Children as young as six are increasingly arriving at England’s A&E departments with mental health concerns, while the number waiting for an ADHD assessment has increased almost thirteen-fold since 2019.
The figures reveal a health service under extraordinary pressure, but they also raise a more difficult question: are children becoming dramatically more unwell, are previously overlooked conditions finally being recognised, or are some of the ordinary struggles of childhood increasingly being interpreted through a medical lens?
Children aged between six and nine are the fastest-growing group of young people arriving at England’s accident and emergency departments with recorded mental health concerns, according to new figures which provide a troubling insight into the scale of demand now facing NHS services.
Data obtained from NHS England through a Freedom of Information request and analysed by the Royal College of Paediatrics and Child Health shows that there were 75,491 A&E attendances involving a recorded mental health concern among children and young people aged six to 17 in 2025, compared with 55,525 in 2019. That represents an increase of 36 per cent in just six years.
But the increase among some of the youngest children is considerably greater. Among six to nine-year-olds, mental health-related A&E attendances rose from 3,870 in 2019 to 6,269 in 2025, an increase of 62 per cent.
There is an important qualification to those figures. The data count A&E attendances rather than individual children, meaning the same child could potentially be represented more than once. Nor does a recorded mental health concern necessarily mean that the child was subsequently diagnosed with a psychiatric disorder. Nevertheless, the increase is substantial and has prompted serious concern among paediatricians about children reaching emergency departments without having received adequate help earlier.
What happens after some of these young people arrive at hospital is perhaps even more alarming. In 2019, 1,964 children and young people with mental health concerns spent more than 12 hours in A&E. By 2025, that number had risen to 6,235, an increase of 217 per cent. At the most extreme end, just 55 children spent more than 72 hours in an emergency department in 2019. Last year, 338 did so, representing a 514 per cent increase.
That means hundreds of children and teenagers with mental health concerns spent at least three days in environments principally designed to deal with accidents, physical illness and medical emergencies while waiting for appropriate care or somewhere suitable to be discharged.
The RCPCH says emergency departments are an essential safety net but are not designed to accommodate children experiencing serious mental health difficulties for prolonged periods. Dr Sam Jones, the College’s Officer for Mental Health, has described children arriving in A&E with problems including self-harm, low mood and eating disorders, and said neurodivergence also frequently features in the cases paediatricians encounter. The College is calling for greater investment in prevention, early intervention and community services so that fewer children deteriorate to the point at which their families have nowhere left to turn but A&E.
Few would dispute that a child in serious psychological distress needs timely and appropriate help. Yet the figures arrive in the middle of a much broader and increasingly important debate about what is happening to childhood, and whether every increase in referrals, diagnoses and recorded mental health problems necessarily represents an equivalent increase in underlying illness.
The Government is currently conducting a major independent review into mental health conditions, ADHD and autism, commissioned in December 2025 and chaired by Professor Peter Fonagy, with Professor Sir Simon Wessely and Professor Gillian Baird as vice-chairs. Its remit includes examining why recorded prevalence and demand have increased, the changing way society understands mental health and neurodevelopmental conditions, and the risks and benefits associated with medicalisation.
Its interim findings contain one particularly remarkable statistic. In April 2019, around 21,000 children and young people were waiting for an ADHD assessment through NHS mental health services. By December 2025, that figure had reached approximately 270,000.
In fewer than seven years, therefore, the waiting list had grown almost thirteen-fold.
Yet the Government review also highlights an important apparent contradiction. Population surveys, which attempt to measure ADHD symptoms across society rather than simply counting those referred to or diagnosed by health services, suggest that the underlying prevalence of ADHD symptoms has been much more stable. NICE estimates that ADHD affects approximately five per cent of children and young people, and the interim review says available population evidence does not indicate anything approaching a thirteen-fold increase in underlying prevalence.
That leaves an obvious question. If ADHD itself has not suddenly become thirteen times more common, why are almost thirteen times as many children waiting to be assessed?
There is no single established answer, and increased diagnosis should certainly not automatically be equated with unnecessary diagnosis. Some of the increase may represent a long-overdue improvement in recognising genuine difficulties which previous generations simply lived with undiagnosed. Greater awareness among parents, teachers and doctors, reduced stigma and improved understanding of the different ways conditions can present are all likely to have brought previously overlooked children into contact with services.
Girls are an important example. Research has found that girls with ADHD are more likely to display inattentiveness and internalising difficulties rather than the conspicuous hyperactivity and impulsivity more commonly associated with boys. As a result, their difficulties can be less disruptive in a classroom and therefore easier for adults to miss. Better recognition of such differences could mean that children who would once have struggled silently are finally receiving appropriate assessment and support.
But improved recognition is not the only possibility being investigated. The Government review is also considering the effects of changing education, work and everyday life, public awareness and expectations, social media and digital change, clinical practice and systems in which access to certain forms of help can sometimes become connected to obtaining a diagnosis.
That question is also being examined by academics. Oxford psychologist Dr Lucy Foulkes and researcher Jack Andrews have proposed what they call the “prevalence inflation hypothesis”. Their argument is not that mental illness is imaginary, nor that awareness of mental health is undesirable. Instead, they suggest that increased awareness can potentially have two effects at the same time.
The first is plainly beneficial: people suffering from genuine mental illness become better able to recognise their symptoms and seek help. The second is more controversial. Foulkes and Andrews suggest that increased awareness may also encourage some people experiencing relatively mild or ordinary distress to interpret sadness, anxiety, stress or worry as evidence of a mental health disorder. In some circumstances, they argue, adopting such a label may subsequently influence how an individual understands and responds to those feelings.
It remains a hypothesis rather than a settled explanation for rising mental health prevalence, and Foulkes has repeatedly made clear that her argument should not be interpreted as saying mental illness is not real. Instead, her work raises a subtler question about whether society has become sufficiently good at distinguishing severe and persistent psychological problems from the inevitable emotional difficulties involved in being human.
A similar and equally contentious debate surrounds ADHD. A major systematic scoping review led by Luise Kazda at the University of Sydney and published in JAMA Network Open examined 334 studies concerning ADHD diagnosis in children and adolescents. The researchers concluded that there was evidence of ADHD overdiagnosis and overtreatment, particularly among children towards the milder end of the spectrum.
The review identified 25 studies suggesting that additional diagnoses may disproportionately involve children with milder symptoms and 83 studies showing increasing pharmacological treatment. But it also exposed an important gap in the evidence: only five studies had directly examined whether the benefits of diagnosis and treatment outweighed the potential harms among these additional, milder cases.
That does not establish that ADHD generally is being overdiagnosed. Indeed, other leading researchers strongly contest any suggestion that rising diagnosis rates prove widespread overdiagnosis. Professor Samuele Cortese has argued that underdiagnosis and undertreatment remain significant problems and that the real question is not whether the total number of diagnoses has increased, but whether individual children are being accurately assessed and receiving appropriate help.
Both propositions can be true at the same time. Children with serious and disabling ADHD may still be going undiagnosed or waiting far too long for treatment, while some children at the mildest end of behavioural variation may potentially be diagnosed despite receiving little benefit from doing so.
Perhaps one of the most fascinating pieces of evidence demonstrating how difficult that distinction can be comes not from medicine but from the school calendar.
Researchers have repeatedly identified what is known as the “relative-age effect”, whereby children who are among the youngest in their school year are more likely to receive an ADHD diagnosis than the oldest children in the same class. A major systematic review and meta-analysis involving 32 studies found that relatively younger children had a 38 per cent higher relative risk of receiving an ADHD diagnosis and a 28 per cent higher relative risk of being prescribed ADHD medication.
The explanation proposed by researchers is strikingly simple. In a primary school classroom, there can be close to a year’s developmental difference between the oldest and youngest pupils. A six-year-old may naturally find it harder to sit still, concentrate or control impulses than a classmate approaching seven. If behaviour is judged primarily against other children in the same classroom rather than against developmental age, ordinary immaturity can potentially appear abnormal.
Intriguingly, the relative-age effect has also been found in teachers’ ratings of ADHD symptoms but not consistently in parents’ ratings, lending further weight to the possibility that comparison with older classmates can influence how behaviour is perceived.
None of this means ADHD is not a genuine neurodevelopmental condition. It plainly is, and for children significantly affected by it, proper diagnosis and treatment can be transformative. Rather, the research illustrates just how difficult it can be to draw an exact line between a clinical disorder and the enormous natural variation in children’s concentration, behaviour, emotional regulation and maturity.
That distinction becomes particularly important when considering children as young as six.
So are England’s children really becoming dramatically more mentally ill?
At present, the evidence does not provide a simple answer. What can be stated with confidence is that demand on health services has risen enormously. Mental health-related A&E attendances among six to 17-year-olds increased 36 per cent between 2019 and 2025. Among six to nine-year-olds, the increase was 62 per cent. More than 6,200 children and young people with a recorded mental health concern spent over 12 hours in A&E last year and 338 spent more than 72 hours there. Meanwhile, the number of children and young people waiting for an ADHD assessment has risen from around 21,000 to approximately 270,000.
Those are extraordinary figures. What they cannot tell us on their own is precisely why this has happened.
Some of the increase may represent genuine deterioration in children’s mental health. Some may reflect conditions that previous generations failed to recognise. Some may result from greater awareness and willingness to seek help. Some may reflect inadequate early support, meaning children deteriorate further before receiving treatment. And some researchers believe part of the increase may represent a broader cultural shift in which behaviours and emotions once regarded as falling within the wide range of ordinary childhood are increasingly understood in clinical terms.
These explanations are not mutually exclusive, and the available evidence does not justify either of the simplistic conclusions sometimes heard in this debate: that Britain is experiencing an unprecedented epidemic of childhood psychiatric illness, or that large numbers of children receiving diagnoses simply need to toughen up.
A severely depressed child, a youngster who is self-harming, someone suffering from an eating disorder or a child whose life is significantly impaired by ADHD needs proper professional assessment and, where appropriate, treatment. Missing genuine illness can have profound consequences.
But there is also a legitimate scientific and social debate about the other side of that equation. Childhood inevitably contains anxiety, sadness, frustration, poor concentration, difficult behaviour, shyness, anger, disappointment and periods of unhappiness. The challenge for clinicians, schools and parents is determining when those experiences represent symptoms of a disorder requiring clinical intervention and when they remain within the extraordinarily broad spectrum of growing up.
The Government’s final review will have to grapple with precisely that distinction.
For now, however, there is one conclusion which requires considerably less debate. Whatever ultimately explains the rise in recorded mental health problems and demand for assessments, children experiencing serious distress need somewhere appropriate to receive help.
A six-year-old spending three days in a busy accident and emergency department waiting for that help should not be considered an acceptable mental health service.
