The System That Waits for Crisis (Then Blames the Child)

I came across this research when Dr Georgia Pavlopoulou shared it on LinkedIn — one of many pieces of work she has contributed to that consistently centre autistic children's and young people's real, lived experience of systems that were never built with them in mind. Her research and advocacy have done genuine work in shifting how the autistic CYP community is seen, heard and supported, and this study is no exception.

The study itself, 'Accumulating harm and waiting for crisis': Parents' perspectives of accessing Child and Adolescent Mental Health Services for their autistic child experiencing mental health difficulties, was led by Dr Emma Ashworth, alongside Lucy Bray, Claire Hanlon, Harvey Stanway, Dr Georgia Pavlopoulou, David Moore, Bethany Donaghy, Elizabeth Coen and Ellen Firth, published in Autism (2025). It's their work, their 300 participants, their analysis — I'm writing alongside it, not on behalf of it.

I want to sit with this research from two places at once. As a psychotherapist who works inside a school, seeing children whose mental health is quietly deteriorating inside a system that rarely recognises its own part in that deterioration. And as the parent of a child who was, in real terms, harmed by that same system before we found another way.

What the research actually found

Three hundred parents and carers across the UK, all with an autistic child who had experienced mental health difficulties, were surveyed about their experience of trying to get help. The picture that emerges is not one of occasional failure. It's a pattern — consistent, structural, and repeated at almost every point along the pathway.

Children in this study were, on average, attending school for 2.7 days a week — not because of truancy, but because the environment itself had become unbearable. And when parents did seek help, the system they met was one built to notice crisis, not to prevent it.

Diagnostic overshadowing: the mechanism doing the harm

The term that runs through almost every section of this study is diagnostic overshadowing — the assumption that a mental health difficulty is simply "part of" a child's autism, rather than something distinct that deserves its own attention and treatment. It shows up as: "anxiety is part of autism, so there's nothing to refer." It shows up as children being turned away because their distress is read as a behaviour to be managed rather than a mental health need to be met.

This isn't a small clinical quirk. It's the mechanism by which autistic children are systematically pushed further down a pathway that only responds once they are in crisis — because until then, their pain doesn't register as separate from their autism at all.

The school–CAMHS loop

One of the most striking findings, for me, sits right at the start of the pathway. Parents described being caught in a loop between school and GP, each institution pointing at the other: "doctor said school should refer, school said doctor should refer." Meanwhile, the child in the middle of that loop keeps deteriorating.

What the study also makes clear — and what I see constantly in my school-based work — is that for many autistic children, the school environment itself is not a neutral backdrop to their mental health difficulties. It is often the primary source of them. One parent put it plainly:

And yet the system asks CAMHS to treat the child's distress without ever asking the school to examine its own contribution to it. We treat the symptom and leave the environment untouched. This is the part of the picture I sit with most as a practitioner inside a school — the near-total absence of institutional self-reflection about what school itself is doing to a child's nervous system.

What the researchers recommend

The authors don't just describe the problem — they set out clear, practical recommendations. Among the most important:

What struck me most, reading through the parents' accounts, was how rarely they blamed individual professionals. Most spoke of kind, well-meaning people working inside a system that gave them neither the training nor the resources to do right by autistic children. That distinction matters. This isn't a story about uncaring clinicians — it's a story about an under-resourced, deficit-framed system that hasn't caught up with what autistic children actually need.

With thanks to Dr Emma Ashworth and her co-authors for undertaking this research, to the 300 parents and carers who shared often painful experiences to make it possible, and to Dr Georgia Pavlopoulou for continuing to put work like this in front of people who need to see it.

Reference: Ashworth, E., Bray, L., Hanlon, C., Stanway, H., Pavlopoulou, G., Moore, D., Donaghy, B., Coen, E., & Firth, E. (2025). 'Accumulating harm and waiting for crisis': Parents' perspectives of accessing Child and Adolescent Mental Health Services for their autistic child experiencing mental health difficulties. Autism, 29(8), 2111–2122. Read the full open-access paper via PMC.