Square Pegs, Round Holes: The SEND Crisis, Education and the Future of ADHD and Neurodivergence

By Dr Rachel V. Gow, PhD, RNutr, FHEAChild Neuropsychologist, Nutritional Neuroscientist and Founder of Nutritious Minds Trust Charity

Perhaps you have watched a bright, imaginative child begin to lose confidence in a system that was supposed to help them flourish.

The child who once asked endless questions now avoids putting up their hand. The child who can speak with extraordinary knowledge about animals, space, music, gaming or engineering has begun to call themselves “stupid”. The child who appears calm and compliant throughout the school day returns home and falls apart over what appears to you as a small request.

Friends and family have suggested you need to apply firmer boundaries, and more consequences. Teachers may start describing your child as disruptive, oppositional, inattentive, defiant or disengaged. The words, “could do better’” and “not performing to their potential” are communicated in school reports and meetings.

But what happens when a child’s behaviour is attracting everyone’s attention, but not the problem itself? Too often, adults misunderstand that behaviour itself, is a form of language, a means of communication when a child cannot articulate in words due to overwhelm, frustration and dysregulation.

Children and young people who are undiagnosed, yet, neurodivergent are repeatedly asked to function in an environment that does not recognise their needs. An environment that metaphorically speaks another language.

This is often the uncomfortable reality at the centre of the SEND crisis. Too many neurodivergent children are being treated like square pegs expected to squeeze themselves into round holes. When they cannot, the child is blamed for the mismatch rather than the mainstream education system being asked to change.

It Is Rarely “Just ADHD” or “Just Autism”

Neurodivergence is an umbrella term describing different ways in which the brain may develop, process information, regulate attention, interpret sensory input, learn, communicate, move and respond to the environment.

It can encompass ADHD, autism, dyslexia, dyspraxia or developmental coordination disorder, dyscalculia, developmental language disorder, Tourette syndrome and a range of related developmental profiles. Children may also experience anxiety, obsessive-compulsive disorder, selective mutism, epilepsy, sleep disorders, sensory processing differences, trauma-related needs or avoidant and restrictive eating.

The important point is that these difficulties rarely arrive in neat, isolated diagnostic boxes.

A child may have ADHD alongside dyslexia, anxiety and sensory processing differences. An autistic child may also experience ADHD, restricted eating, sleep disruption, language-processing needs and emotional dysregulation. Another child may have dyspraxia, dyscalculia and low confidence following years of criticism attached to untidy work, forgotten equipment, slow processing or poor coordination.

Clinical research has documented that approximately 73% of children with ADHD and 64% of autistic children are reported to have at least one additional condition. There is also substantial overlap between autism and ADHD, emotional dysregulation, anxiety, literacy difficulties and restrictive eating.

This matters because a single-label response can lead to single-issue support.

For example, a movement break may help a child with ADHD, but will not address unidentified dyslexia. A visual timetable may improve predictability, but it will not resolve severe sensory distress or anxiety. A behaviour chart may record how often a child leaves the classroom, but it cannot explain whether they are escaping noise, confusion, shame, panic or repeated frustration from perceived academic failure.

A child’s learning profile, communication, sensory processing, executive functioning, emotional regulation, physical health, sleep, nutrition, family context and environment are interconnected. When one part is overlooked, the support offered may be too narrow to make a meaningful difference.

When Distress Is Mistaken for Behaviour

Perhaps you have noticed that neurodivergent distress does not always resemble sadness or fear.

It may appear as laughing at an inappropriate moment, refusing to begin a task, arguing, swearing, ripping up work, leaving the room or putting a head down on the desk. It may present as taking on a persona of the class clown before anyone discovers that reading aloud feels unbearable. It may also look like perfect behaviour at school followed by an explosive collapse at home.

A child who appears not to listen may be unable to process a long sequence of spoken instructions. A pupil who refuses to write may be protecting themselves from another experience of humiliation. A child who becomes aggressive during transitions may be reacting to uncertainty, sensory overload or a sudden loss of control. A young person who appears unmotivated may already be using every available resource simply to remain in the room.

Looking beyond behaviour does not mean ignoring harm, abandoning boundaries or expecting teachers to tolerate unsafe conditions. Teachers are working under considerable pressure, and increasing reports of aggression and violence in schools must be taken seriously.

However, understanding behaviour is not the same as excusing it. It gives adults a greater chance of responding effectively.

Consequences may temporarily stop an action, but they do not teach a child to read fluently, process language, organise their thoughts, regulate intense emotions or tolerate sensory pain. When the underlying need remains untouched, the behaviour often returns, intensifies or changes into avoidance.

The more helpful question is not simply, “How do we stop this behaviour?” It is, “What is this behaviour communicating, and “what type of support can we provide?”.

A System Under Extraordinary Pressure

The SEND crisis is not an abstract policy debate. It is lived daily by children, parents, teachers, SENCOs and professionals attempting to hold together a system that has become increasingly difficult to navigate.

More than 1.7 million pupils in England are identified as having special educational needs. Around 700, 000 children and young people have Education, Health and Care Plans, while more than 1.3 million receive SEN Support without an EHCP. The number of pupils with EHC plans has risen sharply over the past decade, yet access to specialist provision, educational psychology, speech and language therapy, occupational therapy and appropriate placements has not expanded at the same pace.

Families may wait months or years for assessment. Schools are expected to support increasingly complex developmental profiles without sufficient funding, specialist knowledge or external professional input. Local authorities face intense financial pressure, while children deteriorate during arguments about thresholds, categories, budgets and responsibility.

The SEND system is intended to operate through a graduated approach. Ordinarily available provision should include inclusive teaching and everyday classroom adjustments. SEN Support needs to provide more targeted and individualised intervention. An EHCP should secure coordinated and legally enforceable provision when a child’s needs cannot reasonably be met through ordinary school support alone.

On paper, this appears sensible. In practice, many families discover that meaningful support arrives only after the child has fallen substantially behind, stopped attending, received repeated sanctions or reached a point of complete crisis.

That is not early intervention. It is delayed reaction.

Why EHCPs Matter

An Education, Health and Care Plan is not merely an administrative document. It is intended to translate a child’s needs into clear, coordinated and enforceable provision across education, health and care.

A strong EHCP should describe the full profile rather than reducing the young person to a diagnosis or often mismatched category. It should identify each educational need and state precisely what support must be provided.

In England, the SEND Code of Practice groups Special Educational Needs into four broad areas of need: communication and interaction; cognition and learning; social, emotional and mental health; and sensory and/or physical needs.

These categories are used by schools, SENCOs and local authorities to identify the type of support a child may require. They are helpful administratively, but they can also be quite blunt tools, because children rarely fit neatly into one category.

For example, an autistic child may have communication and interaction needs, but also sensory processing differences, anxiety, school avoidance, restricted eating or emotional dysregulation. A child with ADHD may be placed under SEMH, but may also have executive-function difficulties, dyslexia, sensory needs or sleep and eating-related challenges.

This matters for EHCPs because if a child’s full profile is not properly described, the support offered may be too narrow or linked to the wrong category of need. The key point is that SEND categories should guide support, not reduce a complex child to a single label.

For example,  “access to support” is not the same as receiving support. “Regular opportunities for movement” does not explain how frequently those opportunities will occur. “Help with emotional regulation” does not identify who will provide it, for how long or through which approach.

Effective provision must be specific and quantified. The plan should explain what support will be delivered, how often, for how long, by whom and for which identified need. This may include specialist literacy teaching, speech and language therapy, occupational therapy, individual assistance, sensory regulation, mentoring, assistive technology or a specialist placement.

Professional evidence can be invaluable. Reports from educational psychologists, clinical psychologists, psychiatrists, paediatricians, speech and language therapists and occupational therapists can clarify how a child’s profile affects their access to education.

A diagnosis is not necessarily required before support begins, but it can help, and schools should respond to a clearly observed need. It is strongly recommended that the parent undertakes a thorough investigation of their child or young person, resulting in detailed, diagnostic and professional reports containing EHCP supportive language. Such investigative reports are can help prevent difficulties from being minimised, miscategorised or interpreted solely as poor behaviour.

The wording of an EHCP matters because the provision recorded within it is legally enforceable. Vague plans create vague accountability. Clear plans establish defined responsibility.

Inclusion Without Provision Is Not Inclusion

The principle of inclusion is an important topic. Some neurodivergent children are segregated from their peers in allocated learning units and/or denied social and learning opportunities leading to a heightened risk of  exclusion coupled with long-lasting consequences to their self-esteem and confidence.

However, inclusion is not achieved simply by placing a child in a mainstream classroom and hoping that they adapt.

Real inclusion requires suitable teaching, specialist expertise, appropriate staffing, sensory-aware environments, therapeutic input, flexibility and adequate funding. Without these foundations, mainstream placement can become a particularly painful form of exclusion.

The child or young person may be physically present but unable to participate. They may spend much of the day outside the classroom, on a reduced timetable, in corridors, in isolation or waiting to be collected. They may remain technically enrolled while receiving very little meaningful education.

Some neurodivergent children can thrive in mainstream schools when appropriate provision is in place. Others need specialist environments. The decision should not be driven by ideology, financial pressure or assumptions about what inclusion ought to look like. The central question should be: what is the best provision for this young person to learn, self-regulate, develop skills, and belong?

There is no doubt, that inclusion without sufficient provision, specialist staff and funding has arguably contributed to the present crisis. Inclusion is the lived experience of being able to participate, progress and belong.

When School Becomes Impossible

Neurodivergent young people can develop school avoidance, refusal, and in worse, cases school phobia. The dread and anticipatory anxiety can begin on a Sunday evening. A stomach ache appears on Monday morning. Sleep often becomes disturbed. The uniform may feel unbearable. The journey to school can trigger panic. Eventually, the young person cannot cross the threshold into an environment that feels unsafe.

School absence is often framed as a compliance problem. Parents may be reminded of attendance targets, legal duties, penalties and prosecution. Yet persistent absence is significantly higher among children with SEND.

For example, in 2023–24, persistent absence impacted 34.2% of pupils with an EHC plan and 26.3% of pupils receiving SEN Support, compared with 14.7% of pupils without identified SEN.

The question needed to be raised here is not simply “how do we make this child return?” but, “what has made school feel unsafe, intolerable or impossible?”.

The barrier may be bullying, sensory overwhelm, unmet learning needs, communication difficulties, anxiety, masking, shame, hunger, exhaustion, burnout or repeated punishment. A young person may want an education while being unable to tolerate the environment in which it is offered.

Pressure without understanding can intensify distress. The child feels disbelieved. The parent feels blamed. The school feels powerless. Relationships deteriorate while the original need remains unresolved.

Attendance is not created by pressure alone. It develops through safety, trust, access, regulation and belonging.

Exclusion: When Misunderstanding Becomes Removal

School suspensions and permanent exclusions are rising. In spring 2025, 3,320 pupils were permanently excluded from schools in England and more than 312,000 suspensions were recorded. Primary-school exclusions reached a record high, with 558 primary pupils permanently excluded during that term.

These are very young children, and we need to ask what has already gone wrong when a primary-aged child is permanently removed from education?

The inequality is stark. Children receiving SEN Support were almost six times more likely to be permanently excluded than pupils with no identified SEN. Children eligible for free school meals were also almost six times more likely to be excluded than those who were not.

This is not simply a behaviour problem. It is a SEND problem, a poverty problem, an inequality problem and a safeguarding problem.

Teachers deserve safety, meaningful training and effective support. But greater exclusion cannot be the only response. When neurodivergent children and children living in poverty are removed at disproportionate rates, the system must examine what sits beneath the behaviour.

Was the child overwhelmed, academically lost, unable to communicate, sleep-deprived, traumatised, hungry, ashamed, undiagnosed or repeatedly sanctioned without effective support?

Exclusion may remove an immediate difficulty from one classroom, but it can begin a much longer pathway of disadvantage.

The Playground-to-Prison Pipeline

A child excluded from school does not simply lose lessons. They may lose routine, trusted adults, friendship, identity and connection to a wider community. Academic gaps increase, self-esteem deteriorates and vulnerability to exploitation may grow.

The term playground-to-prison pipeline describes the cumulative pathway through which unmet SEND needs, poverty, exclusion, trauma and marginalisation can increase vulnerability to later criminal-justice involvement.

It does not suggest that every excluded child will offend. It identifies a preventable pattern.

By the time a neurodivergent young person reaches the criminal-justice system, there may have been years of missed signals: the forgotten homework, the unread book, the unexplained outburst, the repeated detention, the reduced timetable, the suspension and finally the permanent exclusion.

At every stage, an opportunity existed to ask a different question. Not, “what is wrong with this child?” but “what has been missed, and what support is required now?”.

Waiting for a Diagnosis

Children should not have to wait years before their needs are understood. Yet ADHD and autism assessment pathways are overwhelmed.

There are currently approximately 270,000 open referrals for suspected autism, with most individuals waiting beyond recommended timescales. ADHD waiting times vary sizeably by location, producing a type of postcode lottery in which some children wait weeks while others wait several years.

Families able to pay privately may obtain assessments more quickly. Those without the financial means may remain on waiting lists while their child’s education, emotional wellbeing and confidence deteriorate.

Girls are particularly vulnerable to being missed. Their neurodivergence may be concealed beneath compliance, perfectionism, anxiety, people-pleasing, hormones (puberty) or exhaustion. They may not necessarily disrupt the classroom, but can often disappear quietly within it.

During that wait time, a young person may experience a growing conviction that they are fundamentally at fault. Behaviour can worsen and risks increase. Parents and families need to be supported while waiting for a diagnostic assessment, and Nutritious Minds Trust wants to be that supportive space.

Prevention Before Crisis

Repeated detentions are information. Persistent lateness is information. Avoidance of reading is information. Distress during transitions is information. Going all day without eating is information. Holding everything together at school and collapsing at home is information.

Early intervention begins by noticing patterns before they become crises. It requires professionals who are curious to step in before punitive measures are actioned.

Young people who are neurodivergent may struggle with written work but be exceptional at music production, filmmaking, visual art, engineering, construction, coding or practical problem-solving. Creative and vocational strengths need to be available for those who do not fit conventional academic measures. They can become routes into building confidence, identity, achievement and future employment.

Nutritious Minds Trust Charity is developing BEAANS (Beats, Exercise, Art, ADHD and Nutrition Study) as a preventative early-intervention programme for neurodivergent children at risk of school disengagement, repeated sanctions or exclusion. The BEAANS model brings together creative activities (film production, music, art), physical activity, nutrition and mentoring to build connection and positive pathways before difficulties escalate further. We are seeking funding to launch BEAANS by 2027, and want to hear from you in you are also passionate about early impact, preventative interventions, and grassroots, community projects.

The Future Must Look Different

SEND reform must extend beyond new terminology, digital plans or promises of inclusion. It requires timely assessment, specific provision, trained staff, accountable decision-making, adequate funding, genuine partnership with families and the courage to accept that some children need environments designed differently.

Square pegs do not fail just because they cannot fit into round holes. The mismatch lies in the design. Therefore, we need to consider new models of education.

A truly inclusive education system would not ask every child to learn, communicate, regulate and demonstrate intelligence in the same way. It would recognise difference early, respond with flexibility, nourish strengths, understand distress and create multiple pathways through which children can succeed.

The SEND crisis is real, but the crisis does not have to be the final chapter. The future can be built around prevention rather than punishment, provision rather than promises and understanding rather than blame.

That is the educational model that neurodivergent (and all) children deserve.