ADHD wait lists, benefits and medication need overhauling, landmark review says ...Middle East

A landmark review into rising ADHD and autism diagnoses has recommended a shake-up of waiting lists, a crackdown on medication and a new approach to disability benefits that puts less weight on securing a diagnosis. 

Professor Peter Fonagy’s report has also found these conditions are not overdiagnosed “at scale”, but that a growing number of people are incentivised to seek a diagnosis as the main way to access support.  

It found that recognition of ADHD and autism has “risen dramatically” in recent years and that a continuation of the current system centred around getting a diagnosis is “not sustainable”, with a “serious risk of overdiagnosis” in the future. 

It also said that an “unprecedented” level of smartphone and social media use over the past decade has driven up rates of mental distress among young people and may exacerbate symptoms of ADHD in some children.

Fonagy concludes that mental distress is “rising substantially” and leading to a surge in diagnoses across mental health, autism and ADHD services. 

The review sets out recommendations to bring people with mental distress and who are neurodivergent faster access to support and to help them participate in society.

It states that by 2024, 40 per cent of adults receiving out-of-work and disability benefits screened positive for ADHD traits, and argues that the link between having a diagnosis and being deemed unable to work should be broken. 

Prepare for benefits cuts 

Fonagy’s review is the first of three major reports set to inform the Government’s approach to reforming the welfare system, to tackle rising distress and get more young people into work.

Nearly one million young people aged 16 to 24 are not in employment, education or training (Neet) and the cost of out-of-work and disability benefits to this age group is £8.1bn.

The report will be followed by Labour grandee Alan Milburn’s review into youth joblessness, which is expected to recommend wholesale changes to the welfare system to support young people into work and cut the benefits bill. 

Fonagy’s review lays the groundwork for Milburn’s recommendations – expected to be published after the Budget – by setting the intention for a “needs-led approach” focused on increasing participation in society rather than waiting for a diagnosis to access support. 

Fonagy finds a “substantial” and growing link between mental health and the benefits system, with public spend on benefits associated with mental health – particularly anxiety and depression – estimated at £25.9bn in 2023-24. 

He states that a diagnosis can be “limiting” as it defines people by what they “cannot do”, and should not automatically be interpreted as evidence of fixed or permanent incapacity.

This suggests that having a mental stress or neurodivergent diagnosis should not in itself determine whether someone is considered capable of work or entitled to financial support. 

The report says that because these conditions can fluctuate over time, cash benefits should be combined with “timely treatment, adjustment and employment support where participation is realistic” to avoid creating barriers to re-entering the workplace. 

This aligns closely with the Timms Review into personal independence payments (PIP) – also expected in the coming months – which will recommend a complete overhaul of disability benefits to support more people into work, with some claimants encouraged to swap cash for other forms of support such as therapy. 

Fast-track ADHD waiting lists 

Fonagy has also recommended an overhaul of current autism and ADHD waiting lists in a shift towards early intervention, suggesting hundreds of thousands of people who are currently waiting to be seen by a specialist would face major upheaval.

ADHD waiting lists, referrals and diagnoses have surged in recent years, with the number of children and young people waiting for an assessment rising from around 21,000 in 2019 to 270,000 by the end of last year, according to NHS England monitoring data.

There has also been a rise in the number of people seeking an autism assessment, with 290,000 people on the waiting list as of June – a 15 per cent increase compared to last year, according to the latest NHS data.

The report recommends a “clinically led review of current ADHD and autism assessment waiting lists” to identify the primary concern and “prioritise the most relevant existing pathway” and offer “evidence-based support while waiting”. 

It notes the purpose is “not to remove people from waiting lists” and alternative support should be “actively arranged”.

However, it is not clear what this support would look like and whether people who have already been waiting months would still be able to see a doctor if this recommendation was to be taken on by the Government.

Reduce medication 

The review suggests more people should be “deprescribed” – where healthcare professionals support patients to reduce or stop taking medication – signalling an intention to shift away from long-term reliance on drugs to manage common conditions. 

The number of mental health prescriptions in England continues to rise, driven largely by antidepressants and ADHD medications.

ADHD prescriptions have risen to record levels with a 40 per cent rise in adults taking central nervous system (CNS) stimulants and other drugs over the last year, from from 190 000 in 2024-25 to 267 000 in 2025-26, NHS data shows.

Fonagy calls for “timely medication reviews and safe deprescribing practices should be strengthened and standardised”, suggesting an intention to cut back on medication for ADHD and mental health. 

The report also recommends combining ADHD, autism and mental health services, cracking down on private ADHD clinics and developing an AI-powered tool for assessments and triaging of patients. 

The report calls for a wider crackdown on private ADHD clinics, including greater oversight of diagnostic practises, banning adverts to the public and strengthened regulation of their charges to the NHS.

In response, Health Secretary Yvette Cooper promised to overhaul mental health services to “focus more on the early support young people need to stay in education or work or keep their lives on track”. The review will inform the Government’s mental health strategy, which is expected in the coming months. 

Samrtphone use

The review also concluded that the “digital environment” for today’s under-18s – in which they experience body dissatisfaction, sleep disruption, cyber bullying and harmful content – has made a “meaningful contribution” to their unhappiness.

Girls and young women, children with lower self-esteem or existing emotional difficulties, and those exposed to bullying or exclusion may be especially vulnerable to the harmful effects of social media and smartphone use, the report said.

While the report found that the direct link between soaring rates of ADHD over the past 10 years and smartphone use was less clear than the association with mental distress, there was nevertheless an impact of phone use on attention spans which could have “greater consequences for children with existing difficulties involving attention, executive functioning or emotional regulation”.

Four million under-18s are in “serious distress”, with children who meet the criteria for a common mental health disorder rising from one in six in 1993 to one in four by 2024.

Fonagy said that today’s generation of young people are now facing a “lack of hope” that their lives will be better than their parents’ “for the first time since the Second World War”.

While the adverse impact of smartphone use and social media content on young people has been long suspected, the report’s findings represent a landmark moment and will fuel calls for ministers to take tougher action against the digital sector.

The report also concluded that the Covid pandemic, in which millions of children were kept out of school for periods of several months, accelerated a deterioration in young people’s mental health that was already under way.

The pandemic “removed education, relationships, routines and support from many children who depended on them. Diagnoses of common mental disorders, and particularly ADHD and autism, also increased sharply following the pandemic”, the report said.

It acknowledged that digital technology could for some children with ADHD and autism “provide communication, predictability and connection that may be harder to find elsewhere”.

This meant that the government should not impose “blunt restrictions” which risk removing these benefits.

However, the report said: “Digital technologies have nevertheless altered the attentional environment in which children develop.

The co-chairs’ 10 recommendations to inform Government policy

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