That NHS boards have imposed minimum two-year waiting times for attention deficit hyperactivity disorder and autism assessments shows a health service struggling to deal with the consequences of huge changes in understanding of and social attitudes to these conditions.
asserted
imposed → impose → conditions
Sharp rises in referrals for clinical assessments over the past six years mean nearly 1 million people in England are on ADHD waiting lists, with the average wait already over a year (64 weeks).
asserted
people → mean → year
About 295,000 await an autism assessment.
asserted
295,000 → await → assessment
Formal diagnosis has grown in recent years, slowly from the early 2000s and rapidly since 2020.
asserted
diagnosis → grow → 2020
Between 2020 and 2022, annual incidence of autism diagnosis in three- to 25-year-old males rose from 185 to 580 per 100,000, and from 45 to 320 in females.
asserted
incidence → rise → females
The lengthening waiting lists tell a tale not only of an NHS under financial strain and short of key staff, but also one of deepening distress for many patients and families for whom diagnosis is the key to clinical treatment and other forms of support.
asserted
diagnosis → lengthen → support
The explosion in diagnosis reflects the role of the NHS as a crucial gateway for a range of social support.
asserted
explosion → reflect → support
If assessment bottlenecks mean it cannot deliver timely clinical assessments, this has serious knock-on effects; delays not just in medical help but in access to specialist support in schools or financial support through disability benefits.
asserted
this → mean → benefits
This trend has caught public services by surprise, causing alarm at the Treasury and triggering a bitter culture war that on one side derides this trend as the product of faddish and woke overdiagnosis, and on the other is hailed as the belated recognition of genuine conditions with real-life challenges for individuals.
asserted
that → catch → individuals
The interim report of a government-commissioned review into these trends by Peter Fonagy, published earlier this year, did not take sides.
asserted
report → commission → sides
“Unmet needs, misdiagnosis and concerns about over-medicalisation can coexist in the same system,” he wrote, with a nod to the raging culture war debates.
asserted
he → coexist → debates
What was not in doubt was that more people were experiencing distress, especially younger people, he concluded, and more people were seeking help as a result.
asserted
people → experience → result
Thresholds for referral had lowered, driving more referrals into an NHS poorly equipped to deal with the rise in demand.
asserted
Thresholds → lower → demand
That increase in part reflected improved clinical understanding and greater recognition of unmet needs, especially in previously underdiagnosed groups such as girls and young women.
asserted
increase → reflect → girls
“Some groups that were historically under-identified are now entering the services in greater numbers,” the report said.
asserted
report → identify → numbers
Diagnosis was also driven by institutional demand, whether in schools or the benefit system.
asserted
Diagnosis → drive → schools
It operates as what Fonagy describes as the “practical mechanism through which individuals obtain access to support, adjustments or formal recognition” – or what culture warriors disdain as the “golden ticket”.
asserted
warriors → operate → ticket
The bigger picture driving increases in referrals for diagnosis includes a variety of other factors: the impact of the pandemic, economic insecurity, greater public awareness and a decline in stigma surrounding ADHD and autism.
asserted
picture → drive → ADHD
Fonagy is expected to deliver his final report in the next few weeks.
asserted
Fonagy → expect → weeks
He has shown why the NHS is under huge strain coping with the rise in referrals for autism and ADHD.
asserted
NHS → show → autism
His next task is harder: to recommend ways of fixing the system.
asserted
task → recommend → system
The Aporia
