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

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood, yet its diagnosis remains complex and fraught with challenges. Pediatricians, often the first point of contact for concerned families, play a pivotal role in the diagnostic process. However, they face numerous obstacles that can hinder accurate and timely diagnosis, particularly in resource-limited or culturally diverse settings such as the Middle East and North Africa (MENA) and Arabian Gulf regions. This narrative review explores the key challenges pediatricians face in diagnosing ADHD and highlights practical and emerging solutions. The article offers both a global perspective and a contextualized view relevant to the MENA region. A narrative literature review was conducted using PubMed, Scopus, and Google Scholar, focusing on peer-reviewed studies, clinical guidelines, and epidemiological data from 2010 to 2025 related to pediatric ADHD diagnosis, especially in MENA regions. The review identifies six major diagnostic barriers: (1) Symptom overlap with other conditions [e.g., autism spectrum disorder (ASD), anxiety, learning disabilities]; (2) Reliance on subjective informant reports; (3) Cultural and societal influences including stigma and gender bias; (4) Variability in ADHD training and time constraints in clinical practice; (5) Limited access to multidisciplinary evaluations; and (6) Systemic referral and communication inefficiencies. Comorbidities are highly prevalent and frequently complicate the diagnostic picture. Delayed or inaccurate diagnosis can lead to academic underperformance, family stress, missed interventions, and long-term psychological consequences. Emerging solutions include digital screening tools, artificial intelligence-assisted analysis, structured reporting platforms, and improved training and referral models. Regional data from the Arabian Gulf highlight variable prevalence rates (1.3%-22%) and underscore the need for culturally sensitive diagnostic strategies. To improve diagnostic accuracy and patient outcomes, pediatricians must be supported through better training, interdisciplinary collaboration, validated tools, and policy-level reforms. Tailoring these approaches to local contexts will be key to addressing the growing burden of ADHD, particularly in the MENA region.

Keywords: Attention-deficit/hyperactivity disorder; Pediatric diagnosis; Comorbidity; Middle East and North Africa region; Diagnostic challenges; Subjective assessment

Core Tip: This review highlights the multifaceted challenges pediatricians face in diagnosing attention-deficit/hyperactivity disorder (ADHD), including symptom overlap, informant bias, cultural stigma, and limited access to specialized care, particularly in the Middle East and North Africa region. It emphasizes the critical role of pediatricians as frontline diagnosticians and the consequences of delayed or inaccurate diagnosis on academic performance, family well-being, and long-term mental health. The article also explores emerging solutions, including digital tools, multidisciplinary collaboration, and culturally sensitive screening. Strengthening pediatric training and diagnostic systems is crucial for ensuring the timely and accurate identification of ADHD and improving outcomes for affected children and their families.