ADHD and autism at risk of over-diagnosis, says government review
England Review Warns of Strain in ADHD and Autism Diagnosis System
Ninoda.com – An official review has warned that England could be moving from a period in which ADHD and autism were too often missed to one where some people may be diagnosed incorrectly or unnecessarily. The findings come amid sharply rising demand for assessments, particularly among children and young people, and point to a system struggling to provide timely, consistent support.
Specialists involved in the review said diagnosis rates have increased over the past 25 years. In some younger groups, the number of recorded cases now appears higher than would be expected across the wider population. The review considered people of every age, while placing particular attention on children and young adults, who currently account for the highest levels of diagnosis.
Its conclusions are likely to influence future decisions on NHS provision, benefits, and support for young people who are outside education, employment or training. The review was commissioned 10 months earlier by Wes Streeting, after the then health secretary raised concerns that some young people were being diagnosed too readily and then “written off”.
Diagnosis should not be the only route to support
The review stresses that formal diagnosis remains vital and should be safeguarded. However, it argues that many people are unable to obtain practical help unless they first receive a medical label. That approach can leave families waiting for long periods while schools, employers and health services delay adjustments that could make daily life more manageable.
Experts highlighted changes introduced in 2014 that meant parents often needed an autism or ADHD diagnosis before their children could access additional help at school. The review suggests this has reinforced a narrow system in which assessment can become the sole gateway to assistance.
“Diagnosis remains essential and must be protected - what has to change is that it is no longer the only door through which help can be reached.”
Prof Peter Fonagy, who chaired the review, said the system was under “immense strain”. He said support should be available through broader routes, rather than depending entirely on whether someone has completed a diagnostic process.
Possible alternatives include changes in schools and workplaces, as well as non-medical help for issues such as poor sleep or anxiety. The review also recommends revisiting waiting lists so that people with the greatest level of need can be identified and assessed sooner. Some people on those lists could instead be offered other forms of support where an assessment is not the most appropriate immediate response.
Long waits can have serious consequences
While the review raises concerns about over-diagnosis and misdiagnosis, it is equally clear that delays can cause significant harm. People waiting for assessments for mental health conditions, ADHD or autism can miss vital opportunities for support, especially during childhood and the transition into school.
Ryan Watson and his wife recognised early developmental differences in their son Atlas, when he was between about 12 and 18 months old and was not reaching expected milestones. Despite the severity of his needs becoming clearer over time, the family waited three years for an autism assessment.
Atlas, now nearly seven, is non-verbal, wears nappies and depends on other people for every part of daily care. Ryan said there was no accelerated route for children whose needs were particularly complex.
“You basically go on the list and wait however long until you get to the top.”
The delay created intense pressure as the family tried to secure suitable arrangements before Atlas began school. Ryan and his wife feared he might be sent to a mainstream setting that could not safely meet his needs.
“We were terrified. Anyone who has a child like Atlas will have the same panic that they'll start in a mainstream school where it's not safe.”
Ryan described managing the process as a second job alongside paid employment.
“It was like I had two jobs. I was going to work and then coming home and dealing with these things.”
Atlas received his diagnosis only a few months before he started school. His experience illustrates why the review wants waiting lists to be assessed more actively rather than treated as a simple queue.
Private assessment providers face calls for tighter oversight
The review also calls for stronger regulation of private companies delivering assessments for NHS patients. Concerns were raised about the quality and consistency of services offered by some providers. It recommends a ban on advertising by such firms, alongside more robust oversight of how assessments are carried out.
The issue is particularly significant as NHS waiting times have led many families to seek other options. A faster appointment does not automatically guarantee an accurate or useful assessment, and inconsistency can create difficulties for patients, schools, employers and health services trying to respond to a person’s needs.
The review cautions against treating every challenge in attention, behaviour, learning, emotions or social interaction as requiring a medical diagnosis. It says there is a need to distinguish diagnosable ADHD and autism from the ordinary range of differences in cognition, behaviour and brain function.
Support after diagnosis matters as much as assessment
The review argues that diagnoses can become harmful when they define people primarily through difficulties instead of recognising their abilities, ambitions and potential. That can affect prospects in education, employment and relationships.
Children diagnosed with autism or ADHD before age 17 are about four times more likely to be outside education, employment or training between the ages of 16 and 24. The review says that better ongoing help could improve the chances of fulfilling lives after diagnosis.
That support should include access to therapies and mental health care. Many people with ADHD or autism also experience conditions such as depression, making it important for services to address the whole person rather than focusing only on a single diagnosis.
Economic uncertainty and social media were identified as factors contributing to worsening mental health among young people. The review’s central message is that England needs more responsive support across a wide range of needs: protecting high-quality diagnosis for those who need it, prioritising the most urgent cases, and making practical help available before a label becomes the only option.
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