Missed, not overdiagnosed: reading the Fonagy review properly

Oct 14

6 min read

The independent review into mental health conditions, ADHD and autism did not conclude that ADHD and autism are being overdiagnosed. Several headlines last week told a different story.

The review, chaired by Professor Peter Fonagy with Professor Sir Simon Wessely and Professor Gillian Baird, was published by the Department of Health and Social Care on 9 October 2026. It is a careful, nuanced piece of work. Some of the coverage has not been.

Since publication, we have heard from patients who are worried their diagnosis will now be questioned, and from people on waiting lists wondering whether to give up. This post sets out what the review actually found, where the reporting went wrong, and what it means for you.

Myth 1: "Review finds ADHD and autism are overdiagnosed"

The review states plainly that, on the evidence available, it cannot conclude overdiagnosis is happening at scale. That is the finding. It is not a footnote.

What the authors did say is that the balance of risk is shifting. If current trends continue, the danger moves from people being missed towards people being misdiagnosed or overdiagnosed. That is a warning about the future direction of travel, not a verdict on the diagnoses people already hold.

It is also worth noticing that the review was commissioned after the then Health Secretary suggested mental health conditions were overdiagnosed. Professor Fonagy has publicly said that view was wrong. Headlines that present the review as confirming it have the story backwards.

Myth 2: "A 40-fold rise in autism proves diagnoses are being handed out"

The 40-fold figure compares recorded diagnoses over 25 years, starting from a point when autism was barely being recognised at all. It does not show that people without autism are being diagnosed.

The review separates two numbers that are often confused:

Measure	What it counts	Autism, ages 12–17	ADHD, ages 12–17
Recorded in 2000	Diagnoses written in health records	0.10%	0.26%
Recorded in 2025	Diagnoses written in health records	4.06%	3.88%
Best estimate of true prevalence	Everyone with the condition, recognised or not	About 1.2%	About 3–4%

For ADHD, recorded diagnoses have essentially caught up with the true prevalence estimate. In other words, after decades of under-recognition, services are now finding roughly the number of young people we would expect to have it. That is closing a gap, not inventing a problem.

For autism the picture is more complex, and the review is honest that England has no up-to-date prevalence survey of either condition. It calls for one. Until that data exists, nobody can say with confidence how much of the rise is catch-up and how much is something else.

Myth 3: "People seeking assessment aren't really struggling"

The review found the opposite. People now coming forward for assessment are no less affected than those identified in the past. Their difficulties are real, and the review is explicit that they are not the problem.

It also found a genuine rise in distress. The proportion of adults aged 16 to 64 meeting criteria for a common mental disorder rose from 15.5% in 1993 to 22.6% in 2024, and young women now report the highest rates of any group. The authors say greater awareness alone cannot explain this.

The problem the review identifies is the system, not the patients. When help is only available with a diagnosis attached, demand for diagnosis rises. That is a design flaw in services, not evidence that people are exaggerating.

Myth 4: "Private diagnoses can't be trusted"

The review raised concerns about the consistency and quality of some assessments, not about independent providers as a whole. Independent providers now carry out more than half of NHS-funded ADHD assessments and around a third of autism assessments. Without them, waiting lists would be far longer.

What the review actually describes is what makes an assessment risky, wherever it happens. Misdiagnosis is more likely when an assessment is:

brief, or not carried out face to face
fragmented across different people
done without input from people who know you, or without your records
focused on a single condition, without considering anxiety, mood, trauma or sleep

We agree with every word of that. Anxiety, depression, trauma, ADHD and autism can look alike, and they frequently occur together. A good assessment has to consider all of them.

The review recommends that every ADHD and autism diagnostic assessment becomes a CQC-regulated activity. We welcome this. Kernow Psychiatry is already registered with the Care Quality Commission, and our assessments are carried out by a consultant psychiatrist who also works in the NHS.

Myth 5: "Women getting diagnosed is just a trend"

The review found that girls were historically under-recognised, and that part of the old gap between boys and girls reflected missed diagnoses rather than real differences. It does not suggest that women's growing recognition is evidence of overdiagnosis, and it does not recommend restricting assessment for women.

This matches what we see in clinic every week. Our understanding of ADHD was built largely on studies of hyperactive boys. Women often present with inattention, exhaustion, anxiety and low mood, and many have spent years being treated for those alone. Hormonal changes, including pregnancy and perimenopause, can unmask difficulties that were managed for decades.

A woman diagnosed at 40 is not part of a fad. More often, she is someone who was missed at 10.

What the review actually recommends

The central recommendation is a needs-led system: support should follow what a person needs, with diagnosis as one route to help rather than the only one. That is a sensible principle, and one we support.

The main recommendations and the government's initial response:

CQC regulation of all ADHD and autism assessments, NHS-funded and self-funded. The government says it is working towards this.
A ban on direct-to-public advertising of NHS-funded assessments. The government will raise this with the Advertising Standards Authority.
A clinically led review of current waiting lists in England, to understand each person's main concern and offer support while they wait.
Regular national prevalence surveys for ADHD and autism, so future debates rest on data rather than guesswork.
National pricing for NHS-funded ADHD and autism services, with NHS England consulting on new arrangements from April 2027.

The government will set out its plans in a cross-government Mental Health Strategy in the coming months, and will work with NICE on what the review means for its guidance. None of these recommendations is in force yet.

What this means for you

If you already have a diagnosis, nothing has changed. The review does not call existing diagnoses into question, and it does not change your treatment or prescriptions.

If you are on an NHS waiting list, please do not take yourself off it. The review is clear that nobody should be removed from a list without being connected to appropriate help, and that alternative support should be arranged with you, not simply signposted.

If you are considering an assessment, the review gives you good questions to ask any provider, NHS or private:

How long will the assessment take, and will it be face to face or by video?
Will you speak to someone who knows me well, or look at school or medical records?
Will you consider anxiety, mood, trauma, sleep and hormonal factors, not just the condition I was referred for?
Who carries out the assessment, and is the service CQC-registered?
What happens afterwards, including follow-up and support if I am not diagnosed?

At Kernow Psychiatry, a thorough assessment sometimes concludes that ADHD or autism is not the right explanation. When that happens, we explain why and help you find the support that fits what is actually going on. An honest answer is the point of an assessment.

If you have questions about the review or your own situation, please get in touch.