Are current ADHD categories too broad to reflect very different symptoms?

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I’m genuinely confused about how we’re still lumping so many different presentations under one (or three) ADHD label(s).

Every classroom has something like at least three children in them who have a diagnosis or are on a waiting list for one, and I've heard of classrooms where the majority of children have a diagnosis. It's predicted this is going to rise rapidly in the next few years.

What’s really striking me though is how completely different - and sometimes totally conflicting - the symptoms can be between people all diagnosed with the same thing.

For example:

Some say they’re so overwhelmed and exhausted by everything that they spend all day in bed, can’t get going and struggle with basic motivation. But others say they never sleep, are constantly wired and physically can’t slow down or rest.

Some forget to eat for days because they’re hyperfocused or distracted. Others can’t stop eating and have real issues with impulse control around food.

And that’s before you get into the emotional dysregulation, rejection sensitivity, time blindness, hyperfocus vs total inability to focus and so on. It feels like we’re dealing with quite different underlying issues that all get called “ADHD”.

Would it make more sense to introduce new categories, as we did with ie PTSD? Such as CADHD (Complex ADHD) for those with multiple overlapping and severe issues, and maybe even UCADHD (Ultra Complex ADHD) for the ones whose symptoms are extreme, conflicting and life-altering in multiple domains?

I’m not a clinician, just trying to make sense of it all. Does anyone else think the current three presentations (inattentive, hyperactive/impulsive, combined) are no longer fit for purpose given how broad the diagnosis has become? Or am I missing something?

TIA

To what end though? Medication is titrated to manage the symptoms. Practical support is practically nonexistent. Would you take the minimal resources away from the bog standard ADHDers to give more to UC-ADHDers?

The bigger problem is people being diagnosed with ADHD based on symptoms without understanding their history or current homelife.
A neotypical child who has experienced adverse childhood events can present with ADHD symptoms. Mental health support or social services support could reduce their symptoms. It could take them below the threshold for diagnosis. But instead they are inncorrectly diagnosed and medicated without addressing the cause of their symptoms which in their case is not a congenital neurological difference.

I am aware that I shall sound like a dinosaur, but people have always had complex personalities. We just didn't always have to hyper-analyse or treat them. There were 40 kids in my primary class in deepest Cornwall in 1962, with one teacher. Your nails were inspected for cleanliness, you were expected to produce a clean hanky daily, everyone ate school dinner, and by the time you moved up you could read and write and knew your times table to x5. It was drilled, nobody's little prince or princess was permitted an excuse. Everyone used the outdoor toilets, and there were no kids that weren't toilet trained. I don't remember any serious special educational needs, although there were always quicker and slower learners. There were playground spats and fights, rivalries, but no lasting unpleasant treatment.

Like I said above, a dinosaur, but IMO vastly preferable to the current landscape.

I used to assess ADHD. I don't anymore. Too much overlap with other conditions which were not explored in assessment as all problems were seen as 'because of ADHD' from the start. I felt it was a poor clinical practice and diagnostic overshadowing going too far.

The issue is that it is diagnosed but then not managed. DD was 16 when diagnosed with ASD/ADHD after years of sucessful masking and a total burnout.

The difference to her being now sucessful at uni - we are able to pay for private therapy. Cahms was useless - they couldn't (due to resources) and wouldn't (due to her in general not being a danger to society or herself - their words) provide her with individual support, they offered group session where she was mixed with other girls with such a variety of issues that it was utterly pointless. I am aware that this could very well be our local trust, I heard of more sucess stories.

2 1/2 years of paying for a therapist meant she is now able to manage day to day life, understands her behaviour and her triggers, she learned to read others - to an extend - and can life independently.

In an ideal world every diagnosed child needs an individual therapy plan, not just throwing medication at them and hoping for the best. The parents have to be given support, we had a very good parental course where they explained the background of ADHD, how typical behaviour management does not work and how to parent a ND child depending on how ADHD is presenting.
But like everything - it costs money and as long as the public is not willing to pay for the NHS they can't do more than the absolute basic and fail the majority.

@Papyrophile - you most likely didn't see these children as they were failing, masking to an extend that they somehow managed to survive school and then are lost to society, were not even in mainstream schools.
There is evidence that schooling in the olden days was better as it was less pressure to achieve and more manual jobs were available. Constant influx of media, no or vastly reduced PE, children with overwhelming extra curricular activities means the children of the 1960-1980s had it easier to cope than a child/teen today.

But if I look up my family tree I can pinpoint exactly where my daughter got her conditions from.

There were far fewer premature babies then, who very often grow up to have additional needs. Children with specific needs were in special schools. There are children in mainstream now who not for want of trying can't write simple words at the end of primary. No amount of drilling would teach them their 5x table by the end of infants.

OP, three children in a class of 30 doesn't seem a lot to me but I don't see this range of cases you describe. Three cases of children who really struggle to focus and who benefit immensely from medication? Yes.

snap. I used to assess. I don’t anymore. Not enough assessment of the whole child and possibility of other diagnoses and wider family dynamics.

I agree. It’s even worse with adult diagnoses I think. Everyone has been up chatGPT, YouTube and Reddit and can produce highly rehearsed and selective answers to tick box questions. As most diagnoses are from stand alone NHS or private providers including via RTC there is no access to clinical notes that might paint a different picture and limited selective assessment where if you only have a hammer everything looks like a nail. That’s without even considering the commercial motivation of private providers to award diagnoses. Adult ADHD is a real thing but so are cPTSD, GAD, depression and yes EUPD despite the stigma and I often see people seeking and being awarded ADHD diagnoses where one of those other things is actually far more likely to be the main problem.

Thank you for replying. There is enormous pressure to diagnose and clinicians give in. I did no believe bbc's panorama when it first came out but I changed my mind.