The Only Door.

There is a statistic doing the rounds that suggests roughly one in six boys are now on the National Disability Insurance Scheme. It has the shape of a crisis, which is usually enough for it to be treated as one. The assumption follows quickly: something must be going wrong with the boys. That may be the least interesting explanation available.

On the Sunshine Coast, and more so once you head inland, the more immediate fact is simpler. If a child is struggling, speech, attention, behaviour, the low-grade frictions that make school difficult, there are not many places to go. The public system will see the most acute cases, schools do what they can, which varies and private therapy exists, at a price and often after a wait. The distances are manageable until they are not.

What does work, reliably, is the NDIS. It is not the only support available but it is the only one that is consistently there. And so a diagnosis begins to do two jobs at once: it describes the child, and it unlocks the system. It is around this point that the question of boys re-enters. Boys tend to be noticed earlier. They move more, interrupt more and sit less easily inside the expectations of the classroom. None of this is new. What may have changed is the tolerance for it, and the capacity to accommodate it without formal support. A restless boy in a well-resourced setting is one kind of problem. The same boy in a classroom stretched for time and support is another. In one case he is managed. In the other, he is assessed. This is not quite the same as saying he is disordered, it is closer to saying he is difficult to fit.

The language has expanded to meet that difficulty. Autism and ADHD now describe a wide range of presentations, from profound impairment to something closer to persistent mismatch. The expansion is not necessarily wrong. It is, in many cases, overdue. But it does introduce a quieter problem. As the categories widen, they gather more children. Some need substantial, ongoing support. Others need something lighter, earlier, more situational. The system, however, is not especially good at making that distinction in practice. It has one well-lit doorway and a number of dimmer alternatives. So families make rational decisions, they go where the help is.

In parts of the hinterland, that decision is shaped by fairly ordinary constraints. How far to the nearest paediatrician, how long the wait, whether the school has access to a counsellor this term or whether a speech therapist has an opening before the end of the year. These are not diagnostic criteria, but they have a way of becoming decisive. The result is a system that appears, from a distance, to be expanding rapidly and somewhat mysteriously. Up close, it looks more like water finding the only available channel.

There is a tendency, particularly in political discussion, to treat this as a problem of cost. The numbers are large and getting larger, which tends to concentrate attention. It is a narrower question than it first appears. If one in six boys now requires a diagnosis to access consistent help, the more awkward question is not how to reduce that number, but what sits behind it. Systems do not usually grow at this pace without being asked to do more than they were designed for.

At present, the NDIS is carrying a certain amount of that excess demand, not because it was intended to, but because it can. Which leaves a slightly uncomfortable possibility.

The issue may not be that too many boys are being labelled.

It may be that the label has become the only practical way to be seen.

Remove the label, and it is not clear what, exactly, replaces it.

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The views expressed are those of the correspondent. Factual claims draw on publicly available sources.