Diagnosis and need in ADHD and autism care

AI Summary

ADHD and autism assessment referrals have risen in England and other high-income countries, contributing to pressure on mental health services and longer waiting lists. A UK review proposes a needs-led system that provides support based on individual needs while retaining diagnosis where required, addressing uneven access and variation in assessments.

Referrals for assessment for attention deficit/hyperactivity disorder (ADHD) and autism have risen rapidly in England and many other high income countries,12 alongside substantial increases in recorded diagnoses, growing pressure on mental health services, and lengthening waiting lists. An independent review commissioned by the UK’s Department of Health and Social Care describes long and increasingly dysfunctional assessment pathways; geographical and sociodemographic inequalities in recognition, diagnosis, and access; variation in assessment by private providers; and diagnosis increasingly serving as a gateway to educational, occupational, and welfare support.3 In response, extending needs based models such as Thrive,4 it proposes a “needs-led plus diagnosis” system providing support according to need while retaining diagnosis where necessary.Administrative and population based trends are difficult to reconcile. Among adults in England, self-reported autism increased from 0.9% in 2018 to 2.6% in 2025,5 while population surveys using clinical assessment found stable prevalence of 1% in 2007, 0.7% in 2014,...