Local population

Local population

  • Around 1% of people across all ages are autistic (Roman-Urrestarazu et al., 2021a). 5% of children, and 3 to 4% of adults, are thought to have ADHD (NICE, 2023).
  • The co-occurrence between autism and ADHD estimated to fall between 20 to 70% (Rosello et al., 2022). Other neurodevelopmental conditions, such as dyspraxia, are also more common among people who are autistic or have ADHD (Cleaton and Kirby, 2018; Royal College of Psychiatrists, 2020a).
  • It is estimated that:
    • There are around 7,200 autistic people and 22,500 people with ADHD living in Cambridgeshire.
    • There are around 2,350 autistic people and 7,550 people with ADHD living in Peterborough.
  • ADHD and autism are both highly heritable (Larsson et al., 2014; Tick et al., 2016), hence it is not uncommon that multiple people within the same family have autism and/or ADHD.

ADHD prevalence

Reviews of international literature suggest that 5.29% of children and young people (under 18s) have ADHD (Polanczyk et al., 2007). Using this figure, it is estimated that 7,050 under 18s in Cambridgeshire, and 2,850 in Peterborough, have ADHD.

Figure 2: Estimated number of children and young people (aged 0 – 17) with ADHD, Cambridgeshire and Peterborough. Data sources: The Worldwide Prevalence of ADHD: A Systematic Review and Metaregression Analysis | American Journal of Psychiatry (psychiatryonline.org), ONS Census 2021

It is estimated that around 9,850 adults (aged 18 – 50) in Cambridgeshire have ADHD (5,900 males and 3,900 females) and 3,250 adults in Peterborough have ADHD (1,950 males and 1,300 females).

Figure 3: Estimated of adults (aged 18 – 50) with ADHD, Cambridgeshire and Peterborough. Data sources: Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder | The British Journal of Psychiatry | Cambridge Core,  ONS Census 2021

Local estimates for ADHD in the 50+ age group are about 5,600 adults in Cambridgeshire and 1,450 adults in Peterborough.

Figure 4: Estimated of adults (aged 50+) with ADHD, Cambridgeshire and Peterborough. Data sources: Prevalence of attention-deficit/hyperactivity disorder in older adults: A systematic review and meta-analysis and ONS Census 2021 population

Autism prevalence 

  • It is estimated that 1.1% of the population is autistic (95% confidence interval 0.3% – 1.9%) (Brugha et al., 2016). Using these figures and population data, we can estimate that:
    • There are around 7,200 autistic people living in Cambridgeshire.
    • There are around 2,350 autistic people living in Peterborough.
  • Estimated rates of autism are significantly higher in men (1.9%) than women (0.2%). However, it has been suggested that assessments for autism may draw more on how the condition manifests in men, and this may lead to under identification of autism in women (Brugha et al., 2016).
  • In the school year 2022/23, there were 1,749 children in Cambridgeshire, and 1,064 in Peterborough, who had autism as a recognised special education need.
  • It is estimated that the number of autistic older adults (aged 65+) will increase substantially by 2040, by 32% in Cambridgeshire and 42% in Peterborough, due to the ageing population.

Estimated prevalence

It is estimated that there are 1450 autistic children and young people (aged 0 – 17) in Cambridgeshire and 600 in Peterborough.

Figure 5: Estimated number of autistic children and young people (0 – 17 years), Cambridgeshire and Peterborough. Data sources: Epidemiology of autism in adults across age groups and ability levels and ONS Census 2021

It is estimated that there are 4350 autistic working-age adults in Cambridgeshire (aged 18 – 64) and 1400 in Peterborough.

Figure 6: Estimated number of working-age autistic adults (18 – 64 years), Cambridgeshire and Peterborough. Data sources: Epidemiology of autism in adults across age groups and ability levels and ONS Census 2021

It is estimated that there are 1400 autistic older adults in Cambridgeshire (aged 65+) and 350 in Peterborough.

Figure 7: Estimated number of older autistic adults (65+ years), Cambridgeshire and Peterborough. Data sources: Epidemiology of autism in adults across age groups and ability levels and ONS Census 2021

Projections

In Cambridgeshire and Peterborough, the number of autistic people is predicted to substantially increase by 2040, particularly in the 65+ age group. In 2040, the number of people aged 65+ predicted to be autistic will increase by about 32% in Cambridgeshire and 42% in Peterborough compared to 2023. This is due to the increasing numbers of older adults in Cambridgeshire and Peterborough, rather than increasing prevalence.

Figure 8: Projected autism population, Cambridgeshire and Peterborough, 2023 – 2024. Data source: Projecting Adult Needs and Service Information System, Projecting Older People Population Information System. Note: The prevalence rates have been applied to ONS population projections to give estimated numbers of people predicted to be autistic to 2040.

Rate of diagnosis

In Cambridgeshire and Peterborough, there is a much higher proportion of children and young people with an autism diagnosis on their healthcare records, compared to adults and older adults. This trend is also seen nationally.

Table 2: Proportion of people with an autism diagnosis on their healthcare records by age group, 2024. Data source: Population and Person Insight (PaPI) dashboard. Data analytics for the Population and Person Insight (PaPI) dashboard have been derived from a person-level clinical segmentation data model produced by OBH (Outcome Based Healthcare), using linked predominantly secondary care datasets held in the NCDR, covering people registered to a GP practice in England.

Autistic children and young people known to schools

Between 2015/16 and 2022/23, the number of autistic children and young people known to schools increased by 61% in Cambridgeshire and a 103% in Peterborough. In the school year 2022/23, there were 1,749 children in Cambridgeshire, and 1,064 in Peterborough, who had autism as a recognised special education need. This is higher numbers than the estimated prevalence above.

Figure 9: Number of children with autistic spectrum disorder known to schools, 0-19 years. Data source: Special educational needs in England, Academic year 2022/23 – Explore education statistics – GOV.UK (explore-education-statistics.service.gov.uk), School census data

68% of autistic children known to schools in Cambridgeshire had Education and Health Care (EHC) plans and 32% had special education needs (SEN) support. 61% of autistic children known to schools in Peterborough had EHC plans and 39% received SEN support.

Figure 10: Autistic children with EHC plans and SEN support, 0-19 years. Data source: Special educational needs in England, Academic year 2022/23 – Explore education statistics – GOV.UK (explore-education-statistics.service.gov.uk), School census data

How are autism and ADHD linked to mental health?

  • ADHD and autism are not in themselves mental health conditions, but autistic people and people with ADHD are more likely to experience mental health conditions (Lai et al., 2019; Choi et al., 2022). The factors contributing to this are complex and can include the pressures of ‘masking’ or living in a world designed for neurotypical people (Cassidy et al., 2018; Cook et al., 2021). As a result, a whole system approach is required to improve the mental health and wellbeing of these population groups.
  • There are higher rates of undiagnosed autism and ADHD amongst people seeking mental health interventions than in the general population (Wikramanayake et al., 2018; Bitter et al., 2019).
  • Autistic people and people with ADHD can experience diagnostic overshadowing in mental health services. This is when traits of a neurodevelopmental condition are misattributed to a mental health condition; or when mental health symptoms are misattributed to a neurodevelopmental condition (NHS England, 2023c). This may mean that people do not receive autism or ADHD assessments, or appropriate mental health treatment.
  • Understanding ADHD and autism is important to providing effective mental health interventions, with the Royal College of Psychiatrists stating that that ‘therapies applied without awareness of the autism can be harmful or, at the least, ineffective’ (Royal College of Psychiatrists, 2020a).

Autism and mental health

Autistic people are more likely to develop mental health conditions than their non-autistic peers. Around 30% of autistic adults report being diagnosed with a mental health condition (NHS England, 2023c) and 80% meet the criteria for a mental health condition at some point in their life (Lever and Geurts, 2016). There is a particularly high prevalence of depression, with most studies finding that between 25 – 50% of autistic people experience depression (Ward, 2019).

Table 3: Pooled estimated prevalence of mental health conditions in autistic populations and the general population. Adapted from: Lai et al. 2019

Other research highlights that:

  • Some symptoms of mental ill-health can be different for autistic people, such as distress-related behaviours such as stimming, social withdrawal and sleep problems becoming more obvious (Autistica, 2024a).
  • Autistic people can experience ‘burnout’, which they describe as ‘chronic exhaustion, loss of skills, and reduced tolerance to stimulus’, as a result of the cumulative burden of life stress (e.g. masking, life transitions) and inability to obtain support (Raymaker et al., 2020).
  • Autistic children and adults are more likely to self-harm than their non-autistic peers (Steenfeldt-Kristensen, Jones and Richards, 2020a; Blanchard et al., 2021), with one meta-analysis suggesting that the prevalence of self-injury amongst autistic people (all-age) is 42% (Steenfeldt-Kristensen, Jones and Richards, 2020b).
  • Autistic people die on average 16 years than earlier than the general population, in part due to a higher rate of suicide (Hirvikoski et al., 2016). One study suggests that at least 10% of people who die by suicide are autistic (Cassidy et al., 2022). The risk of suicide is particularly high for autistic women, who are 13 times more likely than non-autistic women to die by suicide (NHS England, 2023c).
  • Research about rates of substance use amongst autistic people is mixed (Ressel et al., 2020), although one study suggests that drug use can sometimes stem from wanting to mask autistic traits and self-medicating mental health symptoms (Weir, Allison and Baron-Cohen, 2021).
  • Autistic people are more likely to report that they have been misdiagnosed with a mental illness than non-autistic people (Au-Yeung et al., 2019), an issue that seems to be particularly common amongst autistic women (Royal College of Psychiatrists, 2020a).
  • Some research suggests that the COVID-19 pandemic was associated with poorer mental health for autistic people, although some people reported positive impacts of lockdowns (Scheeren et al., 2023).
  • There is limited research into the prevalence of mental health conditions amongst autistic people who have extensive support needs (for example, autistic people with complex physical health needs or who are minimally speaking) (Lai, 2023).

A review of studies found that anxiety is a common experience among autistic children and young people (White et al., 2009), with one small study of autistic children (aged 12 – 14) finding that 40% had anxiety disorders (Simonoff et al., 2008). Another small study found that suicidal ideation or attempts was thought to be 28 times higher in autistic children, compared to non-autistic children (Mayes et al., 2013).

Overrepresentation in mental health services

There are high rates of high rates of undiagnosed autism among people seeking mental healthcare. For example, around 1 in 5 women with anorexia in eating disorder services are autistic (Autistica, 2019a) and studies suggest that there are high rates of autism amongst young people with avoidant/restrictive food intake disorder (ARFID) (Sanchez-Cerezo et al., 2023). Up to 10% of adults in inpatient mental health services are autistic, compared to just 1% of the general population (Harper et al., 2019). Autistic women are 5.6 times more likely, and autistic men 3.8 times more likely, to spend time in a mental health inpatient setting than their non-autistic peers (Martini et al., 2022).

Why are there higher rates of mental ill-health amongst autistic people?

Many different factors may contribute to autistic people being more likely to experience mental ill-health:

  • Some evidence shows autistic people are more likely to experience wider determinants that are associated with poor mental health, such as being bullied, unemployed and socially isolated (Hedley et al., 2018; Griffiths et al., 2019). However, research involving people diagnosed with autism in adulthood, who were employed and living independently, still found ‘strikingly high’ rates of anxiety and depression (Gotham et al., 2015).
  • Research involving autistic people shows that ‘masking’ (camouflaging or hiding the characteristics associated with autism) is associated with psychological distress (Cook et al., 2021) and suicidal ideation (Cassidy et al., 2018).
  • Other evidence suggests that cognitive, emotional and sensory factors associated with autism may contribute. For example, autistic people are more likely to experience higher levels of ‘intolerance of uncertainty’, which is linked to anxiety (Jenkinson, Milne and Thompson, 2020).

Local data

These analyses use data form PaPI (the Population and Person Insight dashboard) and are based on diagnoses of autism and other conditions in healthcare records. True prevalence is likely to vary, for example many autistic people do not have a clinical diagnosis (O’Nions et al., 2023).

In Cambridgeshire and Peterborough, people with an autism diagnosis are many times more likely to have a recorded depression or severe mental illness (SMI) diagnosis (as defined by NHS England), compared to the general population. This is true across all age groups: for example, autistic children (aged 0 – 17) were 8 times more likely to have a recorded depression diagnosis; and autistic adults (aged 18+) were over 12 times more likely to have a recorded SMI.

Table 5: Prevalence of depression and severe mental illness (SMI) in autistic population and the general population, Cambridgeshire and Peterborough ICB. Data source: Population and Person Insight dashboard

Co-occurring conditions

The most common co-occurring conditions among autistic children and young people in Cambridgeshire and Peterborough are asthma (4.6 times more common than in the general population), learning disability (20 times more common) and epilepsy (19.4 times more common).

Table 6: Prevalence of co-occurring conditions in children and young people in Cambridgeshire and Peterborough

The most common co-occurring conditions among autistic working-age adults in Cambridgeshire and Peterborough are depression (3.6 times more common than in the general population), learning disability (54 times more common) and asthma (2.9 times more common).

Table 7: Prevalence of co-occurring conditions in working-age adults in Cambridgeshire and Peterborough

The most common co-occurring conditions among autistic older adults in Cambridgeshire and Peterborough are hypertension (1.4 times more common than in the general population), depression (4.3 times more common) and learning disability (163.5 times more common).

Table 8: Prevalence of co-occurring conditions in older adults in Cambridgeshire and Peterborough

ADHD and mental health

There is comparatively less research looking at the links between ADHD and mental health conditions, despite early research indicating that there may be a stronger link between ADHD and mental ill-health than with autism (Hargitai et al., 2023). Studies show that people with ADHD are more likely to develop mental health conditions across their lifetime than the general population, with as many as 80% of adults with ADHD experience at least one mental illness (Katzman et al., 2017). Research has found that:

  • Adults with ADHD are more likely to experience depression, bipolar disorder, ‘personality disorders’ and anxiety disorders than their peers who do not have ADHD (Choi et al., 2022).
  • Between 22 to 55% of people with ADHD report having sleep problems (Hvolby, 2015).
  • There are higher rates of suicidal ideation, suicide attempts and deaths by suicide amongst people with ADHD (Balazs and Kereszteny, 2017).
  • Eating disorders may be more common amongst people with ADHD than the general population, particularly bulimia and binge eating disorder (Nazar et al., 2014).
  • Symptoms of poor mental health can impact ADHD traits: for example, poor sleep may particularly effect on executive function for people with ADHD (Floros et al., 2021). Some people with ADHD report experiencing ‘burnout’, which can make emotional regulation and directing attention more challenging than usual (Neff, 2024).
  • Some research suggests that the COVID-19 pandemic was associated with poorer mental health for people with ADHD (Behrmann et al., 2022). This was compounded by difficulties accessing support services at this time.

Reviews show that children and young people with ADHD are more likely to have oppositional defiant disorder, conduct disorder and to be diagnosed with ‘antisocial personality disorder’ than their peers (Sciberras, Roos and Efron, 2009). Some studies show that children with ADHD are more likely to experience anxiety and mood disorders, although other research has not found a significant association between ADHD and these conditions (Sciberras, Roos and Efron, 2009).

ADHD and substance use

A range of research highlights higher rates of ‘substance use disorder’ amongst adults with ADHD (Choi et al., 2022), with one study finding that over 1 in 5 people with this condition have ADHD (van Emmerik-van Oortmerssen et al., 2012). There may be a greater severity of substance use and poorer outcomes amongst adults who have ADHD, compared to the general population (Faraone et al., 2007).

Overrepresentation in mental health services

There are relatively high rates of ADHD amongst people using mental health services (Gerhand and Saville, 2022), with surveys suggesting that between 17 to 22% of people receiving secondary mental healthcare, and 7% receiving inpatient mental health treatment, have ADHD (Bitter et al., 2019; Asherson et al., 2022). One multinational European study found relatively high rates of ADHD among people receiving outpatient mental healthcare, particularly for people receiving treatment for substance use (Deberdt et al., 2015). There is no research systemically assessing the rate of misdiagnosis of mental illnesses amongst adults with ADHD (Asherson et al., 2012).

Table 4: Prevalence of ADHD among people receiving outpatient mental healthcare for various mental health conditions. Data source: Deberdt et al. 2015

Co-occurring autism and ADHD

There is limited research into the mental health needs of people with both ADHD and autism. Some studies suggest that co-occurring ADHD and autism is associated with a higher risk of anxiety, depression, schizophrenia and bipolar disorder, compared to people with solely autism or ADHD (Chen et al., 2015). Other studies suggest that children with ADHD and autism are more likely to experience depression, anxiety and behaviour or conduct problems, compared to those who solely had autism or ADHD (Casseus, Kim and Horton, 2023).

Trauma

  • Autistic people and people with ADHD are more likely to experience adverse and traumatic events such as bullying and domestic abuse (Arrondo et al., 2023; Trundle et al., 2023).
  • Some research suggests that are complex links between neurodevelopmental conditions and adverse childhood experiences (ACEs), but this relationship is not fully understood (Gajwani and Minnis, 2023).
  • Guidance from the Royal College of Psychiatrists state that trauma-informed care is particularly important for autistic people and people with ADHD, as they often experience bullying and feel that they ‘don’t fit in’ (Royal College of Psychiatrists, 2020b; The Royal College of Psychiatrists in Scotland, 2023).

Suicide

In Cambridgeshire and Peterborough, around 10% of individuals who died by suicide between 2019 and 2021 either had a clinical diagnosis, were pursuing a diagnosis, or believed by those around them to exhibit behaviours suggestive of neurodivergence (including autism, ADHD, dyslexia, dyspraxia and other conditions). Around 5% of people who died by suicide over this period were thought to be autistic; and 5% were thought to have ADHD. These figures include people both with and without a clinical diagnosis.

Additional resources

References

The references for this section can be accessed here

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