Major review finds ADHD, autism over-diagnosed but mental health crisis is real

A sweeping government review released this week has drawn a sharp distinction between two problems that often get lumped together in public conversation: the diagnoses of autism and ADHD are climbing faster than evidence suggests they should, while mental health distress among young people is genuinely, measurably worsening. The report, commissioned a year ago by then-health secretary Wes Streeting after he warned of young people being "over-diagnosed" and "written off," runs over 600 pages and carries implications that ripple across the NHS, schools, welfare offices, and employers.

The evidence on autism and ADHD is real but complicated. Among children aged six to seventeen, more than 4% have received an autism diagnosis—a figure that sits well above the 1% to 2% that research suggests represents the actual prevalence in any population. Similar patterns hold for ADHD. Experts point to a quarter-century of rising diagnosis rates as the culprit, suggesting the system has swung from an era of missing cases to one of catching too many. Yet the review team stopped short of declaring over-diagnosis a settled fact "at scale," partly because the data itself is weak—the most recent comprehensive surveys on true autism prevalence are nine years old, leaving the experts to estimate what has shifted since. Some age groups remain under-diagnosed, a reality the reviewers did not minimize. What concerns them most is the blurring of lines between genuine neurological conditions and what they call "normal human variation in brain function, cognition and behaviour"—the risk that every struggle gets medicalized.

Mental health tells a different story entirely. The review's chair, Professor Peter Fonagy, said flatly that Streeting was "completely wrong" to suggest over-diagnosis there. The data shows one in four young adults aged sixteen to twenty-four now report mental distress, up from one in six thirty years ago. That rise is real. It is being driven not by increases in severe conditions like schizophrenia or bipolar disorder, which have remained stable, but by surges in anxiety, depression, self-harm, and eating disorders. Fonagy and his team link this to economic uncertainty, the pervasive presence of social media, and the erosion of youth services. The conditions are genuine; the crisis is genuine.

What unites the reviewers' concern across both domains is what happens after diagnosis. A diagnosis can become a ceiling rather than a doorway. It can lock a young person into an identity built around difficulty rather than strength, hampering them in school, work, and relationships. Around one-third of sixteen to twenty-four-year-olds who are not in education, employment, or training cite mental health or autism as a contributing factor. Those diagnosed with ADHD before age seventeen are four times more likely to end up in that category than their peers without the diagnosis. The label, meant to explain, can end up excluding.

The system itself is fractured. A third of young people referred to mental health services wait more than a year for help. Of the 900,000 people waiting for ADHD or autism assessments, 90% have waited longer than three months. The NHS Alliance, representing health leaders, described the system as chaotic. But the problem extends beyond hospital waiting rooms. Support is scattered across health, education, employment, and welfare, with no coordination. People navigate repeated assessments, conflicting requirements, and bureaucratic loops just to access help. Half of all ADHD assessments and a third of autism assessments are conducted by private providers and charities, not the NHS itself—and these non-NHS assessors face weaker regulation and oversight. The review flagged direct-to-public advertising of assessments as another concern.

The reviewers are calling for action within twelve to twenty-four months. Waiting lists should be triaged by need rather than processed first-come, first-served. Some people waiting for assessment might benefit from non-medical support—better sleep, more exercise—and could be removed from lists entirely. Assessments before people enter waiting lists should be strengthened to filter out problems that do not require medical intervention. The quality and consistency of autism and ADHD assessments must improve, and private providers must face the same regulatory standards as NHS services. The government has promised to respond and is expected to outline its approach in a mental health strategy due by year's end. Whether the system can move fast enough to prevent another generation of young people from being defined by their diagnoses rather than their potential remains to be seen.