A government-commissioned review says surging referrals, lengthy waiting lists and uneven private provision are exposing serious weaknesses in England’s approach to ADHD and autism diagnosis and support.
England has reached what experts described as a “tipping point” in the way ADHD and autism are recognised and treated, with a government-commissioned review warning that rising demand is exposing weaknesses in diagnosis, support and oversight. The report says the country is seeing a sharp rise in referrals and assessments even though underlying prevalence has remained broadly stable, creating pressure on services and raising the risk that some people are being labelled incorrectly.
The 607-page review, led by Professor Peter Fonagy, argues that diagnosis can be helpful when it is accurate but harmful when it is not. It says an incorrect label can steer people towards the wrong treatment, distract from other conditions or the social pressures behind their difficulties, and in some cases encourage “over-medicalisation”, where ordinary human experiences are treated as illness. The authors also warn that access to help has become too dependent on receiving a formal diagnosis, even where support is needed earlier and more broadly.
Fonagy said life has become harder for many young people because it is more uncertain, more closely watched and leaves less room to recover from stress. His deputy, Professor Sir Simon Wessely, said the system may now be moving beyond a period of underdiagnosis into one where overdiagnosis becomes a real possibility, particularly when assessments are rushed or carried out without enough face-to-face contact. He said the scale of any overdiagnosis is difficult to measure, but added that if present trends continue the risk of it becoming widespread is “very, very likely”.
The report highlights a steep rise in demand. It says more than 560,000 people were awaiting an ADHD assessment at the end of 2025, more than 17 times the number in 2019, while more than 254,000 people were waiting for an autism assessment in December last year. It also cites research showing diagnosed autism among boys aged six to 11 rising from 0.4% in 2000 to 6.3% in 2025, a change the authors say may point to the need for a fresh population survey to establish how common the condition really is.
Private providers come in for particular scrutiny. According to the review, they carry out more than half of NHS-funded ADHD assessments and around a third of autism assessments, yet the quality and consistency of their work is uneven. The authors say ADHD provision bought privately has risen by about 252% in three years, but oversight has not kept pace. They recommend tighter regulation, including bringing private assessors under the Care Quality Commission, and they also call for a review of advertising practices.
The government said it will respond in a new Mental Health Strategy in the coming months. Health Secretary Yvette Cooper said services need to shift towards earlier support that helps young people stay in education or work and keep their lives on track. NHS England said the report marks a major moment in understanding needs across society, while the National Autistic Society said successive governments have failed autistic people. The Royal College of Psychiatrists and the Royal College of Paediatrics and Child Health both welcomed the prospect of reform, but stressed that better support will also require sustained investment in specialist services.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
