ADHD Overdiagnosed, Underdiagnosed, or Both?ADHD Overdiagnosed, Underdiagnosed, or Both?
ADHD Focus
What might explain the increase in the diagnosis of ADHD over the past 30 years, especially in the last 10 years? Overdiagnosis or Underdiagnosis –... The post...
55:46•18 Aug 2026
ADHD: Too Many Diagnoses, Too Few, or Just Wrong Ones?
Episode Overview
- ADHD may be overdiagnosed in some settings, but missed diagnosis and undertreatment appear to be far more common problems.
- A solid ADHD evaluation should cover symptoms, real-life impairment, medical and psychiatric mimics, co-occurring conditions and personal strengths.
- Anxiety and depression can both mimic ADHD and be caused or worsened by untreated ADHD, so both sides need careful assessment.
- Research suggests untreated ADHD is linked with higher risks of substance use, injuries and reduced life expectancy, while appropriate stimulant treatment in diagnosed children may lower later substance problems.
- Quick online assessments or single rating scales are described as screening tools only, not enough on their own for a responsible ADHD diagnosis and treatment plan.
“Much more common is that it’s not diagnosed. It’s missed. And then an even bigger problem than the diagnosis part is that it’s undertreated.”
What can we learn from those who have battled attention issues for decades? Here, psychiatrist and ADHD specialist Dr Mark Stein joins Dr David Pomeroy to tackle a hot question: is ADHD being overdiagnosed, underdiagnosed, or somehow both at once? Across nearly 40 years in the field, Stein explains how public opinion has shifted from panic about “too many kids on stimulants” to a more nuanced view of a complex, lifelong condition.
He recalls a 1990 headline claiming a scandal because “5% to 10% of children with ADHD were taking stimulant medications,” noting that this is now roughly the national rate. The bigger problem, he argues, is missed and poorly treated ADHD: “Much more common is that it’s not diagnosed. It’s missed.
And then an even bigger problem than the diagnosis part is that it’s undertreated.” You’ll hear a really practical breakdown of what Stein calls a thorough assessment, summed up in the acronym SIMMS: **Symptoms, Impairment, Mimics, comorbidities, and Strengths**. They talk through medical and psychiatric lookalikes, the frequent overlap with anxiety and depression, and why a quick online checklist or single rating scale is “a screening measure, not a diagnosis.” The conversation also touches on addiction and substance use.
Untreated ADHD can raise the risk of substance problems, car accidents, injuries and even shorten life expectancy, while well-managed ADHD in childhood may actually reduce later substance use. Stimulant fears are addressed head-on, with Stein stressing that for properly diagnosed ADHD, “there’s a protective effect” rather than a gateway.
Anyone wrestling with their own attention issues, parenting a child with suspected ADHD, or wondering if anxiety or substance use might be masking something else will find this a grounded, detailed chat that still leaves room for hope. Could a better assessment be the missing piece in your story?
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