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Scientists comment on the launch of an independent review into the prevalence and support for mental health conditions, ADHD and autism.
Dr Monique Botha, Associate Professor in Social and Developmental Psychology, Durham University, said:
“Early and accurate diagnosis of ADHD and autism is not merely a clinical exercise but a politically shaped process, determined by funding decisions, service thresholds, and the rhetoric surrounding neurodivergence. Claims of widespread “over-diagnosis” are not supported by empirical evidence; instead, we are confronting a historic under-identification, particularly among women, girls, and ethnic minority groups whose presentations were routinely overlooked in earlier decades. As the evidence base has expanded, our understanding has shifted; traits that were once dismissed or pathologized differently are now correctly recognised as neurodevelopmental. Yet NHS systems have not kept pace. Services are structured to respond to crisis rather than prevention, meaning individuals must endure years of unnecessary suffering before being taken seriously, and are often expected to hit rock bottom before a response. Even neurodivergent children who are struggling to attend school and have parents with ADHD or autism (and so are genetically predisposed to ADHD and autism), are not receiving the evaluations that they deserve in a timely manner, until their functioning is so impaired that they are at a risk of suicide). Government narratives about supposed over-diagnosis, frequently deployed to justify benefit restriction, further delegitimise neurodivergent people and contribute to disbelief, stigma, and gaslighting within healthcare encounters. Parents report being blamed for their child’s struggles, and adults are dismissed, disbelieved, and told that if they did not receive a diagnosis as a child it means that they cannot possibly be a neurodivergent adult. This is based on the idea that children’s services operate effectively (which according to various reports, they do not), and stands in contrast to the evidence that the diagnosed rates of both ADHD and autism sit below actual prevalence if we were to screen the full population.
Primary care for this cohort is chaotic, fragmented, and inadequate shared-care arrangements mean that people who cannot afford hundreds of pounds a month for private prescribing often fall into limbo without access to life-changing medication. This is particularly harmful given strong evidence that ADHD medication is associated with reduced mortality, and that delayed or absent support is linked to higher rates of mental ill-health, suicidality, victimisation, homelessness, and poverty. The rhetoric that people are being over-diagnosed is not only inaccurate but also harmful: this is a cohort of people who have adverse outcomes across almost every area of life (education, mental health, victimisation, housing stability, physical health outcomes), and refusing to label ADHD or autism prevents a coherent, rapid, and transparent response to tackling these inequalities. Across the UK, diagnosis itself is shaped by postcode lotteries that dictate who receives help, when, and under what conditions; an inconsistency that cannot be denied without ignoring years of empirical research documenting systemic inequity. Despite these barriers, many autistic and ADHD individuals report profound improvements in self-understanding, stability, and quality of life once they finally receive a diagnosis. Early identification and support would spare people the prolonged distress, social exclusion, and financial hardship currently baked into the system, and would ultimately reduce long-term costs to the NHS by preventing crises rather than responding to them after avoidable harm has already occurred.”
Dr Ramya Srinivasan, Associate Professor in Child and Adolescent Psychiatry and Honorary Consultant Psychiatrist, UCL Division of Psychiatry and North London Foundation Trust, said:
“I believe that we have good evidence across different study types (studies of self-reported symptoms, clinical interviews & from clinical records) that common mental health problems have increased substantially over the past 10-15 years. This is particularly noticeable in young people & this is especially concerning as arguably this is the group who find it hardest to access evidence-based treatments. It is clearly important that we understand more about how to prevent & treat common mental health conditions.
“Regarding ADHD, we have evidence from comparing epidemiological studies with clinical recorded diagnoses, that ADHD, particularly in adults, is likely under-diagnosed & under-treated. However, current demand for services outstrips capacity & it is important to ensure those most in need are able to access services.”
Miranda Wolpert, Director of Mental Health at Wellcome, said:
“With mental health services under extraordinary strain and many suffering without access to healthcare, it is unsurprising how polarised the mental health overdiagnosis debate is.
“However, trying to improve how we diagnose mental health conditions shouldn’t overshadow the bigger challenge: ensuring people get the right help at the right time.
“The UK health minister’s focus on improving our evidence base is very welcome but we also need more investment in science and innovation to create smarter, more personalised systems of support.
“At Wellcome, we’re funding research to make mental health care more precise and equitable, so that effective support can be delivered rapidly and at scale.”
Chris Martin, CEO, MQ’s, said:
“We welcome this evidence-based approach from the government to address rising mental illness and better understand the complex reasons that drive it.
“Demand for mental health services has long outstripped supply, particularly for child and adolescent mental health services. We hope that this review will lead to strategic investment in prevention and early intervention services, increase access to specialised services and see more money invested in the vital research we need to improve treatments.”
Prof Tamsin Ford, Professor of Child and Adolescent Psychiatry, University of Cambridge, Prof Samuele Cortese, NIHR Professor, University of Southampton and Prof Chris Hollis, Professor of Child & Adolescent Psychiatry and Digital Mental Health, The University of Nottingham, said:
“The UK’s scientific evidence shows that ADHD is actually underdiagnosed. Surveys of both adults and children show that about one in 20 (five per cent) have symptoms and impairment that meet ADHD diagnostic criteria and most of them do not have a clinical diagnosis or access to services.
The narrative that ADHD is overdiagnosed should not be used as an excuse to deny people the care they deserve.”
Declared interests
Dr Monique Botha: None
Dr Ramya Srinivasan: No declarations of interest
Prof Samuel Cortese: has declared reimbursement for travel and accommodation expenses from the Association for Child and Adolescent Central Health (ACAMH) in relation to lectures delivered for ACAMH, the Canadian AADHD Alliance Resource, the British Association of Psychopharmacology, Healthcare Convention and CCM Group team for educational activity on ADHD, and has received honoraria from Medice. S.C. is the Chair of the European ADHD Guidelines Group and member of the Steering Committee of the European Network for Hyperkinetic Disorders (Eunethydis). S.C., NIHR Research Professor (NIHR303122), is funded by the NIHR for this research project. S.C. is also supported by NIHR grants NIHR203684, NIHR203035, NIHR130077, NIHR128472, RP-PG-0618-20003 and by grant 101095568-HORIZONHLTH- 2022-DISEASE-07-03 from the European Research Executive Agency
Prof Tamsin Ford: research group receives funding for research methods consultancy with Place2Be, a third sector organisation providing mental health training and interventions in UK Schools.
Prof Chirs Holls: receives grant funding from UK Research and Innovation (UKRI) and National Institute of Health and Care Research (NIHR). He was a member of the NICE ADHD Guideline committee (NG87) and NHS England ADHD Taskforce Experts in Evidence group. CH is a member of the European Network for Hyperkinetic Disorders (Eunethydis) and the European ADHD Guideline Group (EAGG)