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Rapid response to:


Progress on children’s mental health services is too slow, says commissioner for England

BMJ 2018; 363 doi: (Published 22 November 2018) Cite this as: BMJ 2018;363:k4953

Rapid Response:

Scepticism regarding the NHS survey 'Mental Health of Children and Young People, 2017' and ASD/PDD

I note the recent comment of Prof Philip Graham in Guardian letters [1] regarding the publication of these figures:

" In addition, the rate of autism spectrum disorder was stable between 2004 and 2017, providing no support for the commonly held view that rates of this disorder are rising."

I doubt even using the figures for the 2017 survey [2] against the 2004 survey [3] that Prof Graham is justified since the overall figure for 2004 is 0.9% and the figure for 2017 is 1.2% and my rudimentary maths makes this an un-negligible 33% rise, while the the level for boys was 250% higher between the 17-19 year-olds and the 5-10 year-olds (1% against 2.5%). I also note that these figures are discrepant from the 2004 survey. For instance the 2017 survey measures the level of autism for boys in the 17 to 19 group at 1% when it was 1.9% 5-10 years in 2004, and this suggests inconsistency. In fact, the survey admits [4]:

"ASD was not associated with age. Rates appeared higher in younger age groups than
older ones (1.5% of 5 to 10 year olds; 1.2% of 11 to 16 year olds; 0.5% of 17 to 19
year olds). However, due to the small number of cases identified in the sample, the
survey was underpowered to detect variation."

These projections for England really need to be contrasted with the hard data in the recent Northern Ireland School Census based survey [5] which showed that prevalence in schools had risen from 1.2% in 2008-9 to 2.9% in 2017-18, and which is much more likely to represent conditions across the UK, where daily we hear reports of services under pressure and new schools having to be built - while also being out of line with official education figures [6].

It is doubtful whether these figures for England present either a true assessment of a well-nigh catastrophic situation, or the basis on which to conduct future policy.

[1] Guardian Letters 25 November 2018,

[2] 'Mental Health of Children and Young People in England, 2017 Autism spectrum, eating and other less common disorders' Fig1 p.10

[3] National Statistic 'Mental Health of Children and Young People in Great Britain, 2004' Table 4.1 p.35

[4] Op.cit p.11

[5] Information Analysis Directorate 'The Prevalence of Autism (including Asperger Syndrome) in School Age Children in Northern Ireland 2018', published 10 May 2018,

[6] Responses to Viner RM, 'NHS must prioritise health of children and young people',

Competing interests: No competing interests

28 November 2018
John Stone
UK Editor
London N22