Many individuals who experience symptoms of autism or ADHD do not receive a formal diagnosis — often despite lifelong struggles. This can be due to a combination of how symptoms present, barriers in the healthcare system, societal perceptions, or personal circumstances. Below are the key reasons why some people may not be diagnosed in the UK:
1. Differences in How Symptoms Present
- Gender Differences: Girls often mask their symptoms better and may present less obvious traits like repetitive behaviours or hyperactivity. This can delay recognition and diagnosis.
- Subtle or Masked Symptoms: Some individuals manage to “camouflage” their struggles, particularly in structured settings, leading professionals to overlook signs of autism or ADHD.
- Co-occurring Conditions: Anxiety, depression, or learning difficulties can overshadow neurodivergent traits, leading to partial or incorrect diagnoses.
2. Lack of Awareness or Understanding
- Misinterpretation: Symptoms might be misunderstood as behavioural issues or emotional immaturity (e.g., “lazy”, “rude”, “shy”).
- Stereotypes and Stigma: Many people don’t seek diagnosis due to fear of being labelled or not fitting the typical “profile” of autism or ADHD.
3. Barriers to Accessing Healthcare
- Long Waiting Times: NHS waiting lists for assessments can stretch to years, which can deter individuals from continuing the process.
- Limited Resources: Especially in rural areas, shortages of specialists and diagnostic services mean fewer opportunities for evaluation.
- Funding Constraints: Some services are only available to those meeting strict criteria, which can exclude individuals with more subtle presentations.
4. Diagnostic Criteria and Tools
- Rigid Criteria: Tools like DSM-5 or ICD-11 may not capture individuals with atypical or mixed symptoms.
- Underdiagnosis in Specific Groups: Those with mild symptoms, intellectual disabilities, or from diverse backgrounds are often underrepresented in diagnosis statistics.
- Misdiagnosis: Autism and ADHD are sometimes mistaken for anxiety, mood disorders, or behavioural issues.
5. Age and Developmental Stage
- Delayed Diagnosis: Many adults are diagnosed later in life after years of challenges and misattributed struggles.
- Symptoms Change with Age: Hyperactivity may reduce in adulthood, and autistic individuals may learn to mask difficulties, making diagnosis harder without deeper evaluation.
6. Cultural and Social Factors
- Cultural Differences: Behaviours seen as autistic or ADHD-related may be interpreted differently depending on cultural norms, which may lead to misdiagnosis or dismissal.
- Social Expectations and Gender Norms: Girls may be underdiagnosed due to gender-based assumptions about social behaviours and communication.
7. Personal or Family Factors
- Lack of Awareness at Home: If symptoms are mild or well-masked, families may not realise anything is amiss or may attribute struggles to personality traits.
- Desire to Fit In: Some individuals may avoid diagnosis due to fear of stigma or fear of being treated differently.
8. Misalignment with Existing Services
- Assessment Gaps: If professionals focus only on behaviour or academic performance, they may miss traits like sensory issues or social fatigue.
- Inconsistent Standards: Assessment quality can vary across regions, depending on clinician training and resources available.
Conclusion
There are many reasons why people go undiagnosed with autism or ADHD — from masking and gender differences, to systemic healthcare barriers and diagnostic limitations. Raising awareness and improving access to inclusive, thorough assessments is essential to ensure everyone who needs support can access it. If you’re unsure whether a diagnosis is right for you or someone you care for, seeking guidance from professionals, advocacy groups, or support networks is a strong place to start