Top paediatrician warns NDIS access pressures may be driving rise in autism diagnoses

A senior paediatrician-turned-politician has told Australian media that pressure to gain access to the National Disability Insurance Scheme (NDIS) may be a significant factor behind a surge in autism diagnoses, a claim that comes as the scheme faces rapidly rising costs and government-led reforms.

Dr Mike Freelander, who is leading a parliamentary review of the NDIS, said on Wednesday that some families and clinicians may be seeking or applying autism diagnoses so children can qualify for NDIS-funded services. "I think there is pressure to up-diagnose or over-diagnose so people can get access to a scheme that was not designed for people with mild or moderate developmental needs," he told 7News.

Freelander and other paediatric specialists warned that thousands of children with developmental delays may be receiving autism diagnoses they do not need for access to intensive therapies and supports. Frank Oberklaid, professor of paediatrics at the University of Melbourne, said some children with minor language delays or high energy are being labelled autistic, and that not all such children require the intensive therapy pathways funded by the NDIS.

The comments come amid changes introduced by the Albanese government in August that aim to refocus the NDIS on people with permanent disability and to create an alternative support stream for younger children with mild to moderate developmental needs. Under the reforms, some children with autism or developmental delay will transition from the NDIS to a new program called Thriving Kids, which will target children aged eight and under and emphasise early identification and community-based supports.

Health and NDIS Minister Mark Butler said the scheme has grown "incredibly fast" since it began in 2013 and that its expansion has at times distorted parts of the health and social care system. At a National Press Club appearance, Butler said one in six Australian six-year-old boys is now a participant in the NDIS and that the government is focused on ensuring the scheme becomes sustainable from a budget perspective.

The growth in participant numbers has been driven in recent years by children diagnosed with autism. A Nine Newspapers analysis of new participants during the last financial year found that seven in 10 new entrants were children with autism — 56,000 of the 78,000 people who joined the NDIS between July 2024 and June 2025. The government has said diverting some of these children over time into targeted early-childhood supports is an important element of returning the scheme to its original intent.

NDIS spending has increased rapidly. Treasury figures show the scheme cost taxpayers A$48.5 billion in 2024-25 and is forecast to reach A$52.3 billion in 2025-26. That projected expenditure exceeds Australia’s 2025-26 defence budget and places the NDIS among the nation’s largest programs. Government officials and independent reviewers have raised concerns about long-term sustainability and the need to prioritise support for people with permanent disability.

The current review of the NDIS follows an initial review process begun under former NDIS minister Bill Shorten in 2022. Freelander, who trained and practiced as a paediatrician before entering parliament, has described the scheme as having entered an "adolescence" phase that requires stronger management and clearer boundaries.

The Thriving Kids initiative is intended to offer a national system of supports for families of children with mild to moderate developmental delay and autism and to identify concerns earlier. Government officials have framed the program as complementary rather than a replacement for the NDIS for those with permanent and significant disability, but critics and clinicians have raised questions about how transitions will be managed and whether some families will lose access to necessary services.

Paediatricians have urged careful assessment and clearer diagnostic pathways to distinguish children who need intensive, long-term disability supports from those who would benefit from time-limited or community-based early-intervention services. They also called for improved access to diagnostic expertise to reduce variability in how developmental differences are assessed and diagnosed.

The government has said reforms will be phased in and that families affected by changes will be offered alternative supports. The parliamentary review led by Freelander will feed into broader policy decisions about how the NDIS and related early-childhood supports are structured to meet clinical needs while remaining fiscally sustainable.