The Fonagy review: what it means for autism and ADHD assessments

The government’s independent review into mental health conditions, ADHD and autism has now been published. The review was led by Professor Peter Fonagy, with Professor Gillian Baird and Professor Sir Simon Wessely as vice chairs. Its final report runs to more than 600 pages, and it’s one of the most significant pieces of work on neurodevelopmental services in England for years.

It was commissioned in December 2025, amid a national debate about why demand for autism and ADHD assessments keeps rising. 

At the time, our Founder and Clinical Director, Dr Lisa Williams, told The Guardian: “For too long, the narrative around autism and ADHD assessments has been shaped by ideology rather than evidence.” So, we welcome a review that has looked closely at that evidence.

What the review found

• The rise in distress is real. Mental health problems among 16 to 24 year olds have risen from around one in six to around one in four. The review is clear this isn’t a “snowflake generation”.
• Demand for assessment has soared. Around 560,000 people had an open ADHD referral at the end of 2025, more than 17 times the 2019 figure. More than 254,000 had an open autism referral.
• Overdiagnosis at scale isn’t proven. The reviewers said that, on the evidence available, they could not conclude overdiagnosis is happening at scale. But they warned the risk will grow if current trends continue, especially where assessments are brief.
• Rushed assessments risk misdiagnosis. The review warns that brief assessments, pathways that only look at one condition, and pressure on services all increase the risk of people being misdiagnosed. It also raised concerns about the quality of some assessments by independent providers pathways.
• Help is too often “locked behind” a diagnosis. Families wait weeks, months or years for support from the NHS, schools or welfare because so much depends on having a diagnosis first.
• Support after diagnosis is patchy. Professor Baird highlighted that only a small minority of people diagnosed on the NHS receive any follow-up care.

As Professor Fonagy put it: “Diagnosis remains essential and must be protected.” But, in his words, “a diagnosis at the end of a four-year wait is not a help.”

What it recommends

• Moving from a “diagnosis-dependent” system to a “needs-led plus diagnosis” one. Children and adults would get help earlier, without having to wait for a formal label first.
• A clinically-led review of waiting lists. This would prioritise people with the most urgent needs, such as children at risk of exclusion from school. People with mild to moderate needs would get more support while they wait.
• Bringing all ADHD and autism assessments under Care Quality Commission (CQC) regulation, whether they’re NHS-funded or self-funded.
• Banning direct-to-public advertising of NHS-funded assessments.
• Joining up services. Neighbourhood multidisciplinary teams would bring together health, education, social care and therapy services.

The government has accepted the direction of travel. It will work with NHS England and the CQC to regulate assessments, consult on national prices for NHS-funded services from April 2027, and ask NICE to review its guidance. A new Mental Health Strategy is due in the coming months. The review expects key actions to be implemented over 12 to 24 months, with longer-term reform over the next decade.

Our view

We welcome much of what this review says.

Quality matters. A diagnosis should never be a box-ticking exercise. A rushed or inaccurate assessment fails the person who came for help and can mean the real cause of their difficulties is missed. We support consistent standards and regulation across every provider, NHS and independent alike.

Autism and ADHD often occur together, and both can overlap with anxiety, trauma and other conditions. That’s why our assessments look at the whole person, and why our clinical interviews include a complete psychiatric or psychological evaluation, so nothing is missed or mistaken for something else.

Rising diagnoses don’t mean autism is suddenly more common. This is something Dr Lisa Williams has spoken about before. Earlier this year she told The Independent: “Autism diagnoses have surged by 787 per cent in the UK since 1998, which naturally raises questions around what’s behind this trend.” She added: “It’s simply bad science to automatically assume that this is due to autism becoming much more prevalent.” The review’s findings back that up. Rising diagnoses reflect greater awareness, changing criteria and more adults seeking answers, not a sudden change in how many people are autistic.

Support shouldn’t wait for a label. Dr Williams has long called for reforms to be evidence-based and joined up across education and healthcare. Getting children help in school earlier, based on their needs, is the right ambition.

But diagnosis still matters. The review is right that it “must be protected”. For many autistic and ADHD people, a diagnosis brings understanding, self-acceptance and access to the right support. That’s true for children and for the many adults who have gone through life without answers.

What this means if you’re waiting now

This review sets the direction for the next decade, but change will take time. It won’t shorten an NHS assessment wait any time soon.

If you or your child are waiting for an assessment, you deserve one that is both timely and thorough. At The Autism Service:

• Our assessments are carried out by experienced, qualified clinicians from psychology, psychiatry, nursing, speech and language therapy and occupational therapy, some of whom also work in the NHS.
• Every clinician is registered with their professional regulator, such as the HCPC, GMC or NMC, and we welcome the move to bring all assessment providers under CQC regulation, something which is not currently possible for assessment only services as this is not defined by the CQC as a regulated activity.
• Our assessments follow NICE guidelines and include a detailed developmental history, information from school or work, and clinical observation, using recognised assessment tools such as ADOS-2 and ADI-R for autism, and QbTest for ADHD.
• We’ll always be honest with you, including if we don’t think it’s autism or ADHD, and we’ll help you understand what might be going on instead.
• Support doesn’t stop at diagnosis. Every assessment includes a feedback session to go through your report, tailored recommendations for school or work, and signposting to local services.

If you’d like to talk through your options, our team is here to help. You can find out more about our adult and child assessments, or speak to the team on 0300 303 0667.