Streeting-commissioned ADHD audit finds rising diagnoses do not match prevalence

An independent committee commissioned by health secretary Wes Streeting has found sharply rising diagnoses and referrals for ADHD and autism that do not appear to be explained by changes in population prevalence.

In an interim report, the committee said services are under ‘significant and sustained pressure’, and that the status quo is ‘unlikely to be sustainable or fair’.

An analysis of data from primary care records as well as epidemiological surveys in recent years showed a complex picture where multiple shifts were happening simultaneously creating ‘significant challenges’, the committee found.

In ADHD, referrals, waiting lists for assessment, and recorded diagnoses have increased substantially, particularly among adolescent and young adult females, the report commissioned at the end of last year found.

NHS England figures show the number of children and young people waiting for an ADHD assessment rose from around 21,000 in April 2019 to around 270,000 by December 2025.

GP data also show a sharp acceleration in diagnoses after 2020, with incidence among women aged 20-24 years more than doubling compared with pre-pandemic trends.

Yet population surveys done over the past decade suggest the underlying prevalence of ADHD symptoms has been far more stable, the committee noted.

Among children and young people, the proportion of diagnoses that are followed by medication being prescribed has roughly halved in the post-pandemic period, the report added.

A similar pattern was found for autism where self-identification and diagnoses within health and education systems have increased.

Pulse exclusively revealed in March that the review would take place, when the Government said it would crack down on ‘unregulated private sector’ therapists and counsellors.

The next stage of the review will look more closely quality and consistency of assessments, variation in diagnostic practice, and the extent to which diagnosis is followed by treatment.

It is important to consider the wider social context, including public awareness and the systems which create ‘incentives’ for diagnosis, including for accessing support in school or work, the report said.

In their conclusion, the committee – who have not made any recommendations at this point – said the patterns may also reflect an ‘increasing tendency to medicalise forms of distress that may have broader social or developmental roots’.

A recent analysis from the Health Foundation found a sharp rise in the number of young people not in education, employment or training (NEET) who say ill health is stopping them working.

Not enough is known about inequalities in diagnosis or access, the committee said, but evidence suggests there remain some who would benefit from support who ‘may still be missed’.

The debate on whether conditions were being overdiagnosed or whether increased demand signalled a previously unmet need has become increasingly ‘polarised’, the report said.

When it comes to mental health, the evidence shows consistently that common mental health conditions, such as depression and anxiety, have increased over the past two decades.

Psychological distress among younger people has seen the clearest increase, marking a shift in historical trends where ‘distress’ was more likely to be seen in midlife than early adulthood, the report said.

The biggest increases among young people have been seen in emotional symptoms, loneliness, sleep problems, loss of confidence and difficulty concentrating.

In the next stage, the committee will look in more detail at the drivers of increased distress, how this translates into service use and outcomes, and how services can respond ‘more effectively to different levels of need’.

Dr Amanda Roestorf, director of research at Autistica, said the review ‘highlights that demand is increasing in a system where diagnosis is the main path to support’.

‘The real issue is that people are waiting too long for support. Many are left without help for months or years, which can make things worse.’

Professor Uta Frith, emeritus professor of cognitive development at University College London, said: ‘It is good to know that the independent review into mental health conditions, ADHD and autism is proceeding swiftly.

‘However, the interim report does not raise hopes that we will know what to do about the mounting pressure on services.’

Dr Sameer Jauhar, clinical associate professor in affective disorders and psychosis at Imperial College London, said the interim review was ‘nuanced and thoughtful’.

‘For me, the main message is that a whole systems approach is required across society-not just the NHS.

‘Whilst we have encouraged people to talk about distress and mental health, we now need to be more clear on what this actually means, and how this can be tackled at individual, family, school and societal levels.’