Gaps in the training of mental health providers (including but not limited to clinical psychologists and neuropsychologists) disproportionately affect care for individuals at the intersection of neurodevelopmental disability, racial and ethnic diversity, low socioeconomic status, and adverse childhood experiences (Leppert et al., 2023). These gaps have become more apparent with the growing demand for assessment and treatment of individuals with neurodevelopmental disabilities like autism (Huff, 2021). To better support these individuals and their families, we as a field need to collaborate more intentionally, think creatively, and adapt existing approaches to better meet their diverse and complex needs. This requires careful consideration of the foundational skills clinicians need to effectively serve neurodevelopmental populations.
There is no one-size-fits-all approach to caring for individuals with neurodevelopmental disabilities, underscoring the importance of individualized, developmentally informed care (Lord et al., 2022). As a starting point, we propose several core competencies for clinicians that we believe will benefit families. There is a need for clinicians to (1) become well-versed in disciplines that are often not a sufficient part of clinical training including patterns of social, cognitive, and language development; (2) learn how to effectively balance the needs of families and professional expectations in report writing and recommendations (i.e., families often receive psychological reports that are lengthy, jargon-heavy, and difficult to interpret); and (3) move beyond abstract discussions of culturally- and trauma-informed care and more clearly operationalize what these frameworks look like in practice when supporting individuals with neurodevelopmental disabilities.
Knowledge of human development across the lifespan is fundamental to clinical training and practice. Given the prevalence of neurodevelopmental conditions and the associated mental health needs of this population, training programs should emphasize the range of developmental trajectories that may emerge, rather than assuming a linear course. There often is a gap in clinicians’ understanding of neurodevelopmental conditions, both related to developmentally appropriate assessment and treatment. This is mainly due to the limited training that graduate students in traditional clinical psychology programs receive related to treating individuals with NDDs. This lack of training in supporting individuals with NDDs is not limited to the United States but rather seems to be a global problem (J. Razza et al., 2014; Man et al., 2017; Sheerin et al., 2025). Following formal training, clinicians wanting to serve populations with NDDs must often take training into their own hands by completing continuing education courses online (Huff, 2021), but this may not be sufficient for building clinical competence. Results from a U.S. online survey of mental health professionals and organizations serving individuals with NDDs suggested little motivation among established clinicians to seek additional training, with some endorsing the belief that individuals with NDDs cannot benefit from therapy (Lamar, 2020). Authors concluded that “the existing mental healthcare workforce is not prepared to serve people with IDD” (Lamar, 2020). Thus, we propose that psychology curricula be refined to better prepare clinicians to assess and treat individuals with NDDs using culturally- and trauma-informed care.
Assessment
Approximately 22.6% of children in the United States have a mental health, emotional, developmental or behavioral disorder, with the highest rates observed among children living below the poverty line and those who have experienced two or more adverse childhood events (Child and Adolescent Health Measurement Initiative [CAHMI], 2019–2020; Leppert et al., 2023). This overlap makes it particularly challenging to assign accurate diagnoses and could have even larger consequences for appropriate treatment.
Given the overlap in symptoms across diagnoses, it is critical that clinicians have tools that extend beyond mood and anxiety measures to provide a more comprehensive picture of functioning (both areas of strength and challenge). This includes having a range of cognitive assessments in their repertoire to assess for receptive and expressive language, visuospatial skills, abstract reasoning and processing speed abilities. Additionally, assessment of adaptive skills is also beneficial, as it can provide insight into how an individual can navigate daily demands and access their own community. Information obtained from these tools are often instrumental to differential diagnoses and determining appropriate interventions and levels of support for all patients including those with NDDs.
Proficiency in administering a broad range of assessments represents only the first step. For instance, clinical students, including those in specialist areas such as neuropsychology, receive excellent training in the most widely used instruments in cognitive testing, but with little awareness of alternative tests and strategies that better address issues relevant to neurodiverse or developmentally delayed populations. These training gaps include what to do when a patient scores at the floor of an instrument, how to support comprehension of instructions, and how to ensure that a patient is sufficiently motivated to carry out tasks on tests when they do not have automatic social or cultural understanding of why they are participating in these activities. Given the limitations of assessments when administered with individuals with NDDs, results must be interpreted with caution. Interpretation should also account for cultural factors, such as the language spoken in the home, and/or beliefs about disabilities that may lead to different developmental priorities. These challenges highlight the importance of flexible, developmentally informed assessment practices as a core clinical skill, which span beyond administration of assessments alone.
Feedback
Effective communication with family members is essential following assessments and/or throughout treatment as it plays a critical role in patient outcomes. For instance, following an assessment of a young individual or an adult with a severe NDD, caregivers are often given information to help guide the next steps for the patient’s care during a feedback call and through a written clinical report. The content and the way in which information is relayed back to the family will likely influence how the family acts on that information. Although research suggests that reports should be concise and accessible (e.g., without jargon; Gerstle et al., 2025), trainees are often taught to prioritize documentation requirements established by the field of psychology/neuropsychology and insurance providers, rather than focusing on what would be most helpful for the patients themselves.
It is not uncommon to see clinical reports that are over 10-15 pages and templated with a long list of very general recommendations. Based on anecdotal evidence in our own work with families who have children with NDDs, families often report feeling overwhelmed by long reports and unsure about what they should prioritize. If the intention of the report is to communicate with other providers or insurance companies, this needs to be communicated to the family. Providing a brief, plain-language summary letter that highlights key findings and actionable recommendations can improve understanding and follow-through, particularly for families with limited English proficiency or lower levels of formal education. At times, practices within the field are guided more by tradition than by ongoing evaluation because they have been in place for years. However, clinicians need to strike a balance between meeting families’ needs and professional expectations.
Treatment
Assessment findings should directly inform treatment goals and intervention selection. Many individuals with neurodevelopmental disabilities present with co-occurring anxiety, depression, and obsessive-compulsive symptoms. For clinicians, this raises important questions about how evidence-based treatments should be adapted when these conditions occur in the context of a neurodevelopmental profile. Cognitive behavioral therapy (CBT), for example, is an evidence-based treatment for anxiety and related conditions (Peris et al., 2015). However, traditional CBT protocols often rely on abstract reasoning, verbal insight, and independent generalization of skills, which may limit their effectiveness for individuals with NDDs (Wood et al., 2009). As a result, treatment for co-occurring conditions often looks meaningfully different for individuals with NDDs and frequently requires greater caregiver involvement and collaboration with other providers, including psychiatrists.
Exposure and Response Prevention (ERP) is a first-line treatment for obsessive compulsive disorder (OCD), but its implementation with individuals with NDDs requires careful attention to developmental level, cognitive flexibility, communication style, and sensory sensitivities (Boyd et al., 2011; Flygare et al., 2020). Clinicians need experience differentiating anxiety-driven compulsions from developmentally-embedded routines or restricted interests, as well as adjusting exposure tasks to be highly structured and supported by visual cues or modeling. Similarly, individuals with NDDs may present with repetitive behaviors that resemble compulsions but serve different functions. Habit Reversal Training (HRT), including Comprehensive Behavioral Intervention for Tics (CBIT), can be effective for addressing tics and body-focused repetitive behaviors, though adaptations may be required when working with individuals with NDDs (Kohler et al, 2025). These adaptations may include simplified language, increased repetition, environmental modifications, and a greater emphasis on external supports rather than internal self-monitoring. In such cases, treatment success is often tied to aligning intervention strategies with the individual’s developmental profile rather than strict adherence to standard protocols. While some strategies may be effective for some individuals, no single approach will work for all. For psychologists working with neurodevelopmental populations, competence in treatment extends beyond learning modified protocols. It requires the ability to conceptualize how co-occurring conditions interact with neurodevelopmental profiles and to thoughtfully adapt evidence-based interventions accordingly. Training programs must prepare clinicians to move beyond diagnosis-driven treatment models toward developmentally informed, individualized care that reflects the complex realities of individuals with neurodevelopmental disabilities.
Resources for Providers
There are several resources that can help providers strengthen their preparedness to serve individuals with NDDs and their families. Joining different professional listservs (e.g., APA Division 33 Listserv [DIV33], International Collaboration for Diagnostic Evaluation of Autism [IDEA]) may be an accessible first step to identify trainings related to assessment, treatment, and intervention for individuals with NDDs. These listservs also provide opportunities for consultations around assessment and treatment strategies or referral information from colleagues with specialized expertise. Additionally, providers may benefit from attending the annual national and international conferences that focus specifically on issues related to neurodevelopmental disabilities such as the Gatlinburg conference, International Society for Autism Research (INSAR) conference, and the Meeting on Language and Autism. Online resources where providers can find resources for their patients with autism and other NDDs include the Autistic Self Advocacy Network and Autism Speaks, particularly their 100 Day Kits for young children and school age children and their Transition to Adulthood Tool Kit.
References
Boyd, B. A., Woodard, C. R., & Bodfish, J. W. (2011). Modified exposure and response prevention to treat the repetitive behaviors of a child with autism: A case report. Case Reports in Psychiatry, 2011, 241095. https://doi.org/10.1155/2011/241095.
Child and Adolescent Health Measurement Initiative. 2019- 2020 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Accessed March 24, 2022. www.childhealthdata.org.
Flygare, O., Andersson, E., Ringberg, H., Hellstadius, A. C., Edbacken, J., Enander, J., Dahl, M., Aspvall, K., Windh, I., Russell, A., Mataix-Cols, D., & Rück, C. (2020). Adapted cognitive behavior therapy for obsessive-compulsive disorder with co-occurring autism spectrum disorder: A clinical effectiveness study. Autism, 24(1), 190–199. https://doi.org/10.1177/1362361319856974
Gerstle, M., Beattie, J. F., Peugh, J., Quinton, T. L., Bradley, A., LeJeune, B., & Beebe, D. W. (2025). Impact of text difficulty and visual emphasis on pediatric neuropsychological evaluation reports: The parent’s perspective. The Clinical Neuropsychologist, 39(1), 17-36.
Huff, C. (2021). Working with adults with developmental disabilities. Monitor on Psychology, 52(8), 54-61.
- Razza, N., Schwartz Dayan, L., Tomasulo, D., & S. Ballan, M. (2014). Intellectual disability and mental health: Is psychology prepared? Advances in Mental Health and Intellectual Disabilities, 8(6), 381–389. https://doi.org/10.1108/AMHID-04-2014-0010
Kohler, K., Rosen, N., & Piacentini, J. (2025). Description, implementation, and efficacy of the comprehensive behavioral intervention for tics as first-line treatment for tourette and other tic disorders. Journal of Child and Adolescent Psychopharmacology, 35(3), 126-134.
Lamar, R. R. (2020). National needs assessment: Mental health services for people with intellectual and developmental disabilities. Mental Health and Developmental Disabilities National Training Center. https://www.mhddcenter.org/wp-content/uploads/2020/04/MHDD-National-Needs-Assessment-2020.pdf
Leppert, M. L., Bettencourt, A., & Harrison, J. N. (2023). Behavioral concerns in early childhood consultation: diagnostic overshadowing and comorbidity. Clinical pediatrics, 62(11), 1315-1317.
Lord, C., Charman, T., Havdahl, A., Carbone, P., Anagnostou, E., Boyd, B., … & McCauley, J. B. (2022). The Lancet Commission on the future of care and clinical research in autism. The Lancet, 399(10321), 271-334.
Man, J., Kangas, M., Trollor, J., & Sweller, N. (2017). Clinical competencies and training needs of psychologists working with adults with intellectual disability and comorbid mental ill health. Clinical Psychologist, 21(3), 206-214.
Sheerin, F., Fleming, S., Burke, E., Byrne, K., Cleary, M., Doyle, C., & Keenan, P. (2025). Exploring mental health issues in people with an intellectual disability. Learning Disability Practice, 28(2).
Peris, T. S., Compton, S. N., Kendall, P. C., Birmaher, B., Sherrill, J., March, J., … & Piacentini, J. (2015). Trajectories of change in youth anxiety during cognitive—behavior therapy. Journal of consulting and clinical psychology, 83(2), 239.Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224–234.
Maira Tafolla, PhD
Correspondence: mtafolla.magana@ucsf.edu
Nicole Rosen, PhD
Catherine Lord, PhD, ABPP
Board Certified in Clinical Psychology