The public debate about ADHD and autism has become increasingly polarised. Commentators argue over whether these conditions are being ‘overdiagnosed', whether private clinics are inflating numbers or whether rising rates reflect changing culture rather than genuine need. Amid the noise, the conversation risks missing the point entirely.
Whatever position people take on prevalence, one fact is undeniable - demand for assessment, support and treatment has risen dramatically and the NHS is struggling to meet it.
The BABCP's submission to the Government's independent review into mental health conditions, ADHD and autism seeks to refocus the discussion on that reality. Increased awareness may have encouraged more people to seek help. Diagnostic practices may also have evolved. But the question of whether or not conditions are being over- or underdiagnosed is less important than the reality that hundreds of thousands of people are waiting months or years for the support that makes daily life safer and more manageable.
The interim report published by the review in this month (June) recognises that regardless of which side people fall in the debate, population prevalence, administrative diagnosis, service demand and underlying need do not always move together, and that the challenge to policymakers lies in that divergence and how the system responds to it.
The system is already overwhelmed
The numbers are stark. ADHD referrals for children and young people have risen from around 21,000 in April 2019 to roughly 270,000 in December 2025. In some areas, adults wait up to eight years for an assessment while children can wait more than four. NICE guidelines state autism assessments should begin within three months of referral, a standard that has become increasingly difficult for services to achieve.
These figures do not tell us whether more people have ADHD or autism than previous generations, but they do tell us something more urgent - the NHS cannot keep pace with demand.
Families can spend years on waiting lists without answers. Schools increasingly find themselves trying to manage complex needs while specialist support remains unavailable. Adults who have struggled throughout their lives often face years of waiting for a diagnosis that may help them finally understand themselves.
Whether prevalence is rising, stable or unchanged, the reality is that people are seeking help now.
Why debate ‘overdiagnosis' when ‘under-support' is the real problem?
Differences in diagnostic criteria, referral pathways and data-collection methods make regional and international comparisons unreliable. Meanwhile, evidence suggests far from being over-identified, many autistic and ADHD people - particularly women, adults and marginalised groups - have historically been missed.
The interim report adds important detail here. It found a sharp acceleration in ADHD diagnoses after 2020, with incidence among women aged 20 to 24 more than doubling compared with pre-pandemic trends, while increases among males were considerably smaller. This pattern of late identification in women is exactly the under-recognition problem the BABCP has highlighted.
At the same time, the report has an extremely interesting finding - population surveys, which do not rely on referral or diagnosis, suggest the underlying prevalence of ADHD symptoms has been broadly stable over recent decades, with NICE estimating prevalence at around 5% in children and young people and 3% in adults. The review is careful to note this does not mean rising diagnoses are invalid as: ‘the evidence points to a more complex picture in which relatively stable underlying prevalence can coexist with rapidly rising diagnosis, referral and service demand.' But regardless of where people stand on what is driving demand, the practical challenge remains the same: large numbers of people are seeking support and the NHS is insufficiently resourced to meet it.
Even when assessments finally happen, support does not automatically follow.
Many people who receive an ADHD or autism diagnosis also experience anxiety, depression or other common mental health difficulties.
NICE recommends cognitive behavioural therapy (CBT) for many of these conditions and, in specific contexts, for adults with ADHD. Yet access to NHS Talking Therapies is variable with long waiting times and workforce shortages continuing to affect many parts of the country.
Many therapists lack the specialist training needed to work confidently with neurodivergent clients. That creates a situation in which people finally receive a diagnosis only to discover there is no timely treatment pathway attached to it.
A workforce not yet equipped for the scale or complexity of need
Workforce capacity is a serious concern.
Neurodivergent people face elevated risks of a range of mental and physical health difficulties. Research has identified higher rates of anxiety and depression while studies have also highlighted poorer life expectancy among some neurodivergent groups.
CBT can be highly effective for common mental health difficulties experienced by neurodivergent people when therapy is informed by an understanding of their individual needs, communication styles and lived experiences. However, many clinicians report limited confidence in adapting evidence-based therapies for neurodivergent clients.
Meanwhile neurodivergent clinicians – often those best placed to understand this cohort - face barriers such as sensory‑unfriendly workplaces, stigma about disclosure and unrealistic administrative loads. Many leave the profession early, further reducing capacity.
The result is the NHS simply does not have enough appropriately trained people with the right skills to meet growing levels of demand.
What would getting ahead of demand actually look like?
If the Government's review is to be meaningful, it must move beyond questions of prevalence and focus on how the NHS can build a system that has the capacity, flexibility and equity required for the coming decade.
That means reducing waiting times for assessment and support rather than years'-long waits that push people into crisis. It also means ending postcode lotteries for quality diagnostics and investing in evidence‑based psychological therapies, alongside the workforce needed to deliver them.
That requires strengthening neurodiversity‑informed clinical training so mental health professionals feel confident supporting neurodivergent people effectively and appropriately. Early intervention should be prioritised wherever possible, particularly in schools and community settings so that difficulties do not escalate into crises.
Another priority should be workplace reform so that neurodivergent clinicians can stay in the profession and raising neurodiversity awareness and inclusive practice across services and communities to promote understanding, flexibility and belonging.
Above all, it calls for support that is not activated solely by diagnosis, but offered through a needs-led pathway before, during and after the diagnostic process.
This is not about expanding services to fit ‘overdiagnosis'. It is about recognising that people are already in distress and seeking support. The NHS - working with schools, local authorities and voluntary partners - must be capable of responding in a timely, humane and evidence‑based way.
