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A forthcoming government review is expected to recommend changing how people with attention deficit hyperactivity disorder (ADHD) are assessed and supported in England. Under the proposed approach, having ADHD symptoms would not automatically lead to a formal diagnosis or referral to an NHS clinic.
Instead, people would be assessed according to the difficulties they face and the support they need at school, college, work or elsewhere. The proposal has been criticised by ADHD and autism organisations, which warn that it could amount to rationing healthcare and leave some people relying on self-diagnosis.
What the proposed system would change
The review, led by Prof Peter Fonagy of University College London, is expected to recommend that NHS ADHD clinics focus on people who would benefit most from a formal diagnosis. This could include people who need medication or whose difficulties are especially acute.
People judged to be less severely affected might not be referred for a formal diagnosis. Instead, they could receive help following a broader, “holistic” assessment of their needs. The stated aim is to provide targeted early support without making a diagnosis a requirement for every form of assistance.
Examples described in the proposals include one-to-one classroom help for children, quiet rooms in schools, classes for parents supporting children with ADHD symptoms and greater flexibility from employers.
Why the proposals are being considered
The independent review of mental health conditions, autism and ADHD was commissioned by the then health secretary, Wes Streeting, amid concerns about rising sickness-benefit claims linked to mental health, autism and ADHD diagnoses.
Its interim findings reportedly concluded that the current system places pressure on children and adults to obtain a formal diagnosis in order to receive support. Official figures cited in the source say 800,000 patients are waiting for NHS assessments, with some waiting for years. Complaints about autism and ADHD services in England have more than tripled over five years.
The review also cites the wider economic and employment consequences associated with undiagnosed and untreated ADHD. The source reports that about 100,000 people with ADHD who are not in education, training or work receive health-related benefits because of their condition, while an ADHD taskforce calculated the cost of undiagnosed and untreated ADHD at £17bn.
Critics’ concerns
Critics argue that limiting access to formal assessment could create a two-tier system in which some people receive specialist care while others are expected to manage without a diagnosis.
Henry Shelford, chief executive of ADHD UK, described the proposal as rationing and said there was no “mild” ADHD. He also warned that people without access to formal assessment could turn to social media for answers, leaving schools and employers to make decisions about support without clinical guidance.
Shelford said diagnosis can help people change their circumstances, improve employment prospects and support career success. He also pointed to claims about differences in life expectancy for people with ADHD, although the source does not provide methodological detail for those figures.
Mel Merritt of the National Autistic Society said denying people a diagnosis could worsen existing inequalities. The organisation is also concerned about the review’s proposed holistic approach to autism support.
What happens next
The final report is expected shortly, with the review due to report next week according to the source. The government says Prof Fonagy’s findings will inform a new national approach and has declined to comment on the recommendations before publication.
Until the report is released, the details of any changes remain uncertain. The central question will be how a needs-based system would decide who receives specialist assessment, how support would be funded and how people could access treatment when a formal diagnosis is clinically important.
AI tools were used to assist with the preparation of this article.
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