This informal CPD article ‘When Reasonable Adjustments Are Not Enough: Understanding Complexity in Autism’ was provided by Freda McEwen of Insideout Programme, an organisation offering systemic, trauma-informed, and reflective training for parents, carers, and professionals supporting neurodivergent children and families.
Autism Spectrum Condition is a lifelong neurodevelopmental difference that cannot be treated or cured. Professional responses therefore focus on reasonable adjustments to improve accessibility and reduce distress. While these adjustments are essential, many professionals and parents can report ongoing difficulties even when adjustments are well implemented.
This article explores why reasonable adjustments may not always be sufficient, particularly where co-occurring conditions, trauma, medical experiences, neglect or relational insecurity are present. Drawing on systemic and trauma-informed perspectives, the article highlights the risks of diagnostic overshadowing and emphasises the importance of formulation-led, contextual understanding.
Introduction
Reasonable adjustments are a cornerstone of ethical and lawful practice when supporting autistic children and young people. Across education, health and social care settings, professionals are encouraged to adapt environments, communication and expectations to reduce barriers and support inclusion. For many autistic individuals, these adjustments make a meaningful difference (4).
However, practitioners and parents frequently report situations where reasonable adjustments are in place and implemented with care and consistency, yet the child continues to struggle. Behaviour may escalate, attendance may reduce, sleep may deteriorate or emotional regulation may remain fragile. In these situations, parents often feel blamed or exhausted, and professionals may feel uncertain about what more can be done.
This article highlights that such situations do not necessarily indicate failure of adjustments, parenting or professional competence. Instead, they often signal complexity beyond autism alone, requiring a broader, systemic understanding.
Autism Spectrum Condition: A Neurodevelopmental Overview
Autism Spectrum Condition is a lifelong neurodevelopmental difference that affects how individuals experience communication, sensory input, social interaction and predictability (1, 2). Autism itself is not treatable, and interventions do not aim to change the autistic person. Instead, support focuses on reducing distress and increasing accessibility through environmental and relational adaptations.
Reasonable adjustments typically include predictable routines and clear structure, visual supports, reduced sensory overload, flexible expectations, adapted communication, and safe spaces with supported transitions. These adjustments are necessary and often effective. However, they primarily address accessibility rather than the full range of experiences that may shape a child’s emotional and behavioural responses.
Co-Occurring Conditions and Diagnostic Overshadowing
A significant proportion of autistic children and young people experience co-occurring conditions such as anxiety, trauma-related stress, attachment difficulties, sleep disruption, gastrointestinal discomfort or the impact of prolonged medical treatment (2, 5). These experiences interact with autism and influence regulation and coping capacity.
A key risk in professional practice is diagnostic overshadowing, where all distress and behaviour are attributed to autism. When this occurs, trauma, fear, grief, neglect or unmet basic needs may be overlooked. Reasonable adjustments for autism alone may therefore fail to address the primary driver of distress (3).
The absence of an additional formal diagnosis does not mean that co-occurring experiences are absent. Trauma, neglect and relational insecurity do not always sit neatly within diagnostic categories, yet they have profound effects on behaviour and emotional regulation (3, 6).
Methodology and Practice Approach
This article adopts a practice-based, reflective methodology drawing on anonymised and composite examples from professional settings. Names, identifying details and narratives have been changed to protect confidentiality. The examples are illustrative rather than clinical case studies and are used to support professional learning and reflection.
The analysis is informed by trauma-informed, systemic and neurodevelopmental perspectives, with a focus on understanding behaviour within context rather than isolating it within diagnosis.
Neurodevelopmental perspectives
Practice Examples: When Adjustments Are Not Enough
In professional practice, there are many situations where autistic children continue to display significant distress despite appropriate adjustments.
In one example, an autistic child was removed from the family home by police during the early hours of the morning due to domestic violence and parental substance misuse. Although the child was later cared for by a sibling who implemented consistent routines, calm environments and sensory supports, the child continued to wake at the same time each night distressed and destructive. The behaviour reflected trauma re-enactment linked to time-specific threat rather than failure of adjustments (6, 8).
In another example, an autistic adolescent returned home following a prolonged hospital admission related to a life-limiting illness. Despite reduced timetables and careful transition planning, the young person refused to attend school. The behaviour reflected loss of safety and control following medical trauma rather than avoidance linked to autism (6).
In a further example, an autistic child who had experienced food deprivation began taking food from bins at school. This behaviour was initially attributed to autism, delaying recognition of neglect-related survival responses (6, 8).
These examples demonstrate that reasonable adjustments alone cannot resolve distress rooted in trauma, fear, deprivation or loss of safety.
A Systemic Understanding of Ongoing Distress
From a systemic perspective, a diagnosis of autism sits within a wider network of experiences, relationships and responses. Behaviour cannot be understood without considering what the child has lived through, how safe they feel and how the surrounding system responds.
When reasonable adjustments are not enough, the most helpful question is not what else can be put in place, but what is maintaining this child’s distress. This shift supports formulation over escalation and curiosity over control.
Implications for Professional Practice
Professionals are encouraged to avoid assuming non-compliance or poor implementation, listen carefully to parental narratives and lived experience, consider trauma, neglect, medical history and relational safety, support parents and carers emotionally as well as practically, and move beyond checklist approaches towards formulation-led thinking (3, 7). When distress persists, it often signals the need for deeper understanding rather than additional strategies.
Conclusion
Reasonable adjustments are essential in supporting autistic children and young people, but they are not always sufficient. Autism is a neurodevelopmental difference that requires understanding, accessibility and respect. When distress continues despite appropriate adjustments, professionals must look beyond autism alone and consider co-occurring experiences, trauma and systemic factors.
Reframing these situations as signals of complexity rather than failure supports more ethical, compassionate and effective practice. A systemic, formulation-led approach enables professionals to respond with curiosity, attunement and care, improving outcomes for autistic individuals and their families (3, 7).
We hope this article was helpful. For more information from Insideout Programme, please visit their CPD Member Directory page. Alternatively, you can go to the CPD Industry Hubs for more articles, courses and events relevant to your Continuing Professional Development requirements.
REFERENCES
- World Health Organization. (2019). ICD-11: International Classification of Diseases (11th Revision). WHO.
- American Psychiatric Association. (2022). DSM-5-TR. APA Publishing.
- Bath, H. (2008). The three pillars of trauma-informed care. Reclaiming Children and Youth, 17(3).
- Department for Education. (2015). Special educational needs and disability code of practice: 0 to 25 years.
- NICE. (2022). Autism spectrum disorder in under 19s: support and management (CG170).
- Porges, S. W. (2018). The Polyvagal Theory. Norton.
- Siegel, D. J. (2020). The Developing Mind (3rd ed.). Guilford Press.
- van der Kolk, B. (2014). The Body Keeps the Score. Penguin.
