ADHD & AUTISM | Four-year waits in Northern Trust as landmark review calls for earlier help

Friday 9 October 2026

Patients in the Northern Health and Social Care Trust area have faced waits of more than four years for an adult autism assessment, as a landmark independent review warns that people are being left without timely support because help is too often dependent on securing a diagnosis.

The major UK Government-commissioned review, published on Friday 9 October, calls for fundamental changes to mental health, ADHD and autism services in England, arguing that people should receive appropriate assistance according to their needs rather than waiting months or years for a formal assessment.

Its findings raise significant questions for Northern Ireland, where some adults face autism assessment waits of up to seven years and thousands of children remain on waiting lists.

The review, chaired by Professor Peter Fonagy, concludes that mental health difficulties have genuinely increased, particularly among young people, while growing demand for ADHD and autism assessments has exposed serious weaknesses in how services respond.

Crucially, it also warns that obtaining a diagnosis does not necessarily guarantee access to the practical help or specialist treatment people need.

Northern Trust autism waits reach 4.2 years

The Northern Health and Social Care Trust, which provides services across Ballymena, Antrim, Ballymoney, Coleraine, Larne and surrounding communities, has acknowledged substantial pressures on adult autism and psychological services.

In its 2025/26 annual performance report, the Trust confirmed that the longest waiting time for an adult autism assessment was 4.2 years.

It attributed increasing pressures to growing demand and greater complexity among people referred for assessment, particularly within Clinical Health Psychology and Learning Disability Psychology services.

A targeted programme of waiting list initiatives achieved a 2.5% reduction in the number of people awaiting assessment.

However, the Trust said those measures had also played a critical role in preventing waiting times from increasing to an estimated six years.

The figures highlight the difficulties facing patients seeking specialist assessment, particularly when prolonged uncertainty can affect education, employment, relationships and everyday life.

The Trust's annual report also identified wider pressures across mental health services, including acute inpatient units operating consistently at or above full capacity.

Thousands of children awaiting autism assessments

The challenges extend across Northern Ireland.

Figures provided by Health Minister Mike Nesbitt in October 2025 revealed that 17,205 children were awaiting an autism assessment across the five Health and Social Care trusts.

Of those, 5,923 were waiting within the Northern Trust, the highest number recorded among the five trusts at that time.

The figures demonstrated the scale of unmet assessment demand affecting children and families across the region, although they represent the position reported in 2025 rather than a newly published October 2026 total.

The Department of Health has separately acknowledged that some children and young people face waits of up to three years for autism assessment, while adults can wait up to seven years.

ADHD provision presents additional challenges, with the Department previously confirming that Northern Ireland does not have a regionally commissioned ADHD assessment service covering adults and children, and provision varying between trusts.

In the South Eastern Trust, the number of children awaiting ADHD assessment increased from 467 at the end of 2020/21 to 1,902 by 31 January 2026.

These are separate ADHD figures for the South Eastern Trust and should not be confused with autism waiting lists or Northern Trust assessment numbers.

New figures reveal children's mental health pressures

The latest Northern Ireland CAMHS statistics, published by the Department of Health on Thursday 8 October, provide further evidence of demand for children's mental health services.

At 30 June 2026, there were 1,731 waits for an initial CAMHS assessment across Northern Ireland.

Of those, 651 had exceeded nine weeks, representing approximately 38% of the total.

The Northern Trust recorded 231 waits, while the Belfast Trust had the highest number at 917, including services provided for the South Eastern Trust area.

The Department cautioned that the latest statistics were compiled following the introduction of the Encompass electronic patient record system and should be treated as a break in the previous data series.

The figures relate specifically to CAMHS assessments and are not equivalent to ADHD or autism diagnostic waiting lists.

Nevertheless, they provide further context for the pressures affecting children and young people seeking mental health support.

Why the independent review was commissioned

The UK Government appointed Professor Peter Fonagy in December 2025 to lead the independent review, supported by Professor Sir Simon Wessely and Professor Gillian Baird as vice-chairs.

Its remit extended beyond rising diagnosis rates and lengthy waiting lists to examine why recorded mental health conditions, ADHD and autism have increased, and how clinical practice, social expectations and cultural influences may be contributing to those trends.

The review also considered the benefits and potential risks of medicalisation, including whether difficulties linked to social, educational or environmental pressures are sometimes being addressed primarily through medical diagnosis rather than other forms of support.

A further priority was identifying ways to prevent mental ill health, strengthen resilience and provide earlier intervention before difficulties become more severe.

The review examined alternative models of support within and beyond the NHS, including the role of schools, employers and community services in helping people alongside appropriate clinical care.

Its overarching aim was to identify how people could receive the right support, at the right time and in the right place, without unnecessary barriers or delays.

Major review challenges diagnosis-first system

The 599-page independent review into the prevalence of, and support for, mental health conditions, ADHD and autism was chaired by Professor Peter Fonagy, supported by vice-chairs Professor Gillian Baird and Professor Sir Simon Wessely.

Its central recommendation is a fundamental shift away from services where access to help frequently depends on securing a diagnosis.

Instead, the authors advocate a needs-led approach alongside continued access to diagnosis, allowing people to receive appropriate support before, during and after assessment.

The review warns that continuing with existing arrangements is not sustainable, with people sometimes waiting months or years while their difficulties become more severe.

The authors stress that diagnosis remains clinically important, personally meaningful and essential to treatment for many individuals.

However, they argue that it should not become the only route through which someone can obtain practical assistance with education, employment, relationships or everyday functioning.

For families facing prolonged assessment waits, such an approach could mean receiving appropriate support at an earlier stage, rather than waiting for a diagnostic decision before difficulties are addressed.

Diagnosis does not always guarantee support

One of the review's most striking findings concerns the assistance available after an autism diagnosis.

Among clinicians surveyed as part of evidence considered by the review, 40% reported that no ongoing post-diagnostic autism support was provided.

Only 12.6% described support extending beyond a single session.

These findings relate to evidence examined in England and should not be interpreted as equivalent figures for Northern Ireland.

Nevertheless, they raise important questions about whether assessment services are sufficiently connected to the practical assistance people need after receiving a diagnosis.

For someone who has spent years awaiting assessment, a diagnosis can provide important answers, greater understanding and access to appropriate treatment or adjustments.

But the review warns that assessment alone cannot resolve wider difficulties if suitable support remains unavailable.

The authors argue that services should be judged not simply by the number of assessments completed or diagnoses made, but by whether people's lives and opportunities genuinely improve.

More than 800,000 referrals open in England

The report documents an extraordinary increase in demand for ADHD and autism assessment services in England.

By the end of 2025, more than 560,000 ADHD referrals remained open, over seventeen times the number recorded in 2019.

More than 254,000 autism referrals were also open by December 2025, with over 90% of those waiting longer than 13 weeks.

The review highlights major increases in recorded diagnoses among children and young people, while distinguishing these figures from estimates of how common the conditions are in the population.

Between 2000 and 2025, recorded ADHD prevalence among children aged six to 11 increased from 0.45% to 2.70%.

Among those aged 12 to 17, it rose from 0.26% to 3.88%.

Recorded autism prevalence also increased substantially, rising from 0.24% to 4.58% among children aged six to 11 and from 0.10% to 4.06% among those aged 12 to 17.

However, the authors emphasise that rising recorded diagnosis rates do not establish that widespread overdiagnosis is occurring.

They recognise the importance of improved identification, including among girls and women whose conditions may historically have gone unrecognised, while also identifying growing concerns about misdiagnosis and potential overdiagnosis.

The report calls for consistent, evidence-based assessment standards that protect access to appropriate diagnosis while ensuring individuals receive the right support.

Young people's mental health difficulties are increasing

The review concludes that rising mental health difficulties are real and cannot be explained simply by greater awareness or increased willingness to discuss emotional wellbeing.

In England, the proportion of adults aged 16 to 64 meeting the criteria for a common mental disorder increased from 15.5% in 1993 to 22.6% in 2024.

Among young people aged 16 to 24, the proportion increased from approximately one in six to one in four over the same period.

The authors identify a combination of pressures associated with deteriorating mental health, including financial insecurity, unaffordable housing, uncertainty about the future, educational demands, loneliness and aspects of the digital environment.

They also highlight the importance of recognising overlapping difficulties, with mental health conditions and neurodevelopmental characteristics frequently occurring together.

The report argues that services organised around individual diagnostic categories can struggle to respond effectively when someone is experiencing several interacting difficulties.

It calls for more coordinated support that considers the whole person rather than treating individual conditions in isolation.

Mental health charity calls for immediate help

Leading mental health charity Mind has welcomed the review's findings while calling for urgent changes to how people access services in England.

Its chief executive, Dr Sarah Hughes, who was involved in the review's steering group, said:

“The Fonagy Review echoes what we’ve seen across our services for years. Increased need for support is not due to a ‘snowflake generation’ or a case of overdiagnosis. Young people are crying out for help with their mental health because of genuine life challenges, and it’s time to listen.”

She warned that the existing system was failing young people and called for a model providing meaningful assistance on the same day someone seeks help.

Dr Hughes added:

“Providing help earlier prevents needs escalating. The right care, from someone who really sees and understands you, can prevent years of distress and worsening outcomes.”

Mind is urging the UK Government to introduce a Same-Day Open Access approach within its forthcoming Mental Health Strategy for England.

The charity argues that people seeking assistance should receive an immediate, meaningful response rather than simply being placed on another waiting list.

Private assessments and diagnostic standards examined

The review also examines the rapid expansion of independent ADHD and autism assessment providers in England.

It identifies concerns about the consistency and quality of some assessments, alongside the financial incentives associated with growing demand for diagnostic services.

The authors recommend stronger regulation and oversight to ensure assessments are clinically robust and that public money is used appropriately.

The UK Government has indicated that it intends to strengthen oversight of mental health and neurodevelopmental services, including bringing ADHD and autism diagnostic assessments within Care Quality Commission regulation in England.

The findings are relevant to wider discussions about private assessments, including in Northern Ireland, where some individuals have sought alternatives because of lengthy public waiting lists.

However, the review's findings about providers in England do not establish that equivalent problems exist among private assessment services operating locally.

Concerns over access to specialist diagnosis

While the proposed needs-led approach has attracted support, it also raises questions about how services would determine who requires specialist assessment and treatment.

The review recommends more active management of waiting lists, with individual clinical circumstances taken into account rather than relying exclusively on how long someone has been waiting.

Those experiencing serious mental health difficulties, multiple conditions or significant risks to their wellbeing could receive greater priority.

However, any move towards needs-led services would need to ensure that people with less visible difficulties are not overlooked or prevented from accessing a formal diagnosis where clinically appropriate.

The review itself recognises that diagnosis can be essential to treatment and that people experiencing significant difficulties should be able to obtain specialist assessment within a reasonable timeframe.

The challenge is therefore not simply to reduce the number of people waiting for diagnosis, but to expand meaningful support without weakening access to appropriate clinical care.

What the findings mean for Northern Ireland

Although commissioned by the UK Government, the independent review focuses on services in England.

Health and Social Care is devolved in Northern Ireland, meaning its recommendations do not automatically change assessment pathways or service provision within the Northern Trust or elsewhere in the region.

Nevertheless, the findings raise questions about whether Northern Ireland's existing approach to ADHD, autism and mental health support is adequately meeting the needs of patients and families.

The Department of Health previously received a report in November 2025 examining the need for commissioned ADHD services across Northern Ireland, with the findings intended to inform future service options subject to available funding.

The new review adds further weight to the debate about how services should respond to growing demand, prioritise those with the greatest needs and ensure that practical support is available while assessments are pending.

For families across Ballymena and the wider Northern Trust area, the issue extends beyond the length of a waiting list.

It is about whether children struggling at school, adults facing difficulties in employment and people experiencing deteriorating mental health can access appropriate help before their circumstances worsen.

The Northern Trust's own figures demonstrate that efforts to reduce waiting times are already under way, but also reveal the scale of the challenge still facing local services.

The review's central message is that diagnosis remains important, but it should not be the sole gateway to meaningful support.

With some patients in Northern Ireland waiting years for specialist assessment, that distinction raises a question for policymakers and health service leaders: how can people receive the help they need now, rather than only when they finally reach the front of a waiting list?