PIP for autism
and ADHD has
more than tripled
among young
people — and
deprivation now
explains less
of who gets it

A benefit that has more than tripled since 2019

On 22 September the Nuffield Trust published an analysis of Personal Independence Payment (PIP) awarded to young people for ADHD and autism. Its opening figure is the one that will travel: by April 2026, just over 205,400 people aged 16–24 were receiving PIP for ADHD or autism — more than three times the 2019 figure, at an estimated £1.36bn in 2025/26.

That number alone would make a headline. It is not the finding. The finding is about where the growth has landed.

The authors — Sally Gainsbury, Stelios Vassiliou and Chris Sherlaw-Johnson — took DWP data from Stat-Xplore and mapped PIP for ADHD and autism among 16- and 17-year-olds across England, down to neighbourhoods (Middle Super Output Areas, averaging around 8,000 residents), and set it against the employment domain of the 2025 English Indices of Deprivation. They started at 2019, once the phased roll-out of PIP had settled. What they found is that payments are still highest where deprivation is highest — but the fastest growth has come from the other end of the scale.

The least deprived areas are catching up

Among 16- and 17-year-olds, employment deprivation explained around 22% of the variation in ADHD and autism PIP rates between local authorities in June 2019. By June 2025 it explained around 15%. At neighbourhood level, the most deprived fifth of areas had rates on average 2.5 times higher than the least deprived fifth in 2019; by June 2025 that gap had narrowed to two times.

Read the direction carefully, because it is easy to invert. The deprived areas did not fall. Growth happened everywhere — even in the most deprived fifth of neighbourhoods, where it was slowest, estimated rates rose 2.4 times. It was sharpest in the least deprived areas, where the estimated rate more than tripled. Among 16- and 17-year-olds, around £87m — about 30% of an estimated £296m spent on ADHD and autism PIP for that age group over 2025 — went to young people in the 40% least deprived neighbourhoods, up from around £22m in 2019 (in 2025/26 prices).

Set that beside the rest of the benefit. For 16- and 17-year-olds claiming PIP for every other condition, the Nuffield Trust found the old pattern not only intact but stronger: employment deprivation explained 53% of the variation between local authorities in June 2025, up from 41% in June 2019. The loosening is specific to ADHD and autism. In the authors’ words, it points to “a growing mismatch between how functional impairment (or disability) related to neurodiversity is recognised and supported in individuals and how it is reflected in population-level outcome measures of employment and educational attainment.”

The diagnosis is the gate, and the gate is not evenly placed

The report is careful about what it cannot see. PIP data, it says, “can give us only a partial view of how disability and the need for support is distributed across the population.” The picture is obscured first by unequal access to formal diagnosis, and then by potential inconsistencies in the PIP assessments themselves. It notes that research using GP records has found higher rates of new ADHD diagnoses in the least deprived areas, partly attributed to greater use of private routes to diagnosis among more affluent groups, particularly since the pandemic.

That is the mechanism worth sitting with. For ADHD and autism, the diagnosis has become the key that unlocks most formal recognition. The route to it increasingly runs through private providers — whether paid for by families or commissioned by the NHS, through a Right to Choose pathway now being rationed. A benefit that tracks recorded conditions will track whoever reaches the diagnosis first. It will not map neatly onto need, because the gate does not.

The ethnicity finding sharpens the same point from the other side. Neighbourhoods with a higher proportion of White residents had higher ADHD and autism PIP rates, which the authors say helps explain much lower-than-expected rates in places such as Newham, Brent, Leicester, Bradford and Wolverhampton. They are clear that this is an association, and that it “may indicate that there are barriers to accessing PIP payments and/or ADHD and autism diagnoses for minoritised ethnic groups.”

None of this requires anyone to be gaming anything. Families with time, money and a working knowledge of the system reach the diagnosis sooner; the diagnosis unlocks the benefit; the benefit is spent where the diagnoses are. Each step is reasonable. The distribution is simply what the structure produces.

What the analysis cannot tell us

The report weighs several explanations and settles none. It points to inconsistent PIP assessment and to unequal access to diagnosis, and says of both: “These explanations are likely to be significant and should not be discounted.” It then adds a further possibility, hedged as carefully: that the diagnosis and recognition of these conditions “may have become more detached from an objective assessment of functional impairment”. Anyone citing the report should keep those hedges attached — not least in the debate over overdiagnosis.

What it does say plainly is that PIP was designed to be awarded regardless of means, work or educational achievement, and that a shift towards such outcome measures would be “in stark contrast to the original design of PIP”. That is the policy bind. The interim report of the government’s review of PIP, the Timms review, has already highlighted widespread dissatisfaction with the system, the Nuffield Trust notes, including concerns that assessments are not consistent or fair and are particularly poor at capturing functional impairment in conditions such as ADHD and autism. The Nuffield data arrives into that review as evidence that, for ADHD and autism, the benefit’s distribution may increasingly reflect access to diagnosis as well as deprivation.

A structure that rewards reaching the door

The tempting response is to tighten the gate: stricter assessments, higher thresholds, more scrutiny of claims from comfortable postcodes. That would treat the symptom and keep the structure. The structure is that support for ADHD and autism is routed, overwhelmingly, through a diagnosis, and the diagnosis is distributed by access — to private assessment clinics, to Right to Choose providers still taking referrals, to the time and confidence it takes to push a referral through. Tighten the gate and, on this argument, it is the families furthest from it who are shut out first — and the ethnicity finding suggests some groups already face barriers to reaching it.

The deeper question the report raises, without answering, is why a young person’s need for support has to be proven through a clinical label before any of it arrives. As long as the label is the main key, a benefit built on it will keep drifting toward whoever can afford to have the lock picked. A system that measured need where it arises — in school, in work, in daily functioning — would not produce this map. This one does, and will keep doing so, whatever the next review decides about the threshold.

Citations

Gainsbury, S., Vassiliou, S. and Sherlaw-Johnson, C. (2026) — PIP for ADHD and autism: a weakening link with deprivation? — Nuffield Trust