There is a growing push within the education sector – and beyond – to shift to a needs-led system of support for those with special educational needs and disabilities (SEND).
The recently published Independent Review into Mental Health Conditions, ADHD and Autism, led by Professor Peter Fonagy, said the debate around over-diagnosis of neurodevelopmental conditions like ADHD and autism misses the point because it “risks reinforcing the centrality of diagnosis rather than need and timely access to support and treatment.”
The report called for a “fundamental shift from a ‘diagnosis-dependent’ system to a ‘’needs-led plus diagnosis’ system,” where support is not withheld while waiting for a diagnosis. It found that diagnosis had become “the primary gateway to support that could and should be available earlier.”
Needs-led SEND support would benefit everyone
Now, two academics who both served as topic group members for the independent review, say the move to a needs-led system would benefit everyone.
Writing for TES, they say they were “delighted that the review emphasises that diagnosis is not the same as need.”
The shift in focus is important, because long waits can cause harm.
The review found that more than 560,000 people were waiting for an ADHD assessment by the end of 2025 and that more than 254,000 were waiting for an autism assessment. More than 7 in 10 people who wait over 6 months for an assessment and diagnosis experience their difficulties worsen over that time.
The academics, Mark Mon-Williams and Karen Guldberg, agree that diagnosis does matter, meeting a health need and helping people “to make sense of their experiences, guide treatment and open the door to specialist support.”
They add:
“For many families, it brings a valued sense of identity and community.”
They also acknowledge that clinical expertise also matters in school settings, where “a needs-led approach can never become an excuse for leaving a child’s health needs untreated.”
A diagnosis doesn’t tell the full story
But what they are clear about is that a diagnostic label cannot solve everything.
A diagnosis of autism, ADHD or any other condition cannot necessarily tell a teacher how the child learns, and two individuals with the same diagnosis may need very different support.
And, crucially, a child without a diagnosis may need, and benefit from, the same adjustments made to help a child with a diagnosed neurodivergence to learn effectively.
They explain:
“Teachers are well placed to see these differences because they spend every day getting to know how children learn. However, the system often acts if the view of the teacher doesn’t count until a medical clinician has signed it off. This makes little sense, and it isn’t fair.
“Access to diagnosis is shaped by family income, ethnicity and where you live. This means that a system that waits for diagnosis helps those best able to navigate the clinical pathways.
“None of this is an argument against health services. Health and education bring different, complementary expertise, and children need both skillsets.”
They cite two key frameworks from the World Health Organization that can help illustrate this distinction:
- The International Classification of Diseases (ICD) is the manual that clinicians use to diagnose health conditions
- The International Classification of Functioning, Disability and Health (ICF) focuses on what a person can do in everyday life, and what in their surroundings may help or hinder them
They say the ICF is relevant in an educational setting because it focuses on functioning in context, prompting us to consider what a child can do, what they find difficult and how the classroom helps or hinders them.
Needs-led SEND support can be “simple and inexpensive”
The adjustments made to accommodate a child and ensure their environment properly supports them are often “simple and inexpensive,” with Mon-Williams and Guldberg listing examples such as:
- A visual timetable
- A two-minute warning before transitions
- Instructions given both aloud and in writing
These adjustments can be made for the whole class rather than just specific individuals, helping to make the classroom environment accessible-by-default.
This approach forms the basis of a recent paper co-authored by Mon-Williams, Guldberg and others.
The paper sets out an Educational Needs-Led Framework (ENLF) for neurodivergent learners which positions educational need as “relational and dynamic.”
They describe how “need arises from the fit between a child and their setting, and it changes as either one alters.” Their framework subverts the usual pattern by asserting that concern should lead straight to action in the classroom rather than a referral, waiting time, diagnosis and then, finally, reactive support.
Clinical assessments can, of course, run alongside the support being offered to address any health concerns, but school staff do not need to wait for the health service to complete their process in order to implement reasonable adjustments and provide appropriate support to address challenges.
Health and educations services need to work together
They highlight the importance of health and education services working together.
Health services clearly need to lead on any clinical concerns, while education staff can focus on teaching and provision, and children and families should be involved in setting priorities and judging whether support is helping.
They add:
“We are realistic. Some children will still need intensive, specialist provision. And when support works, it does not mean a child’s difficulty has disappeared. Removing support because a child is “coping” mistakes the benefit of support for the absence of need.”
They also emphasise how a needs-led approach to SEND support will require “time, training and resources” for schools, while health services will require “enough capacity to respond.”
They are calling for an approach which ensures investment in diagnostic services to meet current demand, with work to loosen the link between diagnosis and support only taken once schools have demonstrated that they can meet children’s needs without health practitioners “acting as gatekeepers.”
They conclude:
“Diagnosis answers health questions. Understanding the child in their classroom answers educational questions. It is encouraging to see health and education beginning to speak a shared language.
“The real test is whether we can now organise services around a shared understanding, so that teachers and clinicians can each get on with their jobs, and children can get the right help at the right time.”
Training to support a needs-led approach
First Response Training (FRT) is a leading, national training provider. They deliver a wide and diverse range of training to schools, early years and childcare as well as health and social care and all other industry sectors.
Their training portfolio spans health and safety, first aid, fire safety, manual handling, safeguarding, mental health and neurodiversity training.
FRT have recently co-developed a focused training session on Neurodiversity and Inclusive Practice in Education, which is co-delivered with Experts with Lived Experience and which they have developed and tested extensively in partnership with The Tapscott Learning Trust, an award-winning trust based in London.
The Neurodiversity and Inclusive Practice in Education programme is a co-produced school improvement programme designed to help schools strengthen inclusive practice and improve outcomes for neurodivergent and SEND pupils, whether formally diagnosed or not.
Developed by education leaders and Experts with Lived Experience of autism, ADHD and PDA, the programme embodies a needs-led approach to SEND support in schools.
Adoption of the training programme can help support schools to improve attendance, engagement, wellbeing, belonging and attainment through adaptive teaching, reasonable adjustments and whole-school culture change.
In line with the Schools White Paper and planned National Inclusion Standards, it moves thinking away from a diagnosis-led approach to a pure needs-led approach, and making schools accessible and inclusive by default.
Inspired by the nationally recognised Oliver McGowan Mandatory Training on Learning Disability and Autism, which has trained millions of healthcare professionals across England, the programme combines lived experience, practical strategies, implementation support and impact evaluation to create meaningful and lasting change within education settings.
It also supports schools to develop their Inclusion Strategies and strengthen collaboration with local education, health and care services, ensuring a joined-up approach that helps every child feel understood, valued and able to thrive.
Learning outcomes include:
- Explain neurodiversity and common co-occurring profiles
- Recognise early indicators of dysregulation and unmet need
- Understand why autism and other neurodiverse conditions are described as
- Invisible
- Reflect on your own values, beliefs and practice
- Recognise potential differences, strengths and challenges for neurodiverse pupils
- Identify reasonable adjustments and ways to adapt your practice
- Record the impact
Needs-led SEND support can help every child thrive
Perry Leeks, Project Director at FRT, says:
“We were so excited and privileged to collaborate with members of the neurodiverse community to develop a special programme for the education sector that specifically addresses a very real need, meets key criteria outlined in the Schools whitepaper, and helps teachers reflect on and enhance their practice and the support they offer.”
Daniel Mansfield, Training Hub Director at The Tapscott Learning Trust, added:
“One of the most powerful aspects of this programme is that it moves beyond awareness and focuses on meaningful change in practice.
“Throughout the pilot phase, we saw staff develop a deeper understanding of neurodiversity, reflect honestly on the barriers pupils face and identify practical adaptations that could be implemented immediately.
“The ‘One Child in Mind’ approach helps bring the learning to life, ensuring discussions remain rooted in the experiences of real children rather than abstract theory.
“What stood out most was the impact of learning directly from Experts with Lived Experience, which consistently challenged assumptions, increased empathy and inspired action. Schools left not only with greater confidence and understanding, but with tangible plans to improve inclusion, strengthen relationships and create learning environments where all children can thrive.”
Download our flyer to find out more about Neurodiversity and Inclusive Practice in Education.
For further information on other types of neurodiversity training, visit FRT’s webpage or download the brochure.
You can contact FRT via freephone 0800 310 2300, send an e-mail to info@firstresponsetraining.com or submit an online enquiry.