A child psychiatrist has opened up about a pattern she sees routinely where a neurodivergent child will struggle at school, and the adults around them mistake their symptoms for poor behaviour or a bad attitude.

Dr Anya Ciobanca, consultant child and adolescent psychiatrist at The ADHD Centre, says children who appear disengaged, inconsistent or emotionally volatile at school may be experiencing something far more complex than just a bad attitude.

“Behaviour is never the whole story,” she says. “When we approach a child with curiosity rather than judgement, everything changes.”

Conditions such as attention deficit hyperactivity disorder (ADHD) can go undiagnosed for years because there are often misunderstandings over symptoms. For example, people might think kids who have it are just hyperactive, but there are also more subtle signs that can show up, like day-dreaming or emotional dysregulation.

Girls in particular are likely to remain undiagnosed until later life. Reviews suggest ADHD is identified more often in boys in childhood at a ratio of 3:1 (males to females), while the ratio appears to even out in adulthood at 1:1.

Experts previously told HuffPost UK this happens largely because there’s a gender divide in how ADHD symptoms are expressed (girls tend to demonstrate more inattentive symptoms), and social expectations on girls can lead to them keeping quiet, carrying on, and developing sophisticated masking strategies (sometimes at detriment to their mental health).

“There is a version of ADHD that looks, from the outside, like daydreaming or simply not caring,” says Dr Ciobanca. “But internally, that child may be working extraordinarily hard just to keep up. The effort of masking is immense, and it has a cost.”

In classrooms, children are often doing the best they can with a nervous system that’s working against them, but there are certain signs they might be fighting a hidden battle and need more support.

1. Avoidance of school or specific lessons – this might look like persistent reluctance or distress around certain subjects or transitions.
2. Difficulty starting or completing work – this is often mistaken for laziness, says Dr Ciobanca, but rooted in overwhelm or difficulties with executive function.
3. Emotional outbursts or withdrawal – this can look like frustration, tears or shutting down, particularly after school (also known as after-school restraint collapse).
4. Chronic tiredness or physical complaints of headaches, which can be linked to anxiety or sensory overload.
5. Low self-esteem, negative self-talk, and appearing to cope at school (masking) while falling apart at home.

One child Dr Chiobanca worked with had been labelled by her school as inconsistent and difficult to motivate. But in reality, she was overwhelmed and had developed a profound sense of shame around her difficulties.

Girls with undiagnosed ADHD are “more likely to blame themselves, turning their anger and pain inward”, according to the Child Mind Institute, which noted they’re also more likely to experience depression, anxiety and eating disorders than those without ADHD.

“Once we understood the underlying picture – the interaction between her ADHD, her anxiety and her environment – we could make meaningful changes,” says the psychiatrist. “She no longer had to spend every day just fighting to survive it. That freed up an enormous amount of energy for actually learning.”

With one in 20 children thought to have ADHD, Dr Ciobanca wants to see earlier intervention, more flexible teaching, and emotional wellbeing placed at the centre of education rather than its margins.

“Too much support comes too late. We cannot expect children to learn well when they do not feel safe,” she adds.

If you think your child might be neurodivergent (research suggests around 15-20% of people are), it’s worth exploring this subtly with your child. Dr Chiobanca advises parents to ask their children: “What’s the hardest part of your day?” as this can reveal more than questions about effort or behaviour.

It’s also worth speaking to your child’s school – specifically their class teacher or SENCO (a special educational needs coordinator) – if you notice a pattern of distress or avoidance. Months of avoidance or emotional dysregulation are a signal worth acting on, she notes.

The psychiatrist also urges parents to separate the behaviour from the child, as “struggling children often already feel like failures; they need to know you’re on their side”.

While NHS waiting times for diagnosis can stretch for months, it might also be worth considering a professional assessment. “ADHD and anxiety remain significantly underdiagnosed, particularly in girls,” says Dr Ciobanca.

Yet when children feel safe and understood, “they are far more able to learn and grow,” she adds. “That is the kind of education system worth working towards.”

In 2025, Health Secretary Wes Streeting said he’d launch an independent review into increased demand for autism, mental health, and ADHD services.

Per the BBC, this will involve looking for “evidence of over-diagnosis” – a concern others have raised in previous headlines.

But ADHD UK estimates that about two million cases of ADHD are undiagnosed. “Just one in nine people with ADHD in the UK actually have a diagnosis,” their site reads.

And a new paper, authored by dozens of academics, carers, clinicians, and people with lived experience with ADHD, has said that “There is no evidence that ADHD is over-diagnosed in the UK”.

Instead, they argue that “available data point to under-diagnosis,” and that the narrative suggesting ADHD is over-diagnosed could further block those with the condition from much-needed diagnosis and care.

It’s common to hear ”‘Nowadays everyone has ADHD,’” the paper, published in the British Journal of Psychology, said.

But the authors think it’s important to focus on the empirical data here.

They noted that ADHD rates are generally consistent across the globe, with the most recent research from 204 countries suggesting ADHD prevalence is about 5.4% among under-18s.

A meta-analysis found the rates are roughly 3.3% for adults.

Demand for ADHD diagnoses and care has indeed risen in the UK in recent years. But in 2018 in the UK, “administrative prevalence was 2.5% in boys and 0.7% in girls, and 0.7% in men and 0.2% in women” – far under expected rates.

The authors note this data hasn’t been available since the pandemic.

But “pre-pandemic data suggest that it has remained substantially below the ADHD population prevalence in the UK, providing no evidence at present that ADHD is over-diagnosed at a population level.”

It would take an enormous increase in diagnoses and treatment to, eg, get that 0.2% figure in adult women to its potential 3.3% rate (the number of adult women who meet the diagnostic criteria for ADHD is far closer to men’s than girls have historically been to boys).

Meanwhile, in 2023 (post-pandemic), 24% of those surveyed who were waiting for an NHS ADHD assessment had been doing so for one to two years. 10% had been waiting for two to three years.

The NHS has recently made cuts to ADHD assessments.

The study’s lead author, Professor Samuele Cortese, told Cambridge University: “While misdiagnosis and inappropriate diagnosis do occur, the available evidence indicates that underdiagnosis and under-treatment remain the predominant challenges”.

And senior co-author of the study, Professor Tamsin Ford, added, “While many more people with ADHD are being recognised and treated, we are failing to support many more.

“Overdiagnosis is not a problem, but misdiagnosis may be as people are driven into the private sector by long waits; and sadly, missed diagnoses remain common.”

Professor Cortese also pointed out the potential economic and personal costs associated with these undiagnosed rates.

“They include increased risk of academic failure, suicidal behaviour, substance abuse, criminality, injury and death,” he said.

“The failure to provide treatments which have been shown to reduce these risks represents a major ethical issue that needs to be urgently addressed.”

Parenting a child with ADHD (attention deficit hyperactivity disorder) can be wonderful, although parents often share that it’s not without its challenges.

One particularly exhausting element can be the process of bedtime – that is, helping children wind down for the evening and, ultimately, go to sleep.

Research suggests up to 50-70% of children with ADHD have sleep problems, with delayed sleep onset and bedtime resistance particularly common issues.

“Children with ADHD often have busy minds and bodies, which can make bedtime a real challenge,” sleep consultant Rosey Davidson told HuffPost UK.

Part of this is biological. Some research suggests kids with ADHD release melatonin – the hormone that signals it is time to sleep – around 45 minutes later than neurotypical children. As they get older, this can stretch to nearer 90 minutes.

“This means their natural sleepiness signal comes later, which is one of the reasons they may struggle to fall asleep at the same time as other kids,” said Davidson.

But just because a child has ADHD, it doesn’t mean there’s nothing you can do to help support them to sleep better.

As Emily Whalley, a holistic sleep and wellbeing coach at Fox and the Moon, told HuffPost UK: “We have to work with our children and their individual needs, not against them.

“And just because a child has ADHD, it doesn’t mean the way sleep works no longer applies to them. Biology doesn’t switch off because of neurodivergence.

“The fundamentals of sleep – i.e. circadian rhythm, sleep pressure and nervous system regulation – still matter. In fact, for many children with ADHD, they matter even more.”

So, sometimes going back to basics can really help.

A consistent bedtime routine is crucial for all – old and young, neurotypical and neurodiverse – as brains like the safety of knowing what is coming next.

“Consistent rituals such as a bath, a story, or calm music, signal it is time to wind down,” says Davidson, who is the founder and CEO of Just Chill Mama.

While the routine is important, it’s also crucial to recognise that you might be starting proceedings a bit too early – so take a step back and reassess the actual time your child goes to bed.

As Whalley asks: “Is the child’s body clock running later? Is bedtime actually mismatched to their natural sleep drive?”

She continues: “If a child simply isn’t tired enough at 8pm, no amount of consequences will fix that, we’re working against physiology.”

Getting outside in natural light is so important during the day, as it helps regulate the internal body clock (“it’s like putting in your order for sleepiness at night,” notes Davidson).

As evening arrives, dimming the lights helps to support melatonin production, making it easier to drift off.

“Many children with ADHD are sensory-seeking and need intentional proprioceptive input, what I often call ‘heavy work’, in the late afternoon or early evening,” says Whalley.

Some examples of this “heavy work” might include:

• Rough and tumble play,
• Pushing and pulling games,
• Carrying shopping,
• Animal walks,
• Resistance exercises
• Deep pressure input.

The sleep expert suggests all of these can help regulate the nervous system before we expect stillness. “Sleep doesn’t begin at lights out, it begins one to two hours earlier, with how we prepare the body and brain,” she notes.

Davidson agrees that providing opportunities for movement, deep pressure, or sensory activities earlier in the day can help kids feel regulated and calmer in the evening.

“Research also shows that children with ADHD who are more physically active tend to fall asleep more easily and sleep better overall, so getting out for exercise, or even movement within the home is helpful,” notes the sleep consultant.

“Yoga is excellent as it helps both the mind and body to wind down.”

Slow, quiet activities like colouring, jigsaws, or listening to an audiobook can all help your child’s mind transition from alert to calm in the hour or so before bed.

“Listening to music or audiobooks can also help the mind switch off racing thoughts,” notes Davidson.

If your child is a bit older, writing down their worries or ideas (journalling) before bed can help offload any thoughts that might keep them awake. If they’re a bit younger, drawing pictures and/or discussing their day could also help.

“Children (and adults) with ADHD often ruminate over their day, and struggle to switch off,” says Davidson.

“This is why techniques around managing thoughts and feelings can be helpful.”

The expert noted that for older children and adults, CBT-i (cognitive behavioural therapy for insomnia), which is about changing a person’s thoughts and feelings around sleep, can also be effective.

You’ll probably notice your child comes downstairs multiple times before they eventually fall asleep, which might mean the slim period of downtime you get before your own bedtime is pretty disrupted.

Davidson says for kids who get up repeatedly; gentle, consistent responses work best.

“Consider social stories, roleplaying in the daytime (putting teddies to bed and saying goodnight), and making it [their bedroom] an appealing space,” she said.

“You can also foster ideas around connection – so that they know you will always come back. I like to put up a photo of parents on the wall next to the child’s bed so they have a visual reminder they are always connected.”

Another option to try is a “bedtime pass system”, where your child has one or two “get out of bed” passes each night.

“This gives them a sense of control while still keeping the overall structure and boundaries around sleep,” says the sleep consultant.

“If they do get out of bed, quietly returning them without negotiation is more effective than long explanations or arguments. We can still be loving and responsive but hold the boundary that this is where they sleep.”

Once they do finally settle, Whalley advises considering their sleep quality as children with ADHD are more likely to mouth breathe, snore or experience sleep-disordered breathing, “and fragmented sleep can significantly worsen attention, mood and behaviour during the day”.

“If a child is snoring most nights, breathing through their mouth, grinding their teeth or waking unrefreshed, it’s important this is medically reviewed,” she adds.

“Sometimes what looks like behavioural insomnia is actually poor-quality sleep.”

If your evening downtime is fairly non-existent, you might be left feeling pretty exhausted and like you have absolutely zero chill once you’ve taken your child back up to bed for the sixth time.

Whalley wants you to know you are not failing. Equally, it’s not your child’s fault they are struggling to drift off. “These children are not difficult, they are neurologically wired differently,” says the sleep coach.

But the right adjustments, as well as small biological and sensory tweaks can make “meaningful differences”, she adds. “Progress may not look identical to a neurotypical pathway, but it is absolutely possible.

“ADHD explains sleep challenges, it doesn’t mean they’re untreatable.”

Davidson urges parents to also role model their own healthy behaviours around sleep by talking about how they prioritise it and why, as well as showing their child how they relax and unwind (for example, switching off screens a set amount of time before bed or reading a book).

“Children learn so much by imitation,” she says. “Remember that helping your child sleep is a marathon, not a sprint, and being kind to yourself is just as important as helping them rest.”