Review Urges Support for ADHD and Autism Before Diagnosis
The system for attention deficit hyperactivity disorder (ADHD) and autism leans too heavily on diagnosis as the route to help and cannot keep pace with demand, according to an independent...
The system for attention deficit hyperactivity disorder (ADHD) and autism leans too heavily on diagnosis as the route to help and cannot keep pace with demand, according to an independent government-commissioned review. The Independent Review into mental health conditions, ADHD and autism , chaired by Professor Peter Fonagy, called for a fundamental shift from a ‘diagnosis-dependent’ system to a ‘needs-led plus diagnosis’ system.
The review found that recognition of ADHD and autism has risen dramatically, leading to hundreds of thousands of people waiting for diagnostic assessment and many others struggling to access support. Figures cited in the review showed more than 560,000 people had an ‘open referral’ for ADHD at the end of 2025 – more than 17 times the number recorded in 2019.
“Continuing as we are is not sustainable,” the authors said, adding that people become more distressed because help and support are “locked behind waiting for a diagnosis”. The report said the government must address two failures at the same time: people wait far too long for support, diagnosis, and treatment, and diagnosis has become the primary gateway to support that could, and should, be available earlier.
The aim should not simply be to manage rising demand but to build a better system, the review said, by reducing unacceptable waits, reshaping clinical and non-clinical support, taking a serious approach to prevention and wellbeing, and improving mental health and neurodevelopmental care within and beyond the NHS, particularly in the community.
Support should be available according to a person’s needs before, during, and after assessment, and not be withheld while waiting for a diagnosis, the report said. Diagnosis Should Not Be the Only Route to Help The “heated debate” about whether there is too much diagnosis or too little risks “reinforcing the centrality of diagnosis” rather than need and timely access to support and treatment, the report warned.
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While the authors said they “cannot conclude that overdiagnosis is occurring at scale”, they warned of an “increased risk of misdiagnosis and overdiagnosis”. However, they said that underlying prevalence appeared to be broadly stable and that updated population prevalence studies were needed to fully understand trends.
For many people a diagnosis is clinically necessary, personally meaningful, and essential to treatment, the review said. It can help explain and address difficulties that significantly impair a person’s functioning, participation, and quality of life. It has also increasingly become a requirement to access help through education, health and care plans (EHCPs), through Access to Work, and in parts of the welfare system.
“Diagnosis remains essential and must be protected,” Fonagy said in a press release . “What has to change is that it is no longer the only door through which help can be reached.” New Model of Care and Radical Reform Needed Increasing need, greater awareness and recognition, and the demand that follows are “running up against limited capacity, fragmented pathways and uneven quality,” the report said.
The current system is not working and “incremental fixes” would not work, the authors said. A new model of care and radical reform is needed to provide the right support at the right time, rather than making diagnosis — which “tightly controls access to support” — the only route to help.
The government pledged in a press release that children, young people, and adults experiencing mental distress would receive broader support and advice at the earliest opportunity, without having to wait for a clinical diagnosis. Concerns Over Independent Assessment Providers The report also raised concerns about the “consistency and quality” of ADHD and autism assessments being carried out by independent providers, which conduct more than half of NHS-funded ADHD assessments and more than a third of autism assessments.
Spending on independent-sector ADHD provision has risen by around 252% in 3 years, yet the sector operates without consistent oversight, transparency, or quality assurance, the authors said. Rob Hicks is a retired National Health Service doctor. A well-known TV and radio broadcaster, he has written several books and has regularly contributed to national newspapers, magazines, and online publications.
He is based in the United Kingdom.
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