A government-commissioned review led by Professor Peter Fonagy warns that Britain risks harming children through the over-diagnosis of ADHD and autism. Dr. Max Pemberton argues that shifting diagnostic criteria and a lack of biological markers have turned standard life challenges into perceived neurodevelopmental disorders.
The 2013 threshold shift that doubled diagnoses
Changes to the diagnostic manual in 2013 significantly lowered the bar for what constitutes ADHD. According to the report, the age by which symptoms must appear rose from seven to 12, while the number of symptoms required for an adult diagnosis dropped from six to five. This adjustment had a measurable impact on clinical populations; when researchers tested these new rules on students, 21 percent met the threshold, compared to just 12.7 percent under the previous standards.
Dr. Max Pemberton suggests that these changes have effectively rebranded common struggles as medical conditions. As Dr.. Pemberton notes, the new criteria make it easier for individuals to step over the diagnostic line, even if their symptoms are actually reactions to external stressors . This shift has contributed to a landscape where, as Dr.. Iona Heath, a former president of the Royal College of General Practitioners, observed, the criteria are so vague that "if you want the diagnosis, you'll be able to get it matters."
A 560,000-person backlog and the £1,000 private fix
The UK's ADHD assessment landscape is currently defined by a massive and growing backlog. Monthly referrals for ADHD assessments for both children and adults more than tripled between 2019 and 2024. By the end of last year, more than 560,000 individuals were placed on waiting lists for a formal assessment.
Private medical firms are now performing more than half of all NHS-funded ADHD assessments to meet this skyrocketing demand. This has created a lucrative market where private assessments can cost upwards of £1,000. The report suggests there is little financial incentive for these private providers to avoid a diagnosis,particularly when patients are paying out-of-pocket and are already convinced that a neurodevelopmental disorder explains their difficulties.
The absence of a clear biological marker for ADHD
Scientific research has yet to identify a single gene or a definitive brain scan that can confirm an ADHD diagnosis. While large-scale brain imaging studies show some differences between groups, the overlap is so significant that a scan cannot be used to diagnose an individual. Furthermore, while dozens of DNA stretches have been linked to the condition, each has a vanishingly small effect and is often shared with other psychiatric disorders.
The lack of biological certainty draws parallels to the historical misunderstanding of depression. As Dr. Pemberton points out, in the 1980s, many believed depression was simply a chemical imbalance, a theory now considered overly simplistic because it ignored how life events like debt or bereavement affect mood. There is a growing concern that ADHD is being treated with a similar biological determinism, despite the absence of a clear physiological smoking gun.
Who benefits from a 'diagnosis-dependent' system?
The current UK social infrastructure has created what the Fonagy-led review calls a "diagnosis-dependent" system. In this model, a formal medical label is often the only way for a student to receive extra help at school or for an individual to access specific financial supports. This creates a powerful incentive for people to seek a label, even if their symptoms stem from anxiety, poor sleep, or grief.
Several critical questions remain regarding the long-term impact of this trend. It is still unclear how many of these diagnoses are masking environmental issues like loneliness or economic hardship. Additionally, there is a debate over whether the "neurodevelopmental" label—which implies a fixed, lifelong condition—might inadvertently discourage people from seeking behavioral changes.. Sir Simon Wessely, the review's vice-chairman, has warned that such labels can "close doors" by shaping how individuals perceive their own capacity for change.
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