For thousands of young Australians living with autism or ADHD, the eighteenth birthday marks more than a step into adulthood. It marks the moment the mental health system they have relied on throughout childhood simply stops. A new qualitative study published in the Journal of Autism and Developmental Disorders has captured, in unprecedented detail, what happens at that cliff edge, drawing on the lived experiences of neurodivergent young people, their caregivers and the mental health professionals who try to catch them. The findings paint a picture of a system whose rigid structures, rather than its clinicians, are the biggest barrier to continuous care, and of families quietly holding the entire transition together.
The research, led by occupational therapist Kim Tang of Curtin University together with colleagues in Australia, the United Kingdom and South Africa, used a constructivist grounded theory approach, a qualitative methodology designed to build understanding from the ground up, rooted in the perspectives of people with lived experience rather than pre-existing hypotheses. The team recruited 23 participants: 12 neurodivergent young people aged between 19 and 28, all formally diagnosed with autism or ADHD and with a co-occurring mental health condition; six parents, all mothers, two of whom disclosed their own ADHD diagnoses; and five health professionals, one of whom was also autistic. Semi-structured interviews lasting between 25 and 72 minutes formed the primary data source, followed by feedback workshops in which participants reviewed and refined the research team’s initial interpretations.
The stakes of this transition are considerable. Mental health difficulties are now the leading cause of disability among people aged 12 to 25 worldwide, and neurodivergent young people are up to three times more likely than their neurotypical peers to develop a co-occurring mental health condition. They are also more likely to need continued care into adulthood, yet paradoxically less likely to make a successful move from Child and Adolescent Mental Health Services, known as CAMHS, to Adult Mental Health Services, or AMHS. In most Australian jurisdictions, as in the United Kingdom, that handover occurs at the upper age boundary of 18, a threshold that participants described as arbitrary and developmentally mismatched.
The numbers within the study itself are telling. Although 11 of the 12 young participants, more than 91 per cent, had technically completed their transition to adult services, only four, roughly a third, felt they had been prepared for it. That gap between procedural completion and genuine readiness sits at the heart of the study’s findings. Young people who transition successfully to adult services tend to have better mental health outcomes than those who fall out of care, and the transition period is widely recognised as a moment of heightened risk of disengagement. For neurodivergent young people, the risk is amplified by services that often lack training in how mental health difficulties actually present in autistic people and those with ADHD.
From the analysis, three overarching categories emerged. The first concerns the provision of what participants across all three groups called neuro-affirming care, meaning care that recognises and accommodates sensory, cognitive and communication differences rather than treating them as problems to be managed away. Participants identified transparent communication about why the transition was needed and what it would involve, shared decision-making about which adult provider to see, and choice over what information was passed on in handover summaries as critical features. When clinicians understood neurodivergence, young people could spend their sessions preparing for the future rather than educating their own therapist about what autism means. As one young participant named Cameron put it, describing a therapist he had now seen for two years: “I felt heard, especially with autism. The new therapist that I’ve been seeing for two years now, understood autism.”
Where that understanding was absent, the consequences were concrete. Young people described therapeutic alliances that collapsed under the weight of preconceived ideas about how a neurodivergent person should present. “The way psychiatrists view neurodivergence and the way I present is often at odds with what they think I should be like,” said Felix, another participant. In some cases the mismatch was severe enough that young people took extended breaks from adult services altogether, precisely the disengagement that the transition literature identifies as dangerous. Others described care that felt fundamentally mismatched to their needs. “The help that was given to me wasn’t for me,” Cameron reflected. Participants also flagged the fragmentation of services into separate mental health and neurodiversity camps, with one health professional, Vivienne, observing that “knowledge is sitting in two camps, and people are very much like it’s mental health or it’s autism and ADHD, and it’s actually both.”
The second category concerned the accessibility of the mental health system itself, and here the participants’ accounts were blunt about structural failure. Access varied sharply by state and by geography, with rural young people facing fewer options than those in metropolitan areas. More strikingly, several participants reported that a formal autism or ADHD diagnosis functioned, in practice, as a barrier to referral. “It almost seemed that in WA, autism and having that diagnosis was almost an exclusion criteria for children accessing CAMHS in WA, whereas that was less so in Queensland,” one health professional, Ursula, recalled. Others described referrals that were rejected outright because of a neurodivergent diagnosis, or that simply never got completed, leaving young people feeling they had “fallen through the gap.” One participant, Ian, described being “constantly being handballed between services.”
The rigidity of the age boundary itself drew sustained criticism. Participants and parents argued for flexible or overlapping age ranges, with one parent, Olivia, suggesting “an 18 to 25 or 16 to 25 area, just for those sort of young adults, as opposed to children and adults being so separate.” Without that flexibility, some young people described feeling “kicked out of services” the moment they aged out of CAMHS, underprepared for a system that expects adults to take full agency over their care and often limits caregiver involvement, an expectation that sits awkwardly with the needs of many neurodivergent young adults who still rely on parental advocacy.
That reliance points to the study’s third and perhaps most poignant category: the informal supports, overwhelmingly parents and peers, that bridge the gap the formal system leaves open. Caregivers described providing administrative support such as completing documentation and liaising with services, practical support such as transport to appointments, informational support such as researching options, and emotional support throughout. This work reduced the cognitive load that the system otherwise dumps on young people at 18, an age at which they are legally adults but, as participants emphasised, may not feel developmentally ready to navigate complex referral pathways alone. Blake, a young participant, described his mother as “super helpful with all of that, and that took a significant weight off the struggle to access those services, because I had a parent who would advocate for me.” Peer support mattered too: Blake credited a classmate’s recommendation to a peer navigation program with making his transition “reasonably smooth.”
The study’s authors argue that these findings demand action at two levels simultaneously. At the provider level, clinicians need training in neurodivergence and in how mental health conditions present in this population, alongside the communication practices and shared decision-making that define neuro-affirming care. At the system level, they call for greater flexibility in age boundaries, clearer guidelines delineating each stakeholder’s responsibilities, and eligibility criteria that do not reject referrals on the basis of a neurodivergent diagnosis alone. They also recommend formally integrating informal supports, including peer navigators with lived experience of the transition, into transition guidelines, particularly for young people without family support. The study, co-designed with an advisory group of three neurodivergent young people who had themselves experienced the transition, acknowledges its limitations: the findings are specific to the Australian context, the sample may over-represent professionals already committed to neuro-affirming practice, and cultural and linguistic diversity was not explicitly explored. Yet the central message is hard to dispute. When formal systems constrain the care clinicians can deliver, the burden shifts silently onto young people and their families, and a system designed to support them instead depends on their unpaid resilience.
Subject of Research: The transition of neurodivergent young people from child to adult mental health services
Article Title: The Transition to Mental Health Services From the Perspectives of Neurodivergent Young People, Caregivers and Mental Health Professionals: A Constructivist Grounded Theory Approach
Article References: Tang, K., Wells, R., Thompson, C., Hill, E., Pellicano, E., & Myers, B. (2026). The Transition to Mental Health Services From the Perspectives of Neurodivergent Young People, Caregivers and Mental Health Professionals: A Constructivist Grounded Theory Approach. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-026-07504-z
Image Credits: AI Generated
DOI: 10.1007/s10803-026-07504-z
Keywords: neurodivergence, autism, ADHD, mental health services, service transition, CAMHS, AMHS, neuro-affirming care, grounded theory, caregivers, peer support, Australia
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Glenn Wilkins. (October 4, 2026). Neurodivergent Young People Fall Through the Cracks When Child Mental Health Care Ends. Scienmag. https://scienmag.com/neurodivergent-young-people-fall-through-the-cracks-when-child-mental-health-care-ends/
Glenn Wilkins. “Neurodivergent Young People Fall Through the Cracks When Child Mental Health Care Ends.” Scienmag, 4 October 2026, https://scienmag.com/neurodivergent-young-people-fall-through-the-cracks-when-child-mental-health-care-ends/. Accessed 4 October 2026.
Glenn Wilkins. “Neurodivergent Young People Fall Through the Cracks When Child Mental Health Care Ends.” Scienmag. October 4, 2026. https://scienmag.com/neurodivergent-young-people-fall-through-the-cracks-when-child-mental-health-care-ends/
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