Following on from this article on the problems with neurodivergent research in the Global South, we are now looking at the five main reasons that people cannot access therapy services.

While many of these barriers are not unique to this population group, the cumulative effect of multiple intersectional identities can make it effectively impossible for these individuals to access even frontline mental health support, let alone psychosexual therapy. These barriers can be grouped into five main themes:

1. Access to culturally appropriate diagnostic services and assessment tools
2. Accessibility barriers to general therapeutic services
3. Communication problems with mental health professionals
4. Lack of social awareness and community support
5. Social isolation, shame, and stigma

1. Access to culturally appropriate diagnostic services and assessment tools

There is a consistent and widely acknowledged male bias in neurodevelopmental disorders, particularly in autism (Santos et al., 2022). The putative gender ratios are 3:1 for autism and 2.3:1 for ADHD (Loomes, 2017). Moreover, for ADHD, a girl's first consultation occurs at an older age and takes more clinical visits than for a boy.

Autism is significantly underdiagnosed and misdiagnosed in non-white communities. Even in the US, Latino children typically receive a diagnosis 2.5 years later than white non-Latino children. White children typically receive their diagnosis around 6 years old, compared with 7.9 years for Black children (Zukerman et al., 2015).

The two "gold standard" autism assessment tools (ADOS-2 and ADI-R) lack diverse translations. Most versions are only available in European and Scandinavian languages. It is crucial that this be addressed, "especially in rural and underserved areas, through increased funding and the availability of trained mental health professionals specialised in diagnosis and treatment" (Olatunji et al., 2023).

2. Accessibility barriers to general therapeutic services

Socioeconomic factors like poverty, lack of education, and gender inequality make accessing therapeutic services significantly harder. Psychosexual therapy, in particular, is a secondary mental health service, if provided at all by the state. Therefore, it is usually accessed privately, making it a "luxury" out of reach for many neurodivergent adults with learning difficulties who may struggle to obtain or maintain employment.

Practical barriers also exist in how services are booked. Many neurodivergent adults have a strong aversion to talking on the phone, which may be the only booking method. Those with ADHD may struggle with appointment reminders and punctuality; many services simply discharge patients who are repeatedly late, creating a "revolving door" that prevents actual treatment.

3. Communication problems with mental health professionals

Many national mental health services persist in using colonial rather than indigenous languages. This elitist gatekeeping forces people to express deeply personal experiences in their second, third, or fourth language. Furthermore, the medicalised approach to mental health often dismisses or criticises individuals’ lived experiences.

Linguistic framing also impacts perception. For example:

• In Mainland China, gūdúzhèng (孤独症) translates to "loneliness disease."
• In other Chinese-speaking countries, zìbìzhèng (自闭症) means "closed-self disease."
• In Japan, jihei-shō (自閉症) also highlights social isolation.

In contrast, the French Autisme and English Autism are moving toward being viewed not as an illness to fix, but as an atypical way of being in the world.

4. Lack of social awareness and community support

In many countries, social awareness of neurodivergence is critically low. In a survey on autism awareness, only 13% of participants in India had heard of autism, compared to 100% in the USA (Kapoor, 2019).

In many Latin American cultures, being neurodivergent is often perceived as failing to live up to heteronormative gender stereotypes. Furthermore, the absence of neurotype-based community groups leads to a sense of not belonging and feeling burdensome, both of which are key contributing factors to self-harm and suicidal episodes among autistic people (Pelton et al., 2023).

5. Social isolation, shame, and stigma

Neurodivergence is often viewed as failing to live up to normative societal benchmarks. For example, behaviour labelled as "gifted" in one population may be labelled "disruptive" in another. Many parents worldwide refuse to seek a diagnosis for their children due to intense fear of social stigma.

In a Chinese study, 70% of parents of autistic children felt neglected and discriminated against by society. This intense focus on conformity means that children, especially those without significant language impairments, often fail to receive the specific education they need (Baimbridge-Sutton, 2020).

For a more hopeful perspective on how neurodivergent communities are creating their own spaces for connection, healing, and self-expression, you might also enjoy Neurodivergent Content Creators Redefining Sex, Sexuality, and Relationships.

If you are looking for a more personal and empowering next step, you are warmly invited to join us for Neurodivergent Me, a free, self-paced, 4-week online course designed to help neurodivergent adults explore and better understand their unique sensory needs. Sign up here — we would love to welcome you.