Why Neurodevelopmental Services in NHS Are Struggling to Keep Up

Across Scotland, more children, young people, and adults are seeking assessments for autism, ADHD, and other neurodevelopmental differences. But demand has risen so quickly that NHS Scotland services are under intense pressure, resulting in long waits and stretched teams. Here’s a clear explanation of why this is happening—and how COVID-19 made things even harder.

1. Demand for Assessments Has Grown Rapidly

Awareness of neurodevelopmental conditions has increased across Scotland. Parents, teachers, and adults themselves are now more familiar with the signs of autism and ADHD and are more confident in seeking help.

There has also been a rise in recognition of:

• autism in girls and women

• ADHD in adults

• subtle or masked presentations

• the benefits of early intervention

Scottish charities such as Scottish Autism, Autism Network Scotland, and ADHD Scotland play a major role in spreading awareness and reducing stigma.

2. How COVID-19 Made Things Worse

The pandemic had a deep and lasting effect on neurodevelopmental services across Scotland.

Backlogs grew quickly

During lockdowns, in-person assessments were paused or moved online. Many parts of Scotland had to stop face-to-face assessments entirely for months, causing long queues that services are still trying to recover from.

More developmental concerns were noticed

Families spent more time at home observing their children. Teachers saw significant challenges when pupils returned to school after long periods away. This led to a sharp increase in referrals once services reopened.

Worsening mental health

COVID-19 disrupted routines, schooling, social interaction, and support networks—factors that heavily affect neurodivergent children and adults. Many people who had previously managed well experienced increased difficulties, prompting referrals.

Staff shortages increased

Healthcare staff across Scotland faced sickness, redeployment, and burnout during the pandemic, further restricting capacity.

Together, these factors created a perfect storm: more referrals, fewer staff, and large backlogs.

3. Scotland Faces a Shortage of Specialist Staff

Neurodevelopmental assessments require skilled professionals such as community paediatricians, CAMHS clinicians, clinical psychologists, neurodevelopmental nurses, and speech and language therapists. Scotland faces longstanding recruitment challenges in these areas, especially in rural and island regions.

After the pandemic, pressures on the workforce became even more acute.

4. Underfunding and Local Variation Slow the System Down

Neurodevelopmental services have not been funded at a level that matches today’s referral rates. Although the Scottish Government has invested in this area, services are still recovering from years of rising demand.

Because each health board designs its own pathways, families often experience differences in waiting times and access to support depending on where they live.

5. Referrals Are Becoming More Complex

More people are now being referred with co-occurring needs—for example autism combined with ADHD, anxiety, learning differences, or trauma. These assessments take longer and require coordinated input from multiple professionals, slowing the system further.

6. Support Outside the NHS: The Role of Organisations Like Aspect Autism Consultancy

Alongside NHS provision, some families seek additional guidance and clarity from independent services. Since 2017, Aspect Autism Consultancy has been supporting children, young people, and adults who are looking for advice, answers, and help navigating the assessment process. They provide guidance, diagnostic services where appropriate, and ongoing support, and are known for offering high-quality, regulated reports. For many families, organisations like Aspect Autism Consultancy offer reassurance and continuity at a time when public services are under significant strain.

7. The Impact on Families

The combination of rising demand, COVID-19 backlogs, workforce shortages, and increasingly complex referrals has led to long waits for many families. This affects access to support in school, the workplace, and daily life, and can place significant emotional strain on children, adults, and carers.

Some families choose private routes due to long waits, but this is not affordable for everyone, creating further inequalities.

8. What Scotland Is Doing to Improve the Situation

The Scottish Government and NHS Scotland are taking steps to strengthen neurodevelopmental pathways, including:

• The National Neurodevelopmental Specification (2021)

• Increased funding for local health boards

• Multi-agency working between health, education, and social care

• Early support based on need rather than diagnosis

• Digital tools for triage and communication

• Strengthened post-diagnostic support, particularly for autism

These are promising developments, but sustained investment and workforce expansion are needed.

Final Thoughts

Growing awareness of neurodevelopmental differences is positive—people who previously went unrecognised are now seeking the support they deserve. But NHS Scotland services have been overwhelmed by demand, and COVID-19 significantly intensified existing pressures.

Improving the system will require:

• long-term funding

• investment in workforce training and recruitment

• consistent pathways across health boards

• access to early support without long waits

While NHS teams work tirelessly in challenging circumstances, independent organisations can also offer valuable guidance as individuals and families navigate the journey toward understanding and support.