My thanks to Ms Ono, Dr Friedlander, and Dr Salih for their article, “Falling through the cracks: How service gaps leave children with neurodevelopmental disorders and mental health difficulties without the care they need” [BCMJ 2019;61:114-124 [9]]. It is a powerful reminder that children grow up and develop into adults, with the spectrum of neurodevelopmental disorders continuing into adulthood.

I would like to advocate for the substantial number of adult individuals with neurodevelopmental disabilities presenting with mental health distress. These individuals do not have major neurodevelopmental disorders, but one or more specific neurodevelopmental disorders (e.g., speech, language, or communication disorders; ADHD; learning disorders; motor disorders; and others as described in the DSM-5). They, however, were either not diagnosed as children, or were diagnosed but the support and understanding of the impact of these disorders on their later functioning (personal, social, and employment) did not continue into adulthood. Often very capable individuals start to decompensate when their coping mechanisms (to deal with the neurodevelopmental disorder) are overwhelmed. This can have disastrous consequences for the individual and their families (e.g., unemployment, relationship difficulties, social/financial problems). Comorbid mental health disorders can be present or evolve over time. This can often create a vicious cycle of disadvantage and suffering for all involved.

A multiprofessional team should be available to manage the care of the patient and their family. This team should consist of at least a clinical psychologist, a social worker/MCFD social worker, a case manager, an occupational therapist, a therapist/counselor, a pharmacist to advise on complex polypharmacy, and a psychiatrist.

Thank you for creating the platform to participate in discussions.
—Cobus McCallaghan, MBChB
South Surrey

This letter was submitted in response to “Falling through the cracks: How service gaps leave children with neurodevelopmental disorders and mental health difficulties without the care they need.” [9]