Fonagy review proposes national standards for ADHD and autism assessment

The national standards for ADHD and autism assessment proposed by the Fonagy review (the independent review into mental health conditions, ADHD and autism, October 2026) have not been written yet. The review says they should cover co-occurring conditions, day-to-day functioning, remote or in-person assessment and assessor training, and its evidence shows what good looks like, from the first contact to the signed report.

What this means for you

• Every ADHD and autism diagnostic assessment you do is likely to become CQC-regulated, with national standards to meet.
• Your records will need to show how you reached each conclusion, as well as the conclusion itself.
• Most of it is already in NICE guidance, AQAS and CAAQAS, so you can check your records now.

Proposed assessment standards cover four areas, and none are written yet#

CQC would regulate every provider against the same standards#

The final report, chaired by Professor Peter Fonagy, was published by DHSC on 9 October 2026. Recommendation 5 says all ADHD and autism diagnostic assessments should be CQC-regulated, with the same quality standards for NHS, independent, voluntary and digital providers (p444). CQC confirmed the same day that DHSC has asked it to regulate them once new regulations are in place.

The review's clinician roundtables and provider survey found variation across NHS and independent pathways in assessment length, multidisciplinary input, formulation, attention to co-occurring conditions and how impairment is judged, which it says supports common standards for all providers rather than assumptions about either sector (p165).

The standards would cover co-occurring conditions, functioning, remote assessment and training#

The review says the standards should require:

• assessment of co-occurring conditions and functioning
• clear guidance on when remote and in-person assessment are the right choice
• the same training standards for all assessors

For autism, it also wants more consistent records of what was assessed, the conclusions reached and the support recommended (p179).

No standards, timetable or consultation have been published#

The government says it is working towards making all diagnostic assessments CQC-regulated. Its full response is due in a Mental Health Strategy later this year. No standards or timetable have been published, and no consultation on them has been announced. My guess, and it is only a guess, is that the standards will build on NICE, AQAS and CAAQAS.

Page numbers refer to the report PDF. The rest of our series on the review covers CQC regulation, data reporting and post-diagnostic support.

Misdiagnosis is more likely in five assessment conditions, and records can show each#

The review names the conditions where misdiagnosis is more likely: where assessment "is brief, not face to face, fragmented, made without access to informants or records, and is focused on a single condition" (p14). It cannot conclude that overdiagnosis is happening at scale. It does say that, if present trends continue, the balance of risk is shifting towards misdiagnosis and overdiagnosis (p15).

A record can answer each of those five. How long did the assessment take? Why was it remote? Who did each part? Who was asked, and which records were read? Which other conditions were considered?

Co-occurring conditions are common, but combined assessment needs a clinical reason#

Most young people with a common mental disorder screen positive for ADHD or autistic traits#

By 2024, among 16 to 24-year-olds with a common mental disorder such as anxiety or depression, 57% also screened positive for ADHD and 61% for autistic traits (pp12-13). A positive screen is not a diagnosis, but few people arrive with a single question.

Second conditions are recorded years late, and treatment response differs#

What gets missed when an assessment looks at one condition:

• In one city, children with both autism and ADHD had the second condition recorded four to five years after the first, on average, which the review says may reflect diagnostic overshadowing (p299).
• Autism in children was diagnosed about three years after an earlier anxiety diagnosis, and five years after depression (p204).
• Children with both autism and ADHD respond to stimulants less often than those with ADHD alone: around 50% against 70% to 80%, though stimulants remain an effective and recommended treatment for many of them (p209).

So a template built around one condition is now a quality risk. The record should show which other conditions you considered and why each was ruled in or out.

One combined ADHD and autism pathway had shorter waits; in another, waits rose#

In one city, the median wait for assessment was around 21 to 24 months in an autism-only pathway against seven months in a combined pathway (p299). A second combined pathway went the other way, with waits for assessment rising. The review says comparisons like this do not prove cause.

Tariffs may reward combined assessments, so record the clinical reason for both#

The review also warns that current optional tariffs may encourage combined ADHD and autism assessments because they pay more, whether or not both are needed (p329). Where both are needed, Recommendation 5 wants them done separately in a planned order, with shared clinical oversight (p444). Record the clinical reason for each, in case a commissioner asks why both were billed.

Diagnosis rates and remote assessment: expect to explain both#

Responding independent providers reported diagnosis rates of 66% to 93%#

By provider estimates, independent and Right to Choose providers did more than a third of NHS-funded autism assessments in 2025/26. Providers who responded reported around 90% remote delivery, and 66% to 93% of their assessments ended in a diagnosis, with averages of 79% to 86% (p165, citing the Independent Healthcare Providers Network (IHPN) report).

What the review does not say:

• It gives no NHS figures to compare, because NHS data on case mix and outcomes are not routinely available.
• It does not link remote delivery to the diagnosis rates.
• It does not say what a right diagnosis rate would be.
• The figures cover only the providers who responded.

Even so, I expect commissioners and CQC to ask for your diagnosis rate and case mix. Know both before they ask.

Remote autism assessment still needs to show direct observation#

The review asks for guidance on when to assess remotely but does not write it. In our experience, adult ADHD interviews, developmental histories and informant questionnaires move to video most easily. Autism observation is harder. The review says autism assessment needs developmental history, direct observation, self-report and careful assessment of current functioning (p178), and NICE CG128 and CG142 both expect direct observation, so a remote-first autism pathway needs to show how it meets that. More in remote ADHD and autism assessments.

Formulation should come before diagnosis, and functioning needs the same care#

The review wants formulation and clinical understanding to come before a diagnosis (p263).

Autism assessments should give a formulation whether or not autism is diagnosed#

For autism, people should get a formulation and summary of needs whether or not autism is diagnosed, so someone told "not autism" still leaves with an explanation and a route to support (p179).

This matters for complaints too. Clinicians told the review that after a long wait, a "no" can be devastating for the person, and some people complain after not being diagnosed (p162, p181). A written account of their needs and where to get support gives them something to take away whatever the outcome.

Tools used in ADHD and autism services cover only 8% to 41% of the relevant WHO functioning areas#

Functioning needs the same care. Tools used in ADHD and autism services cover only 8% to 41% of the relevant areas in the WHO's functioning framework, the ICF Core Sets, though the review notes this measures coverage rather than accuracy (p394). Annex A, which the review offers as an illustrative framework rather than a recommendation (p583), names WHODAS 2.0 as one validated measure for adults, and says that where the person's account and the clinician's view differ, both should be recorded (p588).

Front-door assessment, not paper triage, roughly halved waits in one region#

An assessment centre cut closures without assessment to 3% to 5% a month#

In one region, replacing paper triage with an assessment centre cut the share of referrals closed without assessment from 21% to 32% a month to 3% to 5% (p304). The median wait for assessment fell from 63 to 29 days, referrals handled each month rose from 178 to 227, and the median wait for treatment fell from 173 to 84 days. Both waits roughly halved. Referral numbers and case mix stayed broadly the same.

One region replaced paper triage with an assessment centreBefore and after the change. Referral numbers and case mix stayed broadly the same.Before: paper triageAfter: assessment centreReferrals closed without assessment, each monthLower is betterBefore21 to 32%After3 to 5%Median wait for assessmentLower is betterBefore63 daysAfter29 daysReferrals handled each monthHigher is betterBefore178After227Median wait for treatmentLower is betterBefore173 daysAfter84 daysSource: Independent review into mental health conditions, ADHD and autism, DHSC, 2026, page 304, from a regional analysis of ADHD and autism assessments and pathways done for the review. The review does not say what type of service this was. Closure rates are monthly ranges. Contains public sector information licensed under the Open Government Licence v3.0.

The passage sits in the review's chapter on health services, access and pathways (section 14.4), next to data on referrals to children's mental health services. The review does not name the service or say whether it was a mental health or neurodevelopmental service. The figures come from a regional analysis of ADHD and autism assessments and pathways commissioned for the review.

Closing referrals without assessment did not raise treatment capacity#

Across 14 areas, the services that closed the most referrals without assessment went on to treat the smallest share. In the review's words, "Turning people away without assessment did not increase treatment capacity" (p304).

Intake is part of assessment quality, so put experienced staff there#

The regional result, whatever the service type, fits two other findings. One trust put most of its shorter waits down to senior, experienced staff at the front door (p326). Annex A calls putting the least experienced staff at the point of entry a false economy, and supports gathering structured information before appointments (p588). So intake is part of assessment quality: collect the history and questionnaires early, and have an experienced clinician review them.

All assessors should meet the same training standards, so keep a file for each#

Recommendation 5 asks for the same training standards for all assessors (p444). Recommendation 6 asks for a nationally agreed competency framework setting out the knowledge and skills needed at each level of the system (p446). It does not say whether that will cover diagnostic assessors. NICE NG87 already says ADHD should be diagnosed only by a specialist with training and expertise in it. Keep a file for each assessor with their training on each tool (DIVA-5, ADOS-2 and ADI-R), supervision and case counts.

Your records should show seven areas: four the standards should cover and three more the review recommends#

What each assessment record should showFour areas the review says the standards should cover, and three more it recommends elsewhere. For each, pick what your recent records show. Nothing is saved or sent.1Co-occurring conditionsWhich other conditions were considered and why each was ruled in or out. If ADHD and autism were both assessed, the clinical reason for each.Review, Rec 5 · NICE NG87, CG128, CG142 · AQAS, CAAQASEvery recordSometimesNot yet2Day-to-day functioningImpairment in named areas of life, with real examples. For ADHD, at least moderate impairment in two or more settings.Review, Rec 5 · NICE NG87 · AQAS, CAAQASEvery recordSometimesNot yet3More than one informantWho was asked, when they were chased and what came back, and what you tried when no one was available.Review, p14 and p181 · NICE NG87, CG142 · AQAS, CAAQASEvery recordSometimesNot yet4Formulation for every outcomeThe person's needs explained before criteria are applied, and a summary of needs even when the answer is not ADHD or not autism.Review, p179 and p263 · NICE CG128Every recordSometimesNot yet5Remote or in personWhy this patient was seen remotely or in person. For autism, how direct observation was done.Review, Rec 5 · NICE CG128, CG142 · AQAS, CAAQASEvery recordSometimesNot yet6Assessor trainingA file for each assessor with training on each tool, supervision and case counts.Review, Recs 5 and 6 · NICE NG87, CG142 · AQAS, CAAQASEvery recordSometimesNot yet7Post-diagnostic planA clear explanation, a profile of strengths and needs, co-occurring conditions, advice on adjustments and routes back into care.Review, pp165-166 · NICE CG128 · AQASEvery recordSometimesNot yetYour result0 of 7 markedAnswer all seven to see where your records fall short and what to fix first.The national standards have not been written yet. Areas from the Independent review into mental health conditions, ADHD and autism (DHSC, 2026): co-occurring conditions, functioning, remote or in person and assessor training from Recommendation 5 (p444), the other three from elsewhere in the review; what the record should show reflects current NICE guidance (NG87, CG128, CG142) and the AQAS and CAAQAS standards. Contains public sector information licensed under the Open Government Licence v3.0.

For audit checklists, see AQAS for adults and CAAQAS for children. The post-diagnostic plan is covered in the post-diagnostic offer.

You can take six steps now, before the standards are written#

1. Take your ten most recent completed assessments and mark each area in the self-audit above.
2. Where an area only sometimes appears, make it a required field in your report template.
3. Write down when you assess remotely, when you switch a patient to face to face, and record the reason for each patient.
4. Work out your diagnosis rate and case mix, by condition and by who pays.
5. Only combine ADHD and autism assessments where there is a clinical reason for both, and record it.
6. Look at who reviews new referrals, and how much they know before the first appointment.

Where Cerebric fits#

Much of this evidence comes from admin. Cerebric collects the patient's history and questionnaires before the first appointment, and sends and chases informant questionnaires, so the record shows who was asked and when. It records the assessment and drafts the report in your template, with every sentence linked to its source. The clinician reviews the draft, writes the formulation, makes the diagnosis and signs. At clinics using Cerebric, report writing time fell by 75%.¹

Footnotes#

1. Measured at UK Right to Choose and private neurodevelopmental providers using Cerebric, 2025–26. ↩