A major UK review commissioned by the then-health secretary has concluded that young people face a genuine risk of over-diagnosis for ADHD and autism, but rejected claims of over-diagnosis for mental health conditions.
The 600-plus page review, chaired by Prof Peter Fonagy, found that more than 4% of children aged six to 17 have been diagnosed with autism, well above the 1-2% that research suggests is the true population rate. Diagnoses for both conditions have risen over 25 years, with some age groups now showing cases above expected levels. The review team stopped short of declaring over-diagnosis happening "at scale," citing weak data. Survey evidence on true autism prevalence has not been updated for nine years. Some age groups remain under-diagnosed, the review noted.
The review directly contradicted the initiating health secretary's claims about mental health. Prof Fonagy stated that increased mental distress among young people is real and measurable. One in four 16 to 24-year-olds now experience mental distress, up from one in six 30 years ago. The review linked this rise to economic uncertainty, social media impact and loss of youth services. Critically, severe mental illness rates for conditions like schizophrenia and bipolar disorder have remained stable, the review found. The rise consists of anxiety, depression, self-harm and eating disorders.
The review warned that diagnosis itself poses risks. Labels defining young people by "difficulties" rather than "strengths and potential" can close doors to education, work and relationships. Around a third of 16 to 24-year-olds not in education, employment or training cited mental health or autism as a factor. Those diagnosed with ADHD before age 17 are four times more likely to be unemployed or out of education than those without diagnosis.
Waiting times represent a systemic failure across both conditions. One-third of young people referred to mental health services wait more than a year for treatment. Of 900,000 people waiting for ADHD or autism assessments, 90% have waited longer than three months. The review recommends reassessing all waiting lists to prioritise those most in need, ending first-come-first-served systems.
The review called the support system "falling short" and fragmented across the NHS, schools, workplaces and welfare agencies. It recommended banning direct-to-public advertising of assessments and improving regulation of private providers, who conduct half of ADHD and a third of autism assessments without NHS-level oversight. The government has committed to acting within 12 to 24 months.