ADHD and autism diagnosis gaps for South Asian children in the UK

South Asian children in England are consistently underrepresented in ADHD and autism diagnoses compared with their share of the child population. This is not a single "underdiagnosis percentage" that can be quoted, because no such figure exists in the evidence base. What does exist is a set of consistent, documented gaps between diagnosis rates and population share, and between the likelihood of South Asian children being identified compared with White British children. This article sets out what the evidence actually shows, why the gap likely exists, and what parents, carers and schools can do.

What the evidence shows

A UK population-based cohort study found that male and White British heritage individuals were more likely to have received a diagnosis for ADHD than females and those of South Asian heritage or other ethnicities. According to this study, the lowest diagnosis rates of all were found among South Asian girls, indicating that ethnicity and sex can compound each other when it comes to who gets identified and diagnosed.

The Children's Commissioner for England's October 2024 report on waiting times for assessment and support for autism, ADHD and other neurodevelopmental conditions adds further detail specific to England. The report states that in community health services, Asian and Black children made up just 1% and 4% of ADHD diagnoses respectively, despite making up 12% and 6% of the child population. That is a clear gap between diagnosis share and population share, though it is a different measure from an "underdiagnosis rate", and the report does not attempt to convert it into one.

The same Children's Commissioner report cites Oxford research showing that Asian pupils (a category covering Indian, Pakistani, Bangladeshi and Other Asian backgrounds) are around half as likely to be identified with autistic spectrum disorders as their peers. Again, this is a relative likelihood of being identified, not a diagnosis of how many children "should" have autism but do not.

Why precise underdiagnosis figures do not exist

It is important to be honest about the limits of the data. Diagnosis-share versus population-share comparisons, and relative-likelihood-of-diagnosis figures, tell us about disparities in who is coming forward, being referred and being assessed. They do not tell us the true underlying rate of ADHD or autism in South Asian communities, because that would require a population-wide clinical assessment that has not been carried out. Any specific "X% underdiagnosed" claim you might see elsewhere should be treated with caution, as it is not something the cited sources support.

Possible barriers behind the gap

The sources referenced here do not set out a definitive causal explanation, but the pattern of results, lower diagnosis rates concentrated among South Asian children and particularly South Asian girls, is consistent with barriers that are widely discussed in relation to access to neurodevelopmental assessment more broadly. These can include:

• Differences in how symptoms are recognised or described within families, schools and communities.
• Stigma or unfamiliarity with what an ADHD or autism assessment involves.
• Language and communication barriers when engaging with GPs, schools or health services.
• Broader system-wide pressures, since the Children's Commissioner's October 2024 report focuses substantially on very long waiting times for assessment across the population as a whole in England, which can compound existing inequalities in who reaches an assessment in the first place.

What NICE guidance says about diagnosis

NICE guideline NG87 sets out the UK clinical framework for how ADHD should be diagnosed and managed. It does not itself discuss ethnicity-specific diagnosis gaps, but it is the guideline against which any child's referral and assessment pathway in England should be measured. Understanding the standard process set out in NG87, including the fact that diagnosis should be made by a specialist following a comprehensive assessment, can help parents know what to expect and what questions to ask.

What a standard assessment pathway should involve

Under NG87, a full ADHD assessment should gather information from multiple sources and settings, not rely on a single observation. This matters when thinking about the diagnosis gap, because if information from home, school or community settings is missed, incomplete or not sought in a way that reflects a child's actual context, a child could be overlooked even where symptoms are present.

What parents and carers can do

• Keep a simple written record of any concerns about attention, activity levels, impulsivity or social communication, across different settings such as home, school and other activities.
• Ask your GP or school special educational needs coordinator (SENCO) directly about the referral pathway for an ADHD or autism assessment, and what NICE guideline NG87 says should happen at each stage.
• If communication is a barrier, ask whether interpretation support is available at appointments, and request that concerns be recorded clearly in your child's notes.
• Where waiting times are long, ask what support is available in the meantime through school-based provision, since the Children's Commissioner's October 2024 report highlights that waiting times for assessment across England can be substantial regardless of ethnicity.

What schools can do

• Ensure that any concerns raised by South Asian families are followed up with the same rigour as concerns raised by any other family, and are not minimised, misattributed to language or cultural difference, or filtered out before reaching a referral point.
• Review whether referral rates from the school reflect the ethnic make-up of the pupil population, using the kind of comparison the Children's Commissioner's October 2024 report applies at a national level.
• Build relationships with families that make it easier to discuss neurodevelopmental concerns without stigma, recognising that this is one of the barriers repeatedly referenced in the wider literature on access to diagnosis.

A note on scope

This article deals with data patterns in England and a UK-wide cohort study. NICE guidance and referral pathways can differ between England, Scotland, Wales and Northern Ireland, so families outside England should check the equivalent guidance for their nation before assuming the same pathway applies.

ADHD Tribe provides non-clinical coaching support for adults with ADHD. We do not diagnose or treat ADHD or autism, and nothing in this article should be taken as a substitute for a formal assessment from a qualified clinician. If you have concerns about a child, please speak to your GP or your child's school.

Looking beyond diagnosis rates alone

It is worth remembering that a diagnosis rate is the end point of a long chain of steps: a concern being noticed, a conversation being had, a referral being made, an assessment being completed, and a decision being reached. A gap at the end of that chain, such as the diagnosis-share figures reported by the Children's Commissioner, could reflect a gap introduced at any single point along it, or at several points simultaneously. This is why the report's own framing is cautious, describing disparities in identification and diagnosis rather than asserting a specific level of "true" underdiagnosis.

Why waiting times matter for everyone, including South Asian families

The Children's Commissioner's October 2024 report is primarily about waiting times for assessment and support for neurodevelopmental conditions in England, and it describes these waits as substantial for the population as a whole. Long waiting times affect every family attempting to access an ADHD or autism assessment, but where a family also faces additional barriers, such as unfamiliarity with the system, stigma, or communication difficulties, a long wait can compound those barriers rather than simply adding to them. A family that is less confident about navigating the system, or less certain that a referral will be taken seriously, may be less likely to chase up a stalled referral during a long wait.

Talking about this without shame or blame

None of the evidence summarised here should be read as suggesting that South Asian parents or communities are somehow failing to notice or respond to their children's needs. The pattern documented by the cohort study and by the Children's Commissioner's report is about disparities in a health and education system's response, not about family behaviour. Health services, schools and local authorities carry the primary responsibility for ensuring referral pathways are accessible and consistently applied, in line with the process set out in NICE guideline NG87, regardless of a family's ethnicity, language or background.

Where to go for more information

Families wanting to understand more about how assessments should work can read NICE guideline NG87 directly, which sets out the recommended assessment process in detail, including the requirement to gather information from multiple settings before reaching a diagnosis. The Children's Commissioner for England's October 2024 report is also publicly available and includes further detail on waiting times and disparities across different neurodevelopmental conditions, not just ADHD and autism.

References

• PMC7618364 - UK population-based cohort study on ADHD diagnosis by sex and ethnicity
• Children's Commissioner for England - Waiting times for assessment and support for autism, ADHD and other neurodevelopmental conditions, October 2024
• NICE guideline NG87 - Attention deficit hyperactivity disorder: diagnosis and management