Record rise in disability payments for schoolchildren sparks debate over ADHD and autism diagnoses

A sharp rise in disability living allowance claims for secondary-school-aged children has prompted new debate about possible overdiagnosis of conditions such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

A column by psychiatrist Dr. Max Pemberton cited Department for Work and Pensions (DWP) analysis showing 362,520 children aged 11 to 15 in England and Wales were receiving disability living allowance (DLA), representing roughly 10% of that age group. Payments range from about £1,520 to £9,770 a year depending on assessed need.

Pemberton and others argue a combination of broader diagnostic criteria and parental pressure has fuelled a rise in labels such as ADHD and autism, creating incentives to seek diagnoses that carry financial and educational support. A recent Policy Exchange report, backed by former health secretary Jeremy Hunt, said common definitions of mental ill health and neurodivergence had been “stretched too far,” contributing to what it called widespread overdiagnosis among children. The think tank estimated the associated bill for children’s health benefits, special educational needs and disabilities (SEND) support and mental health services at about £16 billion a year.

Clinicians and researchers have raised similar concerns. A widely cited study found autism diagnoses rose by about 787% between 1998 and 2018, a pattern some experts interpret as evidence of expanding diagnostic boundaries. Professor Uta Frith of University College London said that trend “strongly suggests that the diagnosis of autism has been stretched to breaking point,” while Dr. Mike Shooter, a former president of the Royal College of Psychiatrists, has described ASD as “vastly and dangerously over-diagnosed.” Those views were cited in Pemberton’s column.

Advocates for people with disabilities and some clinicians counter that rising numbers can reflect greater awareness, improved access to assessments, and better identification of previously overlooked needs. They warn that narrowing diagnostic criteria could deny support to children with genuine difficulties. DLA entitlement is based on assessed need for extra care or limited mobility compared with peers without a health condition or disability, and payments are intended to offset additional costs faced by families.

The debate has policy implications for how scarce resources are allocated. Policy Exchange warned that “poor incentives” in benefits, education and health systems can prompt “diagnosis-seeking behaviour” that places services under unsustainable strain. Pemberton wrote that an expanding definition of mental illness risks diverting support from children with the most severe needs and produces inequities, with those whose parents are better informed or more assertive more likely to secure assistance.

Government and NHS officials have said services are working to balance timely diagnosis with appropriate thresholds for specialist support. Assessments for SEND, DLA and clinical diagnoses typically involve multidisciplinary input, and recent reforms have aimed to speed up access to autism and ADHD assessments while maintaining clinical standards. Campaigners and some clinicians, however, say waiting times and regional variation in services still drive families toward private assessments or alternative routes to support.

Pemberton’s column also welcomed a separate development in hospital care policy: the national rollout of “Martha’s Rule,” which allows families to request an urgent second opinion when they are concerned about care in acute hospitals. Piloted after the death of 13-year-old Martha Mills, the measure has registered about 5,000 calls and 241 potentially lifesaving interventions, according to trial figures cited by supporters. Pemberton used that example to underscore the complexity of decisions about diagnosis and treatment and to argue for systems that protect genuinely vulnerable children.

Experts say multiple factors are likely driving the rise in diagnoses and benefit claims, including increased public awareness, changes in diagnostic frameworks that use spectrum categories, improved screening in schools and primary care, and social factors that affect behaviour and learning. Some clinicians note that when diagnostic categories are described as spectrums, there is a risk of “diagnosis creep” as milder presentations are brought within diagnostic thresholds.

Policy discussions are expected to focus on tightening assessment criteria, improving equity of access to specialist services, and reviewing incentives across benefits and education systems. Advocates for disabled children caution that any policy changes must avoid disadvantaging those with genuine needs and that support should not be contingent solely on narrow diagnostic labels.

The debate reflects broader tensions in child health about how to distinguish between clinical disorders and variations in behaviour and development that may respond to educational or social interventions. Ministers, clinicians and campaigners say further research, clearer clinical guidance and better resourcing of assessment and support services will be needed to ensure children who need help receive it while protecting the sustainability of public services.