Fonagy review warns of ADHD and autism overdiagnosis risk as youth distress rises

What the review found

The 607-page review, led by Professor Peter Fonagy, found that mental distress has risen substantially in England and "cannot be explained by greater awareness alone". Its authors said they "cannot conclude that overdiagnosis is occurring at scale", but warned of an "increased risk of misdiagnosis and overdiagnosis" as the system relies on a diagnosis to unlock help. They described the current system as one that "falls short", with people waiting years because help is "locked behind waiting for a diagnosis", and called the continuation of a diagnosis-centred approach "not sustainable". The review was commissioned by Wes Streeting while he was health secretary, after he told an interview that young people were over-diagnosed and "written off", a comment he later apologised for.

Rising distress among young people

Among 16 to 64 year olds, the share with a common mental disorder rose from 15.5% in 1993 to 22.6% in 2024, and among 16 to 24 year olds it climbed from about one in six to one in four over the same period.

Academics say around four million children are in "serious distress", a figure that could reach 4.5 million by 2030 without action. Around two million children and young people aged up to 24 were estimated to have self-harmed in 2024, and that number could rise by half a million in a few years if current trends continue. Among 16 to 24 year olds with a common mental health condition, 57% also had ADHD traits and 61% had autism traits.

Fonagy listed financial pressures, insecure work, unaffordable housing, a lessened sense of belonging, social media and reduced spending on youth clubs as contributing factors. He also wrote of his own past in the review's foreword:

I am in awe of their courage. Young people are contending with more powerful forces than I ever faced. They are not fragile. They are outnumbered.

Waiting lists and private clinics

ADHD waiting lists reached 560,000 in December 2025, more than 17 times the number recorded in 2019, and more than 254,000 people had an open autism referral in the same month. The review called for tougher regulation of private firms offering assessments for the NHS, citing concerns about quality and consistency, and for a ban on their advertising. Families are waiting years, and the Watsons waited three years for an autism assessment for their son Atlas, who is now nearly seven, non-verbal and relies on others for all aspects of daily care. Ryan said there was no fast-track route for children with the most complex needs.

Fonagy said the threshold for seeing people is too high:

We are waiting too long. The threshold for seeing people is too high and too many people are untreated.

Benefits, work and what comes next

Nearly one million young people aged 16 to 24 are not in education, employment or training, and the cost of out-of-work and disability benefits for this age group is £8.1bn. By 2024, 40% of adults receiving out-of-work and disability benefits screened positive for ADHD traits, and the review argues that the link between having a diagnosis and being deemed unable to work should be broken. Children diagnosed with autism and ADHD before the age of 17 are around four times more likely to be not in education, employment or training between 16 and 24. Simon Wessely, a leading psychiatrist and the review's vice-chair, rejected the idea that young people's struggles were personal failings:

That's sometimes been attributed to personal failures, people being told they're making it up, it's all in their head, which is absolute nonsense,

The review is the first of three reports set to inform the government's approach to welfare reform. Alan Milburn's review of youth joblessness is expected after the Budget, and the government says it will set out its response in a new Mental Health Strategy in the coming months.