ADHD and autism review finds risk of overdiagnosis
The new review calls for “radical reform” of the current system in England.
A new Government-commissioned review's found ADHD and autism are at increased risk of overdiagnosis.
The new review which calls for “radical reform” to support people, saying the current system in England “falls short”.
The authors said while they “cannot conclude that overdiagnosis is occurring at scale”, they warned of an “increased risk of misdiagnosis and overdiagnosis”.
The harm of "inaccurate diagnosis"
The report says diagnosis can “do harm when it is inaccurate” by directing someone towards the wrong treatment as well as “obscure co-occurring conditions or the social environmental causes of their difficulties”.
And overdiagnosis can lead to “over-medicalisation” where ordinary, healthy, life experiences are turned into medical problems, they warned.
The authors said “the line between the social and the medical is beginning to blur” and gave an example of a student experiencing “marked loneliness but not major depression” being prescribed antidepressants “when a better option would be anything that increases their social networks”.
The report said such scenarios could mean people are “medicalised to their detriment”.
Meanwhile, it raises concerns about the “consistency and quality” of ADHD and autism assessments being carried out by private providers, which conduct more than half of NHS-funded ADHD and a third of autism assessments.
The cost of private ADHD provision has “risen by around 252% in three years”, yet there is not consistent oversight, transparency or quality assurance over the sector, the authors said, adding: “What has happened here is that a major, publicly funded activity has been allowed to grow faster than the arrangements meant to guarantee its quality and value.”
The 607-page document states that the country is “experiencing a profound change in the need for support for people with mental health problems and neurodevelopmental conditions”.
Mental health problems “increased substantially” in the young
Review chairman Professor Peter Fonagy said “life has become harder” for young people because it is “more uncertain, more relentlessly observed and appraised, with less belonging and fewer opportunities to take time out, to recuperate and recover”.
The authors highlight how mental health problems have “increased substantially”, particularly among children and young people.
The proportion of working-age adults with a common mental health disorder, such as anxiety or depression, has increased by almost half over the last three decades, the researchers said, with 15.5% of adults aged 16 to 64 diagnosed with a common mental disorder in 1993 rising to 22.6% in 2024.
“The rise in mental health problems is real, is affecting everyday functioning, and cannot be explained by greater awareness alone,” the authors wrote.
Meanwhile, recognition of ADHD and autism has “risen dramatically” leading to hundreds of thousands of people waiting for assessment and “many others” struggling to access support.
The review points out that population prevalence rates – which estimate how many people have a condition – for ADHD and autism have “remained broadly stable” over recent decades.
But “administrative prevalence”, which reflects the demand on services, has risen sharply.
Estimates suggest that around 3.8% of five to 15-year-olds have ADHD and 1.2% of young people are estimated to have autism, with no equivalent adult data.
The latest figures show more than 560,000 people had an ‘open referral’ for ADHD at the end of 2025 – more than 17 times the number recorded in 2019.
More than 254,000 people had an open autism referral in December last year.
“Waiting lists have grown rapidly, reflecting not only rising need but a system unable to keep pace with demand,” the authors said.
They added: “This does not, by itself, establish that overdiagnosis is currently occurring at scale… however, the evidence suggests we are entering a phase in which the balance of risks between underdiagnosis, misdiagnosis and overdiagnosis may be changing, with the risks of misdiagnosis and overdiagnosis becoming increasingly important considerations for policy and service delivery.”
The review highlights increased recognition of ADHD and autism in women and girls, a “marked growth in public awareness of neurodevelopmental differences or traits that can occur to varying degrees across the population” and a “broadening” of diagnostic criteria.
“Most people are sometimes inattentive, anxious or socially uncomfortable,” the report states.
“Having ADHD- or autism-related traits does not necessarily mean someone has a diagnosable condition.”
But the authors warned debate about diagnosis can take away the focus from people’s needs and timely access to support and treatment, adding that under-recognition of conditions persists.
Waiting lists
The current situation of people waiting “weeks, months or years” because help is “locked behind waiting for a diagnosis” is not sustainable, they said.
Calling for a fundamental shift from a “diagnosis-dependent system”, the authors highlighted how diagnosis “tightly controls access to support”.
Having one has become a “requirement to access help” through education and parts of the welfare system, they said.
The current system is “not working for the people it is meant to serve” and “falls short”, with long waiting times and lack of access to care, they said, adding: “Incremental fixes will not close that gap: what is needed is a new model of care and radical reform.”
Among the report’s recommendations are a review of current waiting lists and regulation of private providers.
Dr Nick Broughton, national priority programme director for mental health, learning disabilities and autism at NHS England, said: “This is a landmark moment for how we better understand the mental health needs across society, in particular the struggles many young people are now facing.
“As Professor Fonagy’s review has found, there has been a genuine increase in the number of young people seeking help in recent years, and it’s our job alongside other sectors to ensure we are providing the best support to them when they need it.
“We have taken important steps in addressing these challenges, with six million pupils now able to access NHS mental health support in classrooms, and we’re making it easier for people to get support for ADHD and autism conditions before and after diagnosis.
“But collectively there’s much more to do to give young people the best chance at succeeding in a complex and ever-evolving society, while keeping pace with new technology and the pressures that can bring – the NHS is ready to play its part.”