Early Detection in Neurodiverse Children: Why It Matters

Understanding who gets missed, what to watch for, and how timely assessment can change a child’s future.

For many parents, there is a hesitancy and caution around diagnosing conditions such as Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). This is often driven by underlying anxieties, such as fear of stigma, the label coming to define their child, or concerns around discrimination and exclusion. Parents may also harbour unconscious feelings of guilt or shame, fearing that the diagnosis will reflect poorly on them or their parenting practices. There can also be a hope that, with time, their child will outgrow their challenges.

These concerns are further complicated by a notable spike in diagnoses since the late 1990s. This has led to some scepticism and a covert, albeit pervasive, view that professionals may be over diagnosing.

However, when we talk about early detection, the real conversation does not end with diagnosis. It lies beyond the label, in understanding the co-occurring struggles, developmental trajectory, and missed signs that only become obvious when a young person starts to unravel. This is especially important in a world that is increasingly digitised and not well-suited to support optimal childhood development. Early detection is not just helpful. It is essential.

Understanding Early Detection

Early detection is the process of identifying subtle changes in a child's developmental, emotional, or behavioural profile before these challenges escalate into more entrenched difficulties. It is about tuning into cues that something may be unfolding beneath the surface. These cues often reflect shifts in social engagement, emotional regulation, learning capacity, or patterns of thinking that do not align with typical development.

In neurodiverse children, these early signs are frequently misunderstood. A quiet child may be labelled shy when they are actually socially anxious or withdrawn. A child who explodes at home but masks in school may be seen as manipulative when they are actually overwhelmed and exhausted. Rigidity might be praised as focus or intellect but may also signal cognitive inflexibility or sensory distress.

The goal of early detection is not to apply a label prematurely, but to provide an opportunity for meaningful intervention, informed guidance, and developmentally appropriate support.

It is also important to acknowledge that a diagnosis can be liberating for parents. Society often perpetuates the myth that parenting is the primary driver of a child's development, but this does not hold up to scrutiny. Increasingly, research highlights that genetic factors account for 40 to 80 percent of the variance in most neurodevelopmental conditions, including ADHD and ASD (Gizer et al., 2009; Thapar et al., 2013).

Understanding that a child’s challenges may stem from their neurobiology, not only environmental influences, can be a powerful relief. It breaks the stigma, softens guilt, and allows families to access relevant, evidence-based support. Indeed, few parenting books are written for the neurodivergent child.

A dear friend once shared how she sought advice from a sleep expert. Despite following the guidance to the letter, her son still has atypical sleep patterns years later. Fortunately, she was able to see this through a developmental lens, rather than blame herself. She understood that she was doing enough.

With the right guidance, parents can feel less overwhelmed, more empowered, and ultimately become more attuned caregivers. This is perhaps the greatest gift any child can have: to be seen and celebrated for who they are, without judgment.

Who Is Most Likely to Be Missed?

Even when parents and educators are paying close attention, some children are simply harder to spot. Not because their needs are less real, but because they manifest differently. This may be due to a quiet nature, more adept masking, or high ability. These are the children who fly under the radar until something eventually unravels.

• Girls and gender-diverse children, who often mask symptoms effectively and present with more subtle difficulties. This is influenced by stronger social mimicry, a tendency to internalise distress, and differences in how traits appear across genders. Diagnostic tools are also historically normed on male profiles.

• Gifted children, whose advanced cognitive abilities can overshadow social, emotional, or executive functioning challenges. High academic achievement can mask distress, and these children are often assumed to be fine because they perform well.

• Children from racial minorities or multilingual backgrounds, who often face systemic barriers to diagnosis. These include cultural stigma, limited access to appropriate services, socioeconomic disadvantage, and implicit bias within healthcare and education.

• Children with subclinical or partial profiles, who show signs of difference but do not meet full diagnostic criteria. These are often the quirky but coping children whose needs are minimised or misunderstood.

  
  

These children often present in ways that fall between the cracks of existing systems. They may be repeatedly assessed and discharged with no diagnosis or given labels that do not capture the full picture, such as anxiety, defiance, or poor parenting.

Why Early Detection Matters in Neurodivergent Youth

When we think about early detection, it is not simply about a diagnosis or label. It is about recognising subtle vulnerabilities before they escalate into entrenched struggles. When signs are missed or minimised, children are left without the scaffolding they need to develop a strong sense of self, regulate their emotions and behaviour, and ultimately reach their potential. These missed moments can snowball over time. What may begin as confusion or distress can evolve into chronic overwhelm and disengagement from learning, relationships, and everyday life.

1. Comorbid conditions are common

• Approximately 32.8% of children with ASD also meet criteria for ADHD, and 9.8% of children with ADHD are later diagnosed with autism (Antshel & Russo, 2019)

• Around 40% of children with ADHD also experience symptoms of anxiety (CDC, 2023)

• Nearly 50% of children with ADHD present with behavioural or conduct problems (CDC, 2023)

In adults, the question is not whether a person has a comorbidity, but rather which comorbidity is present. A large-scale review found that 78.5% of adults with ADHD had at least one psychiatric comorbidity, most commonly mood disorders, anxiety, and substance use (Katzman et al., 2022).

2. Delays increase risk

Research shows that the longer it takes to identify mental health challenges in neurodivergent individuals, the more likely they are to experience:

• School exclusion

• Misdiagnosis (e.g. autism mistaken for BPD)

• Escalation to inpatient care

• Compounded shame and identity confusion

• Higher rates of comorbid conditions

  
  

3. Timely support can change the trajectory

Early support can prevent crisis, reduce diagnostic overshadowing, and help families understand their child’s developmental wiring, not just their behaviour.

4. The cost of late or missed diagnosis

Recent UK-based research also highlights the broader societal and economic costs:

• Lifetime cost for an individual with ASD and intellectual disability in the UK is estimated at £1.23 million, and £0.80 million for those without intellectual disability (Buescher et al., 2014)

• Annual cost of supporting children with ASD in the UK is estimated at £2.7 billion, and £25 billion for adults (Buescher et al., 2014)

• Undiagnosed adult ADHD may cost the UK billions annually in lost productivity and increased reliance on social support (Glover & Williams, 2018)

• Individuals with ADHD have healthcare costs more than four times higher than those without the condition (Ginsberg et al., 2014)

  
  

These figures make a strong case for timely, accurate diagnosis. A diagnosis is not just good clinical practice, but sound public policy and an ethical responsibility.

What Should You Watch For?

Many children, and even adults, who are neurodiverse often struggle to articulate their internal experiences. As such, distress often emerges behaviourally. As Dr Ross Greene says, “Children who are struggling often show us with their actions what they cannot say with words.” Some signs may include:

• Social: Loss of friendships, intense but one-sided interests, withdrawal from peers, difficulty understanding or responding to social norms

• Emotional: Mood swings, shutdowns, fear of abandonment, emotional reactivity or overdependence on routines or objects

• Cognitive: Executive dysfunction, learning gaps, inconsistent performance at school, or difficulties keeping up with academic expectations

• Sensory: Avoidance or seeking of sensory input, sensitivity to noise or touch, frequent shutdowns in busy environments

• Behavioural: Meltdowns, impulsivity, rigid behaviours around food, sleep disturbances, or apparent oppositionality

  
  

From Red Flags to Roadmaps: The Role of Assessment

A high-quality developmental or psychological assessment is not about chasing labels or ticking boxes. It is a structured opportunity to step back, take stock, and understand a child’s profile within the broader context of their life.

Thoughtful assessments:

• Clarify complex or overlapping presentations (e.g. ADHD versus trauma, ASD traits versus anxiety)

• Provide practical and tailored recommendations for school, home, and therapy

• Equip families with the understanding and language to advocate for their child

• Help professionals set developmentally realistic goals

• Identify when progress has stalled so support can be adapted appropriately

In this way, assessment becomes more than an endpoint. It becomes a roadmap. When used well, it helps everyone around the child hold them in mind more clearly, more accurately, and more compassionately.

Final Thoughts

Early detection is more than a clinical aim. It is a relational, ethical commitment to see children in their context and respond in a timely, informed way. Every child deserves to be understood, not just managed. And every family deserves access to support that meets them where they are.

Written by Kirstan Lloyd

Kirstan is a Chartered Psychologist and Psychotherapist, and founder of the Helix Centre. Her clinical work focuses on complex mental health, neurodevelopmental conditions, and relational approaches to psychotherapy.

References

1. Antshel, K. M., & Russo, N. (2019). Autism spectrum disorders and ADHD: Overlapping phenotypes and diagnostic challenges. Neuropsychiatric Disease and Treatment, 15, 1871–1880. https://doi.org/10.2147/NDT.S208041

2. Buescher, A. V. S., Cidav, Z., Knapp, M., & Mandell, D. S. (2014). Costs of autism spectrum disorders in the United Kingdom and the United States. JAMA Pediatrics, 168(8), 721–728. https://doi.org/10.1001/jamapediatrics.2014.210

3. Centers for Disease Control and Prevention. (2023). Data and statistics about ADHD. https://www.cdc.gov/adhd/data/index.html

4. Ginsberg, Y., Quintero, J., Anand, E., Casillas, M., & Upadhyaya, H. (2014). Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: A review of the literature. Primary Care Companion for CNS Disorders, 16(3). https://doi.org/10.4088/PCC.13r01600

5. Gizer, I. R., Ficks, C., & Waldman, I. D. (2009). Candidate gene studies of ADHD: A meta-analytic review. Human Genetics, 126(1), 51–90. https://doi.org/10.1007/s00439-009-0694-x

6. Glover, A., & Williams, R. (2018). A new approach to ADHD: A Demos report. Demos. https://demos.co.uk/project/a-new-approach-to-adhd

7. Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2022). Comorbidities in adults with attention-deficit/hyperactivity disorder (ADHD): A meta-analysis of 58 studies. PLOS ONE, 17(11), e0277175. https://doi.org/10.1371/journal.pone.0277175

8. Thapar, A., Cooper, M., & Rutter, M. (2013). Neurodevelopmental disorders. The Lancet, 379(9830), 412–421. https://doi.org/10.1016/S0140-6736(11)61329-5

9. Greene, R. W. (2014). The explosive child (5th ed.). HarperCollins.