I am writing this out of a whirlwind of emotions: frustration, dismay, and genuine bewilderment. However, it is important to be clear that this is not a critique of individual clinicians, but of the systems and structures within which they are required to practise.
In clinical practice, we repeatedly see people with ADHD and other neurodevelopmental conditions being denied access to assessment, treatment, and support. Not occasionally. Not exceptionally. Routinely. The reasons given are numerous, but the underlying message is strikingly consistent: your needs do not meet the threshold for care.
When I step back and examine the rationales used by health boards to justify these decisions, I am left genuinely dumbfounded. Why is such a large cohort of people — neurodivergent individuals — systematically denied access to appropriate care and treatment?
I work primarily within ADHD and autism services, and this is where I witness this inequity daily. I am exposed not only to patient experiences, but also to the clinical reasoning and administrative justifications offered by professionals and health boards, often implemented through rigid “blanket rules.” To my knowledge, there is no other health condition where individuals are so frequently denied any opportunity for assessment, treatment, or support.
Neurodivergent patients are excluded from even the chance to understand themselves: how their brain works, their strengths, their challenges, and what support or treatment might help them function and flourish. This reflects, at best, a profound lack of understanding — and at worst, a lack of empathy or willingness to listen to the lived reality of these individuals.
The impact of untreated ADHD and autism is not abstract. It is daily, cumulative, and often debilitating. Denial of care contributes to worsening social and interpersonal difficulties, educational and vocational disruption, increased risk of self-harm and suicide, substance misuse, co-occurring mental health conditions, poorer physical health outcomes, and persistent erosion of self-esteem, confidence, and sense of identity. These are not secondary concerns — they are predictable consequences.
The Financial Argument Does Not Hold
I am under no illusion that referral rates for ADHD and autism assessments have increased exponentially in recent years. This is not because these conditions are “trendy.” Anyone who lives with ADHD or autism will tell you this is not an identity adopted lightly. People seek assessment to understand themselves, access appropriate treatment, and secure reasonable adjustments at work or in education — all of which they are entitled to.
When referral rates rise in other areas of healthcare, waiting lists grow, funding pressures are acknowledged, and services adapt. Yet thousands — likely tens of thousands — of neurodivergent people across the UK are facing waits of several years, if they are offered access at all. Some are told waiting lists are closed. Others are informed there is simply no local provision.
If any other patient group were subjected to this level of exclusion, it would rightly provoke public outrage. These services are publicly funded. Neurodivergent people are taxpayers too.
Crucially, denying access now does not save money — it defers cost. Untreated ADHD and autism are associated with increased GP attendances, mental health service use, emergency presentations, poorer educational outcomes, higher rates of school exclusion, increased contact with the criminal justice system, higher accident rates, unplanned pregnancies, and poorer long-term employment prospects.
Early assessment and intervention are consistently associated with better engagement, improved outcomes, and reduced long-term service use. Waiting until individuals reach crisis point is neither clinically sound nor economically rational. It is reactive, inefficient, ethically indefensible, and harmful.
Why are we intervening only once people have lost their jobs, failed their education, developed secondary mental health conditions, or entered the criminal justice system? By that stage, care becomes more complex, more expensive, and less effective. This is not preventative healthcare — it is institutionalised firefighting.
The Justifications We Hear — and Why They Fail
The justifications outlined below represent only some of the recurring rationales encountered in clinical practice and are not exhaustive
“Symptoms are not severe enough.”
This rationale implies that intervention should only occur once a person reaches crisis point. Clinically, this approach is difficult to justify. ADHD and autism are developmental conditions in which impairment is cumulative, not episodic. Early identification and intervention are associated with improved functional outcomes, reduced secondary mental health difficulties, and better engagement with services. Waiting for deterioration not only causes harm, but paradoxically increases long-term demand on healthcare, education, and social services. Prevention and early intervention are core principles of good clinical care — not optional extras.
“There is no co-occurring mental health condition.”
This reasoning reflects a fundamental misunderstanding of neurodevelopmental trajectories. ADHD and autism frequently precede, rather than follow, conditions such as anxiety and depression. Early assessment reduces diagnostic complexity, mitigates the development of secondary psychiatric conditions, and avoids unnecessary or ineffective treatment pathways. Delaying assessment until comorbidity emerges increases patient distress, increases service utilisation, and often results in inappropriate prescribing or repeated, unsuccessful psychological interventions.
“There is no provision in the area.”
Geography does not determine the presence or severity of a neurodevelopmental condition. A lack of local provision is a systems failure, not a clinical justification for exclusion. Patients should not be penalised for structural inequities in service commissioning. This approach undermines principles of equitable access to healthcare and disproportionately disadvantages already vulnerable populations.
“The waiting list is too long.”
Extended waiting times are an indicator of unmet need, not an argument against care. Closing waiting lists or refusing referrals does not reduce demand; it displaces it. Individuals remain symptomatic, unsupported, and at increasing risk of secondary difficulties while waiting. Clinically, prolonged delays are associated with poorer outcomes, greater complexity at presentation, and reduced responsiveness to intervention when care is finally accessed. In addition, this forces people to seek private care, which is then often dismissed by health boards, for a whole variety of reasons, which warrants separate consideration and is beyond the scope of this piece.
“Forms were not returned, so the patient was discharged or removed from the waiting list.”
This rationale disproportionately disadvantages individuals with executive functioning difficulties, which are a core feature of ADHD. Requiring strict administrative compliance without reasonable adjustments effectively excludes the very population these services are intended to support. Clinically, non-completion of paperwork should be understood as a marker of unmet need, not grounds for discharge.
Disqualifying an individual without opportunity for re-submission is inherently prejudicial, particularly when the task in question — form completion, organisation, and timely return — directly reflects the impairments under assessment. Removal from a waiting list for difficulties intrinsically linked to ADHD, especially in the absence of appropriate prompts, reminders, or support, directly conflicts with principles of reasonable adjustment and person-centred care.
“The patient moved area.”
Neurodevelopmental conditions do not resolve with a change of postcode. Disrupting or terminating access to assessment and treatment due to relocation fragments care and introduces avoidable delays. Continuity is particularly important for neurodivergent individuals, for whom transitions are often associated with increased stress and functional decline. Systems should facilitate transfer of care, not reset access entirely.
“The patient is functioning too well / is in employment or education.”
This rationale conflates surface-level functioning with absence of impairment. Many neurodivergent individuals sustain employment or education through significant compensatory effort, masking, and personal cost. Functional impairment in ADHD and autism is often internalised and context-dependent, affecting emotional regulation, cognitive load, fatigue, and mental health rather than visible output alone. Dismissing need on the basis of apparent functioning risks overlooking significant distress and long-term burnout.
“Symptoms are better explained by trauma, anxiety, or depression.”
This framing incorrectly assumes diagnostic hierarchy or overshadowing rather than diagnostic complexity. ADHD and autism frequently coexist with trauma-related symptoms and affective disorders, and may precede or exacerbate them. Excluding neurodevelopmental assessment until other conditions are “treated” risks circular care pathways and prolonged distress. Comprehensive assessment is often required to determine primacy, interaction, and appropriate sequencing of intervention.
“The patient did not struggle in childhood.”
This reflects a narrow interpretation of developmental history. Many individuals, particularly women and those from structured or supportive environments, do not experience overt childhood difficulties or have incomplete collateral information. Absence of documented childhood impairment does not equate to absence of symptoms. Developmental trajectories are heterogeneous, and retrospective recall is inherently limited. Clinical assessment should consider contextual factors rather than rely on rigid historical thresholds.
“The patient is requesting assessment for secondary gain.”
This rationale lacks evidential basis and risks pathologising help-seeking behaviour. Requests for assessment are most commonly driven by long-standing difficulty, distress, and a desire for understanding and appropriate support. Framing assessment as contingent on perceived motivation undermines therapeutic trust and introduces subjective bias into access decisions.
Taken together, these justifications reveal a pattern that extends beyond individual clinical decisions. They reflect a system that prioritises administrative thresholds, risk aversion, and resource containment over equitable access to care. The cumulative effect is the routine exclusion of neurodivergent individuals from assessment and treatment, despite clear evidence of need and predictable consequences when support is withheld. None negate the presence of a neurodevelopmental condition. None reduce impairment. None remove the duty to provide equitable care.
This is not an argument for preferential treatment, but for parity of esteem. Neurodevelopmental conditions are lifelong, biologically based differences that significantly affect functioning across the lifespan. Denial of access to assessment and evidence-based intervention is not neutral; it actively compounds disadvantage and undermines long-term outcomes. Until this is acknowledged at a system level, we will continue to fail a population that deserves understanding, support, and the opportunity to thrive.
If healthcare systems are to be clinically effective, economically responsible, and ethically defensible, neurodevelopmental services must be commissioned and delivered in a way that reflects both evidence and lived reality. Early access, reasonable adjustments, and continuity of care are not aspirational ideals — they are foundational to good clinical practice.
This is not about preferential treatment — it is about ending second-class care.
Katie Deas, Clinical Services Manager
About the author
Katie Deas is the Clinical Services Manager at ADHD Direct. She is a specialist clinician with extensive experience in ADHD assessment, treatment, and post-diagnostic support across children, adolescents, and adults. Katie is particularly passionate about translating clinical knowledge into clear, practical guidance that helps people better understand their brains, reduce unnecessary struggle, and access meaningful support.
