ADHD Incidence Trends Accelerated After DSM-5 Changes and COVID-19 Disruptions
Key Clinical Summary
- In a cohort of 2 743 914 individuals aged 3 to 29 years in British Columbia, the annual incidence of attention-deficit/hyperactivity disorder (ADHD) diagnoses increased over 2 decades and accelerated after DSM-5 implementation and the COVID-19 pandemic.
- After DSM-5 implementation, the incidence rose most in elementary school–aged children and high school–aged adolescents.
- After the pandemic, the sharpest immediate increases were seen in female adolescents and female young adults, with female rates surpassing those of same-aged males for the first time recorded in this dataset.
A research letter published April 8, 2026, in JAMA Network Open found that attention-deficit/hyperactivity disorder (ADHD) diagnosis rates in people younger than 30 years in British Columbia, Canada, rose steadily from 2003 to 2023 and appeared to accelerate after both DSM-5 implementation and the COVID-19 pandemic.
The largest post-pandemic increases were observed among female adolescents and young adults.
Study Findings
Researchers used linked administrative health data from British Columbia to examine incident ADHD diagnoses among residents aged 3 to 29 years enrolled in the province’s universal health plan between 2003 and 2023. The retrospective cohort included 2 743 914 children and young adults, 1 376 580 of whom were male. ADHD diagnoses were identified using physician visits, hospitalizations, or ADHD-specific prescriptions, and analyses were stratified by age group and sex.
Across the full study period, 110 874 males (805.4 per 10 000; 95% CI, 800.7-810.2) and 74 264 females (543.1 per 10 000; 95% CI, 539.3-547.0) were newly diagnosed with ADHD. Before either intervention period, the incidence was already increasing from 2003 through 2012.
Following DSM-5 implementation from 2014 to 2019, the annual incidence accelerated among elementary school–aged male children by 9.8 per 10 000 and female children by 3.5 per 10 000. Among high school–aged adolescents, annual increases were 7.8 per 10 000 for males and 6.7 per 10 000 for females.
From 2021 to 2023, after the onset of the COVID-19 pandemic, the largest immediate increases occurred among high school–aged female adolescents, rising from 86.8 per 10 000 in 2019 to 203.7 per 10 000 in 2021, and among female young adults, rising from 54.1 per 10 000 to 183.2 per 10 000. The most pronounced post-pandemic trend accelerations were observed among elementary school–aged boys (annual change, 23.7 increase per 10 000) and girls (20.2 increase per 10 000).
Clinical Implications
For clinicians, these findings suggest that the recent rise in ADHD diagnoses may reflect more than a single cause. The study points to a combination of evolving diagnostic criteria and pandemic-related disruption, with notable age- and sex-specific differences.
The authors noted that DSM-5 revisions, including wording that emphasized functional interference rather than clinically significant impairment, may have broadened diagnostic identification. They also suggested that pandemic-related stressors may have intensified ADHD symptoms and revealed previously unmet needs, particularly among female adolescents and young adults.
The findings are particularly relevant for healthcare professionals involved in pediatric, adolescent, and young adult mental health care. The sustained post-pandemic increase among females may affect referral patterns, assessment demand, and service planning. At the same time, the study does not establish causality and may undercapture individuals diagnosed outside public systems or those who remained undiagnosed.
Expert Commentary
In the discussion, Zishan Cui, PhD, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada, and co-authors wrote that the post-pandemic rise among female adolescents and young adults was “surpassing same-aged males for the first time on record.” They added that this pattern “highlights the importance of monitoring age- and sex-specific diagnostic trajectories.”
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