The Fonagy report revealed and implications for autism, ADHD and mental illness

"ADHD and autism at risk of over-diagnosis, says government review" https://www.bbc.co.uk/news/articles/crkg7n1ypj24o 

One of many media headlines around the final Fonagy review into autism, attention-deficit hyperactivity disorder (ADHD) and mental health conditions seeing the light of day today: https://www.gov.uk/government/publications/independent-review-into-mental-health-conditions-adhd-and-autism-final-report 

And as expected, as the various media leaks have noted, the headline is that there's a 'risk' of quite a bit of overdiagnosis, particularly when it comes to autism and ADHD and that the explosion of private sector assessment services is probably going to see some much needed regulation. The days of your average Joe or Josephine waving their 'I have an assessment certificate' without suitable professional qualifications and experience are numbered it seems. Indeed, shortly following the publication of the report, the CQC here in Blighty said they were probably going to oblige: https://www.cqc.org.uk/news/cqc-regulate-autism-and-adhd-diagnostic-assessments and with it multiple websites no doubt removed unevidenced words like 'neuroaffirming' and the like.

Obviously there's lots of nuance around such headlines. Lots of nuance. And lots of different opinions about the report and how the media have covered it. But there's quite a few positives too:

• We should, hopefully, eventually see a move towards less 'autism or ADHD assessments' to something a little more comprehensive like a 'behavioural, neurodevelopmental and psychiatric assessment' combined, complete with non-assumptions. This on the basis that there is no doubt that people are genuinely suffering but that the ICD-11 already tells us that 'autistic or ADHD traits are not the sole domain of a diagnosis of autism or ADHD' https://icd.who.int/browse/2025-01/mms/en#437815624. 
• We should see other diagnostic options - less socially desirable but probably more fitting for some - being assessed and diagnosed e.g. https://www.psychiatrictimes.com/view/when-the-wrong-diagnosis-is-the-most-dangerous-prescription . 
• And we should hopefully see more action around how autism - probably autisms (plural): https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/from-autism-to-the-plural-autisms-evidence-from-differing-aetiologies-developmental-trajectories-and-symptom-intensity-combinations/4D9B0B35DCF03FDBA4E001F7DC9B02D6 - are more likely 'autisms plus' rather than being a standalone condition: https://pmc.ncbi.nlm.nih.gov/articles/PMC13512144/ just like many people (including me) have been saying and what that means for those more comprehensive assessments. Same probably goes for ADHD(s) too.

There's more besides across the report and various media too.

"Not everyone with ADHD and autism traits needs a diagnosis, major review finds" https://www.independent.co.uk/news/uk/home-news/adhd-autism-overdiagnosis-mental-health-streeting-welfare-b3063507.html which brings us full circle back to the idea that concepts like the 'broader autism phenotype (BAP)' were really good explanations of subthreshold autism(s). That autistic traits are very much part of the human experience outside of just being 'pathological'. Obviously, what turns autistic traits into autism is because traits begin to manifest well outside of the 'typical' in both severity and persistence and, importantly, also interfere with day-to-day life. That's why gold-standard tools like ADOS do a great job of highlighting the 'outside of typical' but it is clinical opinion - professional clinical opinion - that makes the final judgement call on 'interfering with day-to-day life' and onwards the diagnosis or not. The other side of this is recognition that autistic traits are NOT now considered the sole domain of a diagnosis of autism. Even if some autistic traits may be deemed 'atypical', if the pattern of presentation of those traits (and others) is better fitting of something else, well, then it's either that something else or potentially autism plus that something else that should be diagnosed. Again also apply to ADHD.

And finally: "There are weaknesses in the data. Evidence about the true level of autism relies on surveys that have not been done for nine years, so the review team have had to estimate what has happened since." https://www.bbc.co.uk/news/articles/crn8wyl4n42yo This refers to the observation that we don't actually know how many kids and young people have autism here in England or the UK. Well, that's not entirely accurate...

Take for example, Northern Ireland, who have been collecting data on school-aged autism diagnoses for nearly 20 years. Their latest report: https://www.health-ni.gov.uk/sites/default/files/2026-05/asd-children-ni-2026.pdf puts the school-aged autism rate for 2025/2026 at 6.2% (8.6% in males). Of course this is administrative data so perhaps not the same as other kinds of data. But I would have thought that education departments aren't likely to hand out important diagnoses like autism if they didn't have to because they end up costing them money. And government bean counters don't like spending money if they don't have to.

The publication of the Fonagy review is a Red Letter Day. For lots of reasons. Not least recognition that behavioural, neurodevelopmental and psychiatric disorders are really, really disabling. And we need to do a lot more to accurately assess and diagnose so that targeted help and support and intervention can be suitably provided.

The end of the (science) road for 'neurodivergent'?

Mapping Clinical Diagnoses Associated With Neurodiversity and Neurodivergence in Mental Health Research: A Scoping Review https://pubmed.ncbi.nlm.nih.gov/42747846/

"While neurodivergence and neurodiversity are valuable for capturing lived experience, their lack of specificity may introduce substantial heterogeneity in research focused on clinical categories."

Pretty much says what many - particularly professionals - have been thinking for a while: by all means use your (non-evidenced) 'neurodivergence' in your social media and pop psychology articles and the like but when it comes to using such (non-evidenced) terms in science and particularly in objective, supposedly replicable science, maybe think again.

And more: "prioritizing precise diagnostic descriptors in clinical practice and research involving clinically defined conditions, while reserving neurodivergent for studies and contexts focused on self-identification and identity." Indeed.

There's been numerous times when 'neurodivergence' and other neuro-prefixed malarkey have been used in 'supposed' science, typically under the auspice of 'community preference' or with some 'we shouldn't use words like disorder' in mind. It's of course noble to help try and reduce stigma but typically doesn't actually fit in with what science is supposed to be along lines of objectivity and importantly, accuracy and reproducibility. 

My main beef with something like 'neurodivergence' (aside from not actually being rooted in any science) is that people seem to make up what it actually includes and importantly, doesn't include. You've probably seen the AI slop 'umbrellas' trying to convince people that conditions like autism, ADHD, schizophrenia, and more are somehow 'united' in some new and alternative 'way of thinking'. Its neuroBS of course but it doesn't stop some. And when it comes to the 'deviant' ways of thinking, things like the various -philias for example, you won't typically find them mentioned, despite their perhaps being the archetypal 'neurodivergences'. Same goes also for still highly stigmatised but life-changing diagnoses like personality disorders and more too, which again aren't typically the nice socially-acceptable face of neurodivergence.

But it appears that time is being called on such neuroshenanigans and how science is about accuracy and objectivity and not the neurofashion de jour. All of this added to a bit of sea change in various opinions around what some elements of academia seem to be trying to pass off as science.

Next up: how the self-diagnosis of conditions like autism and ADHD have also been included and passed off as 'autism' and 'ADHD' by some 'science'. And that's also definitely mudded the waters of certain studies and their findings. Hold on to your neurohats...

"an identity rather than a disorder": how some people are (wrongly) framing ADHD and more

"Some people now regard ADHD [attention-deficit hyperactivity disorder] as “an identity, rather than a disorder”, with the result that many obtain assessments from poor quality private providers, which lead them to “believe they have a condition needing treatment”, said the psychiatrist Dr Marios Adamou, the founder of the UK Adult ADHD Network." https://www.theguardian.com/society/2026/aug/18/great-adhd-myth-rising-diagnosis-without-treatment

If there is one voice who is 'tellin' it like it is' in the context of serious and disabling neurodevelopmental disorders like ADHD and autism, that voice is psychiatrist Marios Adamou. 

And not only is he talking sense in the media, he's also got the research record to back it up in terms of his studies on triage models of adult autism assessment (see here), bringing reality to bear on the concept of 'masking' across various neurodevelopmental disorders such as ADHD (see here) and autism (see here) (hint: it's probably not compatible with said disabilities), the hows-and-whys people seek ADHD and autism assessments (see here) and what can happen when professionals say 'it 'aint ADHD or autism' (see here). 

And I for one, want to hear a lot more of his professional and research-informed opinions over and above the neurobabble - often impossible neurobabble - that some have spouted in these days of (social media) trainers and coaching. Reality is re-entering the room. And not a moment too soon, particularly for those who are genuinely disabled by what are disabling behaviourally-defined neurodevelopmental disorders (and the c**p they've had to endure at the hands of identity politics and its purveyors).

Next up: the conversations needed around who is actually qualified to assess for and diagnose ADHD or indeed, related diagnostic labels like autism (see here) (hint: probably not someone who just as a certificate in one or more assessment tools but no clinical qualifications, skills and experience) and just how forensic assessments need to be (see here), particularly keeping mind that ADHD and/or autistic traits are probably not the sole domain of a clinical diagnosis of ADHD and/or autism according to the ICD-11 diagnostic criteria. Oh, and as per our recent contribution to autism science, an appreciation that autism (and ADHD and more) are rarely stand-alone conditions (see here) thus introducing yet more clinical complexity. If in doubt, seek out an expert.

Autism spectrum disorder: has it lost its meaning and is it leading to misdiagnosis?

Autism spectrum disorder: has it lost its meaning and is it leading to misdiagnosis? https://www.cambridge.org/core/journals/psychological-medicine/article/autism-spectrum-disorder-has-it-lost-its-meaning-and-is-it-leading-to-misdiagnosis/AF834026D004D42B1963BEA515495AC6

A new paper from Prof. Uta Frith that is already making some media headlines including "Academic warns that ‘almost magnetic attraction’ to having condition means term is being misused." This follows recent previous headlines based on what she's said. Now, there'll all in a science paper.

And what a paragraph this is: "Among drivers for the increase in prevalence are cultural changes, such as the desire for inclusion, harm avoidance, reliance on self-report, and the acceptance of masking. These have all led to a lowering of the diagnostic threshold. Furthermore, the popularity of the concept of autism boosted numbers via self-diagnosis and a search for identity."

That's going to be absolute garlic to some (particularly where (neuro)marketing, training and other livelihoods are part-and-parcel of the social media age in which we live). But actually, she's probably right as per what's been said by quite a few other notable people and what the data seem to be telling us. By saying that I actually also believe we are seeing a part real increase in (childhood) autism as per what various stats from various geographies have been telling us for quite a few years.

Talk about 'masking' - it's actually reputation management - and the myriad of 'self-diagnosing' - but not self-diagnosing other less palatable conditions which very much overlap with autism - are receiving some well-deserved scrutiny these days. Not least in the context that according to the ICD-11 criteria, autistic traits are not the sole domain of a diagnosis of autism on the basis of those boundary conditions that accompany clinical descriptions, and to decipher what is what takes (medical) professional and multidisciplinary examinations and not some random who just holds a certificate on one or more autism assessment - that's assessment not diagnosis - instruments. 

When eminent people such as Prof. Frith are writing an article like this, it's probably time to start listening. That won't make an iota of difference to some who are already invested in stuff like 'self-diagnosis is 100% valid' and the like. But for everyone else, a correction is starting to happen and happen not a moment too soon. And too her media quote: "Splitting up the spectrum would ultimately prevent misdiagnosis" is already happening as per the rise and rise of profound autism and the realisation that 'heterogeneous' is not just a word.

Next up: the Fonagy review is probably due to report soon here in Blighty (https://www.gov.uk/government/collections/independent-review-into-mental-health-conditions-adhd-and-autism) and what its found around autism, ADHD and more. I can probably guess that they won't be disagreeing with Prof Frith...

"In 2024, the prevalence reached 21.1‰ among boys": Autism in France

Part of the title to this post - "In 2024, the prevalence reached 21.1‰ among boys" - represents a detail from a recent paper titled: Epidemiology of Autism Spectrum Disorders in French Children Aged 8 https://link.springer.com/article/10.1007/s10803-026-07433-x

Alongside the observation that 21.1 per 1000 boys aged 8 years old may have autism in France (registry-based prevalence), the additional headline is that "ASD at age 8 increased markedly ranging from 2.1‰ in 2003 to 13.5‰ in 2024." 

Around a third of kids with autism also had an intellectual (learning) disability and about a fifth had comorbid attention-deficit hyperactivity disorder (ADHD) according to this data. Oh and the sex ratio was 5:1 boys:girls.

I dunno. Is it perhaps time to starting worrying about how many children are presenting with clinically relevant behaviours leading to being diagnosed with a serious neurodevelopmental disability like autism? Y'know worrying to the extent that the old 'all better awareness' is basically a call for inaction rather than action around hows-and-whys? Worrying about what those figures mean for children (and no, they weren't 'masking' or other stuff), their families, education and healthcare systems and society more widely when it comes to adult outcomes like social care and employment et al?

Added to data from other geographies such as Northern Ireland (see here) where over the last 5 years, they've registered an increase in school-aged autism from 4.2% in 2019/2020 to 6.2% in 2025/2026 and now affecting 8.6% of boys, it's getting a bit concerning don't you think?

'Profound autism' defined: moving closer to compartmentalising the heterogeneous 'autisms'

 A short post to bring a new paper to your attention: Developing a consensus research definition for profound autism using a modified Delphi method https://link.springer.com/article/10.1186/s13229-026-00727-y 

Follows on from the INSAR conference proceeding that moved things on from the previous US CDC definition that moved things on from the Lancet introduction.

Highly likely that there'll be more honing of the term and what it covers but the reasons for not using it (or using some other word salad) are getting smaller and smaller and smaller...