Understanding the scale of need

The extent of unmet needs in ADHD services, inconsistent pathways and long delays in the assessment and treatment of ADHD were rightly highlighted in the first part of the report. ³ ADHD affects around 5% of children and 3–4% of adults according to UK prevalence estimates, ^{3,Reference Steibahl16} with around 80% of adults having at least one coexisting psychiatric disorder. A significant number of people with ADHD, however, remain undiagnosed and unsupported, often with serious consequences. ^{3,Reference Khan, Ahmed and Stott7,9,Reference Szymaniak, Bell, Shivakumar and Malhi17,Reference Suetani, Parker and Scott18} Recent evidence suggests that, although concerns about overdiagnosis exist, the main challenge in the UK remains underdiagnosis and unmet need, highlighting the urgency of improving service access and assessment pathways. ^{Reference Martin, Rouquette, Langley, Cooper, Sayal and Ford19,Reference Cortese, Daley, Hollis, Rae, Ani and Asherson20}

On the other hand, international data show marked variation in administrative and diagnosed prevalence of ADHD across countries. This reflects differences in healthcare systems, diagnostic practices and access to treatment rather than actual differences in underlying prevalence. In the USA, population-based surveys indicate high levels of identification, estimating that around 9% of children have received an ADHD diagnosis. ^{Reference Danielson, Bitsko, Ghandour, Holbrook, Kogan and Blumberg21}  In some Nordic countries, including Iceland, reported rates of ADHD medication use are comparatively high and approach the levels seen in North America. ^{Reference Zoëga, Furu, Halldórsson, Thomsen, Sourander and Martikainen22} Taken together, these findings suggest how configuration of services can influence observed prevalence and that underdiagnosis is context-specific rather than universal.

Untreated ADHD leads to poorer educational outcomes, impaired functioning and a higher risk of unemployment, self-harm and offending. ^{Reference Shaw, Hodgkins, Caci, Young, Kahle and Woods23–Reference Knecht, de Alvaro, Martinez-Raga and Balanza-Martinez27} Large epidemiological data show that adults with ADHD experience a notably reduced life expectancy, with around 6.8 years lost for men and 8.6 for women. ^{Reference El Baou, John, Lewer, Mandy and McKechnie28} This increased mortality is mostly associated with potentially modifiable factors, including psychiatric comorbidity, substance use and a higher incidence of physical illness. ^{Reference Knecht, de Alvaro, Martinez-Raga and Balanza-Martinez27}

The taskforce correctly identifies ADHD as a public health matter rather than a narrow diagnostic concern. Unless prompt identification and earlier intervention are ensured, the system will continue to respond late and this will cause long-term personal, social and economic losses. ^{Reference Doshi, Hodgkins, Kahle, Sikirica, Cangelosi and Setyawan29}

Strengths of the taskforce vision

Challenges and risks ahead

Critical reflections on the taskforce report

Despite the taskforce’s report being comprehensive and wide-ranging, a deeper examination of certain areas would have strengthened its impact. One such area where discussion is limited is the variation in diagnostic practice across services. The report mentions inconsistent pathways but stops short of elaborating on the differences in assessment quality between regions or sectors. This gap can be addressed through the development of a clear quality framework and accompanying guidance defining the standards for ADHD assessments.

The report acknowledges inconsistency in ADHD pathways and assessment models, but the underlying conceptual and nosological variation receives limited attention. Symptoms of ADHD lie on a continuum, yet diagnostic systems rely on categorical classification that carries the risk of either under- or overdiagnosis. Differences in assessment processes, access to developmental history and threshold for clinical significance are all factors that can potentially influence diagnostic and treatment outcomes. This in turn has implications for equity, clinical governance and comparability of diagnosis between healthcare providers. Clarity about minimum assessment standards, supervision structures and well-defined protocols to manage complex or borderline cases can improve consistency and clinical outcomes in this regard.

It is welcome that the taskforce views ADHD as a lifelong public health challenge rather than a specialist psychiatric issue. However, the success of this model will depend less on the ambition of policy documents and more on whether the healthcare system can reconcile increasing demand with the finite resources of workforce and funding. Unless robust parallel structural investment is in place, there is a risk that reform efforts may unintentionally widen disparities, increase fragmentation and shift pressures between sectors instead of easing them.

Public discussions regarding ADHD diagnosis have raised issues relating to quality of the diagnostic process and variability among different service providers. In addition, there is a need to recognise the differences between private assessments, which occur outside NHS services, and those provided through the NHS Right to Choose arrangements, because these are subject to different governance and contractual frameworks and may have different assessment thresholds and diagnostic practices. The independent sector, like other areas of healthcare, can make an important contribution towards addressing unmet need and help in reducing waiting times. Instead of framing NHS and the independent provision as competing systems, it would be more beneficial to focus on promoting increased collaboration and integration between the two sectors.

It is important to make the distinction that the taskforce was tasked to produce policy recommendations, but it was not mandated to issue formal clinical guidance. The report therefore does not specify clear criteria against which current assessments may be measured, although it does call for improved national standards to be put into place by organisations including NICE, NHS England and the Care Quality Commission. The implementation of regulatory and quality standards should be pursued by the relevant national bodies.

The report acknowledges the need for increased primary care involvement, outlining broad recommendations for GP training pathways, localised funding for shared care and access to specialist advice. However, it provides limited detail on the precise practical implementation of medication oversight and how these responsibilities can be seamlessly integrated into an already stretched general practice sector. Any increase in ADHD-related responsibilities in primary care without fully realised protected training time, specialist input and robust governance arrangements may result in increased medical uncertainties, medico-legal issues and disintegrated care.

Shared care is currently practiced in the NHS for other long-term conditions. For example, specialist services are tasked with the development of assessment and treatment plans for cases of diabetes, asthma and depression, whereas GPs are responsible for ongoing monitoring and prescribing within established protocols. A similar model in the treatment of ADHD would need to dependably incorporate the components hinted at by the taskforce: standardised training frameworks, clear prescribing guidance, rapid access to specialist advice and protected clinical capacity within primary care. Without such concrete precautions firmly in place, the likelihood exists that workload will simply be transferred to overburdened GPs, resulting in potential disruption to continuity of care and risks to patient safety. This aspect of the taskforce’s proposal would have been improved by expanding their recommendations into a more carefully planned, phased and resourced implementation roadmap.

The momentous phenomena of artificial intelligence and machine learning have unexpectedly found relevance in every aspect of human endeavour. In healthcare too, it is a rapidly emerging area of research and early implementation has already begun in most fields, including in psychiatry. The report, however, does not specifically mention the use of artificial intelligence/machine learning in ADHD assessment and management. It is worth mentioning that artificial intelligence-supported systems could be utilised at different levels and stages of care including referral triage, documentation, data analysis, scoring of scales, monitoring of follow-up and so on. However, its application in ADHD clinical pathways remains largely with the research and early implementation phase and requires robust evaluation before adoption.

Despite its enormous potential, some risks related to artificial intelligence/machine learning implementation should also be pointed out. Artificial intelligence and machine learning algorithms trained on insufficient or skewed data-sets can compromise diagnostic accuracy in underrepresented groups and may reinforce existing inequities. Without a trained clinician, an artificial intelligence tool could inadvertently lead to diagnostic inflation. Over-reliance on automated tools may, therefore, reduce the quality or validity of clinical formulation, particularly in complex neurodevelopmental presentations. Artificial intelligence should thus be thus viewed, at least at present, as a supportive adjunct rather than a replacement for comprehensive clinical assessment and professional judgement.

Aside from these developments, a broader digitalisation of healthcare services is already under way in line with national strategies and NHS England’s long-term plan. Overall, the recommendations of the taskforce are aligned with this direction and aimed at improving data systems and administrative processes. Pilot work has been started in some settings: for example clinician-checked automated report generation and other digital support tools for assessments workflows. Although these measures would certainly improve future practice, they cannot substitute for professional expertise. The necessity to conduct rigorous scrutiny concerning their safety, fairness and precision arises before wider deployment of these tools.

Finally, although it is mentioned that a cross-sector approach is highly important, less detailed consideration is provided to the specific training needs within education, employment and social care. These issues are addressed in greater depth in parallel workstreams, however, including the recently published Department for Education Neurodivergence Task and Finish Group report ³¹ and the soon-to-be-published Department for Work and Pensions Expert Panel on Neurodivergence report. These set out more specific expectations with regard to their individual responsibilities and training and delivery methods. The taskforce report also emphasises the need for cross-government coordination, including alignment of funding and training approaches across departments.

Future directions

The final ADHD taskforce report is an ambitious document, providing an agenda towards transforming the current system of supporting people living with ADHD. By highlighting the importance of early intervention, cross-sector collaboration, improved data systems and a strengthened and more confident workforce, the document acknowledges the extent of challenges and opportunities for reform. In this context, the response from RCPsych provides a measure of realism, reminding policymakers of the importance of sustained investment, a strengthened workforce and national oversight.

Looking ahead, success will rely on translation of the report’s ambition into concrete action steps. This will entail the provision of ongoing, long-term funding so that efforts to support the development of the necessary digital platforms, early support services and workforce expansion move rapidly past the pilot stage. In addition, national guidelines need to be set with respect to waiting time periods, assessment protocols and care pathways. As involvement from schools, employers and justice settings becomes more active, it will be necessary to increase cross-sector governance in order to avoid unnecessary delays.

We must not ignore the fact that the primary stakeholders are individuals suffering from ADHD and their families, and hence their continued involvement will be crucial to the successful implementation of this policy change. In addition, ongoing outcome monitoring and continuous research will be of great importance to ensure that improvements in access translate to better quality of life, reduced risk and more equitable long-term outcomes. The taskforce has provided a clear blueprint and roadmap. The greatest challenge now is to keep the momentum alive and ensure quantifiable and sustainable improvement for people with ADHD around the world.