Abandoned at 25: The Quiet Ejection of Adults from ADHD Services

Services in Coventry and Warwickshire Will No Longer Refer Adults Over 25

On May 22nd, 2025, Coventry and Warwickshire Integrated Care Board (ICB) released a letter that effectively cuts off ADHD assessments and treatment referrals for individuals aged 25 and over. Disguised as a “temporary policy” to address service backlogs, this decision quietly enacts the systemic abandonment of neurodivergent adults— particularly those who were failed by the very systems that now claim they’ve “established coping mechanisms.”

Let us be clear: this policy is not about triage. It is about exclusion.

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Over 7,500 children and young people are reportedly waiting for ADHD assessment in the region. In response, the ICB has chosen to suspend adult referrals, arguing that the benefit of diagnosis and treatment is less significant for those over 25. But this logic fundamentally misunderstands both the purpose and impact of late diagnosis for adults— particularly AuDHD (Autistic & ADHD) adults whose experiences have been consistently erased or misinterpreted by services (Munday et al., 2025).

As I wrote in Unusual Medicine, and reiterated in my guidance for educators, Autistic in School, the medical model of neurodivergence is insufficient for capturing the complex, chaotic, and emergent ways that Autistic and ADHD experiences manifest. Many of us reach adulthood not only undiagnosed but misdiagnosed— our distress framed as personality disorder, our sensory overload seen as anxiety, our executive dysfunction mistaken for laziness.

Before I explore the deeper implications of this move, it's important to see what was actually said.
Here is the letter issued by Coventry and Warwickshire ICB:

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Accurate diagnosis in adulthood can be life-saving.
Late-diagnosed individuals often report profound shifts in self-understanding, relationships, and mental health following a formal diagnosis. This is especially true for AuDHD adults, who face a higher risk of depression, addiction, and suicidality. Yet, instead of investing in the diagnostic infrastructure required to address these risks, the ICB has chosen to cut off access entirely for adults who haven’t already entered the queue.

The Right to Choose— one of the last viable pathways to adult diagnosis— has now been limited to under-25s. This is not just gatekeeping. It is age-based discrimination under the guise of resource management. And it compounds the structural injustice experienced by adults who were never given the opportunity to be recognised as neurodivergent children in the first place.

As I argued in The New Normal, diagnosis is not the endpoint— it’s the doorway to language, community, and survival. But when access is denied, especially for those navigating multiple marginalisations (such as trauma, substance use, or poverty), the effects are devastating. We explored this extensively in our research on substance use and autism, where participants described years of clinical invalidation and delayed recognition. The system only noticed them once they were in crisis.

This new policy ensures that more people will be left to reach that crisis point before help is even considered.

Once systems are restructured around exclusion, that exclusion becomes the new default.

The ICB letter frames this shift as “temporary,” but history teaches us that once services are restricted, they rarely return to previous levels. And when neurodivergent people are forced to “cope” in silence, without diagnosis or support, the result is not resilience— it is suffering, invisibility, and harm.

Leaving adults with unrecognised ADHD does not honour the fact that they are equally deserving of care.
They are survivors of a diagnostic culture that has always failed to see them.

We must resist the idea that being over 25 makes your needs irrelevant.
We must reject policies that reinforce neuronormative assumptions that autism and ADHD are “conditions of childhood”.
And we must speak out— because if this is allowed to stand, it will not be the last firewall built around our care.

The email provided in the letter to raise concerns is cwicb.commissioning@nhs.net

Full Text From Letter:

Accountable Officer – Phillip Johns

Chair – Danielle Oum

Headquarters: Shire Hall

Market Place

Warwick CV34 4RL

Tel: 02476 324399

www.happyhealthylives.uk

22nd May 2025

Dear Colleagues,

Re: ADHD assessments and treatments

We are writing to inform you of a significant change in the commissioning of ADHD assessments

and treatments following the introduction of a new policy by the Integrated Care Board (ICB).

As you are aware, the current ADHD assessment system in Coventry and Warwickshire has been

facing considerable challenges, particularly regarding access for children. At present, over 7,500

children and young people are awaiting assessment, with some facing waiting periods exceeding

ten years. This situation is unacceptable and highlights the urgent need for a revised approach to service provision.

Clinical experts emphasise the profound impact that an ADHD diagnosis can have on children, enabling them to succeed academically, develop vital social skills, and adapt to society more effectively. By contrast, adults have generally established coping mechanisms that mitigate the effects of their condition. While diagnosis and treatment for adults can be beneficial, the transformative impact is considerably less significant.

To address these challenges, we are committed to implementing a comprehensive transformation programme for ADHD services. This will encompass improvements in the identification of symptoms, assessment processes, and subsequent support and care. While this long-term work is being carried out, we must take immediate steps to alleviate the backlog and prioritise those in greatest need.

Temporary Policy Implementation: Effective immediately, the following changes will apply:

• The ICB will only commission new ADHD referrals for individuals aged under 25, including Independent Sector Right to Choose organisations and Coventry and Warwickshire Partnership Trust (CWPT).

• ADHD assessments and treatments will be commissioned only for providers meeting the requirements outlined in the new ADHD policy (see attached FAQs).

• The ICB will not commission new assessments for individuals aged 25 and above. However, this will not affect adults who have already been referred.

• GPs may continue referring patients under 25 years old to any provider that meets the criteria set forth in the new policy.

• For advice on supporting adults aged 25 and above who present with significant complexities, please read the attached FAQs.

We understand that this policy change may raise concerns, and we welcome any questions or feedback you may have. Please do not hesitate to contact the ICB at cwicb.commissioning@nhs.net, as we are keen to engage with you throughout this transition.

Thank you for your cooperation and ongoing commitment to patient care.

Yours sincerely,

Dr Imogen Staveley

Chief Medical Office