A warning without a verdict
The review, led by Professor Peter Fonagy of University College London, was commissioned by the Department of Health and Social Care and ordered last year by then-health secretary Wes Streeting to understand why diagnosis rates are rising and waiting lists are lengthening. Its authors say the risk of misdiagnosis and overdiagnosis is growing, but stop short of declaring it widespread. The report states that the latest research "does not, by itself, establish that overdiagnosis is currently occurring at scale". The Independent gives the report's length as 607 pages, while the BBC describes it as more than 400 pages.
I think what we see is a warning sign [about overdiagnosis], not a definitive statement.
Fonagy's findings have been described as the biggest inquiry of its kind in the world to date, according to The Guardian. The report warns that the balance of risks between underdiagnosis, misdiagnosis and overdiagnosis may be changing, so that the risk of overdiagnosis is becoming more important.
Rising diagnosis rates
Last year 5% of teenage boys had an ADHD diagnosis, up from 2% ten years earlier. Among girls of the same age the diagnosis rate rose from 0.5% to 2.5% over the same period. The report says NHS diagnosis rates for ADHD and autism among children and young people are now approaching, and for some groups already exceeding, population prevalence estimates. For autism, the BBC reports that more than 4% of children aged six to 17 have been diagnosed, against a true level that studies place at 1-2%. That comparison carries a caveat: the surveys underpinning the true-level estimate have not been carried out for nine years, so the review team had to estimate what has changed since.
The NHS figures also leave out most diagnoses made by private clinics and all of the people still on waiting lists. Professor Simon Wessely, a psychiatrist at King's College London and one of the report's authors, said:
It's probably even worse than it looks.
Private clinics and NHS strain
Private firms currently carry out more than half of NHS-funded ADHD assessments and about a third of autism assessments. These firms are weakly regulated and may market their services directly to potential clients, while the NHS often ends up paying growing bills. The Guardian reports that the NHS is losing psychologists, psychiatrists and nurses to private clinics, and that one NHS trust in England has already limited its neurodevelopmental service to the most urgent cases. Health secretary Yvette Cooper said tighter rules mean:
people can be confident that assessments are high quality and that the NHS is not being overcharged by independent or private providers
About 810,000 children and adults in England are waiting for an assessment.
Regulation and cost
The Care Quality Commission announced on Friday that it will start inspecting private clinics offering diagnostic assessments for ADHD and autism. Those clinics are currently unregulated, and non-NHS clinics offering only diagnostic assessments will in future have to register with the CQC. Its interim inspector of mental health care, Adrian James, said:
This new responsibility will... close a significant gap in our oversight, meaning that people receiving these diagnoses can have far greater confidence in the service they are receiving.
The report also estimates the cost of unnecessary diagnosis. Young people diagnosed with ADHD before the age of 17 are about four times less likely to be in education, employment or training in early adulthood, and each one costs taxpayers 244,000 pounds over their lifetime.
Mental health among young people
The review concludes that the rise in mental health problems seen among young people is real and calls for better support for all conditions. Rates of anxiety and depression among 16 to 24-year-olds rose from 18.9% in 2014 to 25.8% in 2024, according to figures cited by inews. Young women are almost twice as likely as young men to report common mental health conditions.