos on TikTok alone.

All of the above means that the diagnostic situation for ADHD is getting more complex at the same time as awareness of ADHD is increasing rapidly.

And, as Gilmour points out, awareness does not necessarily translate to understanding.

“Some aspects of the scientific advances haven’t yet reached the mainstream understanding - for example, the fact that in a minority of cases, ADHD may be late onset - and very often, media and social media misrepresent the science, which makes the picture muddled for the general public,” she warns.

So, is the rise in ADHD cases not all that it seems?

The impact of Covid and social media

Some have raised concerns about young people using social media videos to self-diagnose with ADHD, given the risk of misinterpreting symptoms that could be signs of a different issue. 

As Mulholland puts it: “Young people are looking for reasons why they’re struggling. It’s almost, ‘If I have the label, I can deal with it.’ We need to shift that mindset. We shouldn’t diminish their need: some people will want a diagnosis, but others may just need more flexibility in support.”

And there may be another social media-related factor contributing to the apparent rise in ADHD, too, says Abrahams. She saw referrals increase after the coronavirus pandemic, and believes that extra time spent online during national lockdowns may have done more than just fuel young people’s awareness of the condition.

“The impact of the pandemic and our adjustment to different ways of working, and receiving such constant and immediate information, will take years to fully understand,” she says. “Recognition, demand and response have never been so immediate and it is likely this will have a huge impact on emotional wellbeing and attentional responses.”

This doesn’t necessarily mean that people think they have ADHD but don’t. Recent studies suggest that the pandemic may have presented particular challenges for people with ADHD, even exacerbating their symptoms in some cases.

• ADHD: Six steps to support pupils with the condition
• SEND: Four ways to help pupils with ADHD
• DfE SEND plan: Everything you need to know

A systematic review by Julie Behrmann and colleagues, published in 2021, found that the “Covid-19 pandemic is associated with increased ADHD symptoms and psychological difficulties”.

Gilmour says we should be very cautious about drawing firm conclusions from such studies. Indeed, the researchers themselves caution that the methodological quality of evidence included in their review was “low to moderate”, and so more research is needed to understand the long-term effects of the pandemic.

However, these findings are supported by another review, by Jack Hollingdale and colleagues, also published in 2021, which concluded that, overall, “the pandemic has exacerbated the core symptoms of ADHD and co-occurring difficulties”.

Ultimately, and perhaps unsurprisingly, then, there is likely to be a combination of factors behind the rise in the number of pupils presenting with behaviours related to ADHD. Whatever the cause, though, there is no doubt this rise is creating challenges for schools, which are trying to support pupils as best they can within a system that is under significant strain.

“We rely on the wider system working efficiently and in a timely manner to put support in place,” says Finch.

Unfortunately, she adds, waiting times for diagnoses through child and adolescent mental health services (Camhs) are currently through the roof. And the process for obtaining an education, health and care plan (EHCP) - the document required to secure ring-fenced local authority funding to support individual pupils - is often difficult for families to navigate.

The government has revealed plans to simplify this process but changes are not set to happen until 2025.

In the meantime, without the guidance or financial support offered by an EHCP or diagnosis in many cases, schools are being left to manage alone, says Finch. 

“There’s an increased need for schools to support students before diagnosis, often without any increase in funding to do so or a clear understanding of a student’s specific area of difficulty,” she explains.

At the same time, teachers may be dealing with expectations from parents that the school should complete and chase referrals to Camhs, and offer help on how to support children both at school and at home, she adds. 

That would be hard enough even if there was extensive training on ADHD, but that isn’t happening. A survey published by the charity ADHD UK shows that 63 per cent of teachers haven’t received adequate training to support pupils with ADHD.

What support can schools give?

So, how can schools cope with the increasing demand for support in this area within the limited resources they may have available?

Alison Willett, education director at the National Association for Special Educational Needs (Nasen), says there are some basics teachers can be familiar with that will help. 

“Every child with ADHD is an individual child with individual needs,” Willett says. “Often teachers feel they need to know everything about ADHD, but the key is focusing on building a positive and nurturing relationship with the child and their family, talking about their strengths, what their needs are, what their difficulties feel like, and then using those conversations to inform the support offered.”

At Finch’s school, as well as providing teachers with regular training around conditions such as ADHD, there is also a focus on ensuring that all students are able to implement strategies to support their own learning, with targeted interventions for those who need extra help with this. 

Lunchtime sessions, which are open to all, cover how to take control of routines, task initiation and procrastination, and coach students in how to use self-reflection and self-advocacy to request adjustments they would benefit from in the classroom. Certain students are also offered executive functioning training, which takes place once a week during tutor time. 

“Our staff are trained to use specific strategies in lessons, but students also know they are responsible for helping themselves,” says Finch.

Mulholland stresses that many of the approaches that may support children with ADHD, like the sessions run by Finch’s school, are practices that all pupils will benefit from. 

“What’s vital for some is often valuable for all, and effective targeted support can be fed directly into whole-class planning and teaching to improve SEND provision,” she explains, adding that leaders should try to take a holistic view and consider SEND practices across the entire school.

“Every child with ADHD is an individual child with individual needs”

Nasen’s self-evaluation template is a good place for leaders to start when considering this, she notes. There are eight areas of focus, each with statements to reflect on, and leaders have to think about the schools’ strengths, areas for development and the involvement of key stakeholders.

Of course, there is only so much that schools can do without additional support, and Willett is keen to point out that the government has a role to play, too. 

For example, having a “stringent accountability agenda” can “work against inclusion” because it can lead to children’s individual needs being “lost in efforts to meet attainment standards”. The lack of a joined-up approach to teacher training around special educational needs and disabilities (SEND) is also an issue, she adds. The sector is currently missing “the right career-long training and support for ongoing professional development in SEND”.

There have been high hopes that the SEND review would finally bring about much-needed transformation here, as well as greater consistency of provision. However, many of these changes aren’t due to take place until 2025, which has raised doubts about whether they will happen at all, given that we may have a brand-new government in place after the next general election.

And so, just as young people are turning to their TikTok influencer peers to find out more about why they might be struggling, schools have little choice but to turn to one another and to sector leaders for guidance on how to cope.

Luckily, there is plenty of that guidance available, from organisations like Nasen and the ASCL, as well as charities like the ADHD Foundation and ADHD UK - and it’s likely to be a lot more reliable than what you might find on TikTok.

As Mulholland wrote in a Tes column in September, “nobody is pretending that this work is easy. With ever-increasing pressures on school finances and the continuing rise in demand for education, health and care plans, schools will need good systems and processes to cope”.

The work might not be easy, but it is important - because there is no sign of the demands for support slowing down any time soon.