What a new psychiatric editorial tells us about diagnostic accuracy, clinical expertise and the importance of patient choice.
TL;DR: A specialist ADHD or autism clinic should not take a narrow view of mental health. A recent British Journal of Psychiatry editorial warns that separating neurodevelopmental and psychiatric services can lead to missed diagnoses, repeated assessments and gaps in care.
At The ADHD & Autism Clinic, our consultant psychiatrists also work in the NHS, bringing experience of wider psychiatric practice to neurodevelopmental assessments. That breadth can help clinicians question initial assumptions, although no clinician is immune to bias. We support better NHS access alongside the right of patients to choose a private assessment when it suits them.
Can specialist ADHD and autism services become too specialised?
An adult attends an ADHD assessment after years of struggling with concentration and organisation. They also describe disturbed sleep, low mood and increasing difficulty functioning at work. Are these symptoms of ADHD, depression, another condition, or several conditions occurring together?
The answer cannot safely be assumed before the assessment begins.
In October 2026, Anita Thapar, Miriam Cooper and Samuele Cortese published a guest editorial in The British Journal of Psychiatry questioning the growing separation of neurodevelopmental and psychiatric services. Their argument is that narrowly defined services can fragment care, duplicate assessments, weaken clinical expertise and leave important needs untreated.
This challenges private clinics too. The question is whether a specialist service retains sufficient breadth of clinical judgement to see beyond the condition it assesses.
Why ADHD, autism and psychiatric conditions cannot be considered in isolation
ADHD and autism are neurodevelopmental conditions whose characteristic features begin during development. Depression, bipolar disorder, psychosis and anxiety disorders have different features and courses.
These conditions frequently coexist. An autistic person or someone with ADHD can develop a separate mental health disorder. Difficulties with attention, motivation, sleep and emotional regulation can also have several explanations.
The editorial highlights the consequences of organising services as though these clinical categories were entirely separate. A mental health team might fail to recognise previously unidentified ADHD. A neurodevelopmental service might attribute emerging depression to autism or lack the resources to manage it. Meanwhile, the person may be passed between referrals and waiting lists.
There is also a risk of diagnostic overshadowing: allowing a known or suspected diagnosis to prevent proper consideration of another. Avoiding that problem requires clinicians to establish what difficulties have been present since childhood, what has changed and what is impairing the person’s everyday life.
The importance of broad psychiatric experience
Psychiatry has always required clinicians to think beyond a single diagnostic category. A comprehensive assessment involves understanding developmental history, mental state, physical health, medication, personal circumstances, risk and the interaction between different conditions.
Specialist expertise remains valuable. However, experience confined almost entirely to one type of presentation may make it harder to recognise unfamiliar disorders or competing explanations. This is one of the concerns raised by Thapar and colleagues.
At The ADHD & Autism Clinic, our consultant psychiatrists also practise in the NHS. Our clinical team includes Dr Andrew Iles, Dr Alexandra Blackman and Dr Stephen Attard, whose work spans NHS psychiatry and independent practice. Their backgrounds include assessing and managing wider psychiatric presentations, not simply identifying neurodevelopmental traits.
This breadth matters when the question is not just whether a person meets the criteria for ADHD, but whether anxiety, depression, trauma, a sleep disorder, substance use or another condition offers a better explanation, or is present alongside ADHD.
Working across sectors does not prove greater diagnostic accuracy or eliminate error. Its potential value is in preserving broader clinical experience alongside specialist knowledge.
Why confirmation bias matters in an ADHD assessment
Confirmation bias is the tendency to seek or interpret information in ways that support an initial belief. In a clinic where most people attend because they suspect ADHD, the danger is that both patient and clinician may begin with the same expectation.
People may seek assessment after considerable research. Their concerns deserve attention, but clinicians must evaluate evidence independently, including findings that challenge the suspected diagnosis.
For example, concentration problems associated with a recent depressive episode should not automatically be interpreted as lifelong ADHD. Equally, a longstanding developmental pattern should not be dismissed simply because the person has also experienced depression. Some people will have both conditions.
A sound assessment asks not only, “What supports ADHD?” but also, “What might explain these difficulties differently?” It considers onset, persistence, impairment in different settings, alternative explanations and the possibility of co-occurring conditions.
The fee for a private assessment purchases the clinician’s time and judgement. It cannot purchase a diagnosis, prescription or predetermined conclusion. An assessment might support ADHD or autism, identify another explanation, or establish that further information is necessary.
Can a specialist private clinic still provide holistic care?
Yes, provided that its clinicians recognise both the strengths and the limits of their service. A clinic can have a specialist purpose without viewing every problem through that specialty alone.
The ADHD & Autism Clinic focuses on adult neurodevelopmental assessment and related care. Our clinicians consider relevant psychiatric difficulties during assessment and, where appropriate and within the service’s scope, may address associated mental health needs or recommend further specialist input. A private assessment does not replace comprehensive NHS mental health services, emergency care or every form of psychological treatment.
Recognising a condition is not always the same as being the appropriate service to treat it. Good practice includes appropriate referral and clear communication.
These principles are consistent with NICE guidance on ADHD and NICE guidance on autism in adults, both of which require attention to other mental and physical conditions as part of assessment.
Why improving NHS access is in everyone’s interests
The editorial also asks an important question about the organisation of NHS services. When neurodevelopmental assessments are separated from other psychiatric care, people may face successive waiting lists even when substantial parts of the assessments overlap.
Better integrated pathways, wider training and more timely NHS assessment would benefit patients. If someone can obtain a comprehensive, clinically appropriate assessment sooner through the NHS, without paying privately, that is a positive outcome. It should not be regarded as a threat to independent healthcare.
For some, paying for an assessment is not a free choice in any meaningful sense: it may reflect the difficulty of accessing NHS services within an acceptable timeframe. Improving access would reduce that pressure and make decisions about private care more genuinely voluntary.
At the same time, some people will continue to choose private healthcare because they value greater flexibility, a particular clinician or a different appointment arrangement. These are legitimate preferences. There should be no suggestion that private care is inherently superior, or that the NHS cannot provide excellent assessments.
In England, eligible patients may also be able to choose an alternative NHS-funded provider through Right to Choose. This is distinct from self-funded private assessment and depends on the provider and referral criteria. Pathways and patient-choice arrangements differ across the UK.
What should patients look for when choosing an assessment?
Whether NHS-funded or private, patients can expect an assessment that:
- explores childhood development and the persistence of relevant difficulties into adult life
- examines functional impact at home, work, education and in relationships, as appropriate
- considers psychiatric and physical health, medication, sleep and other possible explanations
- uses questionnaires or computerised assessments as supporting information rather than independent proof of a diagnosis
- explains uncertainty, alternative diagnoses and appropriate next steps without assuming the outcome in advance.
Ask who will address any additional mental health needs and how findings will be communicated with consent.
Frequently asked questions
Does working in both NHS and private psychiatry prevent diagnostic bias?
No. Broad experience may help clinicians recognise alternative explanations and maintain wider diagnostic skills, but every clinician can be influenced by bias. A careful assessment process and willingness to reconsider initial impressions remain essential.
Is a specialist ADHD clinic inconsistent with the editorial’s recommendations?
Not necessarily. The editorial criticises rigid separation and loss of broader expertise, rather than specialist knowledge itself. The concern applies where a clinic’s remit or approach prevents other conditions being recognised, assessed or appropriately referred.
Do I need a private assessment to receive good care?
No. NHS assessment may be entirely appropriate, and in England an eligible Right to Choose referral may offer additional NHS-funded options. The right route depends on clinical needs, local access, preferences and finances. Support for some difficulties can also begin without a formal neurodevelopmental diagnosis.
Conclusion: specialist knowledge, broad judgement and genuine choice
The strongest lesson from Thapar and colleagues is not that specialist services should disappear. It is that services must not become so narrowly focused on a diagnostic category that they lose sight of the person.
The ADHD & Autism Clinic’s approach is informed by consultant psychiatrists who continue to work across NHS and independent practice. That breadth is relevant because a reliable assessment must be prepared to find ADHD or autism, another psychiatric explanation, both, or neither.
We would welcome faster, better-connected NHS pathways. Alongside them, there remains a place for independent assessment that respects clinical uncertainty and gives adults a meaningful choice about where and by whom they are seen.
If you are considering an assessment, you can explore our adult ADHD and autism services and decide whether they are suitable for your circumstances.