What the Fonagy Review means for the future of ADHD and autism diagnosis, assessment quality and patient care
A landmark government review calls for better diagnostic standards, stronger regulation and earlier support. We explain what this means for patients and why The ADHD and Autism Clinic welcomes the emphasis on clinical quality.
10 October 2026
The publication of the government’s independent review into mental health conditions, ADHD and autism on 9 October 2026 marks an important moment for neurodevelopmental healthcare in England.
Image: Professor Peter Fonagy. Credit: Guilford Press.
Commissioned by the government under Health Secretary Wes Streeting and chaired by Professor Peter Fonagy, the review examines the dramatic increase in demand for ADHD and autism assessments, the difficulties people experience accessing appropriate care, and concerns about inconsistent diagnostic standards.
Its conclusions have attracted considerable attention, particularly its discussion of potential overdiagnosis and the quality of some independent assessments.
However, the review’s central message is more nuanced: people deserve timely access to accurate diagnosis, appropriate treatment and support that reflects their individual needs.
At The ADHD and Autism Clinic, we welcome this emphasis on clinical rigour, professional accountability and care that extends beyond simply providing a diagnostic label.
Are ADHD and Autism Being Overdiagnosed?
One of the review’s most widely discussed findings concerns the substantial increase in recorded diagnoses.
The number of people diagnosed with ADHD and autism has risen considerably over the past two decades. However, an increase in diagnoses does not necessarily mean an equivalent increase in the underlying prevalence of these conditions.
Greater public awareness, improved recognition and changing diagnostic practices have helped identify people whose difficulties might previously have been overlooked.
Importantly, the review acknowledges that there is insufficient evidence to conclude that widespread overdiagnosis is currently occurring. It also finds no evidence that people now presenting for assessment are less impaired than those assessed previously.
Nevertheless, the authors identify legitimate concerns about misdiagnosis and overdiagnosis, alongside the continuing problem of underdiagnosis.
All three can cause harm.
An incorrect ADHD diagnosis could result in inappropriate treatment while overlooking anxiety, trauma, sleep disorders or another explanation for someone’s difficulties. Conversely, failing to recognise genuine ADHD can leave someone struggling unnecessarily for years.
The answer is not to make diagnoses easier or harder. It is to make them more accurate.
Why Comprehensive Psychiatric Assessment Matters
The Fonagy Review highlights the risks associated with brief, fragmented assessments that focus narrowly on a single diagnosis without adequately exploring developmental history, functional impairment or alternative explanations.
These concerns reinforce the value of assessment undertaken within a comprehensive psychiatric framework.
At The ADHD and Autism Clinic, our consultant psychiatrist-led approach places clinical judgement at the centre of assessment.
ADHD cannot be reliably diagnosed using a questionnaire alone. A diagnosis requires careful consideration of symptoms, their developmental origins, their persistence across different settings and their impact on everyday functioning.
Our ADHD assessment approach incorporates structured clinical assessment, recognised screening and diagnostic instruments, and relevant developmental and collateral information. These may include the ACE+ assessment framework, the Adult ADHD Self-Report Scale (ASRS), information from people who know the patient well, and QbCheck where clinically appropriate.
These instruments can provide valuable supporting evidence, but no individual questionnaire or computerised test can establish an ADHD diagnosis independently.
The clinician must interpret the available information, assess its reliability and consider the complete clinical picture.
A high-quality assessment should establish not simply whether symptoms are present, but why they are occurring and what treatment or support may help.
Looking Beyond ADHD and Autism
Another important recommendation is to move away from fragmented services that consider ADHD, autism and mental health conditions in isolation.
This reflects the reality that neurodevelopmental and psychiatric difficulties frequently overlap.
Someone seeking an ADHD assessment may also experience depression, anxiety, obsessive-compulsive symptoms, trauma-related difficulties or significant sleep disturbance. Some individuals may have both ADHD and autism.
At The ADHD and Autism Clinic, the breadth of our psychiatric expertise allows these possibilities to be considered together.
A consultant psychiatrist can evaluate neurodevelopmental symptoms alongside co-occurring mental health conditions, medication effects, physical health considerations and relevant psychosocial circumstances.
This matters because identifying ADHD does not automatically explain every difficulty someone experiences.
Equally, the presence of anxiety or depression should not lead clinicians to dismiss underlying ADHD.
A comprehensive formulation can identify interacting difficulties and guide a more individualised approach to treatment.
Stronger Regulation of Private ADHD Clinics
The Fonagy Review raises significant concerns about inconsistent standards across independent ADHD and autism assessment providers.
It recommends that all ADHD and autism diagnostic assessments become subject to Care Quality Commission (CQC) regulation, alongside stronger oversight of commissioning, advertising and assessment quality.
These proposals are intended to give patients greater confidence in the services they use.
The ADHD and Autism Clinic is already a CQC-registered healthcare provider.
CQC registration brings obligations relating to safe care, appropriate governance, record-keeping, staffing, safeguarding and other regulatory requirements relevant to the services provided.
While registration does not guarantee that every clinical decision will be correct, it establishes an important framework of accountability.
We believe that independent providers should be able to demonstrate the quality of their assessments, the qualifications of their clinicians and the safeguards surrounding their clinical practice.
Patients should not have to choose between timely access and clinical quality.
Can ADHD Be Diagnosed Accurately by Video?
The review also raises concerns about assessments conducted remotely, particularly when they are brief, lack supporting information or do not adequately explore alternative diagnoses.
This is an important issue for The ADHD and Autism Clinic, which provides consultations by video.
However, the distinction between the method of consultation and the quality of the assessment is crucial.
A video consultation does not remove the need for a detailed clinical interview, developmental history, collateral evidence or rigorous diagnostic reasoning.
Remote assessment can offer meaningful advantages, particularly for people who find travelling difficult, experience anxiety in unfamiliar environments or have demanding work and family commitments.
It also enables patients to access specialist expertise without being limited by geography.
Nevertheless, remote assessment has limitations. Where the available information is insufficient, or clinical concerns require an in-person examination or further investigation, additional assessment may be necessary.
Our position is straightforward: video assessment should meet the same clinical standards expected of an in-person consultation.
Convenience should never take precedence over diagnostic accuracy or patient safety.
Diagnosis Is Important, but It Is Not the End of the Journey
Perhaps the review’s most important proposal is to move from a system dependent on diagnosis towards one that responds earlier to people’s needs.
Many people currently wait months or years for an ADHD or autism assessment, sometimes without meaningful support during that period.
The review argues that practical assistance should not always depend on obtaining a formal diagnosis.
We support this principle.
Reasonable adjustments in education or employment, organisational strategies and appropriate psychological support may be helpful even before a diagnostic assessment has been completed.
However, a formal diagnosis remains important when it provides access to evidence-based treatment, clarifies complex difficulties or informs longer-term clinical management.
For ADHD, diagnosis may also lead to consideration of medication where clinically appropriate.
At The ADHD and Autism Clinic, our approach recognises that assessment should inform what happens next.
Where treatment is indicated, this may include medication initiation and titration, monitoring of effectiveness and adverse effects, psychological interventions, practical strategies or communication with other healthcare professionals.
For people diagnosed with autism, the focus may include understanding individual needs, identifying co-occurring difficulties and recommending appropriate adjustments and support.
The objective is not simply to produce a diagnostic report. It is to help patients understand their difficulties and make informed decisions about their care.
What Does the Fonagy Review Mean for Patients?
The review’s recommendations have not all become government policy, and further decisions about regulation, clinical guidance and service delivery are expected.
Nevertheless, its direction is clear.
Patients should expect assessments that are thorough, evidence-informed and undertaken by appropriately qualified professionals. They should receive clear explanations of diagnostic conclusions, including uncertainty where it exists.
They should also expect clinicians to look beyond a single diagnostic label and consider what will genuinely improve their daily lives.
For independent providers, this creates an opportunity to demonstrate that accessible care and rigorous clinical standards are entirely compatible.
Our Commitment at The ADHD and Autism Clinic
We believe the principles underpinning the Fonagy Review are consistent with the standards that should guide responsible psychiatric practice.
Accurate diagnosis requires time, expertise, careful listening and a willingness to consider alternative explanations.
It also requires recognising when a diagnosis is justified, when further assessment is needed and when someone’s difficulties may be better understood in another way.
As a CQC-registered, consultant psychiatrist-led service, The ADHD and Autism Clinic is well placed to respond to the review’s emphasis on comprehensive assessment, clinical governance and individualised care.
We will continue to follow developments in government policy and professional guidance, adapting our practice where necessary to maintain high standards.
Our priority remains unchanged: to provide thoughtful, clinically robust ADHD and autism assessments that help patients understand themselves and access the treatment and support they need.
About The ADHD and Autism Clinic
The ADHD and Autism Clinic is a CQC-registered independent healthcare service providing specialist assessment and treatment for ADHD and autism, with consultations available by video.
Our consultant psychiatrist-led approach emphasises comprehensive clinical assessment, diagnostic accuracy and personalised recommendations.
If you are considering an ADHD or autism assessment, contact The ADHD and Autism Clinic to learn more about our services and assessment process.