Focusing on ADHD and autism diagnosis won’t cut costs and wastes money that should be spent on urgent support

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Last week, Wes Streeting announced a review into rising diagnoses of autism, ADHD, and mental health conditions. “Wes Streeting orders inquiry into mental health ‘overdiagnosis’” yelled a Times headline, atop a sub-heading explaining that they actually mean neurodivergence. The article frames the review as a “fresh crackdown on welfare spending”, going on to say the review will consider “whether normal feelings and stresses are being “overpathologised” and a panel of experts will examine how social media, smartphones and the cost of living have contributed to a rise in mental distress that has led to long waiting lists for NHS services.

This stance should be a surprise to no one, given Streeting’s public claims that these conditions are overdiagnosed, leading to people being unnecessarily “written off”.

Following significant criticism from clinicians, charities, neurodivergent adults, and families, Streeting began to soften his position. After taking a social media beating, he acknowledged in The Guardian that his previous position was “divisive” (not “wrong”, obviously). After dropping the announcement and taking the public’s temperature, he claims he is “not prejudging” and the review aims to ensure people receive the right support at the right time. He described the review as “rigorous” and “evidence-based,” promising to involve experts and people with lived experience.

However, Streeting’s earlier comments and the initial coverage of the review has already influenced public discourse. Changing the tone midway does nothing to undo this.

Diagnosis as a Lifeline

For many neurodivergent people, as well as those with mental health conditions, diagnosis is not a label applied quickly or lightly. In reality, diagnosis often comes only after years (or decades) of misunderstanding, misdiagnosis, and systemic neglect. Even when a diagnosis is made, many are then left with no post-diagnostic support.

For others, support doesn’t start until a diagnosis is made. While support is not supposed to be dictated by formal diagnosis, the lack of it is often a huge barrier to educational support, workplace accommodations, therapy, medication, social care, and disability benefits when needed.

A diagnosis, however late, is also hugely validating to adults who’ve lived their lives being bullied, feeling socially excluded, blamed for relationship breakdown, being passed over at work, feeling overwhelmed by life and not knowing why, and generally feeling like they are lacking as a human. Diagnosis says: you’re neurologically different and the world isn’t built for people like you. It’s not your fault. You may be deliciously weird, but you are perfect, whole, and there is a whole tribe of humans just like you. You belong.

It’s telling that Streeting equates diagnosis with being written off – it’s almost as though we should be providing support to people once diagnosed. Perhaps Streeting could focus on that?

Services in Crisis

On X, Streeting wrote that his overdiagnosis comments were “poor—and our evidence on autism, ADHD and mental health is too”. Unfortunately for Streeting, that’s patently nonsense.

While the public narrative focuses on overdiagnosis, the evidence we have tells a different story. As of September 2025, over 227,000 people in England had open referrals for suspected autism, with more than 90% waiting longer than the 13-week target recommended by NICE. NHS England published the Autism Assessment Framework and Operational Guidance two years ago to reinforce standards for assessment, but ICBs have seen their budgets cut by 50% this year, and they cannot afford to follow it. At least nine Integrated Care Boards have paused the “Right to Choose” ADHD and autism assessments, leaving families with no timely route to evaluation.

One in four adults in England now experiences a common mental health condition. Specialist mental health referrals are rising, but understaffed and under-resourced services struggle to respond. Families often face repeated rejections, delayed therapy, and preventable deterioration, reinforcing that unmet need rather than overdiagnosis is the critical issue.

Access to Child and Adolescent Mental Health Services (CAMHS) in England remains critically strained, with long waiting lists and a high proportion of referrals closed before treatment. According to the Children’s Commissioner for England, nearly 958,000 children and young people had active referrals to CAMHS in 2023–24. Half of those referred “in crisis” had their referrals closed or were waiting for a second contact by the end of the year, and only around 32% received at least two contacts with services within the year.

It is utterly nonsensical to argue that conditions are being excessively diagnosed when people cannot access assessment in the first place. These delays are not signs of overdiagnosis; they are a symptom of chronic lack of capacity, growing year on year.

ADHD: Underdiagnosed and Undersupported

ADHD is similarly neglected, and we have firm evidence that Streeting’s overdiagnosis claims are bunk. NHS Digital estimates up to 2.5 million people in England may have ADHD, based on prevalence rates, yet almost 670,000 children and adults were awaiting assessment as of June 2025. Others estimate that only 1 in 9 people with ADHD have a formal diagnosis.

In response, NHS England convened the Independent ADHD Taskforce, which produced Part 1 and Part 2 reports. As these figures suggest, the Taskforce found that ADHD is significantly under-recognised, underdiagnosed, and under-treated. Key findings included insufficient service capacity, long waiting lists, inconsistent prescribing and follow-up, and entrenched inequalities across gender, ethnicity, and socioeconomic status. It estimated a population prevalence of ADHD at about 3–5%, in line with prior scientific estimates.

The avoidable societal costs of untreated ADHD are staggering, exceeding £17 billion annually through

educational failure (from lack of support, leading to under-achievement, school exclusion, lost potential)
long-term unemployment (not being able to secure, or keep, suitable work)
mental and physical ill-health (leading to higher health and social care usage),
substance use/misuse (to cope with the mental health impact)
lost productivity (from the impact of unmanaged ADHD symptoms and from depression and illness),
increased welfare demand (when it all falls apart),
impact on the criminal justice system (when young men, in particular, don’t get the educational support they need)

Crucially, the Taskforce found no evidence of overdiagnosis, instead highlighting widespread unmet need. The ADHD Taskforce’s reports already provide extensive evidence and recommendations on capacity, access, and funding. The announcement of this review certainly suggests that the endless reviews will be repeated until one justifies their stance.

The false economy of denying support

Reducing or delaying diagnosis may appear to save money in the short term, but evidence shows the opposite. Given the rest of the current climate around support for SEND, it’s telling that the government is willing to shoulder this avoidable cost—and spend money on more reviews—rather than spend that money funding support.

Similar dynamics are evident in other policy areas. The recent change to remove specific vehicles from the Motability scheme doesn’t save the taxpayer money since additional costs are covered by the recipient, but it certainly plays into the priorities of an increasingly resentful electorate, being wholly misled.

Increasingly, “support” is pitched as an alternative to “diagnosis”, as if we can do away with the need for diagnosing if support is sufficient. As if diagnosis itself is meaningless, despite the availability of effective treatments for various conditions that fall within the remit of this review. It’s hard to come up with a benign reason for this misrepresentation, given the cost of providing support that could be reduced with equal input from health professionals. It would certainly reduce pressures on the NHS if we stopped assessing and treating these conditions, but it would simply—and disproportionately—increase pressure on the rest of our public services.

Wider Policy Context

Streeting’s review exists within a broader landscape that blames vulnerable children and adults for the cost of their needs, even though those rising costs are the fault of a system at breaking point. The upcoming SEND White Paper looks more likely than ever to reduce legal rights to statutory assessment and support.

The recent Budget revealed central government will take over SEND funding from 2028, and subsequent comments reveal their intention to heavily cut funding.
The rushed, recently launched “SEND National Conversation” has five predetermined priorities (Early, Local, Fair, Effective, and Shared) that do not reflect the significant evidence provided to the Education Select Committee’s Inquiry.
It was recently announced that Best Start Family Hubs would offer early support for SEND, framing that support as a way to prevent needs from becoming “medicalised.”
The recently announced review into the number of young people “NEET” not in education, employment or training (we can think of a few reasons for that).
And, just this weekend, coverage of the fact that the government will be subsidising the private sector once more, by funding construction and hospitality jobs for those same young people, with benefits removed if they refuse without a “good reason”. When asked for an example of a good reason, Pat McFadden mentioned “family emergency” but not disability, naturally.

To families, it feels as though we are witnessing a coordinated series of moves intended to justify stripping rights from vulnerable people with the public’s consent. This would be hard to stomach even if it did save money, but it won’t. Yet again, they’re prioritising short-term savings over longer-term efficiency, at the expense of the well-being of disabled children and adults.

A hostile environment, a hostile world

It’s hard to avoid cynicism at this point, given the context. Unsurprisingly, those affected and their families feel this is another move to prioritise misinformed public perception and cost-cutting over the legitimate needs of those requiring support to thrive.

Of course, there is always the possibility that this review will finally lead to proper funding of services, but we aren’t holding our breath.

The information we already have is clear: the issue here is not overdiagnosis but a system that no longer functions. Evidence from the ADHD Taskforce, CAMHS data, autism services, and mental health provision clearly shows unmet needs that must be addressed urgently. If this review starts from an assumption of overdiagnosis, it risks repeating past failures to address the root cause of the issue instead of delivering meaningful support.

Whether there is over- or under-diagnosis, or both, (depending on gender and on different communities), the net public health harm comes more from under-recognition and unmet need than from overdiagnosis. Surely that’s the priority?

Promoted

Research articles of interest:

Autism in England: assessing underdiagnosis in a population-based cohort study of prospectively collected primary care data O’Nions, Elizabeth et al.The Lancet Regional Health – Europe, Volume 29, 100626. This population-based study estimated substantial underdiagnosis of autism in adults, with a large proportion of adults likely autistic but without a recorded diagnosis. Access to adult diagnostic services is a major bottleneck. (The Lancet)
The changing prevalence of ADHD? A systematic review (2025) Review of 40 studies across 17 countries (data 2020–2024) — concluded no conclusive rise in ADHD prevalence globally. Incidence fluctuated during COVID-19, but overall prevalence remains stable. Quality of data is weak or inconsistent in many cases. (ScienceDirect)
Prevalence of attention‑deficit hyperactivity disorder (ADHD): systematic review and meta‑analysis (2024): Meta-analysis of 103 studies: found variation in prevalence estimates by methodology. Clinical-diagnosis studies cluster around 4–5%. Shows how sampling and assessment method strongly influence whether ADHD is “present” — key support for caution around diagnosis/overdiagnosis. (Cambridge University Press & Assessment)
An ADHD evaluation and management review — (2025 review in a psychology journal): Argues ADHD is heterogeneous, often overlapping with other conditions (anxiety, sleep problems, neurodivergent traits). Emphasises necessity for comprehensive assessment (not just checklists), and highlights diagnostic complexity. (Frontiers)

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About
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Rachel Filmer

Parent Carer and Campaigner at Stop Safety Valve

Rachel Filmer is a SEND campaigner and parent of disabled twins boys, who are thriving in a specialist school following an arduous tribunal process in 2020.

Since then, Rachel has volunteered supporting local families through the EHCP and appeal process. She is passionate about the legal rights of disabled children and empowering parents to challenge unlawful decision making.

Rachel previously worked in publishing and international events before setting up her own business as an artist and tutor. For the last six years she has worked in co-production, predominantly within maternity and reproductive health, and strongly believes that SEND services should be designed alongside those accessing them.

Rachel founded local campaign group BCP Alliance for Children & Schools (www.BCPACS.uk) bringing together parents, education staff and unions to campaign against funding and service cuts within education. She also started the national Stop Safety Valve campaign