Response

I read with great interest the study by Cooper and colleagues on attention-deficit hyperactivity disorder (ADHD) identity and the preferred terminology among adults with ADHD in the UK. ^{Reference Cooper, Thomas, Burnley and Smith1} This study is clinically important because it shows that ADHD is not only a diagnosis, but also a term through which some adults understand themselves. One of the most practical findings was that 247 of 319 participants, or 77.4%, preferred the term ‘person with ADHD’. ^{Reference Cooper, Thomas, Burnley and Smith1}

However, this majority preference should be interpreted with caution. In the same sample, 23 participants preferred ‘ADHDer’, 30 preferred ‘AuDHDer’ and 77 participants reported co-occurring autism. ^{Reference Cooper, Thomas, Burnley and Smith1} These findings suggest that terminology preferences may differ among people with overlapping neurodivergent identities. This caution is also relevant to broader debates about ableism and person-first diagnostic language. Although person-first expressions such as ‘a person with a disorder’ have been used to avoid reducing individuals to a diagnosis, Cherney and Malhi highlight that the misuse of psychiatric, psychological and disabling terms can reinforce stigma, depending on social context and the perspectives of those being described. ^{Reference Cherney and Malhi2} Indeed, similar work in the UK autism community has shown marked variation in preferred terminology. In Kenny and colleagues’ survey of 3470 UK autism community members, about 40% of autistic adults endorsed ‘autistic’ whereas only 18% endorsed ‘person with autism’; by contrast, ‘person with autism’ was endorsed by almost half of professionals. ^{Reference Kenny, Hattersley, Molins, Buckley, Povey and Pellicano3} The same may be true for adults with ADHD.

Therefore, I would encourage the authors to show terminology preference by key subgroups, such as co-occurring autism, age, sex/gender, diagnostic status and sources of learning about ADHD. This would help clinicians avoid overgeneralising the majority preference and choose language more carefully in patient-facing communication.