Attention-deficit/hyperactivity disorder in India: epidemiology, diagnostic inequities, treatment gaps, and public...

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder and an emerging public health concern in India. This review summarizes current evidence on the epidemiology, diagnosis, treatment, environmental influences, and public health implications of ADHD in the Indian context. Reported prevalence estimates vary widely across regions and populations, reflecting differences in study design, diagnostic practices, awareness, and access to healthcare. Although DSM-5-based diagnostic frameworks and culturally adapted assessment tools are increasingly available, access to specialist evaluation and treatment remains uneven, particularly in rural and underserved areas. Current management strategies emphasize a multimodal approach combining pharmacotherapy, behavioral interventions, educational support, and family-centered care. However, treatment access and continuity are often limited by financial constraints, inadequate healthcare infrastructure, specialist shortages, and sociocultural barriers. The review also examines the potential influence of early-life adversity, environmental exposures, lifestyle factors, and pandemic-related disruptions on ADHD risk and symptom expression. Overall, the available literature highlights persistent challenges, including underdiagnosis, regional disparities in care, and important gaps in evidence. Strengthening epidemiological surveillance, improving equitable access to services, and supporting context-specific research are essential for improving ADHD outcomes in India.