The Fonagy review in charts: 7 findings for ADHD and autism services

The Fonagy review (the independent review into mental health conditions, ADHD and autism, published by the Department of Health and Social Care on 9 October 2026) runs to 599 pages. It draws on GP records, national surveys, NHS data and studies it commissioned, and most of its numbers sit inside long chapters.

We picked the seven findings a clinic lead or clinician can act on, in three groups: who is now coming forward, how complex their needs are, and where people are lost before they are seen. Each chart says what it found and what it means for your service.

What this means for you

• The people you assess are changing: more young adults, more inattentive presentations and more people who already see themselves as autistic.
• Several conditions at once is now the usual case, so screen for the second condition early and plan assessments for both.
• Referrals turned away tend to come back, and gaps by ethnicity may begin before referral. Check who reaches your service, not only how long they wait.

For the review's recommendations, see the 10 recommendations and what each means for providers. For diagnosis rates by age and sex, including the later age at which adults now say their ADHD difficulties began, see ADHD and autism diagnosis trends providers should plan for.

The people coming forward have changed#

Findings 1 and 2 show that the people now seeking assessment are more often young adults, more often inattentive, and more often already identify as autistic. Tools and training built around hyperactive boys will miss some of them.

1. Far more young people say they are autistic, and most adults who do have no diagnosis#

In the GP Patient Survey, the share of 16 to 24-year-olds who say they are autistic went from about 3.8% in 2019 to 8.9% in 2025. The survey changed its question in 2019 and began a new series in 2024, so years either side of those changes are not strictly comparable. In the Adult Psychiatric Morbidity Survey, 3.4% of adults say they are autistic and 1.2% report a professional diagnosis, so nearly three adults identify as autistic for every one diagnosed.

Set expectations before the assessment starts, and plan a proper outcome for people who are not diagnosed. A clinician quoted in the review describes people whose understanding has "solidified" over a long wait: "if you then reach a conclusion that they don't have autism, it can be devastating for a patient." Self-identification is neither a reason to turn a referral away nor a result.

Say they are autistic, GP Patient Survey, EnglandShare of each age group who say they are autistic, 2018 to 2025.20252025: aged 16 to 24, 8.9%, up 5.1 points since 2019; aged 25 and over, 2.0%, up 1.3 points since 2019.Aged 16 to 24, by year: 2018 3.4%, 2019 3.8%, 2020 3.5%, 2021 4.1%, 2022 5.4%, 2023 6.4%, 2024 8.7%, 2025 8.9%. Aged 25 and over, by year: 2018 0.6%, 2019 0.7%, 2020 0.7%, 2021 0.8%, 2022 1.0%, 2023 1.3%, 2024 1.7%, 2025 2.0%. Years before 2025 are approximate. The 2018 question asked about a developmental condition such as autism or ADHD, and the survey began a new series in 2024, so years either side of 2019 and 2024 are not strictly comparable.Aged 16 to 248.9%Up 5.1 points since 2019Aged 25 and over2.0%Up 1.3 points since 20190%2%4%6%8%10%8.9%2.0%20182019202020212022202320242025Source and notes

2. The rise in adult ADHD symptoms is in inattention; hyperactivity has barely changed#

On the adult ADHD screening questions, the average inattention score rose from about 8.0 in 2007 to 8.6 in 2024, while the hyperactivity score stayed at 4.6. The sharpest single rise was in avoiding or delaying tasks that need a lot of thought, from 12.1% to 18.8% of adults.

Inattentive presentations overlap most with anxiety, depression, poor sleep and stress. Resource differential diagnosis as the core of the assessment, not a formality.

Adult ADHD screening questions, EnglandAverage score for each group of questions2007201420242024: inattention score 8.6, hyperactivity score 4.6. Share of adults who report each difficulty at the screening level: Avoiding or delaying tasks that need a lot of thought, 18.8% (2007: 12.1%); Difficulty getting things in order, 26.9% (2007: 21.3%); Trouble wrapping up the fine details, 32.3% (2007: 27.5%); Problems remembering appointments, 30.9% (2007: 29.0%); Fidgeting or squirming, 27.6% (2007: 24.8%); Feeling overly active, as if driven by a motor, 13.3% (2007: 12.9%).Inattention score · 4 questions8.6Up about 0.6 since 2007Hyperactivity score · 2 questions4.6About the same as 2007Share of adults who report each difficulty at the screening level. Open circle: 2007.Inattention questionsAvoiding or delaying tasks that need a lot of thought18.8% +6.7Difficulty getting things in order26.9% +5.6Trouble wrapping up the fine details32.3% +4.8Problems remembering appointments30.9% +1.9Hyperactivity questionsFidgeting or squirming27.6% +2.8Feeling overly active, as if driven by a motor13.3% +0.40%10%20%30%Source and notes

More than one condition is now the usual case#

Findings 3 to 5 show that several conditions at once is now typical, and that pathways built for one condition can delay the second.

3. Three or more conditions is now the most common pattern in adults who screen positive for ADHD#

In 2024, 44.6% of adults screening positive for ADHD traits had three or more types of condition, up from about a third in 2007. Fewer than one in four had ADHD traits alone. These are screening results, not diagnoses.

Treat several conditions at once as the usual case. Plan for longer assessments, a wider mix of skills in the team and real time for differential diagnosis.

Adults screening positive for ADHD, by number of condition typesAdults 16 and over in England, 2007, 2014 and 2024.44.6%44.6% of adults who screened positive for ADHD in 2024 also had at least two other types of condition, the largest group.Three or more typesTwo typesOne type (ADHD traits only)2007 (approximate): three or more types about 34%, two types about 34%, one type (ADHD traits only) about 32%.2014 (approximate): three or more types about 37%, two types about 34%, one type (ADHD traits only) about 29%.2024: three or more types 44.6%, two types 32.6%, one type (ADHD traits only) 22.8%.2007approx.34%34%32%2014approx.37%34%29%202444.6%32.6%22.8%Share of adults screening positive for ADHD traits, by how many of six types of condition they had: common mental disorders such as anxiety and depression, personality disorder, substance dependence, ADHD traits, autistic traits and probable psychosis. Each bar adds to 100%.Source and notes

4. Children already diagnosed with anxiety, depression or an intellectual disability waited years longer for an autism diagnosis#

In GP records, autism diagnosis in children came around three years later after an earlier anxiety diagnosis, five years after depression and seven years after an intellectual disability. In one city's linked records, the second of autism and ADHD was recorded four to five years after the first.

When a child is referred with anxiety or depression, or already has one neurodevelopmental diagnosis, screen for autism and ADHD at that point. Do not wait for the first diagnosis to run its course.

Delay to autism diagnosis after an earlier diagnosisChildren diagnosed with autism before 18. One block is one year.Year 7After an earlier anxiety diagnosisaround 3 yearsAfter an earlier depression diagnosisaround 5 yearsAfter an earlier intellectual disability diagnosisaround 7 years12345678The same pattern in one city’s linked recordsChildren with both: second of autism and ADHD recorded4 to 5 years after the firstAnxiety or depression recorded laterChildren with a neurodevelopmental condition19.5%Other children8.7%Source and notes

5. In one city, a combined ADHD and autism pathway had about a third of the wait#

By 2024, the median wait for assessment in one city was 7 months on a combined ADHD and autism pathway, against around 21 to 24 months on the autism-only pathway. Time to diagnosis was shorter too, including against the city's ADHD-only pathway (16 months against 25).

Consider assessing ADHD and autism together in one pathway, not one condition after another. This is one observational comparison in one city: the review says it does not establish cause, and a second combined pathway saw waits rise.

Median waits on combined and single-condition pathways in one cityMonths, by 2024.Combined ADHD and autism pathwaySingle-condition pathwayMonth 50Wait for assessment. Autism-only pathway: median around 21 to 24 months. Combined pathway: median 7 months. Combined took about a third of the wait.Wait for assessmentCombined took about a third of the waitAutism-only21 to 24 monthsCombined7 monthsReferral to diagnosis. Autism-only pathway: median around 50 months. Combined pathway: median 25 months. Combined took half the time.Referral to diagnosisCombined took half the timeAutism-onlyabout 50 monthsCombined25 monthsTime to diagnosis, per patient. ADHD-only pathway: median 25 months. Combined pathway: median 16 months. Combined took 9 months less.Time to diagnosis, per patientCombined took 9 months lessADHD-only25 monthsCombined16 months1 year1 yr2 years2 yrs3 years3 yrs4 years4 yrsMedians, by 2024. A second combined pathway saw waits to assessment increase; its median time to diagnosis was 4.9 months overall, rising to around 14 months for adolescents in 2023.Source and notes

Who reaches assessment, and who is turned away#

Findings 6 and 7 are about who gets through the door: referrals turned away come back, and in one city the ethnicity gap appeared to start before referral, not in the wait.

6. A third of children's referrals were rejected unseen, and three in ten of those came back within a year#

Across ten children's mental health services, 32.3% of 202,244 referrals were rejected without the child being seen, and around three in ten of those children were referred again within a year. Half of all referrals ended in recorded treatment.

A rejection does not end the need. A front door should point each family to support or advice that fits, not only say no.

Referrals to ten children's mental health services in EnglandUnder-18s, financial years ending 2016 to 2019. Shares are of all referrals received.All referrals received202,244202,24467.7%67.7%Seen and assessed136,893 referrals32.3%32.3%Rejected without being seen65,351 referralsTreated50.3% · 101,812Discharged with no recorded treatment14.5% · 29,243Treatment not known2.9% · 5,838About 3 in 10of the children turned away were referred again within a yearThe hatched block is illustrative. The review gives "around three in ten" children turned away, not a count of referrals, so it is drawn as three tenths of the rejected bar.Source and notes

7. ADHD and autism are recorded far less often in South Asian and Black groups, and in one city the gap appeared to start before referral#

In GP records for 2025, 0.4% of South Asian people had a recorded ADHD diagnosis, against 1.7% of White people. In one city, South Asian children made up 21% of referrals to assessment pathways but about a third of all children. Once referred, waits showed no consistent difference by ethnicity. The review says this suggests inequalities may arise before people enter the pathway, and asks for caution in reading these figures.

Check equity in who reaches your front door and in your referral mix, not only in how long each group waits.

Referrals to assessment in one city, and recorded ADHD and autism by ethnic groupOne city · children referred to assessment pathwaysShare of all childrenShare of referralsWhite British children67% of referrals · about half of childrenSouth Asian children21% of referrals · about a third of children0%25%50%75%100%Once on the pathway, no consistent gap. In this city and a second one, waiting times showed no consistent differences by ethnicity or deprivation.Across England · recorded prevalence in GP records, 2025, % of peopleADHDADHD, Mixed: 2.0%Mixed2.0%ADHD, White: 1.7%White1.7%ADHD, Black: 0.7%Black0.7%ADHD, South Asian: 0.4%South Asian0.4%AutismAutism, Mixed: 2.2%Mixed2.2%Autism, White: 1.9%White1.9%Autism, Black: 1.1%Black1.1%Autism, South Asian: 0.6%South Asian0.6%Source and notes

Where the numbers come from#

Every value comes from the review's final report, with the page it is on in the note under each chart. Values the report prints are given as stated. Values we read from the report's charts are marked approximate, and where we did a sum ourselves, such as a gap between two figures, the note says so.

Where we write 2024 for the Adult Psychiatric Morbidity Survey, as the review does, it means the 2023/4 survey. Many of these numbers come from screening questionnaires in national surveys, which show an increased likelihood of a condition, not a diagnosis. Several come from one city or a small group of services, which the notes also say. The rest of our Fonagy review coverage explains the recommendations, the move to CQC regulation, the new data rules for Right to Choose providers and the share of NHS-funded assessment that independent providers now do. Our article on the post-diagnostic offer the review expects covers support after diagnosis, including how autism and ADHD at 17 were linked to being out of education or work at 23.