The final item of business is a members’ business debate on motion S7M-00314, in the name of Helen McDade, on the cost of undiagnosed attention deficit hyperactivity disorder and autism in outcomes and life chances. The debate will be concluded without any question being put. I call Helen McDade to open the debate.
Motion debated,
That the Parliament recognises the increasing demand for ADHD and autism assessments among both children and adults across Scotland, including in Mid Scotland and Fife; acknowledges that over 50% of individuals with ADHD are also autistic; notes that previous diagnostic criteria prevented dual diagnoses, contributing to the historic and systemic under-diagnosis of adults; further notes that the most up-to-date Scottish ADHD prescription data shows that only 0.17% of adults are currently receiving treatment compared with the diagnosed expectancy of 4%; highlights that neurodivergent people comprise 25% of the Scottish prison population and up to 20% of mental health inpatients, and notes the view that early identification, assessment and support can lead to better life outcomes.
18:00
Apologies—it is getting late in the day for everybody. I thank all those who have stayed for this very important debate.
The motion gives some frightening statistics about the prevalence of autistic spectrum disorders and attention deficit hyperactivity disorder. In some ways, it is a pity that we are having the debate so late this evening, as there may not be as many people here with a special interest in the subject, and what we are talking about is really important. It is now estimated that one in 31 children in the US will have autistic spectrum disorders. I will come back to that, as it is something that can be argued about.
The motion highlights the importance of early diagnosis of both autistic spectrum disorders and ADHD to allow much-needed advice and help to be given to those who are affected, and to their families, in order to improve life chances. The comorbidity of both conditions is rightly highlighted, but it is important medically that the conditions are also considered separately. I was a veterinary surgeon, and so I like accurate diagnosis as an important way to ensure that the correct treatment, where possible, and targeted assistance can be given.
I will consider ADHD first. People with ADHD can be offered medical treatment where appropriate, although if it can be addressed without treatment, with coping mechanisms, that is preferable. Either way, early diagnosis is important.
I am grateful to Helen McDade for taking my intervention—I offer my apologies for having to leave early, but I am very grateful that she has brought the debate to the chamber.
Does she recognise that, in particular health board areas such as NHS Lothian, young people are being asked to wait for as long as eight years for a diagnosis? I have a constituent called Abigail who is 16 years old; she has been told to wait eight years for diagnosis, by which time she will have left child and adolescent mental health services and transited into adult services. She worries—quite rightly—that she may be at the back of the queue for an adult services diagnosis. Does the member recognise that that is a particular problem in Scotland right now?
I thank Alex Cole-Hamilton for that intervention, and I absolutely recognise that that story is, unfortunately, common everywhere. We probably all have similar stories of meeting people in that age bracket who are going to transition to adult services without ever getting a diagnosis, having been told years ago that they would get one. I will come back in a minute to discuss what might help with that, but the situation absolutely cannot go on like that.
The CAMHS situation demonstrates that we are in crisis. The low percentage of affected adults who have a diagnosis is worrying; some of those adults will have been the young people who have waited for a diagnosis and then transitioned—that might not be the right word; rather, they disappeared and then came back for help as adults.
I have spoken to an adult I am close to, who recently had a private diagnosis of attention deficit disorder, which she has found very helpful in understanding various difficulties that she has experienced and in enabling her to be directed to ways of managing situations. I am sure that there are others who are taking that route if it is possible and where they can afford it. The diagnosis has made a significant difference to her life, and we need to look at that aspect.
Yesterday, I spoke to the Royal College of Psychiatrists in Scotland, which has published a report entitled “Multi-system solutions for meeting the needs of autistic people and people with ADHD in Scotland”. The RCP recommends a layered approach with a pyramid of care whereby the least affected would perhaps be able to self-diagnose and then be pointed to resources and ways to self-manage.
There are a lot of issues to be discussed around that, but we need to do something. Is the RCP report the equivalent, perhaps, of sticking a finger in a hole in the dam? It is necessary crisis management, but the report itself recognises that it is a way of trying to ensure that the psychiatrists who are dealing with the most severe cases do not have a long list of others to see. However, where are those others? They still need help. This epidemic, which causes untold misery, needs to be not only acknowledged but investigated.
I will take a slight diversion here. I have been told by my family that, as a vet with experience in the environment, I sometimes go off on the wrong analogy. This time, I will try an environmental one.
There is a concept in ecology called the shifting baseline syndrome. It is a gradual generational amnesia whereby each new generation sees a progressively degraded environment, which they accept as normal. I suggest that it could be applied medically in this context. Is there really not a change, and a drastic increase, in the numbers of children who are affected in this way? Here, I differentiate myself from the psychiatrists, who have said that the unprecedented rise is due to increased public awareness, unmet historical need, population growth, evolving diagnostic criteria and the impact of Covid-19. I am sure that those things all have a part to play. However, I would ask people to consider that, if something is happening that is causing a massive increase—not a pretend thing or something that has not been diagnosed before—that means that there is a tragedy happening, and we have a duty to look at that.
Others, like the psychiatrists, can give an alternative view. They might suggest that autism has always been here and that the increase is down to better diagnosis and relabelling. They might say that such children were in special schools or that their father is an engineer. However, if there is the slightest chance that that is not what is happening, we have a duty to look at it.
Putting to one side those who are less affected by autism and those with ADHD, the evidence in our communities and the burden of care that we see might suggest that something is very different from the child population of 50 years ago. Some of us might say, “Well, I spoke to teachers and asked what happened in the past.” I come from a town up north—Thurso—which is 100 miles from the nearest big place that those children might have been taken, for instance. I think that those of us who have been around for long enough can say that there is something different going on here. It is therefore essential that, as well as looking at the crisis here and now in social care, as the Royal College of Psychiatrists has usefully suggested, we take a more strategic view.
An increasing number of professionals, as well as families, are clamouring for an investigation into possible contributing factors. Risks that might be considered include genetic traits, which are then affected by environmental, pollution, iatrogenic and nutritional factors and factors in pregnancy and in the first years of life. It is not possible to have an epidemic of a genetic condition. That is simply the case—we cannot have an epidemic of something that is purely genetic, and we have an epidemic, whatever its causes, so research should be an absolute priority. We have a crisis in care, but we must say what we are going to do to look at this. We need to dam the flow and not just stick our finger in the dyke.
I thank everyone for taking part in the debate and I ask the Minister for Mental Wellbeing, Public Health, Sport, Alcohol and Drugs to seriously consider what kind of research should be undertaken on this subject.
18:08
I thank Helen McDade for bringing this members’ business debate to the chamber. It is such an important subject, and I applaud her for putting it forward, considering the negative and derogatory views of neurodiversity that have been expressed by some of those higher up in her party.
The true cost of undiagnosed ADHD and autism in Scotland is not merely a line on a national health service budget sheet; it is a compounding mental health and economic crisis. The cost of failing our neurodivergent community is not only a personal tragedy for the individuals and families who are affected, but a monumental failure of our societal infrastructure and a drain on our economy.
That is not helped by local health and social care partnerships, including the Aberdeenshire health and social care partnership in my constituency, completely stopping adult diagnosis pathways to make budget savings. Children, adults and working professionals are having to wait months and, in some cases, years just to understand how their brains work.
What happens when people are left without a diagnosis? Navigating a world that is built for neurotypical people without proper tools and coping mechanisms causes deep psychological strain, frequently leading to mental breakdowns and, in some cases, thoughts of suicide. Without early intervention, neurodivergent individuals are frequently misdiagnosed with general mental health issues and end up receiving treatments that fail to address their core needs. It should not be necessary to have an existing mental health diagnosis to even be able to access the pathway for an ADHD or autism diagnosis—that is fuelling the unmanageable waiting lists.
With diagnosis, coping mechanisms and strategies can be put in place and catered for, including sound-cancelling headphones to prevent overwhelm or stimming devices to occupy hands. The recent review by the Royal College of Psychiatrists, which has already been referred to, warns that, without dedicated neurodevelopmental diagnostic pathways that cover ADHD and autism together, individuals will be pushed into overstretched mental health and justice systems, showing up only when they have already reached a crisis state.
I know that all too well, because two of my adult children have experienced it. During their 20s, they both found themselves in crisis and it was only at the suggestion of their respective counsellors that they realised that autism might be the root cause of their issues with coping in their environments. For one of them, it explained so much about the struggles that they had during high school and it even explained their challenging behaviour as a toddler and young child.
Girls are frequently misdiagnosed due to their presenting differently from boys, which is because they are so good at masking, and they are typically diagnosed much later and into their 20s—I could go off on a tangent about how that is discriminatory towards women.
The cost to the mental health of those individuals and their families should not be underestimated. They need support through the whole process of diagnosis, from realising that there might be something to investigate to the waiting time for the investigation and the post-diagnosis period. Support is needed even if the threshold for diagnosis is not met, because there was clearly something that made the person take that route of investigation in the first place.
I have heard from people whose children are diagnosed that they recognise traits in themselves and then seek diagnosis as an older adult. When they get that diagnosis, they discover that there is little support out there for older adults, because most support services concentrate on family support for children, which leaves older adults floundering.
We are locking away immense talent, creativity and potential as undiagnosed and post-diagnosis neurodivergent people are left without the support that they need, leading to lost productivity and preventable unemployment. We are choosing a reactive, crisis-driven system instead of investing in a proactive and preventative support-based system. That status quo is counterproductive and cruel.
We must standardise multifaceted diagnostic support pathways across all NHS health boards and health and social care partnerships so that a person’s geography does not dictate their access to the care that they need. We must also elevate neurodivergence out of the shadows, because it is not an illness to be cured but a spectrum of human difference that requires targeted and timely support. When interventions are timely, we create stronger families, calmer classrooms and a more productive society.
It is time for Scotland to commit to a comprehensive whole-system approach, and it is time to invest in our neurodivergent citizens, unlocking their potential and saving their lives.
18:14
I refer to my entry in the register of members’ interests, which shows that, until 8 May, I was employed at Scottish Autism.
I welcome the opportunity to debate this topic and I am grateful to Helen McDade for bringing the motion to the chamber. The motion notes that, historically, autism and ADHD were mutually exclusive diagnoses, whereas we now understand that a great many neurodivergent people are likely to have traits that relate to both neurotypes and profiles. That is sometimes known in the neurodivergent community as auDHD.
There is a growing consensus among the community, academics, clinicians and support professionals that neurodevelopmental assessments should be holistic and combine consideration of different traits and neurotypes rather than simply giving a binary answer to the question of whether someone fits a particular profile such as autism, which means that the person must start the process of referral and assessment once again for a different profile, such as ADHD, if different needs or traits become evident.
It is important to state that holistic pathways should result not just in achievement or refusal of diagnosis but in an assessment or profile of need that can then be used in relation to meaningful accommodations and support, whether those are in education, social care settings or employment, or in accessing other services and activities. Such a profile can be a useful tool in parental or self-advocacy to have those needs met.
A true pathway should be one of assessment, diagnosis and support for neurodivergent people. That last step is really important. It could include peer support, parental education programmes and support provided by the third sector in the community, as last year’s report by the Royal College of Psychiatrists in Scotland recognises.
None of that is breaking news, and it is worth considering where we are with regard to neurodevelopmental pathways and access to them in Scotland. During the final years of the Scottish autism strategy, which ended in 2021, combined neurodevelopmental pathways were explored by the national autism implementation team that is based at Queen Margaret University. The approach has been adopted in parts of Scotland, including Fife, the region that I represent, but is by no means available across the board. Adult autism diagnosis pathways were withdrawn by NHS Forth Valley at the start of last year, for example. That inconsistency of assessment across Scotland remains an issue, as last year’s report by the Scottish Parliament information centre found.
At the end of the autism strategy, stakeholders were assured that assessment and diagnosis were a priority in the post-Covid recovery and transformation planning. As such, they were not included in consultations on the proposed learning disabilities, autism and neurodivergence bill. However, we have some way to go in delivering that consistent support.
We have seen the successful pilot of a neuroaffirmative diagnosis service delivered by the third sector in Edinburgh—the number 6 service that is run by Autism Initiatives, which was evaluated highly by those who accessed it—but I understand that that pilot has now ended. Last year, while I was working at Scottish Autism, I was co-author of a report on experiences of autism assessment and diagnosis, along with colleagues from autistic-led disabled persons organisations: Autistic Mutual Aid Society Edinburgh, Scottish Ethnic Minority Autistics and Autism Rights Group Highland. The research laid bare the frustrations and feelings of abandonment felt by people who are left waiting for months and years on end, often with little communication about the process of assessment and who they might see or when, and who frequently find little in the way of support after diagnosis. That is exactly the story that we heard Dawn Black recounting. However, it was also recorded that, for some, diagnosis was life changing and was about more than just meeting clinical need, as it brought clarity, self-understanding, identity and a community of peers.
When we talk, as the motion does, about the cost of undiagnosed autism and ADHD, our main focus must be the human cost of failure. We should be clear that, when we talk about the prevalence of neurodivergent people in the criminal justice system or in mental health services, we are not talking about a temperamental predisposition but about the consequences of unmet need.
I therefore welcome the Scottish Government’s commitment to take forward the recommendations of the Royal College of Psychiatrists in Scotland on combined neurodevelopmental pathways for assessment, diagnosis and support across Scotland. However, let us be clear that those who require support cannot and should not wait any longer.
18:18
I congratulate and thank Helen McDade for securing this important debate. I am glad to see that there are cross-party contributions this evening.
I am also glad that we are getting a better understanding of how widespread neurodivergence is, that we are seeing parents get help after realising that their child’s neurodivergence is not a first for the family, and that children in schools are getting support that can help them to thrive in education rather than just scrape by, with folk assuming that they are difficult or stupid. I am glad, too, that people who were previously stigmatised are learning that their brain simply works differently and that, with a bit of help, they do not need to struggle.
When someone feels like they do not fit in and they do not know why, they can start to resent the world and their peers, who think that the person is difficult and unfriendly instead of just quiet and busy thinking about 12 things at once. They can also resent the rules and expectations that nobody will write down for them but that people will quickly use as an opportunity to humiliate them if they get them wrong. I am not surprised that many neurodivergent people are in prison, that many develop unnecessary mental health or behavioural issues or that many withdraw from those social spaces that were quietly excluding them anyway.
Knowing all that I know about the high rate of comorbidity of ADHD and hypermobility, it did not come as a surprise when I was told in January this year that my mental health diagnosis, which came with a great deal of difficulty, stigma and, as it turns out, the wrong treatment over years and years, was misdiagnosed neurodivergence.
I have ADHD and I am likely autistic. I am lucky that, because, over the years, I have become very aware of what works for me, that has not changed my view of myself or how I manage my symptoms. My brain just works differently and that lets me get through volumes of correspondence, long briefings and arguments quickly. However, I now know that I should have been taking advice from those who understand ADHD, not from those who were looking at me through the lens of a condition that I do not have. I can now access the right people and I can read about my condition, not a label. What I cannot do is get help from the NHS. I have been advised to go private, which is something I hate seeing in a letter that is headed “NHS”.
NHS Highland is taking only adult ADHD referrals that meet level 3 criteria, which I and many people in my caseload do not meet. Some people I am supporting are on the edge of becoming acute. They are struggling to work and get about their daily lives. They are feeling worse with each week that passes without intervention. Looking at the burden that is placed on NHS boards, it is not surprising that we have ended up here.
Having ADHD or autism does not necessarily mean that someone needs to be on a psychiatrist’s books for life. A child with ADHD who can be managed with some changes to their school day should just have those changes made. Not dealing with those people creates urgent cases that never needed to become urgent. People who are forced to manage on their own and are referred to websites for support without a diagnosis end up with serious mental health issues and the loss of employment and relationships. They then cost the NHS more time and money than if they had just been dealt with when they first presented. We need to rethink how we manage patient lists, rethink what neurodivergence means and move away from the assumption that any patient will be a lot of work. Instead, we should just check what that person needs.
Many people with neurodivergence will be able to manage with primary care. It might be that no one beyond the person’s GP is needed to manage the post-diagnosis situation. All that might be needed is guided self-management and the awareness of what their diagnosis is, which will give them the necessary confidence to ask for adjustments at school or the workplace. They might need a prescription and some oversight, and they might need someone to go to in a crisis, but a regular appointment with a psychiatrist, once they are stable, might add little to their lives.
We cannot expect NHS boards to make those changes on their own. If we want GPs to take more of an active role, which I hope we do, they must be given clarity about what they should do and the confidence to do it. That requires a review of national pathways and expectations when it comes to the long-term treatment of neurodivergent people. I hope that the Government is willing to be bold and not just keep doing what we have always done.
We must support and resource the NHS and primary care to look at the person, not the waiting list, not how busy the diary is, and not whether someone meets level 3 criteria. Primary care must simply see that there is a person who needs help and ask how it can best offer that help.
18:23
I welcome the opportunity to add to this important members’ business debate. I want those who are directly affected by the issue that we are discussing to know that their experiences will be listened to in the Parliament.
The issue affects not only our young people and adults in our communities, but everyone around them—their families, siblings, parents, children, partners and even their friends and colleagues. I suspect that no one is left untouched by it.
I am an optimist, so, rather than focusing on the challenges that we face, I want to look at some potential solutions. In my first speech, I spoke about serving with vision, bravery, compassion and integrity, and all those traits must be brought into the debate. Having a bold vision of how we can improve the current situation is vital. I was proud to stand on a Scottish National Party manifesto that set out that vision, making it clear that we need to take action by adopting the four-tier national pathway that was set out by the Royal College of Psychiatrists.
We need to be brave and acknowledge that the current system is not working. We need to be brave by exploring other ways to support our young people and adults, especially those in tier 1, at which level people can be offered support with or, importantly, without a diagnosis.
Can we be brave—or even radical—and consider reforming our education system? Can we incorporate outdoor, nature-based learning into our core curriculum on a daily basis? Can we ensure that sport and movement—both of which have been shown to be beneficial to us all—become part of everyone’s daily habits? How can we value creativity more in order to harness the complex and wonderful minds of those with neurodevelopmental conditions while simultaneously better equipping our young learners with the tools to navigate this increasingly artificial intelligence-powered world?
Compassion and integrity remain at the core of the challenge that we face. When young people are struggling without support, at times, judgment and frustration might be felt by those around them, families might be flung into crisis and school systems might fail. We must remember that this is not a choice for the individual. They are not being difficult; they are simply trying to navigate a life and a world that has not been built for them.
Adults who might have coped their entire lives might find themselves in crisis or slowly drowning in circumstances in which they had never expected to find themselves. Their normal coping methods might suddenly no longer work, and they might be unable to navigate their life with the certainty that they once had. That is a terrifying prospect for anyone.
Whether it is for our young people or our adults, let us ensure that we remember those core values. Let us remember to have vision, to be brave and to serve with compassion and integrity.
18:26
I sincerely thank Helen McDade for lodging the motion for debate.
I have close lived experience of autism and ADHD, and I know from my inbox that there is a widespread issue with waiting times for assessments. In East Lothian, for example, the number of adults waiting for an ADHD assessment from NHS Lothian is in the thousands, but only 120 assessments were completed between January and August 2025. That is not a dig at the exceptional people who deliver the service and those who advocate for better treatment, but it is a sign that the work has not been mainstreamed enough. Strategies have been bold but are not as tangible as they could be, and practice can vary depending on age, gender and geography, as we have heard from other speakers.
As Dawn Black mentioned, there has been an increase in the number of women with an ADHD diagnosis, due to testing and assessment having historically been geared towards young boys. ADHD might not be picked up among girls, because girls are less likely to have symptoms of hyperactivity. As the member said, they mask for a longer period and their conditions can be ignored or misdiagnosed, which can have an impact for the rest of their lives. Symptoms not only differ between the genders but can be worsened by puberty, menopause and the other societal barriers and stigma that women already face.
This morning, I met Scottish Autism, a great organisation, and learned about the fantastic work that it does through its outreach services and its evolving approach to education. We discussed the increased demand, which Helen McDade’s motion mentions, but I do not think that that means solely that more people are coming out as autistic these days. After all, we must remember that, 40 or 50 years ago, people—not all, but some—were probably institutionalised or left to suffer in silence, whereas more people are now able to notice the symptoms and reach out for support as a start. We all know that diagnosis can be a powerful tool, but it is not the be-all and end-all. Many people seek a diagnosis to confirm what they have always known and believed in themselves, to enable them to access local support services or to allow them to be the best advocate for themselves in the workplace.
I also want to touch on employment. In Scotland, the disability employment gap is about 50 per cent, which is a startling and harrowing statistic, and the gap for autistic folks is closer to 30 per cent. That shows that they are further marginalised through a lack of clear avenues of support in the community.
Before my meander into politics, I worked at Inclusion Scotland, the nation’s leading voice on disability rights. I helped to set up internships in the public and third sectors for disabled people and autistic people who might not otherwise be able to engage with or enter the job market through traditional means, and I worked equally with individuals and employers to ensure that accessibility and inclusion were key at all stages.
I mention that, because I believe that employers have a duty to include everyone. Moreover, as decision makers in the Parliament, all members play a part in inclusion, too, whether that be advocating for our most vulnerable in every area in which the Parliament holds a remit or fighting against far-right nonsense that paracetamol or vaccines cause autism, which is just eugenics wrapped in—quote, unquote—“efficiencies”.
It is positive that we are now acknowledging these existences. As a society, as parliamentarians and as people, we have a duty to provide the basic support that everyone needs. Autistic people and people with ADHD have always been around and always will be. With decency and humanity, they can live their best lives, and that is the best life outcome.
18:30
I declare an interest as an employee of NHS Lothian.
The truest measure of a society is how it supports its citizens to fulfil their potential. By that metric, Scotland’s approach to neurodiversity is costing us our future. We are looking not at a simple administrative backlog in NHS diagnostic clinics but at a catastrophic drain on Scottish potential, public finances and human life chances. The price of undiagnosed and unmanaged ADHD and autism is paid daily in ruined school careers, broken employment, relationship breakdowns and tragic mental health crises. When we leave people in limbo, the cost does not vanish; it merely shifts to more expensive parts of our state. We see it in schools, where bright children are excluded because their dysregulated behaviour is mislabelled as defiance, and in our economy, where capable adults cycle through unemployment because they lack workplace accommodations.
However, there is an equally damaging factor that we rarely talk about: the agony of the unknown. Our waiting lists are swollen with thousands of people who are left to languish for years. Let us be entirely honest: not everyone on those waiting lists has ADHD or autism—some are experiencing modern burnout, trauma or other misaligned mental health conditions—but the prolonged uncertainty is just as damaging to our economy and lived experience as being undiagnosed. People put their lives on hold; they delay career moves, pause education and suffer psychological paralysis while waiting for a clinical rubber stamp that might never come or might eventually tell them that they do not qualify.
I agree with Victor Currie that it is damaging for a person to wait for a long time without a diagnosis if all their support hangs on it. I agree, too, that a number of people on the waiting lists will not meet the diagnostic thresholds. However, does he not agree that the appropriate way forward is to ensure that people get the right support at the right time in the right place when they first ask for it?
Absolutely. I thank the minister for her intervention. I will answer her question more fully in the rest of my speech.
We cannot move through this crisis by funnelling every potential patient through a highly specialised illness pathway. We must stop treating neurodevelopmental differences like acute medical emergencies and start treating them through a modern public health framework. Let us look at how Scotland tackles obesity: we do not send every person who gains weight straight to a bariatric surgeon or we would have a massive waiting list, as we do for neurodevelopmental conditions. Neither do we place them on a five-year waiting list for clinical consultation before they are allowed to change their diets. Instead, we use a public health structure that prioritises preventative action, public education and community initiatives.
We must try to apply that framework to neurodiversity and mental health. The core of our strategy must move out of our hospitals and into our neighbourhoods for that first tier of treatment, because a significant proportion of cases on our current waiting lists are subclinical. Those individuals face genuine executive dysfunction, sensory overload and emotional regulation challenges, but they do not require highly specialised medical intervention or prescription medication.
We need to give people the tools to help themselves immediately. That means funding open-access community-led support groups. It also means rolling out digital coaching platforms supported by the Royal College of Psychiatrists, that are co-ordinated so that we have a single, solid standard on which we can rely and that teach time management, emotional regulation and organisational strategies.
If we shift our focus to immediate community-level empowerment, a person who is struggling with focus will be able to access help that day and will not need to wait three years for a consultant appointment at which they are told how to structure their day. That immediate support would resolve the damaging uncertainty and give subclinical individuals the belief that they need without ever touching an NHS waiting list.
Where such community-led strategies are not enough, our existing local infrastructure—GPs, school counsellors and workplace occupational therapists—must be empowered to step in. Instead of waiting for a formal diagnostic passport, local professionals should implement targeted adjustments. A school can adapt a child’s environment or an employer can adjust an adult’s working hours based on the traits that they present with, rather than a clinical label.
By filtering out and managing subclinical and mild cases in the community, we will clear the runway for our specialists. In that way, it will finally be possible for highly specialised psychiatric care, multidisciplinary diagnostic teams and complex medication management to be reserved strictly for the most complex acute cases and for those who genuinely require specialist medical care to be seen in weeks rather than years.
The current strategy of building ever longer waiting lists and relying on a consultant-led appointment as some sort of silver bullet while human potential rots is a failure of statecraft and imagination. The economic cost of doing nothing is a luxury that Scotland cannot afford. Let us democratise support and eliminate the toxic damage of clinical uncertainty by giving people answers and tools on day 1. We need to fund the community, restructure our pathways and treat the crisis like a public health challenge.
18:36
Tapadh leibh, Oifigeir Riaghlaidh. I welcome the opportunity to respond to Helen McDade’s important motion, and I thank her for raising an issue that affects so many individuals, families and communities across Scotland.
The Scottish Government recognises the increasing demand for ADHD and autism assessments among children and adults and the pressure that that is placing on services across the country. We also recognise the importance of the recent neurodevelopmental summits that brought together members from across the Parliament and beyond and established a clear cross-party consensus on the scale of the challenge and the need to make meaningful progress.
I acknowledge the historical context that is highlighted by the motion, which is that the diagnostic criteria have not always accounted for the high levels of co-occurrence in neurodevelopmental conditions such as ADHD and autism. That, alongside factors such as a lack of awareness and stigma, has contributed to underdiagnosis of adults. As a result, many people have gone without support for far too long.
On the question of prevalence that Helen McDade raised, so far, the consensus on the scientific evidence is as described by the Royal College of Psychiatrists in Scotland. What we are seeing is not a sudden increase in neurodevelopmental conditions but the result of historical underdiagnosis, particularly for adults and some specific groups, as well as much greater awareness and reduced stigma.
The Scottish Government is not currently funding any research on cause and prevalence, but an independent review of mental health conditions, ADHD and autism is under way in England. Although the review is focused on England, we will undoubtedly consider any findings and learnings from it. The interim report notes that there is limited evidence that there has been any increase in prevalence and that the epidemiological evidence suggests that the numbers are broadly stable.
I recognise that awareness of needs has increased and that an increasing number of people are seeking help and support. Collectively, we must meet that need, because the impact of going without support reaches beyond the individual and affects the workplace, the criminal justice system and the wider health infrastructure. The overrepresentation of neurodivergent people in prisons and mental health settings highlights the consequences of unmet need. We have a collective responsibility to work together to make Scotland a place where neurodivergent people are welcomed, valued and supported.
I note the statistics that Helen McDade referred to with regard to ADHD medication. However, it is important to recognise that medication is not the right intervention for everyone with ADHD. Although we must ensure that those who want and would benefit from medication can access it, caution is required when interpreting the statistics.
Improving access to medication for people with ADHD is only one element of the holistic support that is needed for neurodivergent people. To achieve that vision of holistic support, we committed in our manifesto to implementing a stepped care approach for adults with neurodevelopmental conditions, as proposed by the Royal College of Psychiatrists. That will reshape how support is accessed, ensuring that people can access support at the right time and close to home, without having to wait for a diagnosis before they receive help. The support will include improved information for people and their families, self-help resources, an increased third sector support offer and a reshaped clinical offer to make access to diagnostic assessment easier when that is the right step for the individual.
Within the first 100 days of this parliamentary session, we will engage with stakeholders to agree a route map for delivering that new model for adults. That work will build on the shared understanding from the summits that progress must be collective, sustained and focused on delivering practical change.
The work on neurodevelopmental support for adults complements our ongoing implementation of the national neurodevelopmental specification for children and young people, which sets clear expectations that children and young people should receive support that meets their needs as early as possible. Recognising the challenges that are involved in meeting rising demand, we partnered with the Convention of Scottish Local Authorities last year to review the specification’s implementation in order to identify what is working well and where further action is needed. That highlighted the significant pressures that services are facing and the need for clearer national direction and practical support to deliver timely, neuro-affirming care across Scotland.
We have acted on that learning by committing to a programme of action that is supported by a cross-sector task force, bringing together expertise from health and education bodies, local government and the third sector. That is strengthening national leadership, improving shared understanding and supporting tangible improvements for children, young people and their families.
Progress is already being made. We have strengthened national communications on neurodevelopment and are in the final stages of improving information for families through Parent Club. We are also working with partners to develop a shared national picture of what support around a child should look like and how services should work together to deliver that, which is underpinning ongoing system improvement. Alongside that, we have backed delivery with additional investment. Last year, we provided more than £2.9 million to support projects that improve access to neurodevelopmental support, which includes family support, transition pathways and new assessment tools.
Let me be clear: the issues that are raised in the motion are complex but not insurmountable. There is now clear consensus across Parliament on the scale of the challenge and the need to act. Our shared task is to turn that consensus into delivery. By focusing on the right interventions for individuals and community-based support, we can build a Scotland in which neurodivergent individuals are understood, supported and empowered.
I am grateful for colleagues’ interest in and focus on the issue across the Parliament, as well as for the lived and professional experience that we collectively bring. This Government remains committed to working in partnership to turn our ambition into reality.
Meeting closed at 18:43.
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