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This narrative review explores the key challenges pediatricians face in diagnosing ADHD and highlights practical and emerging solutions. The article offers both a global perspective and a contextualized view relevant to the MENA region. A narrative literature review was conducted using PubMed, Scopus, and Google Scholar, focusing on peer-reviewed studies, clinical guidelines, and epidemiological data from 2010 to 2025 related to pediatric ADHD diagnosis, especially in MENA regions. The review identifies six major diagnostic barriers: (1) Symptom overlap with other conditions [e.g. , autism spectrum disorder (ASD), anxiety, learning disabilities]; (2) Reliance on subjective informant reports; (3) Cultural and societal influences including stigma and gender bias; (4) Variability in ADHD training and time constraints in clinical practice; (5) Limited access to multidisciplinary evaluations; and (6) Systemic referral and communication inefficiencies. Comorbidities are highly prevalent and frequently complicate the diagnostic picture. Delayed or inaccurate diagnosis can lead to academic underperformance, family stress, missed interventions, and long-term psychological consequences. Emerging solutions include digital screening tools, artificial intelligence-assisted analysis, structured reporting platforms, and improved training and referral models. Regional data from the Arabian Gulf highlight variable prevalence rates (1.3%-22%) and underscore the need for culturally sensitive diagnostic strategies. To improve diagnostic accuracy and patient outcomes, pediatricians must be supported through better training, interdisciplinary collaboration, validated tools, and policy-level reforms. 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