What the Fonagy Review interim report actually says about ADHD and autism trends
The Independent Review into Mental Health Conditions, ADHD and Autism published its interim report on 31 March 2026. Chaired by Professor Peter Fonagy, the review was commissioned to examine why so many people who are autistic, have ADHD, or experience mental health conditions are not getting support as quickly or as early as they need it. The interim findings have already generated significant media attention — but the coverage and the content tell rather different stories.
The Fonagy Review’s central finding is that multiple processes are occurring simultaneously. For common mental health conditions — principally anxiety and depression — there is evidence of a genuine increase in population prevalence over the past two decades, particularly among younger people. Adult prevalence rose from around 15–16% in the early 1990s to around 23% by the mid-2020s.
For ADHD and autism, the picture is materially different. Epidemiological estimates of underlying prevalence appear broadly stable, while administrative diagnoses, referrals, and self-identification have increased substantially. The Fonagy Review states this explicitly: “This does not imply that one set of trends is ‘real’ and the other is not. Rather, it suggests that several processes may be operating at the same time.”
The Fonagy Review identifies these processes as including changes in levels of distress, improved recognition of previously unmet need, changes in help-seeking behaviour, institutional incentives associated with diagnosis, and changes in professional and public understanding. It explicitly rejects the polarised framing that dominates public debate — the idea that rising diagnoses must reflect either genuine deterioration or fashionable over-labelling.
What the Fonagy Review does not do is conclude that ADHD and autism are being overdiagnosed. It states that “underdiagnosis, misdiagnosis and overdiagnosis are not mutually exclusive possibilities” and that all three may be occurring within the same system simultaneously.
The circular logic of "medicalisation" — building the gateway, blaming the queue
The Times headline (front page no less) that accompanied this report’s release (“Children ‘incentivised’ to get ADHD and autism diagnoses, say experts“) framed the findings as evidence that children are being “incentivised” to seek ADHD and autism diagnoses. This framing deserves scrutiny — not because it is entirely fabricated, but because it inverts the direction of responsibility.
The Fonagy Review itself identifies the incentive structure. Section 9.3 states: “In many parts of the current system, diagnosis functions not only as a clinical classification but also as a gateway to resources, adjustments and formal recognition. This is particularly evident in education, higher education and employment, where documentary evidence of a diagnosis is often required before support can be provided.”
The Equality Act 2010 is framed around substantial and long-term impairment of functioning rather than diagnosis alone. In practice, however, institutions frequently rely on diagnosis as the most readily available form of evidence that support is warranted. The Fonagy Review notes this gap between legal intent and operational reality — but the implication is clear. The “incentive” to seek diagnosis is not a character flaw in help-seekers. It is a design feature of a system that made diagnosis the only reliable route to support.
The “medicalisation” complaint follows the same circular pattern. The Fonagy Review expresses concern that “a wide range of difficulties — particularly those arising from social, educational or environmental pressures — may increasingly be interpreted primarily through a medical lens.” But who built that lens? The diagnostic gatekeeping infrastructure was not created by families seeking assessments. It was created by policymakers who tied support entitlements to clinical categorisation.
When support is only available through diagnosis, people will seek diagnosis. When early, accessible help is limited, difficulties escalate and presentations become more clinical. The system creates the very pattern it then characterises as problematic behaviour.
The data within the report that undermines the "overdiagnosis" narrative
The Fonagy Review contains substantial data — and much of it directly contradicts the “overdiagnosis” framing that dominates media coverage.
ADHD administrative prevalence remains below epidemiological benchmarks. The Fonagy Review cites NICE prevalence estimates of around 5% in children and young people and 2–3% in adults. Recorded prevalence in primary care as of June 2025 was 1.19% overall — materially below these benchmarks. “Even with very substantial administrative growth, recorded prevalence in most age groups remains below the epidemiological benchmarks usually cited in policy and clinical guidance.”
The waiting list data tells a story of unmet demand, not excessive supply. NHS England monitoring data show that the number of children and young people waiting for an ADHD assessment rose from around 21,000 in April 2019 to around 270,000 by December 2025. This is not a system overwhelmed by frivolous referrals. It is a system that cannot process legitimate demand.
The demographic shifts suggest historical underdiagnosis being corrected. The sharpest increases in ADHD diagnosis have occurred among adolescent and young adult females — groups historically under-recognised. The Fonagy Review notes that “Incidence among adolescent and young adult females has risen particularly rapidly, to the point that the historical sex ratio appears to be narrowing markedly.” If ADHD were being overdiagnosed, we would expect to see expansion beyond plausible prevalence bounds. Instead, we see expansion into populations previously excluded from recognition.
Self-identification trends reflect awareness, not pathology. The proportion of 16–24 year olds reporting that they have autism rose from 5.4% in 2022 to 8.9% in 2025. Among adults overall, the corresponding proportion rose from 1.4% in 2022 to 2.6% in 2025. The Fonagy Review correctly notes that self-identification cannot be equated with clinical prevalence — but it also cannot be dismissed as delusion. The more parsimonious explanation is that people are recognising experiences that were previously unnamed.
What the Fonagy review recommends versus what the headlines imply
The Fonagy Review’s actual recommendations point toward structural reform, not diagnostic restriction. It calls for “a fairer, more proportionate and more coherent system in which support is better matched to need and available earlier — without unnecessary delay or dependence on diagnosis alone.” More coherent? Where have you heard that before? Here, first, on The Neurodiversity Directory, that is.
The Fonagy Review is not a call to reduce diagnosis. It is a call to reduce the dependence on diagnosis as the sole gateway to support. The distinction matters enormously. The Fonagy Review explicitly states that its purpose is “not intended to minimise the challenges people are facing, question the legitimacy of lived experience, or contribute to any stigmatisation or re-stigmatisation of mental health and neurodevelopmental conditions.”
The National Autistic Society’s response was pointed: “Too much attention is being placed on questioning people’s motivations for seeking a diagnosis.” This captures the core problem with the media framing. When the system makes diagnosis the only reliable route to support, questioning why people seek diagnosis is not analysis — it is blame-shifting.
The Fonagy Review identifies a genuine problem — but the problem is system design, not individual behaviour. When early, accessible help is limited, difficulties escalate. When support is tied tightly to diagnostic labels, demand for diagnosis will rise. The solution is not to restrict access to diagnosis. The solution is to create alternative routes to support that do not require years-long waits for clinical validation of difficulties that are already apparent.
The Fonagy Review interim report is a serious document that attempts to hold multiple truths simultaneously. Its misrepresentation as evidence of “incentivised” diagnosis serves a different agenda — one that reframes structural failure as individual pathology. The data within the report itself tells a different story: a system that cannot meet legitimate demand, populations historically excluded from recognition now seeking it, and a gatekeeping infrastructure that creates the very patterns it then pathologises.
The final report is due in summer 2026. It will inform SEND reform and the Alan Milburn Review on young people and work. Whether its recommendations address the structural problems it has identified — or whether they are filtered through the same individualising lens that shaped the initial coverage — remains to be seen.
Citations
Department of Health and Social Care — Independent review into mental health conditions, ADHD and autism: interim report
National Autistic Society — Response to the interim report of the independent review into the prevalence of autism, mental health and ADHD
