A new Government-commissioned review into ADHD, autism and mental health conditions in England has warned that the nation has reached a “tipping point” where people are at risk of being misdiagnosed with the conditions, and it calls for “radical reform” to support people.
The review highlights a mismatch between the true rates of ADHD (attention deficit hyperactivity disorder) and autism in society and the numbers seeking help for the conditions. Experts warned that misdiagnosis – where something is wrong but the diagnosis made by a professional is either completely or partially wrong – could be one of the factors behind the discrepancy.
Concerns over private providers and overdiagnosis
They also pointed to pressure for diagnosis from private providers and called for tighter restrictions on those carrying out assessments for the conditions. The review warns that diagnosis can “do harm when it is inaccurate” by directing someone towards the wrong treatment and “obscure co-occurring conditions or the social environmental causes of their difficulties”.
The authors said overdiagnosis can lead to “over-medicalisation” where ordinary, healthy, life experiences are turned into medical problems. They stated: “Most people are sometimes inattentive, anxious or socially uncomfortable. Having ADHD or autism-related traits does not necessarily mean someone has a diagnosable condition.”
The report gives 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”. Such scenarios could mean people are “medicalised to their detriment”, the report said. In some cases a diagnosis can “close doors”, leaving people feeling they are unable to do or achieve things because of it.
Rising diagnoses and waiting lists
The 607-page document states the country is “experiencing a profound change in the need for support for people with mental health problems and neurodevelopmental conditions”. The authors highlight how mental health problems have “increased substantially”, particularly among children and young people.
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 head of the Division of Psychology and Language Sciences at UCL added: “There is a real rise in distress and it’s substantial and is genuine and there are a range of drivers.”
Meanwhile, recognition of ADHD and autism has “risen dramatically”, leading to hundreds of thousands of people awaiting 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.
Call for radical reform
Estimates suggest around 3.8% of five to 15-year-olds have ADHD and 1.2% of five to 19-year-olds have autism, with no equivalent adult data. The latest waiting list figures showed more than 560,000 people had an “open referral” – and therefore were on the waiting list for an assessment – for ADHD at the end of 2025, which was more than 17 times the number recorded in 2019. More than 254,000 people had an open autism referral in December last year.
Diagnosed autism in boys aged between six and 11 has risen from 0.4% in 2000 to 6.3% in 2025, according to research for the review. This suggests “the possibility” of overdiagnosis, review vice-chairman Professor Sir Simon Wessely said, adding: “The question is how big?” He said it is likely a fresh population survey will be undertaken to give a “definitive answer” on prevalence of the condition.
Sir Simon said: “We are moving away from a period of underdiagnosis into a kind of tipping point in which other things might be happening as well.” He said the “risk of misdiagnosis is more likely when systems are under extreme stress”, with brief, non face-to-face assessments during which a “multitude of alternative diagnoses and of co-occurrence” could be missed. On overdiagnosis, he said it is difficult to know whether this is happening because of a lack of data, but he added: “If these present trends continue, the risk of overdiagnosis, over medicalisation is very, very likely.”
The report 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. Sir Simon highlighted “pressure” from the private sector, including providers advertising ADHD and autism assessments to the public, adding most GPs have concerns about the quality of assessments “and the incentives behind this”.
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.”
Calling for a fundamental shift from a “diagnosis-dependent system”, the authors said currently having one has become a “requirement to access help” through education and parts of the welfare system. 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.”
Government response
In response, the Government has pledged a major overhaul of mental health support with a renewed focus on prevention and early help, including greater support in schools, colleges and communities. NHS leaders have been tasked with examining how people can access advice, assessments and treatment more easily.
Ministers also pledged to strengthen the oversight and regulation of ADHD and autism assessments, including taking up the report’s recommendation that private providers who provide ADHD and autism assessments should be regulated by the Care Quality Commission, and a review of advertising practices.
Health Secretary Yvette Cooper said: “It is clear that mental health services need to change to focus more on the early support young people need to stay in education or work or keep their lives on track. We will set out our response in a new Mental Health Strategy in the coming months, building on the new mental health services we are already providing in schools and in the community.”
Dr Nick Broughton, national priority programme director for mental health, learning disabilities and autism at NHS England, described the report’s publication as a “landmark moment for how we better understand the mental health needs across society”, and said there is “much more to do to give young people the best chance at succeeding in a complex and ever-evolving society”.
Mel Merritt, from the National Autistic Society, said: “This report sets out clearly that successive governments have failed autistic people. The harm and distress autistic people are facing is real and widespread and there is a desperate need to build a system that supports the needs of autistic people.”
Professor Subodh Dave, president of the Royal College of Psychiatrists, said people “showing initial signs of distress shouldn’t need a diagnosis to access basic levels of support at school, work or within their communities” and added that the review should “drive renewed focus on mental health at every level of society in England, particularly for people with severe and enduring mental illnesses”.
The Royal College of Paediatrics and Child Health said the report’s recommendations will be “important steps towards improving children’s wellbeing and ensuring that need is identified appropriately, and support is available when it is needed most” but that they “must be accompanied by sustained investment in diagnostic and specialist services, which remain essential to providing timely, high-quality care for children and young people”.
The Independent Healthcare Providers Network, representing private providers, said the sector’s capacity and capability “will be vital in improving services for patients” and added they “look forward to collaborating with the Government in taking forward the work that needs to be done to ensure timely, high-quality assessments, treatment and wider support is available for everyone who needs it”.
