England urged to improve support as review warns of ADHD and autism diagnosis pressures
Constantvpn.com – An independent review has warned that England’s approach to ADHD, autism and mental health support is under severe pressure, with concerns that some younger people may now be receiving diagnoses beyond the levels expected in the wider population.
The review, led by senior clinicians, examined people of all ages but concentrated especially on children and young people, among whom diagnosis rates are highest. It found that the sharp growth in diagnoses during the past 25 years has created a system struggling to provide prompt, consistent and effective care.
Its central message is not that diagnosis should be withdrawn. Instead, the experts argue that help should no longer depend so heavily on obtaining a formal label. People should be able to receive appropriate support at school, at work and in everyday life while assessments are underway, or where their needs do not require a medical diagnosis.
Private assessment concerns
The review called for stronger oversight of private providers that carry out assessments connected with NHS care. It raised questions about whether standards are sufficiently reliable and consistent, and recommended a prohibition on advertising by firms offering such services.
Experts also highlighted the possibility that the country could be moving away from a period when ADHD and autism were missed too often and towards one in which over-diagnosis or incorrect diagnosis becomes more likely. They warned against treating every difference in behaviour, thinking or development as a medical condition.
Not every challenge requires a clinical response, the review said. It stressed the need to distinguish diagnosable ADHD or autism from the broad range of normal variation in cognition, behaviour and brain function.
Diagnosis should remain protected
Prof Peter Fonagy, who chaired the review, said the existing system faced exceptional strain. He argued that diagnosis remains vital, particularly for people with substantial and complex needs, but should not be the sole route to practical assistance.
“Diagnosis remains essential and must be protected – what has to change is that it is no longer the only door through which help can be reached.”
That principle has major implications for education and employment. The review noted that diagnoses can sometimes become labels that define an individual through perceived problems rather than their abilities and prospects. This can affect experiences in school, opportunities at work and personal relationships.
Children diagnosed with autism or ADHD before 17 are about four times as likely to be outside education, employment or training between the ages of 16 and 24. The review said better help after a diagnosis could improve their chances of leading fuller lives.
Such help should include access to therapies as well as mental health care. Many people with ADHD or autism also experience conditions including depression, making joined-up support particularly important.
Long waits can cause real harm
While the review expressed concern about inappropriate diagnoses, it also made clear that delayed assessment can be deeply damaging. Families may wait for years while trying to secure suitable education, care and support.
Ryan Watson and his wife noticed developmental differences in their son Atlas when he was between 12 and 18 months old and was not meeting expected milestones. Yet it took three years for Atlas to receive an autism assessment.
As time passed, Atlas’s needs became more apparent. Now nearly seven, he is non-verbal, still uses nappies and depends on others for every part of daily care. Ryan said there was no accelerated pathway even for children with the most complex circumstances.
“You basically go on the list and wait however long until you get to the top.”
The family felt intense pressure to obtain support before Atlas began school. Ryan and his wife feared that their son could be sent to a mainstream setting that would not be safe for him.
“We were terrified,” Ryan says. “Anyone who has a child like Atlas will have the same panic that they’ll start in a mainstream school where it’s not safe.”
Ryan described the burden of navigating the process alongside work as overwhelming.
“It was like I had two jobs,” Ryan says. “I was going to work and then coming home and dealing with these things.”
Atlas received his diagnosis only a few months before he was due to start school.
Prioritising need rather than paperwork
To reduce the risk of similar delays, the review proposed reassessing people already on waiting lists. The aim would be to identify those with the greatest needs and move them forward more quickly, while offering other forms of support to people who may not need a clinical assessment.
Possible alternatives include adjustments in schools and workplaces, alongside practical help with issues such as sleep and anxiety. This could give people assistance sooner, rather than leaving them without support while waiting for a diagnostic appointment.
The review also drew attention to changes introduced in 2014, when parents often needed an ADHD or autism diagnosis before their children could access additional help at school. That arrangement has increased the importance of diagnosis as a gateway to support, even where a child’s needs are already evident.
Economic uncertainty and social media were identified as factors contributing to worsening mental health among young people. The findings are likely to influence future policy on NHS provision, benefits and support for young people who are not in education, employment or training.
The challenge for policymakers will be to protect timely, high-quality diagnosis for those who need it while ensuring that support is based on a person’s circumstances and strengths, not solely on a formal medical label.
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