Challenges in diagnosing attention-deficit/hyperactivity disorder in pediatric practice: A regional and global perspective

Table 5 Challenges faced by pediatricians in attention-deficit/hyperactivity disorder diagnosis

Problem	Key challenge	Description
Symptom overlap with other conditions	Overlapping presentations with other disorders	ADHD symptoms may resemble or coexist with conditions like autism spectrum disorder, anxiety, depression, learning disabilities, sleep disorders, or trauma, complicating differential diagnosis
Subjectivity in assessment	Reliance on subjective reports	Diagnosis depends heavily on parental and teacher observations, which can vary due to bias, setting (home vs school), and lack of objective behavioral tools
Cultural and societal influences	Influence of social norms and stigma	Cultural expectations may lead to misinterpretation of normal behaviors; stigma may delay help-seeking, and gender biases may result in underdiagnosis in girls
Parental and teacher bias	Inconsistent or biased reporting	Emotional, cultural, or educational factors can lead to under-reporting or over-reporting by parents and teachers, leading to diagnostic ambiguity
Time constraints and limited training	Limited time and inadequate behavioral training	Short consultation times and variable ADHD training during residency limit pediatricians’ ability to conduct detailed developmental assessments
Lack of access to multidisciplinary evaluation	Systemic barriers to specialist referral and evaluation	Long waitlists, fragmented pathways, geographic and financial disparities, and high pediatric workloads hinder access to comprehensive ADHD assessment

ADHD: Attention-deficit/hyperactivity disorder.