The clinical leadership at Done Health went to prison for distributing controlled substances after cutting corners on the ADHD diagnosis
A UK billboard offers £100 off an ADHD or autism assessment, or £150 off if you book both
STUDY: Fisher N and Frith U, BMJ 2026
STUDY TYPE: Opinion (commentary)
FUNDING: Independent
Background
In England, private providers now perform over half of government-funded ADHD assessments and a third of autism assessments. A recent review recommended banning direct-to-public advertising of these services.
Here, two autism experts examine the problem (Naomi Fisher, who has a forthcoming book on diagnostic expansion of autism, and Uta Frith, who developed theory of mind in autism).
Summary
Providers profit from doing more assessments, more cheaply. The authors see three results:
- Less qualified staff and shorter visits, leaving no room for a differential diagnosis
- Clinics that assess only for ADHD and autism, so those are the only possible outcomes
- Pressure to diagnose, since a disappointed customer may complain or post a poor review
Without a biomarker, these diagnoses rest on description and shift with culture. Patients and clinicians reinforce each other’s beliefs, and the definitions widen through concept creep. No one’s diagnosis can be disproven.
People with severe or profound autism and ADHD are now a minority within these diagnostic categories and are increasingly left out of research.
Practice Implications
- The incentives apply to US telehealth companies too. Learn more in our Carlat podcast series on the Done controversy.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
