UK Review Finds Over-Diagnosis Risk in ADHD and Autism, But Not Mental Health

A comprehensive independent review into mental health, ADHD, and autism has identified an increasing risk of over-diagnosis specifically for neurodevelopmental conditions, while firmly rejecting similar claims regarding mental health disorders. Commissioned ten months ago by then-health secretary Wes Streeting, the 600-plus-page report has been described as a “generational opportunity” to reshape support systems across the NHS, education, benefits, and employment sectors.

The review highlights that diagnoses for ADHD and autism have surged over the past 25 years. For instance, more than 4% of children aged six to 17 have been diagnosed with autism, significantly exceeding the 1-2% prevalence rates suggested by established studies. However, the report notes data limitations, as current evidence relies on estimates since the last major surveys were conducted nine years ago. Consequently, the team concluded it cannot yet declare that over-diagnosis is occurring “at scale,” though experts warn the country may be shifting from an era of under-diagnosis to one of over-reliance on medical labels for normal human variation.

In stark contrast, review chair Prof Peter Fonagy stated that Streeting was “completely wrong” to suggest mental health conditions are being over-diagnosed. The report confirms a genuine rise in mental distress, particularly among 16-to-24-year-olds, where prevalence has jumped from one in six to one in four over the last three decades. Fonagy attributes this to economic uncertainty, social media impacts, and the decline of youth services. Notably, rates of severe mental illnesses such as schizophrenia and bipolar disorder have remained stable; the increase is driven instead by anxiety, depression, self-harm, and eating disorders.

Both sections of the report emphasize that labels can inadvertently hinder young people by defining them by their difficulties rather than their strengths. Approximately a third of 16-to-24-year-olds not in education, employment, or training report mental health or autism issues as a factor, while those diagnosed with ADHD before age 17 are four times more likely to be NEET. The review calls for improved post-diagnosis support from schools and workplaces, arguing the current system is fragmented and forces individuals to navigate conflicting requirements across care, education, and welfare.

Waiting times remain a critical failure point. A third of young people referred to mental health services wait over a year for assessment, and 90% of the 900,000 people awaiting ADHD or autism checks have waited more than three months. The NHS Alliance has previously described the system as being in chaos. To address this, the review recommends ending the first-come, first-served approach in favor of prioritizing the most urgent cases and reassessing everyone on waiting lists.

The report also raises concerns about the quality and regulation of private sector assessments, which account for half of all ADHD and a third of all autism evaluations. It calls for stricter regulation of non-NHS providers and a ban on direct-to-public advertising of these assessments. With the government expected to publish its mental health strategy by the end of the year, the review urges action within the next 12 to 24 months to prevent further deterioration in support services.