When we talk about the assessment and management of ADHD and Autism, we usually think of psychiatry. Why? Because many years ago, it was decided that these conditions should sit under the umbrella of mental health.
But here’s the problem: we now know that neurodivergence is not a mental illness. ADHD and Autism are neurodevelopmental conditions that begin in childhood and continue throughout life. They affect how people process the world, how they manage emotions, and how they function day to day. To continue treating them as purely psychiatric diagnoses feels, in my opinion, outdated and unhelpful.
Why This Matters
People with ADHD and Autism rarely experience these conditions in isolation. They come with a higher risk of other health problems, often because of the challenges that come with emotional regulation, impulsivity, and navigating a world not designed for them. For example:
ADHD is linked with higher rates of:
- Diabetes
- Obesity
- Alcohol and drug misuse
- Accidents and injuries due to risk-taking behaviour
- Premenstrual dysphoric disorder (PMDD) and perimenopausal difficulties in women
- Sleep disorders
- Cardiovascular disease
Autism is linked with higher rates of:
- Epilepsy
- Gastrointestinal conditions
- Sleep problems
- Anxiety and depression (often as a consequence of unmet support needs, not as a core feature)
- Sensory-related difficulties impacting diet, exercise, and general health
When adults are finally diagnosed — often decades late, with the average age for women being 35 years in some areas — these additional issues are already part of their lives. Add to that the social and situational stress, the challenges of parenting when both parent and child are neurodivergent, and the impact of years of being told to “try harder, listen more, stop making mistakes,” and it’s no wonder that mental health struggles emerge as secondary complications.
The Role of General Practice
The RCGP (Royal College of General Practitioners) already recognises the importance and competence of GPs in the diagnosis and management of ADHD, provided they are supported within a well-structured team. In March 2024, the RCGP published the GPwER ADHD framework — formally acknowledging that GPs with Extended Roles can safely assess, diagnose, and treat people with ADHD. At last, the remit of who can and cannot assess has stepped forward into the light ages — and not before time.
Elsewhere, progress is happening too. In Australia, it is already recognised that ADHD assessment should sit within general practice, not solely psychiatry. To continue insisting that ADHD assessments remain the preserve of psychiatry — when waiting times are 2, 3, 4, even 5 years — is doing patients a disservice. One discipline cannot meet the demand and neither do they need to, and by failing to think beyond traditional diagnostic structures, people are left languishing without support.
Why are patients sitting on NHS waiting lists for years, struggling at school, at university, and in their jobs, when we know there is absolutely no clinical reason for diagnosis to be restricted to psychiatry alone? It’s nonsense.
And let’s not forget that many adults being assessed for ADHD or Autism are already taking medication for chronic health problems such as heart disease, respiratory conditions, or diabetes. They live with multimorbidity, and often take several medicines at once. Having General clinicians with expertise in polypharmacy, risk assessment, and managing the whole person is therefore not optional — it’s essential in todays age. ADHD care doesn’t exist in a vacuum, and generalists trained in holistic medicine are better placed to make sure treatment is safe, effective, and joined up with the rest of a patient’s healthcare.
Let’s Not Forget the Basics
The commonest cause of both ADHD and Autism is genetics. These are inherited neurodevelopmental differences — they are not mental health conditions. Until we broaden our remit and move into current ways of thinking, access to ADHD care will remain inadequate and far from good enough.
So what exactly is stopping the transition? Is it bureaucracy, outdated traditions, professional boundaries, or simply inertia? Whatever it is — it needs to go. Patients deserve better, families deserve better, and the system cannot keep standing still while demand rises.
Time to Move With the Times
It is time to stop looking at ADHD and Autism as simply psychiatric conditions with a bit of “associated anxiety” or “low mood” thrown in. These are lifelong neurodevelopmental differences, present from birth. When they are unrecognised and untreated, people suffer emotionally — not because they are mentally ill, but because the world has misunderstood them and failed to provide the right support.
Yes, psychiatry has played an important role historically, but it is time to move forward. We must treat ADHD and Autism for what they are: neurodevelopmental conditions that deserve a holistic, whole-person approach.
…………………..Not controversial at all, when you stop and think about it.
Waiting times for ADHD and Autism assessments are unacceptable.
Why? Because we continue to label them solely as mental health conditions requiring psychiatric input. No single specialty can ever manage that level of demand — nor should they.
Neurodivergent adults and children should not have to sit in front of a psychiatrist just to be told they have a lifelong condition they were born with — and one that is not a mental illness.
It’s time to end unnecessary barriers and create fair, accessible pathways to recognition and support
It’s time to catch up:
✅ Stop gatekeeping
✅ Improve access
✅ Recognise that, general clinicians are more than capable of delivering the holistic, whole-person care that all patients deserve — and in fact we have so much more to offer in supporting our patients overall health and wellbeing.
