System failures in transitioning neurodivergent youth from child to adult mental health services in Australia

A new Australian study highlights critical gaps in the transition from child to adult mental health services for autistic and ADHD young people, revealing systemic barriers, unmet needs, and the vital role of family support in achieving effective care.

For many autistic and ADHD young people in Australia, turning 18 does not simply mean a new legal status. It can also mean losing access to the child mental health services that have supported them through adolescence, just as their needs remain complex and often long-lasting. A new qualitative study in the Journal of Autism and Developmental Disorders describes that handover as a point where formal care too often stops before adult services are ready to take over, leaving young people and their families to manage the gap themselves. The findings echo earlier research showing that transition works best when it is planned, flexible and genuinely collaborative, rather than treated as a date on the calendar.

The study, led by occupational therapist Kim Tang at Curtin University, drew on interviews and feedback sessions with neurodivergent young adults, parents and health professionals. Its central message is that the biggest obstacles are usually structural, not clinical. Participants described a system that often separates autism and ADHD from mental health, even though the two frequently overlap, and a service model that still relies on rigid age cut-offs. That concern is consistent with previous work on transition pathways in Western Australia, which found that young people can move from being referred, to being seen immediately, to being delayed, or to never engaging with adult services at all.

The study also adds detail to an issue already highlighted in the broader literature: preparation matters. Review evidence has repeatedly shown that young people do better when transition begins early, when CAMHS and AMHS work together, and when information follows the patient rather than disappearing at the point of discharge. The new research goes further by showing how often that ideal breaks down in practice. Although nearly all of the young people in the study had formally completed the move to adult care, only a minority felt ready for it. Participants said they wanted clearer explanations, more choice about the adult clinician they would see and more control over what information was shared between services.

A recurring theme was the value of neuro-affirming care, meaning treatment that adapts to sensory, communication and cognitive differences instead of treating them as problems to be corrected. Young people described therapy that worked when clinicians understood autism or ADHD well enough to focus on support rather than education. When that understanding was missing, some felt misunderstood or shut out altogether. The study’s authors argue that this is not a marginal issue: a scoping review published this year found that poor communication between child and adult services, and limited involvement of neurodivergent young people in decisions, are major barriers to a successful handover.

Perhaps most strikingly, the study shows how much hidden labour is carried by families. Parents often arranged appointments, handled paperwork, tracked referrals and provided transport and emotional support, effectively holding the transition together when services did not. Earlier studies have likewise found that when young people fall through the cracks between child and adult mental health care, the consequences can be distressing for both them and their parents. Taken together, the research points to a clear conclusion: if health systems want young neurodivergent people to stay in care, they must design transitions that are flexible, coordinated and built around real-life needs, not administrative convenience.