SINGAPORE: Children and young adults are “incentivised” to get diagnosed with ADHD and autism and there has been a “medicalisation of distress”, a government inquiry has concluded.

The interim report commissioned by Wes Streeting, the health secretary, found that there are “institutional incentives” to seek a mental health diagnosis as it is the “gateway” to unlock access to special adjustments at school and work.

It said there was “credible evidence of increasing psychological distress” behind a recent rise in mental health diagnoses, but added that normal difficulties may also “increasingly be interpreted primarily through a medical lens”.

Nearly one in ten young adults “self-identify” as autistic, the report said, and there has been a particular increase in diagnoses among girls when they move to secondary school. It added that common childhood behaviours, such as “restlessness or distractibility”, are being medicalised.

It said: “Historical analyses show that behaviours in children once regarded as within the range of normal variation, or even as something to be welcomed in some contexts, are now more often interpreted as requiring intervention or treatment.”

The review was commissioned in December by Streeting to investigate the increase in demand for mental health services and overdiagnosis of conditions such as ADHD and autism.

Professor Peter Fonagy, a clinical psychologist at University College London, who is chair of the review, stressed that there had been “credible evidence of a real increase in distress, especially among young people” and that there was “not a simple story of ‘too much diagnosis’”.

But, writing in The Times, he said: “When support is tied tightly to diagnostic labels, demand for diagnosis will rise. When early, accessible help is limited, difficulties escalate.”

The report said that the “medicalisation” of normal emotions can lead to “inappropriate treatment”, giving the example of how “loneliness is unlikely to respond to antidepressants”.

The NHS says that approximately one in five children and young people in England have a probable mental disorder, up from one in nine in 2017.

A rise in demand for autism and ADHD services has been particularly pronounced. The number of people diagnosed with ADHD has more than doubled since 2021, the review said, highlighting a particularly “unusual” increase for girls and young women.

The report found an “especially marked” increase in autism among girls, particularly those who had recently started secondary school. The number of girls being diagnosed with autism has increased seven-fold between 2010 and 2022.

It said that more young people are “self-identifying” as having autism. NHS data found that “the proportion of 16–24-year olds reporting that they have autism rose from 5.4 per cent in 2022 to 8.9 per cent in 2025”. But for adults it only increased from 1.4 per cent to 2.6 per cent.

The report said there has been a “substantial and sustained increase in autism-related” claims for special educational needs and disabilities (Send) support at school, which has been “especially rapid among girls”.

It suggested that part of the increase reflects changing diagnostic thresholds for autism, as many of those who are diagnosed do not have “severe intellectual disability” as they would have done in the past.

The report has cited the influence of social media. It said “certain platforms, including TikTok, convey a high proportion of factually inaccurate messages around for example ADHD”, but added that social media can help reduce stigma around mental health.

The report highlighted incentives to get a diagnosis, because at school, university and work, a diagnosis is “a gateway to resources, adjustment and formal recognition”. It said: “Where access to support is closely linked to diagnosis, demand for diagnostic assessment may increase.”

Fonagy is leading the independent review along with Sir Simon Wessely, former president of the Royal College of Psychiatry, and Professor Gillian Baird, a consultant paediatrician specialising in autism.

A final report with recommendations is due in the coming months. It will have important implications for government plans to reform the Send system and the welfare system.

The increase in mental health problems has fuelled a rise in economic inactivity. The number of 16 to 34-year-olds off work with long-term sickness because they have a mental health condition rose by 76 per cent between 2019 and 2024.

Alan Milburn, the former Labour health secretary who is carrying out a review into the almost million young people who are not in employment, education or trainings (Neets), hopes to use Fonagy’s findings to inform his recommendations due in the autumn.

Milburn has said anxiety and depression are “normal” and promised to recommend sweeping changes to the welfare system to remove incentives keeping young people out of work.

One proposal being considered by ministers would see sickness benefits for 18 to 24-year-olds linked explicitly to trying to find a job.

However, such changes are likely to be controversial among Labour MPs, who forced the government into a last-minute U-turn on a £5 billion package to cut disability benefits last summer.

The proportion of Neets who are signed off work due to sickness or disability has more than doubled since 2005 to 28 per cent. Two thirds of them cite mental health problems or autism as the reason they are inactive, which is triple the proportion in 2011.

Almost 95,000 people claim personal independence payments (Pip), the main disability benefit, for ADHD — three and a half times the number just before the Covid-19 pandemic. Among 16 to 24-year-olds, Pip claims have risen from about 19,900 at the start of 2020 to 54,500 this year.

‘When support is tied to diagnostic labels, demand will rise’

In recent years, Britain has changed the way it talks about minds, (Professor Peter Fonagy writes). Referrals for ADHD have risen sharply. Autism diagnoses have increased across schools and health services. About one in five adults now meets criteria for a common mental health condition. Waiting lists stretch into years.

Behind these figures lies something real. But also something uncertain. Are more people experiencing distress and dysfunction? Almost certainly, yes, particularly younger people. Are we also recognising, labelling and responding to that distress and dysfunction differently? Again, yes.

The difficulty is that we have tended to collapse these questions into one. We talk as if prevalence, diagnosis, demand and need are interchangeable. They are not.

This is what the independent review into mental health conditions, ADHD and autism, which I chair with Professor Gillian Baird and Sir Simon Wessely, is trying to disentangle.

Our interim report does not offer conclusions. But it does set out something that should shift the debate.

First, there is credible evidence of a real increase in distress, especially among young people. It is not just more frequently reported, it is, in many cases, more impairing. Anxiety, loss of confidence and difficulty concentrating are rising, and these changes are affecting education, work and daily functioning.

Second, the systems designed to respond are not working well enough. Too often they are slow, fragmented and difficult to navigate. Diagnosis has increasingly become the gateway to support, even where it may not be the most appropriate first step in getting people the right support and tools to live well.

Third, the picture is not the same across all conditions. For ADHD and autism, the best population data suggests relatively stable underlying prevalence, while diagnoses and referrals have increased dramatically. That does not mean one set of data is “right” and the other “wrong”. It means different things are happening at the same time: changes in recognition, changes in help-seeking, and systems that increasingly channel people towards diagnosis in order to access support.

Fourth, fairness matters. There are clear differences in who is recognised, who receives a diagnosis and who is missed altogether.

What emerges is not a simple story of “more illness” or “too much diagnosis”. It is a more complex and less comfortable reality.

Distress is real. But how we interpret and respond to it is shaped by the systems we have built. Those systems can amplify demand as much as they respond to it. When support is tied tightly to diagnostic labels, demand for diagnosis will rise. When early, accessible help is limited, difficulties escalate. When pathways are fragmented, people circulate within them.

This is why the answer cannot sit with the NHS alone. Mental health, autism and ADHD are shaped not only in clinics, but in schools, workplaces and communities. Educational expectations, social environments, digital lives, family pressures and economic conditions all play a part in how distress emerges and how it is understood. So must the response.

We need a system that is more proportionate, more responsive and less dependent on diagnosis alone. One that can offer support earlier, in a wider range of settings, and in ways that are aligned to need rather than determined by labels.

That does not mean abandoning diagnosis. For many people, it remains essential — for understanding, for treatment, for access to support. But it does mean being more precise about what diagnosis is for, and what it is not.