Why have ADHD cases spiralled since Covid? Experts at Birmingham's Aston University reveal alarming trend

Prescriptions for drugs to treat attention deficit hyperactivity disorder (ADHD) have jumped 18% year-on-year since the pandemic, research suggests.

Experts said increasing awareness of ADHD, including via social media platforms like TikTok and Instagram, is likely to have encouraged more people to seek diagnosis and treatment for the condition.

However, they warned that “misinformation on these platforms may lead to misconceptions about symptoms, diagnosis and treatment”.

Another reason behind the rise could be the “strong association between the impact of the (Covid) pandemic and the worsening of ADHD symptoms”, they said.

The new study, from experts at Birmingham's Aston University along with the University of Huddersfield, calculated that ADHD prescriptions in England “increased significantly” from 25.17 items per 1,000 population in 2019/20 (before Covid) to 41.55 items in 2023/24, with an average annual increase of 18% nationally.

The team, based in Birmingham, looked at English prescribing data for the five currently licensed ADHD drugs at national, regional, and NHS integrated care board (ICB) levels.

The drugs were three stimulants (methylphenidate which has brand names such as Ritalin, Concerta and Delmosart; dexamfetamine, lisdexamfetamine) and two non-stimulants (atomoxetine and guanfacine).

The study found that methylphenidate remained the most prescribed medication while lisdexamfetamine showed the highest growth rate (55% annually).

Published in the journal BMJ Mental Health, the study said there is an upward trend in ADHD prescription items in all seven regions of England.

“However, there were variations in prescription trends across different regions, with an average yearly increase ranging from 13% in the North East and Yorkshire region to 28% in the London region. The second-highest change in prescriptions per year was noted in South East England (19.37%).”

Regarding the drugs, the experts said use of ADHD medicines in children and adults is supported by “substantial evidence”, including that they improve quality of life and ability, and cut substance misuse.

They also said “the role of medications becomes more important in the absence or lack of availability of alternative treatment options, such as psychological or behavioural therapy.”

On what is driving the rise, the researchers said: “Increased public and professional awareness, partly driven by social media platforms like TikTok and Instagram, has likely encouraged more people to seek assessment, diagnosis and treatment.

“Platforms like TikTok and Instagram have become new hubs for ADHD campaigns, with thousands of people sharing their experiences, coping strategies and journey to diagnosis.

“While social media has been instrumental in spreading ADHD awareness, it is crucial to approach the information with caution, as the accuracy and reliability of the content can vary significantly.

“Misinformation on these platforms may lead to misconceptions about symptoms, diagnosis and treatment.”

The team called for more research on “vetting and moderating ADHD-related information on social media” to ensure awareness efforts “do not inadvertently spread misinformation”.

They added: “Additionally, the role of professional diagnosis and treatment should be emphasised, balancing the role of social media with evidence-based practices.”

On the pandemic, the experts said it has “dramatically altered daily routines” such as through online or hybrid teaching and work, and increased stress levels for many people.

These changes “may have exacerbated ADHD symptoms in some people, making those symptoms more noticeable and prompting individuals to seek diagnosis and treatment.”

More research is needed to work out whether these trends “represent a temporary shift or a more permanent change in ADHD prescriptions”.

Until now, around 5% (700,000) of UK children and about 3–4% of adults are thought to have had ADHD but the new research suggests a rise.

People with ADHD are known to suffer inattention, hyperactivity and impulsivity, and may struggle to concentrate on a given task, or suffer extreme fidgeting.

Dr Ulrich Muller-Sedgwick, ADHD champion at the Royal College of Psychiatrists, said people with ADHD need access to timely and effective assessment, “followed by the appropriate treatment”.

He added: “We’ve seen a significant increase in the number of people coming forward for ADHD support in recent years.

“There are many reasons for this, including improved recognition of ADHD in women, greater public awareness and the impacts of the pandemic which exacerbated many people’s symptoms.

“The right diagnosis and care, including medication and reasonable adjustments, can greatly benefit people’s health and support them to reach their full potential at school, university or work.

“We know that expanding ADHD services through targeted investment would help ensure people receive the vital care they need.”

Dr Paul Keedwell, a consultant psychiatrist and neurodiversity specialist, said: “We know that the rate of diagnosis in children and adolescents was fairly level between 2020 and 2023, but there was a big increase in adult ADHD diagnoses, likely due to improved awareness (especially in women), de-stigmatisation and an increased availability of assessments, especially in the private sector.

“There could also be an impact of the Covid-19 pandemic, including the direct neurological effect of the virus and a catch-up in assessments since the lockdown. Time will tell if this is a blip or a long-term trend.

“Finally, there could be a degree of overdiagnosing. Although there is no clear evidence for this, it is important that all individuals receive a holistic assessment with a psychiatrist.

“Many other mental health conditions can cause ADHD-like symptoms.

“For example, my own clinical work has revealed many cases where inattention problems were caused by untreated depression rather than ADHD.

“Also, ADHD is often accompanied by other mental disorders like autistic spectrum disorder, complex trauma, anxiety and depression.”