Why ADHD and autism diagnoses are rising

A review commissioned by the Department of Health and Social Care examined changes in diagnoses since the turn of the century. It found no major changes in schizophrenia or bipolar disorder, but described a more complex picture for ADHD and autism.

One important factor is underdiagnosis. Adults are now being diagnosed in large numbers, but the review suggests this may partly reflect a catch-up with people whose needs were missed earlier in life. This is particularly relevant to women and people from marginalized backgrounds. For many adults, a diagnosis can validate experiences that have sometimes been met with ridicule or disbelief.

That context matters when interpreting rising numbers: more diagnoses do not, by themselves, show that more people are developing these conditions. The review could not conclude that ADHD or autism is being overdiagnosed. Although the number of young people in the system exceeds population estimates, those estimates may be out of date, and the report calls for more research.

At the same time, the review warns that pressure from rising referrals and diagnostic practices designed to process them quickly could create a risk of overdiagnosis. The evidence therefore points to several possibilities, not one simple explanation.

Risks of overdiagnosis and misdiagnosis

The report could not conclude that overdiagnosis is occurring, even though the number of young people in the system has exceeded population estimates. It cautioned that those estimates may be out of date and called for more research. But rising referrals and pressure to commoditize assessments could increase the risk of overdiagnosis. Online questionnaires and apps may be more likely to rule a condition in than out, potentially leaving people anxious and without professional support.

The report also warned that rushed, unregulated assessments can lead to misdiagnosis. Assessments focused on one condition, conducted in a short time or without solid evidence about developmental history, may miss the wider picture. A neurodevelopmental condition should have clear signals throughout a person’s lifespan; a struggle that is new or has worsened without a major change in context may instead point to a health issue. Distinguishing between these possibilities requires an in-depth consultation with a skilled professional, not an online form or a brief video call. Otherwise, health or mental health conditions may be missed. The report stressed that people’s difficulties are real, while emphasizing the need for careful assessment that considers their history and broader needs.

Why diagnosis should not gate access to support

The review argues that educational, health and employment support should not be hidden behind a diagnosis. When people must wait for a formal label before receiving adjustments or care, their needs go unmet and suffering can continue. Taking those needs seriously and responding with practical support would also ease pressure on the diagnostic system.

This does not mean diagnosis should be rushed. The process requires trained professionals, and there is a shortage of them. A careful assessment takes time; cutting corners risks misdiagnosis and can leave someone feeling despondent or without a full picture of what is going on. Support and assessment are separate needs: people can receive appropriate adjustments while a thorough evaluation is considered.

A good diagnosis can still make a meaningful difference. It can validate someone’s experience and help answer questions they may have had throughout their life. Importantly, a positive assessment should not focus only on difficulties. It can also identify a person’s strengths and ways to overcome hurdles, helping them set goals that match their potential.

What employers should do

Employers commissioning assessments for staff should check providers carefully. A thorough assessment should take hours, not minutes, and consider a broad range of conditions rather than focusing on one at a time. The process should help employees recognise their strengths and possibilities, not leave them feeling helpless. The guidance for employers from the Society of Occupational Medicine sets out what to look for in a provider.

A diagnosis alone is not an outcome, nor does it tell an employer what adjustments are needed: conditions do not predict individual needs. A specialist workplace needs assessment can bring together an employee’s skills, the demands of their role and the resources available in their environment. It can also help determine whether adjustments are feasible and enable the employee to meet performance standards and thrive.

Employers should also recognise that staff may be seeking help in an under-regulated clinical space, where it can be difficult to distinguish reliable practitioners from shortcuts. Waiting lists are long, and employees may be supporting children in distress at the same time. A supportive employer, including one that commissions a high-quality provider, can make a significant difference while staff navigate the process.