ADHD and autism referrals up fivefold since pandemic

Long waiting times mean people with mental health issues are increasingly turning to private practices for a diagnosis
Long waiting times mean people with mental health issues are increasingly turning to private practices for a diagnosis - IZUSEK/E+

ADHD and autism referrals have risen fivefold since the pandemic amid fears that doctors could be over diagnosing the conditions.

More than 172,000 people were waiting for a diagnosis as of December 2023, which was more than five times higher than the 32,220 four years earlier, the Nuffield Trust think tank said.

Experts have said the rise is unlikely to be “simply due to better recognition or help-seeking” and suggested “diagnostic creep” was leading doctors, particularly in private clinics, to over diagnose the conditions.

Prof Sir Simon Wessely, a consultant psychiatrist, told an NHS England board meeting last week that the increase in cases among adults was “remarkable”.

“It’s unlikely that a change on that scale is simply due to better recognition or help-seeking, and it suggests that there’s a degree of diagnostic creep going on, or re-evaluation of feelings, symptoms, emotions,” he told officials.

He said long waiting times meant that people were increasingly turning to private practices which may “not have the standards that we would expect and seem to make the diagnosis incredibly easy” and give people “a label which may or may not be correct”.

The NHS has set up a national attention deficit hyperactivity disorder (ADHD) task force to investigate “the rate of growth within the independent sector and the potential variation in the service models and thresholds being used” as well as whether it is appropriate to prescribe powerful stimulant drugs.

Ministers believe that the surge in adults being signed off work with mental health conditions and behavioural disorders, including ADHD or autism, is a leading cause of Britain’s worklessness crisis.

A record 9.25 million people aged between 16 and 64 are neither working nor looking for work, according to the Office for National Statistics, and the welfare bill is set to soar £100 billion this year.

More than 52,000 adults receiving personal independence payments from the Government list ADHD as their main condition, with most of these aged between 16 and 29. This number is up from 38,000 in 2022.

‘Gone too far’

Mel Stride, the Work and Pensions Secretary, said that Britain’s approach to mental health was in danger of having “gone too far” with the “normal anxieties of life” being labelled as an illness.

Experts are concerned that the spiralling NHS waiting list for those with suspected cases of ADHD and autism and subsequent delays is forcing people to private clinics with less rigorous processes.

New analysis of referral data by the Nuffield Trust found that 79 per cent of people who had been waiting 13 weeks or longer – within which time guidance says a diagnosis should be made – had not had their first appointment with a specialist, up from 44 per cent in December 2019.

Between October and December last year, those who had their first appointment waited an average of nine months from referral, which is five months longer than at the end of 2019

Data also show that the number of people being prescribed powerful medication for ADHD has surged by 51 per cent to 230,000 over the past three years, including a 146 per cent increase among those aged 30 to 34.

Thea Stein, chief executive of the Nuffield Trust, said the rise in demand for assessments was “extraordinary, unpredicted and unprecedented”.

“It is frankly impossible to imagine how the system can grow fast enough to fulfil this demand,” she said.

“The challenge is that we have an obsolete health service model in place to deal with this avalanche of need.”

She called for a joined up approach across education, the health service, and wider society, but said “pumping more money into the current model certainly isn’t the solution”.

Lifelong impact

It is estimated that there are up to 1.2 million autistic people and 2.2 million people with ADHD in England.

ADHD can lead to problems including impulsivity and difficulty concentrating, which can have a lifelong impact and cause problems at school.

About 1.6 million children, or one in nine, are now reported as disabled, which has doubled in just over a decade.

An NHS spokesman said: “The NHS is fully committed to supporting and improving the lives of those with ADHD and autism, which is why we have published new national guidance to help local areas to manage the 50 per cent increase in referrals they have seen over last year.

“NHS England has also begun important work into investigating challenges in ADHD service provision and last month launched a cross sector task force alongside government, to help provide a joined-up approach for the growing numbers of people coming forward for support.”

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