Your Child Never Needed a Diagnosis to Get Help at School.
The Fonagy Review Just Said So.

The government’s independent review of mental health, ADHD and autism was published on 9 October, the eve of World Mental Health Day. It runs to nearly 600 pages, and most of the headlines have boiled it down to one word: overdiagnosis. If you’re a parent, that’s not the part to focus on. Buried in the education chapter is a finding that matters far more for your child, and that you can use from Monday.

Why we’re not leading on “overdiagnosis”

The overdiagnosis argument makes good headlines. For a parent whose child is struggling right now, it doesn’t change anything.

The review itself is careful here. It says the balance of risk may be shifting, and it raises real concerns about the quality of some private assessments. But it also says the evidence “does not show that people presenting today are less impaired than those presenting previously”, and that “People are seeking answers and support for very real problems, and they are not the problem. The problem is a system that leans too heavily on diagnosis as the route to help and cannot keep pace” (Executive Summary, paras 24 and 35).

So here’s our angle. The most important sentence in this review for parents isn’t about how many children are diagnosed. It’s about why families have felt they needed a diagnosis in the first place.

Even the review’s chair was let down by school

Professor Fonagy opens the report with a personal story. He was born with severe dysgraphia, a difficulty with writing. “My school made nothing of it, to them I was a failure,” he writes. It was his university that later let his exam papers be transcribed, “years before any law obliged it to make such an adjustment” (Foreword).

That is the whole argument of this post in one life story. The right adjustment changed everything for him. It didn’t need a label. It needed someone to notice the need and act on it.

What the review actually found

• More children are genuinely struggling. Mental distress has risen substantially, especially among young people. The review says this “cannot be explained by greater awareness alone” (Executive Summary, para 17).
• Far more children are being identified with ADHD and autism. Recorded ADHD in 6 to 11-year-olds has risen more than six-fold since 2000, and recorded autism more than twenty-fold. Best estimates of how common the conditions actually are haven’t changed much. For autism, the review puts the rise down to “changes in recognition, recording, diagnostic concepts, help-seeking and access” rather than a clear change in children themselves (paras 19 and 21; Chapter 8).
• Girls are finally being noticed. One of the most important changes is “the increased recognition of ADHD and autism among girls and women”. Much of the old gap between boys and girls reflected missed girls, not fewer girls (para 25). Why girls are missed →
• Watch Year 7. The biggest rises in recorded autism happen around the move to secondary school, creating “a pronounced peak in recorded prevalence in Year 7 that was not evident a decade ago” (Chapter 8). For many children, needs that were manageable in a predictable primary classroom surface when secondary school asks more of them.
• The waiting lists are enormous. By the end of 2025 more than 560,000 ADHD referrals were open in England (all ages), and more than 254,000 people were waiting for an autism assessment, over 90% of them beyond the recommended 13 weeks (paras 20 and 22).
• Where you live decides how long you wait. The review found median waits ranging “from under two months to more than 1,000 days depending on where a person lived” (Chapter 12).
• “Fine in school” is a known problem. The review notes that difficulties “masked in the classroom, or that emerge mainly at home, may go unrecognised”, and that families “are not always believed when a child appears to be coping in school” (Chapter 13). When school says your child is fine →
• What you see at home counts. “Parents and carers usually know their child best, and what they observe at home constitutes important evidence rather than claims to be verified against classroom behaviour” (Chapter 13).

The part every parent should read: you don’t need a diagnosis

This is the finding the headlines missed. In its chapter on education and SEND, the review says diagnosis has become one of the principal routes to educational support, and then: “This is not, however, what the legal framework intended” (Chapter 13).

It sets out why:

• Reasonable adjustments don’t need a diagnosis. Under the Equality Act 2010, adjustments “should be based on functional need rather than diagnostic status”.
• SEN Support doesn’t need a diagnosis. The review says the SEND Code of Practice “is organised around identifying and responding to educational need rather than diagnostic category”. The Code itself is explicit: “The purpose of identification is to work out what action the school needs to take, not to fit a pupil into a category” (para 6.27). Its assess, plan, do, review cycle, known as the graduated approach (para 6.44), “was explicitly designed to identify emerging needs and provide support before specialist assessment becomes necessary”, in the review’s words.
• An EHCP doesn’t need a diagnosis. “There is no legal requirement for a diagnosis in order to access an EHCP.” The legal test is whether your child has or may have special educational needs, and may need an EHC plan. When councils decide whether to assess, the Code tells them to look at whether a child “has not made expected progress” despite the school taking “relevant and purposeful action” (para 9.14). That’s evidence of need and progress, not a diagnosis.

So why does it feel like you need one? The review is honest about that too: “In practice, however, diagnosis is often regarded as the only way to obtain a fair, objective and robust assessment of need.” And in Chapter 18 it goes further: “The widespread belief that diagnosis is required has itself contributed to diagnosis becoming the gateway.”

Kent is already the test case

Here’s the Kent angle the national coverage won’t give you. Kent families don’t need to imagine a world where support can’t wait for a diagnosis. They’re already living in it.

That report contains a warning worth reading twice: “prolonged waiting times and reduced access to assessments could affect how effectively children and young people with SEND are identified”. Nationally, the Fonagy review found assessment waits ranging from under two months to more than 1,000 days depending on where you live, and calls the variation in SEND outcomes between local authorities “another postcode lottery”. More on the Right to Choose pause in Kent →

The good news is that Kent’s own rules already point the right way. Kent’s Mainstream Core Standards, which set the baseline every Kent mainstream school is expected to meet, say support “is not dependent on a child or young person receiving a formal diagnosis”, and that “Provision will be put in place for presenting needs, with or without any formal diagnosis.” The parents’ guide puts it even more simply: children “don’t need a formal diagnosis for this support to be put into place.”

So in Kent, the review isn’t asking for something new. It’s asking for something that’s already written down to actually happen.

Our view: needs-led only works if someone measures the need

We agree with the review’s direction. Diagnosis should never have been the only door to help. But here’s our worry, and it’s one the review shares.

If “needs-led” becomes another way of saying “let’s wait and see”, the children who lose first are the quiet ones. The girl who holds it together all day and falls apart at home. The boy who’s “fine in class” but can’t start a piece of writing. Their needs don’t show up unless someone looks properly.

The review sees this risk. It warns that “Earlier access without sufficient capacity simply becomes a longer waiting list – or a different form of rationing” (Chapter 19). It insists that needs-led support “should never become another hurdle before diagnostic assessment, nor a reason to delay or withhold diagnosis where diagnosis is needed” (Chapter 19). And its own model says a child’s needs should be described across learning, attention, communication, emotional and sensory needs, and everyday participation, using information “from the young person, their family and education” (Chapter 18 and Annex A).

That’s the missing piece in most schools today: a clear, evidence-based picture of what a child actually needs. Not a hunch, and not a label, but something a school can act on. Until the new system exists, and the review’s own timeline runs to a ten-year reform plan, that evidence won’t appear by itself.

The government’s £1.8 billion “Experts at Hand” programme, bringing educational psychologists, speech and language therapists, occupational therapists and specialist teachers into mainstream schools, should help. But it will take time to reach every Kent classroom, and your child is growing up now.

What you can do now

What happens next

• Nothing changes in law today. SEND law, the Equality Act and your child’s rights are the same as they were last week.
• A Mental Health Strategy is due this year. The review asks the government to set out actions for the next 12 to 24 months and a ten-year reform plan. The government has said it will respond through its Mental Health Strategy.
• Waiting lists will be reviewed. The review recommends a clinically led review of ADHD and autism waiting lists, with support offered while people wait.
• Assessments will be regulated. The government has committed to working towards making all ADHD and autism diagnostic assessments CQC-regulated, NHS or private.
• Support in schools should grow. Experts at Hand, and Mental Health Support Teams reaching special schools, alternative provision and colleges first, are part of the plan.
• It connects to SEND reform. The review is designed to sit alongside the Schools White Paper, Every Child Achieving and Thriving.

About the author: Lauren Robson

Lauren is the founder of Education With Lauren, a qualified teacher and SEND specialist with 16 years’ experience across mainstream schools, Kent County Council provisions and specialist settings. She holds a BA (Hons) in Primary Education with QTS (SpLD, Needs and Inclusion) and an MSc in Neuroscience and Brain Cognition, and is an approved education supplier to Kent County Council.

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