Stop waiting for the label: why it's time for needs-led SEND support

I've spent the last few weeks responding to it on social media. The more I've thought about it, the more I think we're arguing about the wrong question.

Debating whether ADHD is “real” doesn't help a child who can't get through a morning without being sent out of class. It doesn't help a teenage girl who is masking all day and falling apart at home. And it doesn't help an adult who spent 30 years being called lazy.

Their needs are real either way. So why do we keep making support depend on the label?

The waiting list problem

Let's be honest about where we are. Demand for ADHD assessments is rising and waiting lists are long, for children and adults alike.⁴ In November 2025, a BBC investigation found adult ADHD services in 15 areas of England had closed their waiting lists to new patients altogether.⁵ Healthwatch has warned that long waits are pushing families towards private assessments, creating a two-tier system based on who can pay.⁶

It isn't only ADHD. Autism pathways, speech and language therapy, CAMHS and educational psychology services are all under the same pressure.

If we wait for a diagnosis before we act, a child can spend years of their education unsupported. Primary school can be over before anyone has the paperwork.

We cannot wait. And the good news is, we don't have to.

Diagnosis-led, traits-led and needs-led support

Most schools work in one of three ways:

1. Diagnosis-led: “He has an ADHD diagnosis, so we'll use our ADHD strategies.” Support only starts once a professional confirms the label. Until then, the child waits.

2. Traits-led: “She has traits of ADHD, so let's put ADHD strategies in.” This is a step forward because it doesn't wait for a diagnosis. But it still starts from the label, just a provisional one. We pick a box and pull out the strategies that go with it.

3. Needs-led: “What does this child find hard, when and why, and what helps?” We start with the child, not a category. We look at what we can see and what we know, and we build support around that.

Traits-led thinking often comes from a good place. But it can quietly narrow what we notice. Once we've decided a child “looks ADHD”, we see the fidgeting and the distraction, and we can miss the sensory overwhelm, the language processing difficulty, the anxiety or the unmet literacy need sitting right next to it.

The co-occurrence blind spot

This is the part I think matters most.

Neurodivergence rarely comes alone. Around half of people with ADHD have one or more additional conditions.⁷ Autism, dyslexia, dyspraxia, developmental language disorder, anxiety and sleep difficulties often go together.^{8, 9}

In practice, I almost never meet a child whose needs fit neatly into one box.

When we focus on one diagnosis, the other parts of the picture get lost:

• The ADHD child whose “defiance” is actually a language processing difficulty no one has spotted.
• The autistic girl whose attention difficulties are put down to “being autistic” and never looked at again.
• The dyslexic boy whose emotional outbursts are actually a reaction to failing at reading every single day.

Needs-led support is already in the system

This isn't a radical new idea. The SEND Code of Practice describes needs in four broad areas, not diagnoses:

• Communication and interaction
• Cognition and learning
• Social, emotional and mental health
• Sensory and/or physical

The Graduated Approach of Assess, Plan, Do, Review is needs-led by design. Schools do not need a diagnosis to put a child on SEN Support or to make reasonable adjustments, and families do not need one to request an EHC needs assessment.

The framework is there already. Over time, many of us have simply slipped into thinking that we can't act until we have the paperwork.

What needs-led support looks like in practice

Here's how I support schools and families to make the shift:

1. Describe, don't diagnose. Swap “he's so ADHD” for “he finds it hard to start tasks with more than two steps, especially after lunch.” Specific, observable descriptions lead to specific, workable strategies.

2. Look across all four areas, every time. Even when one need is obvious, ask about the others. What about language? Sensory needs? Sleep? Anxiety? Literacy? This is where co-occurring needs come to light.

3. Ask “when” and “why”, not just “what”. Look for patterns. Is it worse in unstructured times? In noisy rooms? After transitions? With certain adults? Behaviour is communication and the pattern is the message.

4. Put pupil voice at the centre. Children and young people are experts in their own experience. Ask them what's hard, what helps and what they wish adults understood. You'll often learn more in ten minutes than from a term of observation notes.

5. Bring parents in as partners. Families see the child across every setting, including the after school meltdown that school never sees. Their view is evidence.

6. Choose strategies by need, not by label. Visual timetables, chunked instructions, movement breaks, a predictable routine, pre-teaching vocabulary, a safe space. None of these “belong” to ADHD or autism. They belong to the children who need them.

7. Review it and adapt. Treat every strategy as a hypothesis. Did it work? For which need? What do we change? This is the Graduated Approach working as it was meant to.

8. Pursue a diagnosis alongside, where it helps.

So does diagnosis still matter?

Yes, absolutely. I want to be really clear about this.

A diagnosis can open the door to medical treatment, including medication where appropriate. It can bring self-understanding, relief and a sense of identity, especially for women and girls and for adults identified late. It can open up community, validation and legal protections, and it can help others understand.

Seek a diagnosis where it's right for the child or young person. Just don't put their support on hold while you wait.

Back to the documentary

Whatever you think of The Great ADHD Myth? it raised a question I think we should all be asking, just from a different angle.

The question isn't “Is ADHD real?”

It's “Are we seeing the whole child, or just the label?”

If we started with needs, there would be less to argue about. The child in front of us needs support today, whatever the paperwork does or doesn't say.

Over to you

• Teachers and SENDCos: Next time you write a support plan, try writing the needs before you write any label. What changes?
• Parents and carers: If you're on a waiting list, you can ask your child's school what they're doing to meet their needs now. You don't need a diagnosis to have that conversation.
• Everyone: Which needs have you seen get missed because the focus was on one diagnosis? I'd love to hear from you on LinkedIn (opens in a new tab) or Instagram (opens in a new tab).

This is the first in a series. Next, I'll look at how ADHD shows up differently across ages and groups, from early years to adulthood, and in girls and women, and at what needs-led support looks like at each stage.

Part 2 is out now: ADHD does not look the same in everyone.

Part 3 is out now: Needs-led support in practice.

References

1. Channel 4. The Great ADHD Myth?, first shown 18 August 2026. Read it (opens in a new tab)
2. BBC News. ADHD charity complains about Channel 4 documentary, 20 August 2026. Read it (opens in a new tab)
3. The Guardian. The Great ADHD Myth? review: the most controversial show of the year is here, Lucy Mangan, 18 August 2026. Read it (opens in a new tab)
4. PREPARE (University of York and The King's Fund). Adult ADHD assessments and diagnosis: data and service provision, May 2025. Read it (PDF) (opens in a new tab)
5. BBC News. ADHD services shutting door to new NHS patients as demand soars, BBC finds, 6 November 2025. Read it (opens in a new tab)
6. Healthwatch England. Recognising ADHD: how to improve support for people who need it, May 2025. Read it (PDF) (opens in a new tab)
7. ADHD Support Australia. Co-morbid conditions. Read it (opens in a new tab)
8. OpenLearn, The Open University. Understanding ADHD, section 1.2.2. Read it (opens in a new tab)
9. Molecular Psychiatry. Genetic neurodevelopmental clustering and dyslexia, 2025. Read it (opens in a new tab)