Fonagy review: ADHD and autism diagnosis trends providers should plan for

Since 2019, recorded ADHD in England has grown fastest among adults in their 30s and 40s, and young women are now newly diagnosed at about twice the rate of young men. The independent review into mental health conditions, ADHD and autism, known as the Fonagy review and published on 9 October 2026, says the shift towards women and adults is consistent with better recognition. It says it "cannot conclude that overdiagnosis is occurring at scale", while warning that the balance of risks is shifting if present trends continue.

What this means for you

• Your growth is in adults, and more of them are women. In 2025, women aged 18 to 34 were newly diagnosed at 892 per 100,000 person-years, against 458 for men.
• Self-identification is rising faster than symptoms. The share of adults who think they might have ADHD rose about eight times in ten years, while the share screening positive for symptoms rose about 1.4 times. Our reading is that referrals will stay high whatever your capacity.
• Most people you assess will have more than one condition, and many adults have little childhood history. Plan clinician mix and appointment time for both.

This is part of our series on the Fonagy review, alongside CQC regulation, assessment standards, the post-diagnostic offer and Right to Choose data reporting.

Recorded prevalence, new diagnoses and survey answers measure different things#

• Recorded prevalence: the share of people with the diagnosis on their GP record in the last five years. It is not how many people have the condition, and it misses some private and Right to Choose diagnoses until they reach the GP (p39).
• New diagnoses: new recorded diagnoses each year, per 100,000 person-years (roughly, per 100,000 people followed for a year).
• Survey answers: what adults told the Adult Psychiatric Morbidity Survey (APMS) at home, whether or not they have a diagnosis.

Adult ADHD diagnosis rates grew fastest: about tenfold at 35 to 64 since 2019#

Recorded ADHD and autism by age group, England, 2000 to 2025Share of each age group with the diagnosis on their GP record.ADHDAutismBarsHeatmap2025 Ages 0 to 17 18 and over 2019 levelRight-hand column: times the 2019 level0–50.069%1.4x6–112.70%2.0x12–173.88%2.2x18–243.10%3.5x25–342.14%6.8x35–441.38%10x45–540.79%10x55–640.29%10x65+0.033%4.3x0%2%4%2025: the biggest rise in recorded ADHD since 2019 is at ages 45–54, from 0.077% to 0.79% (10x).Source: Independent review into mental health conditions, ADHD and autism, DHSC, 2026, Figures ES.1 and ES.2 (CPRD); values redrawn from the charts, multiples our calculation. Contains public sector information licensed under the Open Government Licence v3.0.

Recorded ADHD rose most in adults, but from low starting points#

Recorded ADHD, 2019 against 2025:

Values read from Figure ES.1 (p10); change is our calculation.

The tenfold rises come from low starting points. In percentage points the rise is similar from age 6 to 44, about 1.2 to 2.2 points, but ADHD at 18 to 24 is now higher than at 6 to 11.

Recorded autism rose more evenly, about two to three times at every age#

For autism the shape changes: about two to three times in every age group, from 2.26% to 4.58% at ages 6 to 11 (0.24% in 2000, p10) and from 0.34% to 0.92% at 25 to 34.

Recorded rates in children are now close to or above old estimates#

In children, recorded rates are now close to or above the survey-based estimates of about 1.2% for autism and 3% for ADHD, both from 2017. The review roughly projects ADHD at about 3.8% today (pp9-10), and stresses that these estimates are dated (p12).

ADHD diagnosis rates by sex: women now lead new adult diagnoses#

New ADHD diagnoses by age and sex, EnglandNew diagnoses on GP records per 100,000 person-years. Opens on 2025; one scale for every age group.2025MaleAgeFemale1,3446–1163187212–1779045818–3489226235–545103555+5505001,00005001,000Ages 18 to 34: women overtook men in 2021New diagnoses per 100,000 person-years, 2010 to 2025892458201020212025Ages 18 to 34, 2025: women 892, men 458 new diagnoses per 100,000 person-years.Source: Independent review into mental health conditions, ADHD and autism, DHSC, 2026, Figure 7.2 (CPRD); values redrawn from the chart. Contains public sector information licensed under the Open Government Licence v3.0.

Women aged 18 to 54 have been newly diagnosed more often than men since 2021#

In 2025, women aged 18 to 34 were newly diagnosed with ADHD at 892 per 100,000 person-years, against 458 for men (values read from Figure 7.2). At 35 to 54 it was 510 against 262. In both groups the female rate has been higher every year since 2021. Over 55 the rates are low: 55 for women and 35 for men.

Among children, boys are still newly diagnosed more often than girls#

Children still run the other way. At ages 6 to 11, boys were newly diagnosed at 1,344 and girls at 631; at 12 to 17, 872 against 790.

Recorded ADHD in females rose over tenfold since 2017, consistent with better recognition#

Across all ages, recorded ADHD grew more than tenfold in females between 2017 and 2025, against about threefold in males, though males are still slightly ahead at 1.5% against 1.3% (p131). The review says this is consistent with better recognition of women, adults and inattentive presentations. It says catch-up "appears largely complete among adults", and that a similar process is now under way in children and teenagers (p131). For autism, girls and women are now newly diagnosed more often than boys and men from adolescence on (p169).

Our reading is that the typical new adult patient is a woman, often with anxiety or low mood alongside, and that tools and training built around hyperactive boys will miss things.

Adults who think they have ADHD now recall onset at 21.7, up from 9.8#

One finding complicates this. Adults who think they have ADHD now recall difficulties starting at 21.7 years on average, up from 9.8 in 2014 (p135). The review says this may reflect later recognition, or impairment that shows once family, school or work "scaffolding falls away, particularly among women", and that recall bias limits what can be concluded (pp135-136). In the Dunedin birth cohort, a single New Zealand study, 90% of adult ADHD cases had no childhood history (p136). The review says this raises questions about how consistently ADHD is identified as a condition that starts in childhood (p144). Our reading is that adult assessments with little evidence of childhood difficulties will draw the most questions, and that evidence is hardest to get when parents are not around and school reports are lost.

Self-identified ADHD rose about eightfold in ten years; symptoms rose about 1.4 times#

Adults who think they have ADHD, are told they have it, and are treated, 2014 and 2024Share of all adults aged 16 and over, Adult Psychiatric Morbidity Survey. Each group is part of the one above. 2014 2024Think they might have ADHDabout 8x20140.7%20245.8%Told by a professionalabout 4x20140.4%20241.8%Any treatment, past year20140.1%20240.8%For comparison, adults screening positive on a symptom questionnaire (ASRS) went from 9.7% to 13.9%, about 1.4x.Think they might have had ADHD: 2014 0.7% (95% CI 0.5 to 1%; 45 of 7,542 people); 2024 5.8% (95% CI 5 to 6.6%; 304 of 6,906 people).Source: Independent review into mental health conditions, ADHD and autism, DHSC, 2026, technical annex Tables 1.G.5 and 1.A.7 (APMS); survey answers, not GP records. Contains public sector information licensed under the Open Government Licence v3.0.

These are survey answers; each question was asked only of people who said yes to the one before. Between 2014 and 2024, adults who think they might have ADHD went from 0.7% to 5.8% (about 8 times), those told by a professional from 0.4% to 1.8% (about 4 times) and those treated in the past year from 0.1% to 0.8%. Screening positive on the ASRS symptom questionnaire went only from 9.7% to 13.9%, about 1.4 times, though among 16 to 24-year-olds it rose from 14.6% to 25.0% (technical annex Tables 1.G.5 and 1.A.7). For autism in 2024, 3.4% of adults thought they might be autistic, 1.2% had been told so and 0.1% had treatment (annex p132).

The people coming forward are not less unwell. The review found "those now presenting are no less affected than those identified before" (p15).

Our reading is that demand is driven by self-identification as much as by symptoms, so referrals will not fall when you add capacity. Many people who are not diagnosed are still struggling, which is why support while waiting and a summary of needs whatever the outcome matter.

Most young people with a common mental disorder now also screen positive for ADHD#

ADHD, autistic traits and self-harm have all risen in this group since 2007#

Among 16 to 24-year-olds with a common mental disorder, screening positive for ADHD rose from 36% in 2007 to 57% in 2024, autistic traits from 20% to 61%, and self-harm from 28% to 52% (p198). Among adults screening positive for ADHD, autistic traits rose from 27.2% to 45.6% (p138).

The proposed standards would require co-occurring conditions to be assessed#

Recommendation 5 says assessment standards should require assessment of co-occurring conditions and functioning, and that where more than one assessment is needed they should be carried out separately but in a planned sequence (p444). Our article on the review's assessment standards goes through each.

The deprivation gap in new ADHD diagnoses has closed; gaps by ethnicity remain#

New ADHD diagnoses are now level across deprivation; autism is not#

New ADHD diagnoses used to be far more common in deprived areas. The ratio of new diagnoses in the most deprived fifth of areas to the least deprived has fallen from about 2.3 to level (1.01 in 2025), although recorded prevalence is still higher in more deprived areas (p131). The review suggests uneven access to independent providers may be part of the reason (p132). Autism still shows a gap of about 1.5 to 1 (p170).

By ethnicity, recorded ADHD is lowest in Black and South Asian people#

By ethnicity, recorded ADHD in 2025 was about 2.0% for people of Mixed ethnicity and 1.7% for White people, against 0.7% for Black and 0.4% for South Asian people (p132). The review is cautious about the causes, but wants outcomes reported by ethnicity and deprivation (Recommendation 8, p447), so expect commissioners to ask who you reach.

The review cannot conclude overdiagnosis at scale, but warns the balance is shifting#

The review cannot say overdiagnosis is happening at scale, partly because population data are out of date. It does say that, if present trends continue, the balance of risks is shifting towards misdiagnosis and overdiagnosis, and that some groups are still under-recognised (p15). The conditions it says make a wrong diagnosis more likely, such as brief or single-condition assessments, are all things a provider controls, as our article on the review's assessment standards explains.

Six steps match your service to who is now being diagnosed#

1. Plan capacity around adults. Model referrals by age and sex. Adult ADHD, especially women aged 18 to 54, is where demand has grown fastest.
2. Check your clinician mix. You need assessors confident with adults, with ADHD and autism together, and with anxiety and depression, and trained for inattentive and masked presentations in women.
3. Design for thin childhood evidence. Request informant questionnaires, school reports and early records at referral.
4. Sequence assessments. Where both conditions need assessing, plan the order and record the clinical reason, as our article on the review's assessment standards explains.
5. Plan for after diagnosis. With 1.8% of adults diagnosed and 0.8% treated, the post-diagnostic offer and shared care are part of capacity.
6. Keep your own data. Record age, sex, deprivation and ethnicity now, ahead of mandatory data reporting.

Where Cerebric fits#

Cerebric handles the admin around each assessment: it sends, chases and scores patient and informant questionnaires, gathers history at intake, records the assessment and drafts the report in your template for the clinician to review, edit and sign. Clinical decisions stay with the clinician. At clinics using Cerebric, that has meant 58% more assessments per clinician.¹

Footnotes#

1. Measured at UK Right to Choose and private neurodevelopmental providers using Cerebric, 2025–26. ↩