Fonagy review urges needs-led care as ADHD and autism diagnoses surge

A government-commissioned review warns that diagnosis-first care is delaying help for children with serious mental health needs and may be labelling others too quickly.

Britain is being warned that the rush to identify autism and attention-deficit hyperactivity disorder may be creating new problems even as it tries to solve old ones. A government-commissioned review says the country’s mental health system is under such strain that children with serious needs are waiting too long for help, while the growing reliance on diagnostic labels is starting to distort care.

The review, led by clinical psychologist Peter Fonagy, argues that the current model has become too dependent on formal diagnosis. In its place, the authors want a needs-led system that would allow children to receive support at school and elsewhere while assessments are still under way. The report also says private clinics should come under Care Quality Commission oversight and be barred from public advertising, after warning that the sector has expanded rapidly to fill gaps left by the NHS.

The review’s most striking message is that rising diagnosis rates do not necessarily prove a comparable rise in underlying conditions. It says recorded autism rates among children and teenagers have climbed sharply in recent years, while the best available estimate of prevalence remains much lower. For ADHD, referrals have surged from about 5,000 a month in 2019 to around 17,000 in 2024, leaving more than 560,000 open referrals by the end of 2025. The authors say that increase reflects a mixture of better recognition, changing help-seeking behaviour, and system pressures, rather than simple unmet need finally being discovered.

That conclusion sits alongside an active debate in psychiatry about how often ADHD is missed, and how often it is overcalled. Research in The British Journal of Psychiatry found that prevalence rates tend to look similar when standardised criteria are used properly, and that differences between places often reflect how diagnoses are made rather than how common the condition really is. At the same time, a separate review in JAMA Network Open found convincing evidence that ADHD can be overdiagnosed in children and adolescents, especially when symptoms are mild or borderline. Together, the studies suggest the real problem may be inconsistency: some children go without help, while others are labelled too quickly.

Fonagy says that either error can be harmful. A diagnosis can unlock support, but it can also narrow expectations and make a child seem defined by difficulty rather than potential. The review warns that schools, welfare systems and social media may all be reinforcing a culture in which ordinary childhood traits are recast as illness. It also says the pressure on the system is delaying treatment for children with the most serious mental health problems. Health Secretary Yvette Cooper has promised tighter regulation of assessment services, but the review’s central warning is broader: unless Britain moves away from a diagnosis-first approach, it risks building a system that helps too late, labels too readily and asks too little of the children it is meant to support.