By Dr Tamasine Black, Chartered Educational and Child Psychologist, Founder and Lead Psychologist, Tabla Psychology
The publication of the independent review into mental health conditions, ADHD and autism, chaired by Professor Peter Fonagy, is an important moment for families, clinicians, educators and everyone involved in supporting neurodivergent people.
At Tabla Psychology, we welcome the review and its central message: people deserve careful, evidence-based assessment, timely access to support and a better understanding of their individual needs.
Much of the public discussion has focused on whether ADHD and autism are being overdiagnosed. It is an important question, and one that deserves a serious, scientifically informed response.
However, the review’s findings are considerably more nuanced than some of the headlines suggest.
The review does not establish that widespread overdiagnosis is taking place. It also makes clear that many people genuinely need diagnostic assessment, and that failing to identify their difficulties can have significant consequences.
For our work, the central issue is whether each person receives an accurate, clinically defensible understanding of their difficulties and meaningful recommendations about what will help.
That principle underpins our work at Tabla Psychology.
What does the review actually say about overdiagnosis?
One of the review’s most important conclusions is that underdiagnosis, misdiagnosis and overdiagnosis are three distinct problems. All can exist within the same healthcare system. Historically, many people with ADHD and autism have gone unrecognised, particularly girls, women and individuals whose difficulties are less immediately apparent. Increasing professional knowledge and public awareness have helped some of those people finally understand longstanding challenges. At the same time, rising demand for assessment, inconsistent assessment quality and the complexity of overlapping difficulties create legitimate concerns about inaccurate diagnoses.
The review is careful not to confuse these different issues.
It concludes that the available evidence cannot establish overdiagnosis on a widespread scale, while warning that the risks of misdiagnosis and overdiagnosis may be increasing. Just as importantly, it finds no evidence that people currently seeking assessment are experiencing less severe difficulties than those who presented previously. In other words, rising numbers of people seeking answers should not be interpreted as evidence that their difficulties are imagined, exaggerated or unimportant. A child struggling to attend school, a teenager overwhelmed by everyday demands, or an adult who has spent decades trying to understand persistent difficulties deserves a thoughtful assessment of their needs. They should neither be automatically diagnosed nor dismissed because diagnoses have become more visible.
The Fonagy review explicitly recognises that diagnosis is clinically necessary for many people, personally meaningful for some and essential to appropriate treatment. This is particularly important in discussions about autism and ADHD. For a child with significant attention, executive functioning or social communication difficulties, an accurate diagnosis may help explain why everyday expectations have become so difficult to manage. It may bring together years of apparently disconnected experiences: difficulties with learning, friendships, emotional regulation, organisation, sensory processing or coping with changes in routine. For parents, diagnosis can help replace uncertainty and misunderstanding with a clearer developmental explanation. For educators, a carefully formulated assessment can clarify the adjustments and provision a pupil requires. For adults, particularly those whose difficulties were missed in childhood, diagnosis can offer a meaningful explanation for longstanding challenges and inform future support.
A diagnosis should never define the whole person. But neither should its importance be minimised when it provides a valid explanation for significant, persistent difficulties.
The right response to concerns about overdiagnosis is better assessment, not making accurate diagnosis harder to obtain.
And crucially, the review argues that families should not have to wait for a diagnosis before receiving help with their identified needs.
Why overdiagnosis matters — and how we safeguard against it
Overdiagnosis is not simply a matter of diagnosing too many people. It includes applying a diagnostic label where the relevant clinical criteria are not met, or where ordinary variation and life experiences are unnecessarily medicalised. Misdiagnosis can also occur when one condition is incorrectly identified or when important co-occurring conditions are overlooked. These are genuine clinical concerns.
Difficulties concentrating may be associated with ADHD, but they may also arise alongside anxiety, poor sleep, emotional distress, trauma, learning difficulties or other factors. Social withdrawal does not necessarily indicate autism. Emotional dysregulation does not automatically mean ADHD. Equally, the presence of anxiety or trauma does not rule out an underlying neurodevelopmental condition. Sometimes difficulties coexist, interact and amplify one another. This complexity is precisely why a single questionnaire, brief conversation or isolated observation cannot reliably establish an ADHD or autism diagnosis. At Tabla Psychology, our assessment framework is designed to guard against premature or unsupported conclusions.
We consider developmental history, information from relevant sources and settings, the persistence and functional impact of difficulties, and alternative or co-occurring explanations. We recognise that parents, teachers and young people may describe different experiences. Rather than treating these differences as inconvenient, we examine what they tell us about the person and the demands of different environments.
Standardised questionnaires and assessment instruments inform clinical reasoning; they do not replace it. Our reporting framework requires us to distinguish between evidence, clinical interpretation and diagnostic conclusions. We do not invent missing information or treat screening scores as proof of a diagnosis. Where the available evidence does not support a diagnosis, the appropriate outcome is to explain that clearly, identify the needs that remain and consider what further assessment or support may be helpful.
Where uncertainty remains, it should be acknowledged rather than concealed.
Our responsibility is to reach the conclusion supported by the evidence — whether that leads to an ADHD diagnosis, an autism diagnosis, another explanation or no diagnosis at all.
We believe that is how responsible diagnostic practice protects individuals against both overdiagnosis and underdiagnosis.
Understanding the whole person, not simply looking for a label
One of the most important recommendations in the review is a shift from a system dependent on diagnosis towards one in which needs are identified and addressed earlier, with diagnosis retained where clinically appropriate. We strongly support that principle.
At Tabla Psychology, our Comprehensive Pre-Screening pathway provides an opportunity to consider the difficulties a child, young person or adult is experiencing before deciding which assessment or intervention is most appropriate. For some individuals, a comprehensive ADHD or autism assessment will be the right next step.
For others, educational psychology assessment, investigation of specific learning difficulties, psychological support or a different form of intervention may be more appropriate.
The purpose is not to direct everyone towards the same diagnostic pathway.
It is to ask a more useful question:
What is happening for this person, why might it be happening, and what would help?
This approach also recognises that a person’s difficulties may reflect several interacting influences rather than one isolated condition.
A child experiencing anxiety, literacy difficulties and problems with attention may need a coordinated understanding of all three, regardless of whether a neurodevelopmental diagnosis is established.
Good assessment should make those complexities more understandable, not reduce them to a single label.
Why clinical and educational psychology belong together
The review places considerable emphasis on joined-up support, with expertise drawn from different disciplines. This closely reflects our approach at Tabla Psychology. Our team brings together clinical and educational psychology, specialist teaching and expertise in special educational needs and disabilities. We recognise that understanding a child’s difficulties requires attention to the environments in which those difficulties occur. A pupil’s challenges may look very different in a quiet individual assessment from those experienced in a busy classroom, during unstructured social time or when completing independent work. Our educational psychology and specialist learning assessment pathways examine how children learn, what may be interfering with their progress and which approaches may make education more accessible.
Where appropriate, we also undertake school observations, allowing us to consider the interaction between the child’s needs, the educational environment and the support already available. These observations provide contextual information that can strengthen assessment and recommendations. They are not, in isolation, diagnostic tests. The aim is to translate psychological understanding into practical educational recommendations, such as adjustments to teaching, task presentation, communication, organisation and emotional support.
The outcome should be more than a report identifying difficulties. It should help families and schools understand how to respond to them.
Beyond diagnosis: the importance of practical help
Another significant message from the review is that receiving a diagnosis should not mark the end of someone’s access to meaningful care. Unfortunately, families can spend months or years seeking assessment, only to find that ongoing practical support remains difficult to obtain. We have always believed assessment and support should be connected.
At Tabla Psychology, our diagnostic feedback sessions provide opportunities for children, young people and parents to understand assessment findings, explore their implications and consider practical next steps. Our wider pathways also include psychological and educational interventions tailored to the person’s needs. For younger children, our play therapy pathway offers a developmentally appropriate means of exploring emotions and experiences through play and creative expression, together with opportunities for parental review. We are also developing an additional therapeutic pathway for teenagers, recognising the need for support that is relevant to adolescence, identity, relationships and emotional development.
Alongside this, we have developed further ADHD support pathways, including parent-focused work with Dr Neha Matharu and practical coaching for teenagers and young adults with James Turley, our Specialist Teacher and Specialist Assessor. These coaching appointments are planned to become available from January 2027. The focus includes understanding ADHD-related challenges, managing routines and transitions, developing organisational skills, supporting executive functioning and increasing independence.
Coaching is not a substitute for diagnostic assessment or specialist clinical treatment. It serves a different, practical purpose.
Together, these services reflect an important principle: understanding why someone is struggling should lead to meaningful opportunities for support, not simply the production of a diagnostic report.
High-quality independent assessment has an important role
The review raises legitimate questions about consistency, quality assurance and oversight within mental health and neurodevelopmental services, including independent provision. We welcome appropriate scrutiny and robust professional standards. Families should be able to trust the quality of an assessment regardless of whether it takes place within the NHS or an independent service. Independent assessment should not promise a diagnosis, imply that payment determines the outcome or rely on superficial evidence. It should be carried out by appropriately qualified professionals, using established clinical criteria, transparent reasoning and suitable procedures for supervision and accountability.
At Tabla Psychology, our assessment approach is informed by relevant NICE guidance, established diagnostic frameworks and professional standards.
Our multidisciplinary model supports consideration of different perspectives, while supervision and clinical oversight provide opportunities to examine the evidence, uncertainty and conclusions. We also recognise that good practice requires continuing reflection, evaluation and improvement. No assessment service should be exempt from scrutiny, and no professional should presume that their current methods cannot be improved. We support proportionate regulation that promotes reliable, evidence-based assessment and protects families without unnecessarily restricting access to competent care.
Our response: diagnosis where needed, support according to need
Perhaps the most valuable contribution of the Fonagy review is its rejection of a false choice. We do not have to choose between recognising the risks of overdiagnosis and acknowledging the genuine needs of people seeking assessment. Both matter. We can protect against unsupported diagnoses while recognising that many people have historically gone without an explanation for substantial difficulties.
We can provide thoughtful diagnostic assessment without requiring everyone to obtain a label before their needs are taken seriously. And we can recognise the importance of neurodiversity while still acknowledging that some individuals experience profound difficulties requiring specialist assessment, adjustments and ongoing support.
At Tabla Psychology, these principles are central to the service we are developing and delivering.
We want children, young people, adults and families to receive an understanding of their difficulties that is accurate, compassionate and clinically defensible. We want recommendations to be grounded in evidence and useful in everyday life.
Most importantly, we want the people we assess to have better opportunities to participate, learn, develop relationships, become more independent and experience a good quality of life.
A diagnosis is valuable when it is accurate and useful. Support is valuable when it responds to genuine need. Good psychological practice must deliver both.
That is why we welcome the Fonagy review, and why we believe its central clinical message deserves to be heard beyond the headlines.
Dr Tamasine Black, CPsychol, AFBPsS
Chartered Educational and Child Psychologist
Founder, Managing Director and Lead Psychologist
Tabla Psychology Ltd
Tabla Psychology has been shortlisted for the 2026 ACAMH Lionel Hersov Memorial Award, recognising the application of research, audit, service evaluation and quality improvement in child and adolescent mental health practice.
Further reading: Department of Health and Social Care (2026), Independent review into mental health conditions, ADHD and autism: final report, published 9 October 2026.
