Data Insight: Patterns of education and social care involvement among children with neurodivergence and mental health related referrals

This Data Insight draws on linked administrative data from the Education and Child Health Insights from Linked Data (ECHILD) project to examine patterns of education and social care support and involvement among approximately 396,000 children with recorded history of neurodivergence (ND), mental health (MH), or both ND- and MH-related referrals to NHS-funded mental health services in England.

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Neurodivergent children and young people, such as those who are autistic or have attention deficit hyperactivity disorder (ADHD), are more likely to experience mental health difficulties compared to their neurotypical peers [1-2]. Many neurodivergent children with mental health difficulties will interact with multiple services across health, education, and social care systems, often navigating fragmented and poorly coordinated support pathways [3-4]. These points of contact may provide important opportunities to identify and respond to unmet needs, but relatively little is known about how patterns of service contact differ depending on children's referral histories.

We found that patterns of recorded education and social care support or involvement varied across referral groups and types of support or involvement. Children with histories of both ND- and MH-related referrals had records across a wider range of education and social care indicators, while children with MH-related referrals alone had comparatively fewer records of education-based support or involvement. These patterns may partly reflect the later emergence or recognition of mental health needs, but may also point to differences in how these needs are identified and supported within education settings. Overall, the findings highlight the importance of coordinated, developmentally responsive approaches to supporting children, particularly where needs span multiple systems.

What we found

1. Referral group patterns vary by birth cohorts

The distribution of referral groups differs across birth cohorts (see Figure 1). Overall, 31% of children were recorded in the ND-related referral groups, with higher representation among younger (later born) children. Children born earlier were more likely to have a history of MH-related referrals by 2022 (52%). Children with both ND- and MH-related referrals (ND+MH) formed the smallest group (17%), although their representation increased with age and was highest among earlier-born children.

2. Patterns of education and social care records vary by referral group and type of support or involvement 

2.1. Financial early years support is common across all groups 

Around two thirds of children had a record of receiving EYF, with similar proportions observed across referral groups (Figure 2). EYF entitlement has been near-universal for 3-4-year-olds over much of the study period, and expanded further through policy changes (e.g., additional support for disadvantaged 2-year-olds from 2015 and extended hours for working parents from 2017) [5]. As such, slightly lower recorded receipt of EYF among children in the mental health-only group may reflect the fact that this group includes relatively older children, who experienced the early years at a time when EYF entitlements were less extensive. Many of these children are also likely to have received EYF before their MH-related referral occurred, as mental health referrals tend to be recorded later in childhood. Overall, similar levels of recorded EYF across groups are expected and should not be interpreted as evidence of equitable identification or support of need. 

2.2. SEN and EHCP are most common among children in the ND+MH group

Clear differences emerged in recorded statutory education support (Figure 2). Children in the ND+MH group were most likely to receive support, with around three quarters having a record of SEN status and over a quarter having recorded EHCP provision. This compares with slightly lower levels among children with ND-related referrals only, and substantially lower levels among those with MH-only referrals. 

These patterns likely reflect the closer alignment of SEN and EHCP frameworks with neurodivergence-related needs. Although both SEN support and EHCPs can include a wider range of needs, including mental health, lower levels of recorded SEN or EHCP provision among children with mental health-only referrals may indicate that these needs are less consistently identified or supported within education-based systems. Instead, mental health needs may become more visible in other settings and relationships outside of school and may require identification and support from systems outside of education as a result.

Fraser’s experience illustrates how, for some families, access to this support may come only after needs have escalated substantially: 

“I was only assessed for neurodivergence when my mental health had already deteriorated and I was on the waiting list for CAMHS. My school and the local authority only agreed to support me once my anxiety became so severe that I could no longer attend school. I had been turned down for an EHCP twice and was only finally awarded one after I was hospitalised with Anorexia Nervosa.” 

2.3. School exclusion and social care involvement vary across referral groups     

School exclusion was relatively uncommon overall (Figure 2). Yet, it was twice as frequent among children in the ND+MH group (12%), compared with those with ND- or MH-related referrals only (5-6%). 

Patterns of children’s social care contact also varied by referral group (Figure 2). CIN involvement was highest among children in the ND+MH group, followed by those with MH-only referrals, and was lowest among those with ND-only referrals. CLA status was rare across all groups, but slightly more common among children with MH-only referrals rather than either of neurodivergence-related groups. 

These patterns may reflect higher levels of need and vulnerability among children with overlapping neurodivergence- and mental health-related concerns, as well as differences in how systems respond to behavioural, emotional, and safeguarding needs. Higher exclusion rates among the combined group may also point to challenges in meeting more complex needs within school settings. Our lived-experience advisors highlighted that, for some children, school exclusion or greater involvement with social services may follow earlier difficulties in accessing appropriate educational and wider support, with needs escalating before adequate support is put in place. Higher rates of CIN and CLA among the MH and ND+MH groups could also reflect greater exposure to family and environmental stressors or differences in parental advocacy and involvement, alongside the interaction between mental health needs and safeguarding concerns.

2.4. National context

Nationally published statistics can provide some broader context for the proportions observed in this study, although they should not be interpreted as a direct comparison or reference group. 

Between 2011 and 2021, national figures indicate that around 90-95% of 3- and 4-year-olds received EYF, while take-up among eligible 2-year-olds between 2015 and 2021 was around 58-72% [6]. Between 2015/16 and 2021/22, around 12-13% of pupils received SEN support and 3-4% had an EHC plan or statement [7], while approximately 2-3% of pupil enrolments experienced one or more suspensions in individual academic years [8]. Around 3.2-3.4% of children were recorded as CIN between 2018 and 2022 [9], whereas national CLA figures were around 0.7% in 2021 and 2022 [10].

These figures provide only approximate context and are not directly comparable with our findings. National statistics differ from our analysis in their populations, age ranges and observation periods, and some are annual or point-in-time rates, whereas our measures generally capture whether children had a record of support or involvement across multiple years. Nevertheless, they provide a useful indication of scale and suggest that, aside from EYF, the proportions observed across our referral groups are relatively high in the context of nationally reported figures.

Why it matters 

Children with neurodivergence- and mental health–related needs often interact with multiple public services, but these preliminary insights show that patterns of education and social care support and involvement differ depending on how needs are recorded or recognised.  

• Children with both neurodivergence- and mental health–related referrals (ND+MH group) show greater involvement across several parts of the education and social care systems, underlining the importance of coordination across education, health, and social care systems. Lived-experience advisors also emphasised that coordination alone is not enough: support needs to be appropriate for both neurodivergence and mental health. They highlighted experiences of mental health support not always being sufficiently adapted to neurodivergent children's needs and communication styles, for example, where talking-based approaches are offered despite not being well suited to how a young person communicates or engages.
• Lower levels of engagement with education-based support among children with MH-only referrals should be interpreted with caution. Mental health needs often emerge or are recognised later in childhood and adolescence [11], beyond the age range fully captured in this research. Therefore, some children may not yet have received an MH-related referral during the period captured in this study, but may do so as they get older. However, lived-experience advisors highlighted that mental health difficulties can also be overlooked or misunderstood earlier in childhood, potentially delaying the point at which these needs are identified and appropriate support is provided. In addition, how support is offered within schools, including its visibility to peers, may affect whether children feel able to engage with it. Together, these findings highlight the importance of recognising and responding to mental health needs within education settings in ways that are accessible and acceptable to children.
• Higher rates of school exclusion among children with both ND- and MH-related referrals may indicate points at which existing support is not sufficient to meet more complex needs, reinforcing the importance of appropriate and timely support within school settings. Lived-experience advisors emphasised the importance of staff understanding, training, and consistency in responding to children's needs, particularly where unmet needs may otherwise escalate.
• Similar levels of Early Years Funding across groups likely reflect the broad entitlement to funded childcare, rather than differences in need or access to support. This suggests that variation in how needs are identified and responded to becomes more apparent later in childhood, as children come into contact with more targeted services. 

Overall, the differences observed across referral groups, together with the experiences shared by our lived-experience advisors, point to the need for more joined-up and developmentally responsive approaches to supporting children. This is particularly important for children whose neurodivergence- and mental health-related needs overlap and span multiple systems.