False Assumption Registry

Rising Diagnoses Signal Mental Illness Epidemic

False Assumption: Sharp increases in mental health diagnoses among children reflect a genuine surge in the prevalence of mental disorders.

Summaries Written by FARAgent (AI) on February 09, 2026 · Pending Verification

For most of the past two decades, rising rates of childhood mental health diagnoses were treated as straightforward evidence of a worsening crisis. Advocacy groups, pediatricians, and public health agencies pointed to climbing numbers of children diagnosed with ADHD, autism, anxiety, and depression as proof that American children were genuinely sicker than previous generations. A 2021 study in Public Health Practice documented sharp increases in diagnosed childhood mental illness and framed the trend as a public health emergency demanding more resources and earlier intervention. The DSM's successive expansions, including the addition of Asperger's syndrome and the broadening of autism criteria, were understood at the time as good-faith efforts to capture real suffering that had previously gone unrecognized. Allen Frances, who chaired the DSM-IV task force, later admitted he had not anticipated how dramatically loosened diagnostic thresholds would inflate prevalence figures.

A substantial body of researchers now rejects the straightforward epidemic interpretation. Significant evidence suggests that much of the measured increase reflects diagnostic expansion, shifting clinical thresholds, and institutional incentives rather than a genuine deterioration in children's neurological or psychological health. Schools facing pressure to improve outcomes discovered that disability classifications unlocked accommodations and funding, creating what critics describe as a Goodhart's Law problem: once diagnosis became a metric tied to resources, it ceased to be a reliable measure of underlying need. Parents, too, learned that certain diagnoses carried practical advantages, from extended test time to legal protections, and sought them accordingly. Frances himself wrote in the New York Times in 2025 that autism rates had increased sixty-fold and that he had "played a role in that," a remarkable concession from someone at the center of the diagnostic apparatus.

The practical consequences of this confusion have been significant. Children placed on stimulants or antipsychotics for conditions they may not have had faced real side effects, while genuinely ill adolescents competed for scarce clinical attention in a system stretched thin by millions of new diagnoses. A 2024 HRSA report found that 61 percent of adolescents with a current diagnosis who needed mental health treatment still faced difficulty accessing care, suggesting that the surge in diagnoses did not translate into a corresponding surge in effective treatment. The debate remains live: some researchers maintain that real distress, amplified by social media and economic precarity, underlies at least part of the increase, while a growing number argue the numbers have been systematically inflated by the very systems designed to measure them.

Status: A significant portion of experts think this assumption was false
People Involved
  • Allen Frances chaired the DSM-IV task force in the late 1980s and early 1990s. He approved the addition of Asperger’s syndrome to the autism criteria after clinicians pressed for a way to help children with milder symptoms gain access to services. Task force studies had predicted only a modest increase in rates. Frances later warned in the New York Times that the change had contributed to a sixty-fold rise in autism diagnoses, far beyond what anyone had expected. [8][1]
  • Joseph Tkacz, director at Avalere Health, co-authored a 2021 study that tracked childhood mental illness through insurance claims. The paper reported a 34.6 percent prevalence increase from 2012 to 2018 and documented sharp rises in specific conditions such as anxiety and eating disorders. Tkacz and his colleagues presented the numbers as evidence of growing need within the pediatric population. [4]
  • Wes Streeting, then a British member of parliament and later Health Secretary, publicly questioned whether the surge in mental health diagnoses reflected real illness or the medicalisation of ordinary distress. After criticism from advocacy groups he walked the statement back and ordered an independent review of rising demand. The episode illustrated the political pressure surrounding the topic. [6]
▶ Supporting Quotes (14)
“My task force approved the inclusion of…Asperger’s syndrome, which is much milder in severity than classic autism and much more common. In doing so, we were responding to child psychiatrists’ and pediatricians’ concerns for children who did not meet the extremely stringent criteria for classic autism, but had similar symptoms in milder form and might benefit from services.”— School Daze
“The people clamoring loudest for a diagnosis of A.D.H.D. or autism are often parents.”— School Daze
“Corresponding Author: Janet R. Cummings, PhD, Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Ste 650, Atlanta, GA 30322 ([email protected]).”— Trends in Mental Health Diagnoses Among Publicly Insured Children
“Joseph Tkacz a Avalere Health, Washington, DC, USA ∗ Corresponding author.”— Increasing rate of diagnosed childhood mental illness in the United States: Incidence, prevalence and costs
“Brenna L Brady b IBM Watson Health, Bethesda, MD, USA”— Increasing rate of diagnosed childhood mental illness in the United States: Incidence, prevalence and costs
“Olivia Sappenfield, Cinthya Alberto, Jessica Minnaert, Julie Donney, Lydie Lebrun-Harris, and Reem Ghandour.”— Adolescent Mental and Behavioral Health, 2023
“Minesh Patel, associate director of policy and influencing at mental health charity Mind, said there was "no credible evidence" that mental health problems were being over-diagnosed.”— 'Life being stressful is not an illness' - GPs on mental health over-diagnosis
“Earlier this year, the health secretary Wes Streeting told the BBC's Laura Kuenssberg that mental health conditions were being over-diagnosed and too many people were being "written off".”— 'Life being stressful is not an illness' - GPs on mental health over-diagnosis
“Professor Victoria Tzortziou Brown, chair of the Royal College of GPs, said there's a "difficult balance" for family doctors to strike when patients expect a diagnosis for mental health problems, but don't meet the criteria.”— 'Life being stressful is not an illness' - GPs on mental health over-diagnosis
“We aimed to estimate changes in the global burden of mental disorders among children and adolescents before and during the pandemic.”— Global burden of mental disorders in children and adolescents before and during the COVID-19 pandemic: evidence from the Global Burden of Disease Study 2021
“Per Frances: “Whenever having a diagnosis carries a benefit, it will be overused.””— School Daze
“In the late 1980s and early 1990s, I was the chair of the task force charged with creating the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, or the D.S.M.-IV. ... my task force approved the inclusion of the new diagnosis, Asperger’s syndrome ... Based on careful studies, our task force predicted that the addition of Asperger’s syndrome would modestly increase the rate of children given an autism-related diagnosis.”— Opinion | Autism Rates Have Increased 60-Fold. I Played a Role in That.
“Robert F. Kennedy Jr., secretary of health and human services, is correct that reported autism rates have exploded in the last 30 years — they’ve increased roughly 60-fold — but he is dead wrong about the causes.”— Opinion | Autism Rates Have Increased 60-Fold. I Played a Role in That.
“An exemplary study that showed a positive Flynn effect is Ang, Rodgers and Wänström’s one in which they used the Children of the National Longitudinal Survey of Youth (CNLSY) cohort to showcase the Flynn effect in the PIAT Mathematics test.”— The Other Type of Flynn Effect
Organizations Involved

The American Psychiatric Association published DSM-IV in 1994 and incorporated broadened autism criteria that included Asperger’s syndrome. The manual became the standard reference for clinicians, insurers, schools and educators across the United States. Rates of autism diagnoses rose dramatically in the following decades. The organisation maintained that the changes were intended to improve access to services for children who previously fell through the cracks. [8][1]

HRSA’s Maternal and Child Health Bureau funds and directs the National Survey of Children’s Health, the largest ongoing parent-reported survey of child health in the United States. Its 2023 data brief stated that the share of adolescents with any diagnosed mental or behavioral condition rose from 15.0 percent in 2016 to 20.3 percent in 2023. The bureau presents these figures as national estimates intended to guide policy and resource allocation. [3]

The American Academy of Pediatrics joined two other medical organisations in declaring a national emergency in child and adolescent mental health in 2021. The declaration cited rising diagnoses, emergency department visits and reports of increased anxiety and depression. It shaped public discussion and reinforced the view that prevalence itself was climbing. [2]

▶ Supporting Quotes (21)
“With school funding now on the line, there were unmistakable incentives for children to be diagnosed…Getting a child treated, potentially with medication, could help an entire classroom achieve higher scores, especially if the child’s behavior was disruptive to others. And in some parts of the country, children with disabilities were not counted toward a school’s overall marks, a carve-out that could boost scores.”— School Daze
“Mental health professionals are supposed to improve mental health, but they must also make a living. This discourages recommending low-cost, non-professional alternatives—exercise, friendship—and encourages identifying more ways to intervene.”— School Daze
“JAMA. 2025 Apr 24;333(22):1988–1997. doi: 10.1001/jama.2025.4605”— Trends in Mental Health Diagnoses Among Publicly Insured Children
“Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia”— Trends in Mental Health Diagnoses Among Publicly Insured Children
“Medicaid and CHIP data came from a 100% sample of the 2010 to 2015 Medicaid Statistical Information System (MSIS) Analytic eXtract (MAX) and the 2014 to 2019 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) from the Centers for Medicare & Medicaid Services (CMS).”— Trends in Mental Health Diagnoses Among Publicly Insured Children
“In 2021, 3 health professional organizations that serve children, including the American Academy of Pediatrics, declared an emergency in child mental health,”— Trends in Mental Health Diagnoses Among Publicly Insured Children
“The Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) funds and directs the National Survey of Children’s Health (NSCH), which the U.S. Census Bureau conducts.”— Adolescent Mental and Behavioral Health, 2023
“The NSCH is the largest national- and state-level survey on the health and health care needs of children ages 0-17, their families, and their communities. It is an annual household survey completed by a parent or guardian, either by web or paper and pencil.”— Adolescent Mental and Behavioral Health, 2023
“The Centers for Disease Control and Prevention estimate that between 13% and 20% of American children and adolescents aged 3 through 17 have a diagnosable mental, emotional, or behavioral disorder [8].”— Increasing rate of diagnosed childhood mental illness in the United States: Incidence, prevalence and costs
“This observational, retrospective study used de-identified healthcare claims from the MarketScan Commercial Claims and Encounters Database spanning the period of January 1, 2011, through December 31st, 2018.”— Increasing rate of diagnosed childhood mental illness in the United States: Incidence, prevalence and costs
“The Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) funds and directs the National Survey of Children’s Health (NSCH), which the U.S. Census Bureau conducts.”— Adolescent Mental and Behavioral Health, 2023
“The NSCH is the largest national- and state-level survey on the health and health care needs of children ages 0-17, their families, and their communities. It is an annual household survey completed by a parent or guardian, either by web or paper and pencil.”— Adolescent Mental and Behavioral Health, 2023
“Overall, one in five adults in England report having a common mental health condition, like anxiety or depression, according to a survey published by NHS England.”— 'Life being stressful is not an illness' - GPs on mental health over-diagnosis
“"What we do know though is that the number of people experiencing mental health problems has increased, with 1 in 5 adults now living with a common mental health condition according to the Adult Psychiatric Morbidity Survey," he said.”— 'Life being stressful is not an illness' - GPs on mental health over-diagnosis
“Using data from the Global Burden of Diseases Study 2021, we analyzed incidence, prevalence, and years lived with disability (YLDs) for mental disorders in individuals aged 5–24.”— Global burden of mental disorders in children and adolescents before and during the COVID-19 pandemic: evidence from the Global Burden of Disease Study 2021
“Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, China.”— Global burden of mental disorders in children and adolescents before and during the COVID-19 pandemic: evidence from the Global Burden of Disease Study 2021
“School-level incentives reflect Goodhart’s Law, which states that when a measure becomes a target, it ceases to be a good measure.”— School Daze
“Sometimes called the “bible of psychiatry,” the D.S.M. influences medical practice, insurance coverage, education and treatment selection.”— Opinion | Autism Rates Have Increased 60-Fold. I Played a Role in That.
“To produce one high school graduate with a low-income socioeconomic status costs about $639,000 in today’s dollars.”— If You Can’t Measure It, Can You Improve It?
“In 2021, 3 health professional organizations that serve children, including the American Academy of Pediatrics, declared an emergency in child mental health,”— Trends in Mental Health Diagnoses Among Publicly Insured Children
“None of the peer reviewers or editors at Intelligence or any other journal publishing similar analyses noticed the problem either.”— The Other Type of Flynn Effect
The Foundation

The assumption that sharp increases in mental health diagnoses among children reflected a genuine surge in prevalence rested on several lines of evidence that once looked persuasive. DSM diagnostic expansions, particularly the addition of Asperger’s syndrome in DSM-IV, were presented as good-faith responses to clinicians who wanted milder cases to qualify for services. No reliable biomarkers existed for most childhood mental disorders, so subjective reports and clinician judgment became the sole basis for classification. Goodhart’s Law was sometimes invoked to explain why schools treated diagnoses as targets, yet the same logic was rarely applied to the broader claim that measured prevalence was rising because illness itself was rising. [1]

Large administrative datasets appeared to confirm the trend. A JAMA study using Medicaid and CHIP claims from 22 states found that the share of publicly insured children aged three to seventeen with any mental health or neurodevelopmental diagnosis rose from 10.7 percent in 2010 to 16.5 percent in 2019. The largest increases occurred in attention-deficit/hyperactivity disorder, other neurodevelopmental disorders, trauma- and stressor-related disorders, anxiety, autism spectrum disorders and depressive disorders. Authors described the pattern as a clear signal of growing burden. [2]

National surveys told a similar story. The National Survey of Children’s Health reported that the prevalence of any diagnosed mental or behavioral health condition among adolescents climbed from 15.0 percent to 20.3 percent between 2016 and 2023, with anxiety diagnoses rising 61 percent and depression 45 percent. Claims data from another study showed a 34.6 percent increase in overall prevalence from 2012 to 2018, with anxiety up 95 percent, eating disorders up 96 percent and depression up 73 percent. Global Burden of Disease modelling for 2021 added further weight by estimating an additional 795 cases per 100,000 adolescents during the pandemic period. [3][4][7]

▶ Supporting Quotes (25)
“A second explanation is that the boundaries of mental illness have widened. New diagnostic categories have materialized; old ones have been stretched. Conditions that once described severe impairment increasingly encompass milder, more ambiguous forms of distress or difference, ushering more and more people under their expanding umbrellas.”— School Daze
“Diabetes is confirmed by elevated blood glucose. A broken bone is confirmed by an X-ray. But because the brain is the most complicated thing humans have ever encountered, no such tests or biomarkers exist for most mental illnesses. This means that almost anything can be asserted without fear of falsification.”— School Daze
“School-level incentives reflect Goodhart’s Law, which states that when a measure becomes a target, it ceases to be a good measure.”— School Daze
“the percentage of publicly insured children with any diagnosed mental health or neurodevelopmental disorder increased from 10.7% in 2010 to 16.5% in 2019; this change remained significant after adjustment for covariates (adjusted risk difference [aRD], 6.7 percentage points [95% CI, 5.0-8.4]).”— Trends in Mental Health Diagnoses Among Publicly Insured Children
“The largest absolute increases were observed for attention-deficit/hyperactivity disorder (aRD, 2.3 percentage points [95% CI, 1.4-3.3]), trauma- and stressor-related disorders (aRD, 1.7 percentage points [95% CI, 0.9-2.5]), anxiety disorders (aRD, 1.6 percentage points [95% CI, 1.2-2.1]), autism spectrum disorders (aRD, 1.1 percentage points [95% CI, 0.9-1.4]), depressive disorders (aRD, 0.9 percentage points [95% CI, 0.6-1.3]), and other neurodevelopmental disorders (aRD, 2.6 percentage points [95% CI, 1.8-3.5]).”— Trends in Mental Health Diagnoses Among Publicly Insured Children
“Between 2016 and 2023, the prevalence of diagnosed mental or behavioral health conditions among adolescents increased 35 percent (from 15.0% to 20.3%).”— Adolescent Mental and Behavioral Health, 2023
“The prevalence of diagnosed anxiety increased 61 percent (from 10.0% to 16.1%) and depression increased 45 percent (from 5.8% to 8.4%)”— Adolescent Mental and Behavioral Health, 2023
“From 2012 to 2018, there was a 34.6% increase in the prevalence of mental illness. ... As mental illness is known to be underdiagnosed, the true rate of mental illnesses among children is likely even greater.”— Increasing rate of diagnosed childhood mental illness in the United States: Incidence, prevalence and costs
“eating disorders, anxiety, and depression presented the greatest increases at 96%, 95%, and 73% respectively.”— Increasing rate of diagnosed childhood mental illness in the United States: Incidence, prevalence and costs
“In 2023, parents/caregivers completed questionnaires for 55,162 children 0-17 years, including 18,397 adolescents 12-17 years. Estimates presented in this brief are weighted to represent the population of children living in U.S. households.”— Adolescent Mental and Behavioral Health, 2023
“Between 2016 and 2023, the prevalence of diagnosed mental or behavioral health conditions among adolescents increased 35 percent (from 15.0% to 20.3%). The prevalence of diagnosed anxiety increased 61 percent (from 10.0% to 16.1%) and depression increased 45 percent (from 5.8% to 8.4%); the prevalence of diagnosed behavior/conduct problems was stable.”— Adolescent Mental and Behavioral Health, 2023
“Overall, one in five adults in England report having a common mental health condition, like anxiety or depression, according to a survey published by NHS England. Rates are even higher in young people. For 16-24 year olds, it's one-in-four.”— 'Life being stressful is not an illness' - GPs on mental health over-diagnosis
“What we do know though is that the number of people experiencing mental health problems has increased, with 1 in 5 adults now living with a common mental health condition according to the Adult Psychiatric Morbidity Survey”— 'Life being stressful is not an illness' - GPs on mental health over-diagnosis
“Data obtained from systematic reviews were tested and adjusted for biases using DisMod-MR version 2.1... Based on pre-pandemic data, we estimated an additional burden of 795.0... new cases per 100,000 population.”— Global burden of mental disorders in children and adolescents before and during the COVID-19 pandemic: evidence from the Global Burden of Disease Study 2021
“Increased screen time, school closures and disruptions, reduced physical activity, and limited access to school-based mental health support have all likely exerted significant influence.”— Global burden of mental disorders in children and adolescents before and during the COVID-19 pandemic: evidence from the Global Burden of Disease Study 2021
“New diagnostic categories have materialized; old ones have been stretched. Conditions that once described severe impairment increasingly encompass milder, more ambiguous forms of distress or difference, ushering more and more people under their expanding umbrellas.”— School Daze
“because the brain is the most complicated thing humans have ever encountered, no such tests or biomarkers exist for most mental illnesses. This means that almost anything can be asserted without fear of falsification.”— School Daze
“In the third edition of the D.S.M., published in 1980, autism was tightly defined and considered extremely rare. Criteria for the diagnosis required a very early onset (before age 3) of severe cognitive, interpersonal, emotional and behavioral problems.”— Opinion | Autism Rates Have Increased 60-Fold. I Played a Role in That.
“Based on careful studies, our task force predicted that the addition of Asperger’s syndrome would modestly increase the rate of children given an autism-related diagnosis. Instead, the rate increased more than 16-fold”— Opinion | Autism Rates Have Increased 60-Fold. I Played a Role in That.
“Per-pupil expenditures can tell what a system costs but says nothing about what it delivers.”— If You Can’t Measure It, Can You Improve It?
“You might examine recent public high school graduation rates—which increased from less than 60% in 2013 to 80% in 2024... But if instead, you look at SAT participation and scores from the same cohort and period—which have fallen in all but one year since 2018”— If You Can’t Measure It, Can You Improve It?
“the percentage of publicly insured children with any diagnosed mental health or neurodevelopmental disorder increased from 10.7% in 2010 to 16.5% in 2019; this change remained significant after adjustment for covariates (adjusted risk difference [aRD], 6.7 percentage points [95% CI, 5.0-8.4]).”— Trends in Mental Health Diagnoses Among Publicly Insured Children
“The largest absolute increases were observed for attention-deficit/hyperactivity disorder (aRD, 2.3 percentage points [95% CI, 1.4-3.3]), trauma- and stressor-related disorders (aRD, 1.7 percentage points [95% CI, 0.9-2.5]), anxiety disorders (aRD, 1.6 percentage points [95% CI, 1.2-2.1]), autism spectrum disorders (aRD, 1.1 percentage points [95% CI, 0.9-1.4]), depressive disorders (aRD, 0.9 percentage points [95% CI, 0.6-1.3]), and other neurodevelopmental disorders (aRD, 2.6 percentage points [95% CI, 1.8-3.5]).”— Trends in Mental Health Diagnoses Among Publicly Insured Children
“What they found was that five, six, seven, eight, nine, ten, eleven, twelve, and thirteen-year-olds’ scores trended up in each year of the survey data. The extent of these trends was similar by sex, race, and urbanicity, but children from more educated and higher-earning households showed a stronger Flynn effect—that is, greater score increases in successive years of the data.”— The Other Type of Flynn Effect
“Oberleiter et al. claimed to find a large (~5-IQ point), measurement invariant anti-Flynn effect—that is, real declining ability—in Germany over a brief ten year period (2012-22). ...there were changes in the underlying population being covered in their comparisons. Their results were based on comparisons of three large, population-representative cohorts of secondary school students, but in this period, secondary school attendance became much less selective.”— The Other Type of Flynn Effect
How It Spread

The assumption spread through multiple channels that reinforced one another. Media outlets including the New York Times framed rising diagnosis numbers as evidence that children were becoming more unwell and that schools were failing them. Annual data briefs from the Maternal and Child Health Bureau publicised the NSCH statistics through charts, national estimates and interactive query tools, giving the figures an official cast. Peer-reviewed journals such as JAMA, Public Health in Practice and Psychological Medicine published the underlying studies, lending academic credibility. [1][2][3][7]

Social and cultural mechanisms accelerated the trend. Parents sought diagnoses to secure competitive advantages in school accommodations and resource allocation. Clinicians faced pressure to produce billable interventions rather than recommend free alternatives such as exercise. Social contagion played a role as symptom narratives spread among peers in ways reminiscent of earlier episodes of collective behaviour. Reduced stigma turned disability labels into identities that carried tangible benefits. [1][6]

Institutional actors amplified the message. The NHS in England published surveys claiming one in five adults had a mental health condition, and the charity Mind rejected suggestions of over-diagnosis by insisting prevalence had genuinely increased. Legislation such as the Mental Health Parity Act and provisions in the Affordable Care Act were justified by the belief that under-diagnosis remained widespread. Researchers and professional groups continued to cite emergency department surges and hospitalisations as proof of a crisis. [6][4]

▶ Supporting Quotes (19)
“A few weeks ago, the New York Times ran an article titled America’s Children Are Unwell. Are Schools Part of the Problem? At its core is a question many people are asking: why have mental health diagnoses—especially among children—risen so rapidly?”— School Daze
“Social contagion/memification/copycat effects drive the spread of diagnoses. I see this as closely related to incentives, but importantly distinct. Think of fashion, the fact that suicides spike after being covered in the news (the so-called Werther effect).”— School Daze
“A US national survey of parents in 2016 found that 25% of children had been diagnosed with a mental health, behavioral health, or developmental disorder at some point in their life by a health care professional.”— Trends in Mental Health Diagnoses Among Publicly Insured Children
“Since the 2020 onset of the COVID-19 pandemic, concerns about child mental health have increased. Data have shown increases in anxiety and depression as well as in diagnosed learning disabilities and developmental delays. Furthermore, research has reported increasing percentages of mental health–related emergency department visits and higher numbers and percentages of mental health–related hospitalizations among children.”— Trends in Mental Health Diagnoses Among Publicly Insured Children
“This brief presents newly released 2023 data on youth in the United States, aged 12-17.”— Adolescent Mental and Behavioral Health, 2023
“Over the past decades there has been increasing awareness of mental illness in the United States (US), which has been underscored by the passage of legislation such as the Mental Health Parity Act and provisions in the Affordable Care Act, as well as an increased number of mental health patient advocacy groups [1,2,3].”— Increasing rate of diagnosed childhood mental illness in the United States: Incidence, prevalence and costs
“numerous researchers and practitioners have begun referencing the current state of mental health among US children as a crisis [15,16,17].”— Increasing rate of diagnosed childhood mental illness in the United States: Incidence, prevalence and costs
“NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.”— Adolescent Mental and Behavioral Health, 2023
“2023 Data Release Access the most recent data and supporting materials.”— Adolescent Mental and Behavioral Health, 2023
“One commonly-held view by family doctors, our research suggests, is that society tends to over-medicalise normal life stresses.”— 'Life being stressful is not an illness' - GPs on mental health over-diagnosis
“One commented that young adults "seem to be less resilient since Covid", suggesting they're more concerned with getting a diagnosis than finding coping strategies.”— 'Life being stressful is not an illness' - GPs on mental health over-diagnosis
“Psychol Med. 2025 Mar 18;55:e90.”— Global burden of mental disorders in children and adolescents before and during the COVID-19 pandemic: evidence from the Global Burden of Disease Study 2021
“Citations for all data sources used in the GBD 2021 estimations are provided in a searchable format through a web tool (https://ghdx.healthdata.org/gbd-2021/sources).”— Global burden of mental disorders in children and adolescents before and during the COVID-19 pandemic: evidence from the Global Burden of Disease Study 2021
“The New York Times ran an article titled America’s Children Are Unwell. Are Schools Part of the Problem? At its core is a question many people are asking: why have mental health diagnoses—especially among children—risen so rapidly?”— School Daze
“Social contagion/memification/copycat effects drive the spread of diagnoses. Think of fashion, the fact that suicides spike after being covered in the news (the so-called Werther effect).”— School Daze
“Sometimes called the “bible of psychiatry,” the D.S.M. influences medical practice, insurance coverage, education and treatment selection. ... we were responding to child psychiatrists’ and pediatricians’ concerns”— Opinion | Autism Rates Have Increased 60-Fold. I Played a Role in That.
“Depending on what one reads or to whom one listens, the public is told the following: ... We spend not nearly enough on public education—or way too much.”— If You Can’t Measure It, Can You Improve It?
“A US national survey of parents in 2016 found that 25% of children had been diagnosed with a mental health, behavioral health, or developmental disorder at some point in their life by a health care professional. ... research has reported increasing percentages of mental health–related emergency department visits and higher numbers and percentages of mental health–related hospitalizations among children.”— Trends in Mental Health Diagnoses Among Publicly Insured Children
“None of the peer reviewers or editors at Intelligence or any other journal publishing similar analyses noticed the problem either.”— The Other Type of Flynn Effect
Resulting Policies

School funding policies tied to test scores created incentives to identify students with ADHD, autism or other labels. Diagnoses allowed low performers to be excluded from accountability metrics, provided extra time on tests or justified medication to reduce classroom disruption. These practices became common in districts under performance-based funding systems. [1]

The DSM-IV task force added Asperger’s syndrome in 1994 to address clinicians’ concerns that children with subtler symptoms were being denied services. The change lowered diagnostic thresholds and broadened eligibility for educational and medical support. Within a decade autism-related diagnoses had risen more than sixteen-fold. [8][1]

Federal and state governments responded to the reported surge with increased spending. The United States allocated nearly one trillion dollars to K-12 education in 2023, with New York City public schools spending roughly four hundred thousand dollars per student over the lifetime of one high-school cohort. Medicaid and CHIP, which covered 38.8 percent of American children, faced calls for expanded mental health services based on the same diagnosis trends. The Mental Health Parity Act and Affordable Care Act provisions were enacted on the premise that under-diagnosis was the central problem. [9][2][4]

▶ Supporting Quotes (9)
“Schools funded on test scores are incentivized to over-diagnose so students receive extra time, disruptive students are medicated, or low-performing students’ scores are excluded altogether.”— School Daze
“the passage of legislation such as the Mental Health Parity Act and provisions in the Affordable Care Act”— Increasing rate of diagnosed childhood mental illness in the United States: Incidence, prevalence and costs
“Earlier this week, the Health Secretary ordered an independent review into the reasons for a rising demand for mental health, ADHD and autism services in England, and where the gaps in support are.”— 'Life being stressful is not an illness' - GPs on mental health over-diagnosis
“Schools funded on test scores are incentivized to over-diagnose so students receive extra time, disruptive students are medicated, or low-performing students’ scores are excluded altogether.”— School Daze
“My task force approved the inclusion of…Asperger’s syndrome, which is much milder in severity than classic autism and much more common. In doing so, we were responding to child psychiatrists’ and pediatricians’ concerns for children who did not meet the extremely stringent criteria for classic autism.”— School Daze
“my task force approved the inclusion of the new diagnosis, Asperger’s syndrome, which is much milder in severity than classic autism”— Opinion | Autism Rates Have Increased 60-Fold. I Played a Role in That.
“In 2023, the U.S. dedicated nearly $1 trillion in combined state, local, and federal funding to K–12 education, more than any other program aside from major entitlements.”— If You Can’t Measure It, Can You Improve It?
“From kindergarten through high school, New York City on average spent nearly $400,000 per student in current dollars, or approximately $30,000 per year for the 2013–17 traditional high school cohort examined in this report.”— If You Can’t Measure It, Can You Improve It?
“Public insurance programs, such as Medicaid and the Children’s Health Insurance Program (CHIP), covered 38.8% of US children in 2023, ... These findings highlight the need for access to appropriate services in safety net systems and other settings that serve this population.”— Trends in Mental Health Diagnoses Among Publicly Insured Children
Harm Caused

The consequences of the assumption were felt in several domains. One study estimated one million additional ADHD diagnoses in six years, many of them leading to medication with side effects that included insomnia. Resources that might have gone to children with severe impairments were spread more thinly across milder cases. [1]

Adolescents with diagnosed conditions showed markedly worse outcomes on several indicators. They were three times as likely to be disengaged from school, four times as likely to have multiple school contacts about behavioural problems, five times as likely to miss eleven or more school days for health reasons, twice as likely to have been bullied and ten times as likely to report serious difficulty making or keeping friends. Sixty-one percent of those who needed treatment reported difficulty obtaining it in 2023, a figure that had risen 35 percent since 2018. [3]

Financial costs mounted quickly. Children with mental illness diagnoses incurred average annual medical expenses of $6,055 in 2018 compared with $1,629 for matched controls. Mental health emergency department visits among paediatric patients rose 55 percent from 2012 to 2016, while juvenile mood disorder hospitalisations increased 80 percent between 1997 and 2010. Suicide became the second leading cause of death for teenagers aged fifteen to nineteen. [4]

In Britain, general practitioners reported similar strains. Four hundred forty-seven GPs said they routinely prescribed antidepressants because talking therapies were unavailable. Five hundred eight of seven hundred fifty-two surveyed GPs said adult mental health services were rarely or never adequate, and six hundred forty expressed particular worry about services for young people. Many described the pattern as the medicalisation of normal stresses such as grief. [6]

▶ Supporting Quotes (25)
“This can be as mundane as someone seeking help for everyday stress, acquiring a clinical anxiety diagnosis, and then taking medication that causes insomnia.”— School Daze
“Parent-level incentives resemble a public goods problem. Everyone would be better off with fewer diagnoses because it would allow scarce resources to flow to those who need them most, but individual parents are incentivized to advocate early and often.”— School Daze
“Among adolescents with a current diagnosis who needed treatment or counseling, 61.0% had difficulty getting needed treatment in 2023, a 35% increase since 2018”— Adolescent Mental and Behavioral Health, 2023
“Adolescents with a current diagnosis were 3 times as likely to be disengaged from school, compared to those with no current diagnosis (43.9% “Never” or “Sometimes” engaged vs. 14.9%).”— Adolescent Mental and Behavioral Health, 2023
“Adolescents with a current diagnosis were 4 times as likely to have parents/caregivers report 2 or more contacts from their school in the past 12 months about problems compared to those with no current diagnosis (32.8% vs. 7.4%).”— Adolescent Mental and Behavioral Health, 2023
“Adolescents with a current diagnosis were 5 times as likely to miss 11 or more days of school for health reasons in the past 12 months, compared to those with no current diagnosis (17.7% vs. 3.5%).”— Adolescent Mental and Behavioral Health, 2023
“Adolescents with a current diagnosis were twice as likely to be a victim of bullying in the past 12 months, compared to those with no current diagnosis (60.5% vs. 27.2%).”— Adolescent Mental and Behavioral Health, 2023
“Adolescents with a current diagnosis were 10 times as likely to experience a lot of difficulty with making or keeping friends, compared to those with no diagnosis (20.4% vs. 2.1%).”— Adolescent Mental and Behavioral Health, 2023
“Children with a mental illness incurred significantly greater medical costs compared to matched controls in all years assessed (2018 comparison: $6,055±$27,198 vs. $1,629±$7,274; p < 0.001).”— Increasing rate of diagnosed childhood mental illness in the United States: Incidence, prevalence and costs
“From 2012 to 2016, there was a 55% increase in mental health emergency room visits among pediatric patients [12], while hospitalizations for mood disorders among juveniles increased 80% from 1997 to 2010 [13].”— Increasing rate of diagnosed childhood mental illness in the United States: Incidence, prevalence and costs
“suicide recently surpassed homicide as the second leading cause of death among teenagers aged 15-19, trailing only accidents [14].”— Increasing rate of diagnosed childhood mental illness in the United States: Incidence, prevalence and costs
“Adolescents with a current diagnosis were 3 times as likely to be disengaged from school, compared to those with no current diagnosis (43.9% "Never" or "Sometimes" engaged vs. 14.9%). Adolescents with a current diagnosis were 4 times as likely to have parents/caregivers report 2 or more contacts from their school in the past 12 months about problems compared to those with no current diagnosis (32.8% vs. 7.4%). Adolescents with a current diagnosis were 5 times as likely to miss 11 or more days of school for health reasons in the past 12 months, compared to those with no current diagnosis (17.7% vs. 3.5%).”— Adolescent Mental and Behavioral Health, 2023
“Adolescents with a current diagnosis were twice as likely to be a victim of bullying in the past 12 months, compared to those with no current diagnosis (60.5% vs. 27.2%). Adolescents with a current diagnosis were 10 times as likely to experience a lot of difficulty with making or keeping friends, compared to those with no diagnosis (20.4% vs. 2.1%).”— Adolescent Mental and Behavioral Health, 2023
“Among adolescents with a current diagnosis who needed treatment or counseling, 61.0% had difficulty getting needed treatment in 2023, a 35% increase since 2018, with a notable rise after 2020.”— Adolescent Mental and Behavioral Health, 2023
“We also asked GPs if they ever prescribe medication because they worry patients will not get other help, such as talking therapies, quickly enough. The most common answer - from 447 GPs - is that they do this "routinely".”— 'Life being stressful is not an illness' - GPs on mental health over-diagnosis
“A clear majority of GPs who took part in our research, 508 of 752, said there was rarely or never enough good quality mental health help available for adults in their area. Even more, some 640 GPs, told us they were worried about getting young patients the help they needed.”— 'Life being stressful is not an illness' - GPs on mental health over-diagnosis
“giving people labels such as anxiety or depression "over-medicalises life and emotional difficulties", and that this was taking resources away from people with severe needs.”— 'Life being stressful is not an illness' - GPs on mental health over-diagnosis
“anxiety disorders... became the leading cause of nonfatal disability (12.9 million [8.0–19.3] YLDs), while depressive disorders rose to fourth place (10.9 million [6.8–16.5] YLDs).”— Global burden of mental disorders in children and adolescents before and during the COVID-19 pandemic: evidence from the Global Burden of Disease Study 2021
“an estimated 123.0 million new cases... with an 11.8% average annual increase in the age-standardized incidence rate during the pandemic.”— Global burden of mental disorders in children and adolescents before and during the COVID-19 pandemic: evidence from the Global Burden of Disease Study 2021
“This can be as mundane as someone seeking help for everyday stress, acquiring a clinical anxiety diagnosis, and then taking medication that causes insomnia.”— School Daze
“With school funding now on the line, there were unmistakable incentives for children to be diagnosed…Getting a child treated, potentially with medication, could help an entire classroom achieve higher scores.”— School Daze
“the rate increased more than 16-fold, to one in 150 from an estimated one in 2,500 in the span of a decade. It has been climbing more gradually ever since and is one in 31 today. Our intentions were good, but we underestimated the enormous unintended consequences”— Opinion | Autism Rates Have Increased 60-Fold. I Played a Role in That.
“To yield an eventual single associate’s or B.A. degree recipient from that same low-income cohort, the NYC public school system expended approximately six times the amount spent per pupil, $2.2 million in constant 2025 dollars.”— If You Can’t Measure It, Can You Improve It?
“The 2024 National Assessment of Educational Progress—known as the “Nation’s Report Card”… shows 12th-graders’ performance slipping to a record low.… leaving many unprepared for life after high school”— If You Can’t Measure It, Can You Improve It?
“There are surprisingly many papers out there that conflate ‘the Flynn effect’, as in the psychometric bias-driven change in scores between cohorts, with ‘the Flynn effect’, as in the sampling bias-driven change in scores between select cohorts. ...it misleads people into thinking that there are oftentimes huge and fast population-level changes that just are not so.”— The Other Type of Flynn Effect
Downfall

Challenges to the assumption gathered force from several directions. A BBC survey of 752 general practitioners found that 442 believed over-diagnosis was a genuine concern and that normal life stresses were being turned into medical conditions. Several GPs stated plainly that life being stressful is not an illness. [6]

Critics pointed to perverse incentives operating across schools, parents, clinicians and even students themselves. The absence of biomarkers made it impossible to falsify many diagnoses. Allen Frances, who had once approved the DSM-IV changes, publicly described the explosion in autism rates as an unintended consequence of lowered thresholds. Actual numbers had far exceeded the modest increases the task force had predicted. [1][8]

Reanalyses of earlier data cast further doubt on some supporting claims. A sibling fixed-effects study of the CNLSY eliminated the apparent positive Flynn effect in mathematics scores, turning the trend slightly negative and suggesting the earlier result had been driven by compositional changes in who had children later. Similar scrutiny of German data revealed that reported declines in cognitive scores were partly explained by shifts in school selectivity and demographics. These corrections did not settle the broader debate but illustrated how easily administrative and survey data could be misread. [10]

▶ Supporting Quotes (7)
“Of the 752 GPs who chose to took part in our research, 442 said they believed that over-diagnosis is a concern.”— 'Life being stressful is not an illness' - GPs on mental health over-diagnosis
“One of the most common themes to emerge can be summed up in this remark from a GP: "Life being stressful is not an illness." Another commented: "As a society we seem to have forgotten that life can be tough - a broken heart or grief is painful and normal, and we have to learn to cope."”— 'Life being stressful is not an illness' - GPs on mental health over-diagnosis
“The rise in mental health diagnoses doesn’t require bad actors, conspiracies, or mass delusion—only a modern environment, elastic definitions, misaligned incentives, social transmission, and no effective braking mechanism.”— School Daze
“Instead, the rate increased more than 16-fold ... we underestimated the enormous unintended consequences of adding the new diagnosis.”— Opinion | Autism Rates Have Increased 60-Fold. I Played a Role in That.
“six times the number of college graduates for the same funding as NYC district public schools, a multiple that grows to nearly nine times when comparing low-income students only.”— If You Can’t Measure It, Can You Improve It?
“It’s only when we compare siblings in the same family that we see the effect entirely evaporate. In fact, it goes slightly negative!”— The Other Type of Flynn Effect
“The issues with this result were two-fold. First, their result was not, in fact, measurement invariant. ...Second, there were changes in the underlying population being covered in their comparisons.”— The Other Type of Flynn Effect
Sources
Related False Assumptions
ID: FA-20260209-cbe9787a · Created: 2026-02-09T21:25:46.820534 · Schema v3

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