England review warns of ADHD and autism over-diagnosis risk and seeks tighter regulation

An independent review in England has warned that ADHD and autism are at risk of being over-diagnosed, and has called for tighter regulation of private clinics that offer assessments for the NHS. The review found that diagnoses have risen over the past 25 years, with cases in some younger age groups now appearing to outstrip the numbers that would be expected. But it said the data is too patchy to be certain, and that true levels of the conditions appear to have remained broadly stable.

The review's main concern is that a diagnosis has become the gateway to support. Demand for ADHD and autism services used to be slow. It then increased faster and faster, and waiting lists grew ten times bigger over five years. By the end of last year, more than 560,000 people were waiting for an ADHD assessment, and more than 254,000 had an open referral for an autism assessment. In the last five years, ADHD diagnoses among 12 to 17 year olds rose 15 times, while autism diagnoses rose 40 times. The system is under such extreme stress, the review says, that there is now more risk that people could be wrongly told they have ADHD or autism.

The review says the current system is failing people and needs radical reform. It calls for national standards and tougher regulation of private assessment providers, which it says raises concerns about quality and consistency. Private companies agree that standards are needed. The government accepts there should be more regulation and that people should get help earlier, but more detail will come in its mental health strategy.

Waiting lists should not be first come, first served, the review says. People with severe and complex needs should be prioritised. It also wants support to be available while people wait for an assessment, rather than making help conditional on a diagnosis. The review's chair said a needs-led system would deal with a person's problems there and then, because the need is respected. At present, he said, need is only respected if it is confirmed by a diagnosis, which he called nonsense.

The review also found that mental health distress has risen substantially, especially among children and young people. Mental distress among 25-year-olds is up by 50 per cent since 1993, particularly anxiety and depression. One in four 16 to 24 year olds is now affected, and four million children have been described as being in serious distress. The total cost of mental ill health in England is thought to be around £300 billion. The review points to financial insecurity, unemployment and social media scrutiny as factors making life harder.

The report includes cases that illustrate the human cost. Ryan's seven-year-old son Atlas waited three years for an autism assessment and relies on other people for all aspects of his care. Freya, 23, spent five years on waiting lists and was eventually diagnosed privately after being admitted to a mental health hospital at 15 with anorexia, depression and anxiety. Natasha believes she has ADHD and autism but has waited two years without help, and says she wants a proper diagnosis rather than a tick box exercise. Katie, who has ADHD, took three years to be diagnosed and struggled at university and work before she got support.

Some experts and charities have pushed back at suggestions that over-diagnosis is already widespread. The chief executive of the charity Autistica said the review found no evidence that autism is being over-diagnosed at scale, and warned against using the findings to scapegoat autistic people or cut services. She said many people still face long waits and then receive little support after diagnosis, and that the system unlawfully expects a diagnosis before services are provided. The review itself says the evidence is not strong enough to confirm mass over-diagnosis, but warns that the risk could grow if current trends continue.

The review urges action within the next two years. It wants those most in need to be prioritised on waiting lists and for people to get support while they wait. The government has promised a major overhaul and says plans for a new mental health strategy will be set out in the coming months. For families and patients, the central question is whether the system can move from a diagnosis-first model to one that responds to need earlier and more consistently.