The Fonagy review: what it means for your child

On 9th October 2026 the Department of Health and Social Care published the final report of the independent review into mental health conditions, ADHD and autism. It was chaired by Professor Peter Fonagy, with Professor Sir Simon Wessely and Professor Gillian Baird as vice-chairs, and it set out to answer the question behind a year of heated argument: are more children really struggling, or are more children being labelled? Its answer is that both questions are slightly wrong. Distress among young people has risen and the rise is real. ADHD and autism are being recorded far more often, but there is little sign that they have become more common. And the review's main recommendation is one a parent can use straight away: support should follow a child's needs, and a diagnosis should be one route to it rather than the only one (Department of Health and Social Care [DHSC], 2026a).

What the review found about mental health

The proportion of adults aged 16 to 64 meeting the criteria for a common mental disorder such as anxiety or depression rose from 15.5 per cent in 1993 to 22.6 per cent in 2024. Among 16 to 24 year olds it went from around one in six to one in four, and young women now report the highest rates of any group. The review is clear that this cannot be explained by greater awareness alone, and that it is affecting everyday functioning. It did not find the same rise in severe mental illness: rates of schizophrenia and bipolar disorder have stayed broadly stable. No single cause explains the increase. The review groups the drivers under four headings: more uncertainty and financial insecurity; more evaluation and comparison, at school, at work and online; less belonging and more loneliness; and less time for rest, play, physical activity and uninterrupted sleep. It found that education has become a bigger source of distress than it was for earlier generations, but not that it is the main cause of the rise, and that social media can intensify pressures that are already there (DHSC, 2026a).

ADHD and autism: more diagnoses, not more children

The review separates two numbers that are often confused. Population prevalence is how many children have a condition, recognised or not. Administrative prevalence is how many have it recorded by services. For ADHD, the most recent national survey put prevalence at 3 per cent of five to 15 year olds in 2017, and the review's own rough projection for today is around 3.8 per cent. Recorded ADHD among 12 to 17 year olds, meanwhile, rose from 0.26 per cent in 2000 to 3.88 per cent in 2025. For autism the best estimate of prevalence remains around 1.2 per cent of young people, while recorded autism among 12 to 17 year olds rose from 0.10 per cent to 4.06 per cent over the same period. Monthly referrals for ADHD assessment more than tripled between 2019 and 2024. Part of the change is welcome: the review found that girls were historically under-recognised, and that some of the old gap between boys and girls reflected missed diagnoses rather than real differences. The review is also open about the limits here. England has no up-to-date survey of either condition, and it calls for regular ones (DHSC, 2026a).

Is it overdiagnosis?

Most of the coverage will reach for this line, so here is exactly what it says. The review finds that on the evidence available it cannot conclude that overdiagnosis is happening at scale. It also says that, if present trends continue, the balance of risk is shifting away from children being missed and towards children being misdiagnosed or overdiagnosed, and that this now matters for how services are run. It then adds the qualifier that matters most to parents: the young people coming forward for assessment are no less affected than those identified in the past. Their difficulties are real, and in the review's words, they are not the problem. The problem it describes is a system that leans too heavily on diagnosis as the way in to help. Two more findings explain why a single label so often misses the picture. Having some traits, or identifying as neurodivergent, is not the same as having a diagnosable condition: around one in five secondary pupils in one large school survey described themselves as neurodivergent. And difficulties rarely come alone. Among 16 to 24 year olds with a common mental disorder, 57 per cent screened positive for ADHD and 61 per cent for autistic traits, though a positive screen shows increased likelihood rather than a diagnosis (DHSC, 2026a).

What a good assessment looks like

The most practical part of the report for a parent is its list of conditions that make misdiagnosis more likely. An assessment carries more risk when it is brief, not face to face, fragmented, carried out without input from people who know the child or access to their records, or focused on a single condition. Anxiety, ADHD, autism, trauma and poor sleep can look alike, and the review gives two examples of one being missed behind another: autism diagnosed while clinically significant anxiety goes unnoticed, or untreated ADHD taken for anxiety or depression alone (DHSC, 2026a). That turns into questions you can ask any assessor, NHS or private. How long will it take? Will you speak to school and look at reports? Will you consider anxiety, mood, sleep and anything that has happened in my child's life, as well as the condition we were referred for? The review also recommends that every ADHD and autism diagnostic assessment becomes an activity regulated by the Care Quality Commission, and that direct-to-public advertising of NHS-funded assessments is banned. The government has said it is working towards the first, covering NHS-funded and self-funded assessments alike, and that it will raise advertising with the Advertising Standards Authority (DHSC, 2026b). Neither is in force yet.

What changes now, and what does not

A review makes recommendations. It does not change the law or anyone's place on a list. The government's response, published the same day, commits to setting out its plans in a cross-government Mental Health Strategy in the coming months, says NHS England will consult on national prices for NHS-funded ADHD and autism services with a view to new arrangements from April 2027, and says it will work with NICE to consider urgently what the report means for its ADHD and autism guidance (DHSC, 2026b). For a child already waiting for an assessment, nothing changes today. If you hear talk of lists being reviewed, one line matters: the review recommends a clinically led look at current ADHD and autism waiting lists, but says plainly that no one should be taken off a list without being connected to appropriate help, and that alternative support should be arranged with the person, not simply signposted (DHSC, 2026a).

If you live in Wales

The review was commissioned by the UK government's Department of Health and Social Care, and the government's response describes support across England (DHSC, 2026b). Health is devolved, so its recommendations do not apply directly in Wales, and the Care Quality Commission regulates health care in England only, with Healthcare Inspectorate Wales doing that job in Wales. Wales has been moving in a similar direction on its own terms. In February 2025 the Welsh Government extended its National Neurodivergence Improvement Programme to March 2027 with a further £13.7 million, noting that demand for assessment and support had outgrown the capacity to respond, and pointing to projects that help families reach support without a formal diagnosis (Murphy, 2025). Your GP practice can explain how a neurodevelopmental referral works where you live.

Support that does not have to wait

The needs-led system the review describes will take years to build. Some of it already exists in law. In England, the SEND Code of Practice defines special educational needs by what a child needs, not by a diagnosis, and tells schools to identify need at the earliest point (Department for Education & Department of Health, 2015). In Wales, a learner has additional learning needs if they have a learning difficulty or disability, whether or not it arises from a medical condition, which calls for additional learning provision (Additional Learning Needs and Education Tribunal (Wales) Act 2018). Ask your child's SENCO or ALNCo what staff are seeing and what can be put in place now. Keep short, dated notes of what happens at home and ask the school to do the same, because examples from more than one setting make any later assessment more accurate. And the anxiety, low mood, poor sleep and school avoidance that so often sit alongside suspected ADHD or autism can be assessed and treated in their own right, whether or not a diagnosis follows.

Blip is a specialist mental health service for children and young people aged 7 to 25. We do not carry out autism diagnostic assessments. We do work with young people whose anxiety, mood, sleep or school life is under strain, with or without a diagnosis and whether or not they are waiting for one, and you do not need a referral to start. If your child is struggling now, get in touch. One of our clinicians will talk it through with you and, if it would help, arrange an assessment of what is happening now with a named clinician.