What % of the population is neurodivergent?

My Sunday morning puzzle

Aug 04, 2024

In 2020, Nancy Doyle estimated that 15-20% or 1 in 5 of the population is neurodivergent (Doyle, 2020). Last week Doyle raised alarm bells concerning claims that autism will affect 50% of children by 2050. You can read her article here.

My Sunday morning puzzle. Q: What percentage of the population is neurodivergent, ADHD or autistic? These are my best estimates using the research and stats available.

What % of the population is neurodivergent?

Let’s start with ADHD

A good place to start is with the prevalence of ADHD. ADHD is the #1 co-occurring neurological condition across many forms of neurodivergence. These include

Autism - 50-70% are ADHD (Eaton et al., 2023; Hours et al., 2022)
Tourette’s - up to 75% are ADHD (Lin et al., 2022)
Dyspraxia - 50% are ADHD (Fliers et al., 2011)
Epilepsy - up to 77% are ADHD (Fan et al., 2023)

ADHD and autism have incredibly high psychiatric comorbidity rates. If you are struggling with chronic mental illness you are highly likely to be autistic and/or ADHD.

ADHD is thought to affect around 5% of the population (NICE, 2024). Twin studies have shown heritability up to 88% (Faraone et al., 2019; Grimm et al., 2020). ADHD is underdiagnosed in women at a rate of 2:1 (Slobodin & Davidovitch, 2019). If we assume underdiagnosis at 2:1, around 6.7% of the population has ADHD.

The numbers do not add up

Almost all forms of neurodivergence are underdiagnosed in women as illustrated in the table below. Epilepsy and dyscalculia are the only neurological conditions recognised and diagnosed at a rate of 1:1 (Devine et al., 2013; Karimi, 2013; Wigglesworth et al., 2023). We are equally bad at maths.

It does not take a mathematician to conclude that these numbers do not add up. Twin studies show all conditions are highly heritable - autism up to 90% (Colvert et al., 2015; Sandin et al., 2017). It is statistically improbable that 3x as many men “develop” highly heritable neurodevelopmental and/or neurological conditions.

Parents, teachers, GPs, psychologists and psychiatrists are missing the signs that girls and women are neurodivergent.

Dyscalculia is the most prevalent

Last year whilst working on the neurominorities infographic, I wrote to Renee Hamilton-Newman of Dyscalculia.org, a leading world expert on Dyscalculia, to confirm the numbers. She was insistent dyscalculia affects up to 26% (Butterworth et al., 2011; Gross-Tsur et al., 1996).

Therefore, dyscalculia, not dyslexia, has the highest prevalence affecting up to 26%. From this, we can further infer neurodivergence likely affects up to 26% of the population and that 1 in 4 people is neurodivergent.

Specific learning difficulties (SpLDs) are limited to dyscalculia, dyslexia, and dysgraphia, which frequently show up together at high rates. There are only three SpLDs, not four, not five.

Dyspraxia is not a specific learning difficulty but it can make learning things involving movement more difficult. Dyspraxia is a neurodevelopmental and motor disorder that frequently co-occurs with ADHD or autism. Dysgraphia is often conflated with dyspraxia, as it affects handwriting.

ADHD is also not a specific learning difficulty or learning disability. ADHD is a neurodevelopmental and neurological condition. Gifted AuDHD girls are being overlooked, in part, due to this misconception. They are also better at masking their difficulties.

Around 30% of ADHDers are thought to have dyscalculia (DuPaul et al., 2013). As dyscalculia is identified at a rate of 1:1, and up to 26% of the population are thought to have dyscalculia, we can infer:

Up to 7.8% of the population might be ADHD.

What about autism?

Autism is thought to affect around 1% of the population (National Autistic Society, 2024). Autism is highly heritable at rates of 90% (Colvert et al., 2015). 3x as many males are diagnosed with autism (Loomes, 2017). Recent research has shown that the true sex ratio is 1:1 (Burrows et al., 2022). Assuming a 3:1 underdiagnosis ratio, autism affects 1.75%.

However, autism underdiagnosis rises to 10:1 for girls without an intellectual disability (Fombonne, 2009; Rivet & Matson, 2011). Gifted are most overlooked. So, a minimum of 2% of the population must be autistic.

Autism is correlated with significant intelligence differences (Crespi, 2016; Ruthsatz et al., 2015). Intelligence is highly heritable at rates of 80-95% (Bouchard, 2013; Lichtenstein et al., 2022). From this, we can infer the heritability rate of autism is closer to 95%.

Around half of autistics will have a co-occurring intellectual disability (an IQ <70), putting them in the bottom 2% of the population. Others will have intellectual giftedness (an IQ >130), putting them in the top 2% of the population, and would have previously been diagnosed with Asperger's. Asperger’s and PDD-NOS were removed as a diagnosis in the DSM-5 and now fall under the autism spectrum conditions (ASC) umbrella.

Both intellectual disability and intellectual giftedness are under-recognised in girls and women at rates of 2:1 (Polyak, 2015). Additionally, society believes that 6x as many men are talented savants (Park, 2023). Savant syndrome is a condition characterised by exceptional talents in one or more domains and an eidetic memory. It is not a clinical diagnosis. It is most likely to co-occur with autism.

Parents are 2.5x more likely to Google “Is my son gifted?” (Stephens, 2017). Other research shows we are twice as likely to spot a gifted boy (Freeman & Garces-Bascal, 2015). Only 32% of Mensa members are female (Mensa, 2024). Mensa's membership ratio is 2:1 male.

If we assume that intellectual disability impacts the bottom 2% and intellectual giftedness affects the top 2% (other sources cite 2.5-3%, e.g. Totsika et al., 2022) and that both are under-recognised in women at a rate of 2:1, accounting for women, each would rise to a minimum of 2.7%. Perhaps as high as 3.3-4%. If we take the lower value and accept if you have significant intelligence differences, you are most likely to be autistic, we can infer:

Up to 5.4% of the population might be autistic. This could rise as high as 8%.

Epilepsy is the least prevalent (if we overlook MS)

Epilepsy affects just 1% of the population and is accurately recognised with a diagnosis sex ratio of 1:1 (Wigglesworth et al., 2023).

Around half of autistics are epileptic (Amiet, 2008; Jeste et al., 2015). This is mediated by intellectual disability (Pacheva et al., 2019). Up to 77% of epileptics have ADHD (Fan et al., 2023).

MS is rarer still. MS affects a mere 2.8 million people on the planet and 3x as many women, many of whom will be autistic and/or ADHD (Coyle, 2021; Walton et al., 2020). A recent study with a sample of MS children showed 47% had a diagnosis of ADHD (Ceyhun et al., 2024).

What’s behind the unrecognition of girls and women?

Short answer: Unconscious gender bias. The long answer follows.

Gender bias in healthcare

Whilst men are 3x more likely to be diagnosed with neurodevelopmental conditions, women are 2x more likely to be diagnosed with mental illness and over-prescribed psychiatric meds.

Depression 1:2, Anxiety 1:2, PTSD 1:2, CPTSD 1:2, BPD 1:3 (Pesce et al., 2016; Farhood et al., 2016; Skodol & Bender., 2003; Solomon & Herman, 2009).

This persists even when researchers control for known sex disparities due to gendered violence/ trauma and fluctuations in female hormones.

A man who goes to his doctor with the same mental health symptoms is less likely to be diagnosed with mental illness or medicated with antidepressants.

Countless studies have shown men reporting physical illness are more likely to be diagnosed earlier, more often and given disproportionate access to treatment. Women are dismissed. See Westergaard et al., 2019 for a review.

When a woman goes to her GP reporting illness, they are more likely to be told they are delusional, imagining things, the pain is in their head and refused a referral for treatment or given antidepressants (Samulowitz et al., 2018; Wesolowicz et al., 2018).

Women have been historically excluded from medical research. The studies on ADHD and autism are no exception; research samples continue to be dominated by males (Merone et al., 2022). The diagnostic criteria and screening instruments for ADHD and autism are based on gendered research.

Harmful sex stereotypes and debunked theories, namely the extreme male brain theory of autism (Baron-Cohen, 2002) and extreme female brain theory of psychosis (Larson et al., 2015), together with gender bias in healthcare have led autistic females to be excluded from studies, missed or misdiagnosed with mental illnesses such as BPD, OCD, bipolar or schizophrenia and over medicated.

Gender bias in schools

Because of gender bias, we are more likely to believe men are more intelligent, talented or have greater difficulties that we should help or support.

Classroom studies by Dweck (2006) show that when a little girl or boy behaves badly, we are more likely to blame the little girl personally: “You are a thief”. With boys, we will attribute bad behaviour: “It’s bad to steal” or extrinsic causes like abuse or neglect at home or undiagnosed ADHD.

Many believe that autism and ADHD are underdiagnosed in women due to masking. I think the true problem is societal gender bias, pandering to the needs of boys and men and dismissing female difficulties. Girls and women learn to hide their difficulties to conform to society's expectations of them. So long as we continue to dismiss female difficulties and deny them the support they need, women will continue to mask.

The reverse pattern shows up in the case of success. Classroom studies by Dweck show when a little girl is successful, we are more likely to brush it off as luck or credit others. Whilst we praise boys, we discredit girls for their intelligence, talents and achievements. Recall parents are 2.5x more likely to Google is my son gifted, and we are 6x more likely to believe a boy is a talented savant.

As neurodivergence is characterised by significantly elevated abilities and increased difficulties relative to neurotypicals, we parents, teachers, GPs, psychologists and psychiatrists continue to be unable to spot neurodivergence in girls and women due to unconscious gender bias.

My conclusion

We overlook neurodivergent girls and women due to societal gender bias, if we assume all neurodivergent conditions affect men and women equally, we can infer from these highly unreliable statistics that

Dyscalculia is the most prevalent, affecting up to 26%
Epilepsy is the least prevalent, affecting 1% (if we overlook MS)
ADHD might affect up to 7.8% of the population
Autism might affect 2-5.4% of the population
Around 20-25% or 1 in 4 are likely to be neurodivergent (let’s make it 25 for argument’s sake?)
Around 75-80% or 3 in 4 of the population are likely neurotypical or average
You are neurodivergent if you have strengths or difficulties in the bottom or top 10-12.5%

This is not far away from Nancy Doyle’s estimate that 15-20% or 1 in 5 are neurodivergent.

These numbers should be taken with a pinch of salt being based on unreliable research (and please double-check my maths).

As an autistic person, I enjoyed this Sunday morning puzzle. This was fun!

PS: the research shows that men and women are equally likely to be good at maths and be maths savants (Kersey et al., 2019).

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