How Might a Shift in Referral Pathways Impact Our Neurodivergent Communities?
Note to Reader: This article offers my personal reflections on the Fonagy Report and the wider political discussions surrounding autism, attention deficit hyperactivity disorder (ADHD), mental health, disability and access to support. Drawing on my experiences as an adult-recognised autistic and ADHD woman, I consider how changes to referral pathways and approaches to support may affect our neurodivergent communities. I also explore why recognising neurodiversity, respecting self-identification and understanding the relationship between neurodivergence, mental health, physical health and our wider social circumstances are essential to meeting our needs.
Topics Include: Autism · ADHD · Neurodiversity · Neurodivergence · Mental Health · Self-Identification · Disability Rights · Government Policy · Referral Pathways · Access to Support
As an adult-recognised autistic and ADHD woman, I have been following political discussions about autism, ADHD, mental health and access to support with growing concern. While I welcome efforts to improve services, I worry that changes intended to increase access could unintentionally reinforce existing barriers to recognising and supporting our neurodivergent experiences.
The government-commissioned review led by Professor Peter Fonagy examines increasing demand for autism and ADHD assessments and support. Its recommendations include a needs-led approach alongside diagnosis, more integrated assessment pathways and the use of artificial intelligence (AI) to support decision-making. These proposals also come at a time of wider political discussion about disability benefits, public spending and access to services.
Although separate from the proposed changes to Personal Independence Payment (PIP) discussed in 2025, those earlier debates remain relevant. For many within our neurodivergent community, access to support feels increasingly under scrutiny, despite the ongoing difficulties we face in obtaining recognition, assessments and appropriate services. Changes to how needs are identified and prioritised therefore raise an important question: will support become more accessible, or will existing barriers simply take a different form?
In principle, a needs-led approach could be positive, particularly if it recognises cognitive differences and provides support without requiring people to wait for a diagnosis. However, I worry that greater emphasis on mental health could result in people being directed towards mental health services without sufficient consideration of their underlying neurodivergent experiences. This is particularly concerning for autistic girls and women, whose experiences have historically been overlooked or interpreted primarily through mental health diagnoses.
Mental health support is important, but distinguishing between mental health difficulties, neurodivergent characteristics and distress arising from our circumstances is not always straightforward. Anxiety, for example, may be associated with sensory overwhelm, social exclusion, uncertainty or wider life pressures, often involving several factors at once. Recognising these interactions is essential if support is to address people's needs rather than only their presenting difficulties.
A shift towards needs-led support must therefore be matched by a shift in how services recognise, understand and respond to neurodivergence.
Without appropriate professional knowledge, resources and inclusive assessment processes, existing inequalities may simply be reproduced through new pathways.
Challenges with the Proposed Changes
One concern is whether needs-led assessments will recognise less immediately visible difficulties. For people who mask or have developed extensive coping strategies, maintaining employment, education or everyday responsibilities may conceal considerable exhaustion or distress. Assessing need primarily through observable functioning risks overlooking the support required to sustain participation and wellbeing.
The proposed use of AI also raises questions about bias. If systems are developed using historical diagnostic records without accounting for existing inequalities, they may reproduce patterns of under-recognition, particularly among girls, women and adults whose experiences differ from traditional expectations. AI-supported decisions must therefore be transparent, independently evaluated and informed by diverse neurodivergent experiences.
Greater standardisation and prioritisation could also affect access to diagnosis. Providing support before assessment is welcome, but it should not become a reason to delay or discourage formal recognition. Diagnosis can help us understand our experiences, access appropriate healthcare, and secure support across different areas of life. Changes to diagnostic pathways must therefore be accompanied by sufficient NHS capacity rather than simply redirecting demand elsewhere.
These concerns highlight a broader issue: a needs-led system can only be as inclusive as the knowledge, resources and practices through which needs are understood and met. Changing referral pathways alone will not necessarily address the barriers that neurodivergent people already experience.
Understanding Neurodiversity, Neurodivergence and Diagnosis
Another concern I have about the Fonagy Report is how neurodiversity, neurodivergence and diagnosis are represented. These distinctions are important because they influence how we understand cognitive differences, whose experiences are recognised and what support is considered appropriate.
Neurodiversity refers to the natural and expected diversity of human minds. We all differ in how we think, learn, communicate, process information and experience the world. It is not a diagnosis, nor is it limited to autism and attention deficit hyperactivity disorder (ADHD). Rather, it encompasses human cognitive variation, including differences associated with neurodevelopmental conditions, mental health difficulties and acquired neurological conditions.
Neurodivergence describes ways of thinking, processing and experiencing the world that differ from what is considered typical. It is a broad concept rather than a clinical diagnosis, and its boundaries may be understood differently across communities. Autism and ADHD are examples of neurodivergence, but the concept extends beyond these conditions.
Diagnosis is a formal clinical process through which particular conditions are identified using established criteria. It can support self-understanding and access to treatment, services and reasonable adjustments. However, diagnosis does not create someone's neurodivergence, nor does the absence of a diagnosis make their experiences or support needs any less real.
My concern is that when these concepts are misrepresented or used interchangeably, we risk narrowing our understanding of neurodivergence to clinically recognised conditions. This can overshadow the broader ways in which cognitive differences shape our everyday experiences, interactions with our environments and responses to support.
This becomes particularly important when we consider the value of self-identification.
The Importance of Self-Identification
Long waiting lists, financial barriers and the continued under-recognition of certain groups mean that many autistic and ADHD people spend years trying to understand their experiences without formal recognition.
Self-identification can help us make sense of lifelong experiences, connect with others and explore strategies that support our wellbeing. For some, it provides an important sense of understanding and validation, particularly when their experiences have previously been misunderstood or dismissed.
While self-identification and clinical diagnosis serve different purposes, they should not be positioned as though one necessarily invalidates the other. Formal diagnosis has an important role in healthcare, but it is not the only way people come to understand their cognitive differences or recognise their needs.
Our neurodivergent experiences do not begin when a diagnosis is confirmed.
My wider concern is that misrepresenting the meaning of neurodiversity and neurodivergence, alongside dismissing the value of self-identification, risks allowing community perspectives to remain overshadowed by an NHS approach centred predominantly on clinical diagnosis.
Although diagnosis remains important, understanding neurodivergent people requires us to look beyond diagnostic categories. We need to consider how individuals process information, communicate, navigate their environments and experience everyday life, alongside the support they need and whether that support makes a meaningful difference to their wellbeing.
If we continue to focus primarily on who meets diagnostic criteria, rather than understanding the diversity of neurodivergent experiences, we risk overlooking the very people and needs that services are intended to support.
Recognising neurodiversity means recognising that cognitive differences exist regardless of diagnostic status. Supporting neurodivergent people means listening to our experiences, understanding our individual needs and creating environments and services that respond to those differences.
How Might These Narratives Affect Disclosure and Support?
The language used in public discussions about autism and ADHD can also influence whether people feel comfortable sharing their experiences or requesting support. When certain presentations of autism and ADHD are questioned, particularly among adults, it may reinforce the uncertainty and dismissal that many people have already encountered.
For those of us recognised later in life, our experiences may have been overlooked, misunderstood or attributed to stress and mental health difficulties for many years. If people anticipate having their experiences questioned or their autistic and ADHD characteristics interpreted solely through a mental health perspective, they may become reluctant to discuss their needs with healthcare professionals, employers, educators or even family members.
This matters because people who feel unable to disclose their experiences may also struggle to access appropriate adjustments and support. Their needs can remain unaddressed, potentially contributing to further distress and difficulties with everyday participation.
Recognising diverse autistic and ADHD experiences does not mean overlooking mental health difficulties or the importance of careful assessment. Rather, it means creating environments where people feel able to explore and communicate their experiences without fear of dismissal.
What My Own Experience Has Taught Me
Being recognised as autistic and ADHD in adulthood helped me understand experiences that had shaped much of my life. Over time, I have developed practical strategies, learned to respond to my needs and gradually found ways to participate more fully in everyday life. This has included moving from part-time to full-time employment, albeit in a slightly clumsy, chaotic way!
Appropriate healthcare has also contributed to improvements in my health and wellbeing, although this remains an ongoing journey. Medication for ADHD and perimenopause, including a low-dose antidepressant, alongside treatment for a respiratory condition, has helped me manage different aspects of my health. Greater self-understanding, access to resources and opportunities to participate in work and society have also made a difference.
What I have come to recognise is that these improvements cannot be attributed to any one intervention. My wellbeing is shaped by the interaction between my neurodivergent characteristics, physical and mental health, relationships, environments and the support available to me.
I have not become less autistic or less ADHD as my ability to function has changed. What has changed is my understanding of myself, my health and the circumstances in which I live.
My experience is not a blueprint for everyone else. Across our neurodivergent communities, our needs, responsibilities, resources and opportunities differ and can change throughout our lives. Some of us may need considerable support with everyday activities, while others may appear to manage independently but experience significant difficulties behind the scenes.
Our ability to work, manage daily responsibilities or live independently should not determine whether our experiences are recognised or our needs considered worthy of support.
For me, this is why discussions about autism, ADHD and mental health need to extend beyond diagnostic categories and observable functioning. They need to consider the person, their circumstances and the different forms of support that can make everyday life more manageable and meaningful.
Towards Recognition of Neurodiversity
Through my work at ND Perspective and in my forthcoming book Balance, I explore what it means to recognise neurodivergent experiences as part of human diversity. The aim is not to make everyone think, behave or function in the same way, but to understand how our characteristics interact with our health and environments, while exploring neuro-affirmative strategies that support everyday life and wellbeing.
Recognising neurodiversity does not mean overlooking disability, distress or the need for healthcare. Our experiences are shaped by differences in how we think, communicate and process information, alongside the environments and circumstances in which we live. Access to healthcare, education, employment, financial security and supportive relationships can all influence our opportunities to participate and our quality of life.
As the government considers the report's recommendations, I would like discussions to move beyond diagnostic numbers and the cost of services towards a fuller understanding of our lives. Improving mental healthcare should complement, rather than replace, recognition of neurodevelopmental differences. Equally, providing support based on need should not mean restricting access to diagnosis for those who want or require it.
A genuinely needs-led approach must recognise that needs are not determined by diagnostic status alone. They emerge through the interaction between our individual characteristics, health, environments and circumstances. Meeting those needs requires services with the knowledge, capacity and flexibility to respond to different experiences, alongside meaningful involvement from neurodivergent communities in how those services are designed and delivered.
Accepting neurodiversity as part of human diversity should not require us to demonstrate particular strengths, achievements or levels of independence. Nor should improvements in wellbeing or participation suggest that we no longer experience disability or require support.
Shifting the focus from autism and ADHD towards a mental-health-first approach will not change who we are as neurodivergent people. But it may change whether our experiences are understood, believed and appropriately supported.
Ultimately, I believe the conversation needs to be about more than how we manage demand for diagnosis. It needs to consider how we recognise neurodivergent experiences, listen to our communities and ensure that support makes a meaningful difference to people's lives.
As these discussions continue, our community needs opportunities to share our experiences and contribute to the decisions affecting us.
How do you think a greater focus on mental health within autism and ADHD referral pathways might affect our neurodivergent communities?
I welcome your thoughts and experiences in the comments. With contributors' permission, we may use insights shared here to inform a future ND Perspective community article exploring different perspectives on this topic.
Let's reimagine inclusion together,
Jess xx
Jessica Dark – Founder of ND Perspective and author of Balance, due for publication on 19 November 2026.