This is the second in an occasional series on neurodiversity in Bermuda

Imagine a child assessed for ADHD, or another neurodevelopmental condition, at 5. Then again at 9, 13, 17. Perhaps 22.

Darrien Ray, a registered psychologist who works with The Reading Clinic, counted the cycle out on his fingers. Schools and exam boards may want updated assessments every few years as a child develops. Each assessment a family have to pay for can run into the thousands.

In my first piece in this series, I wrote about ADHD being real and touched on my own late diagnosis. Recognising it later in life brought a potent combination of relief and grief. It makes me wonder about the children in Bermuda’s classrooms today. How many are struggling quietly — or loudly? How many are learning to hide it, or beginning to believe they simply aren’t good enough? And how often are the adults around them trying to work out whether they qualify or deserve help?

For many families, the first hurdle is whether an assessment is accessible at all. Concern might begin with a teacher, a parent who recognises something familiar, a paediatrician or a speech therapist. Families who can pay privately can approach a psychologist directly. Those relying on insurance generally need a paediatrician’s referral. Dr Ray sometimes advises parents to gather letters from the school, the paediatrician and the psychologist, so that three voices make the same case.

That means that families must do the legwork, gathering documentation from different providers before they can even begin. Dr Ray estimates that the process takes four to five months for most families. Some manage it in weeks; others wait more than a year. Demand often surges around the start and end of the school year, when teachers meet parents and concerns are raised.

Kelly Madeiros, managing director of Solstice, a private provider that carries out assessments, sees the same pattern: “Usually when exam season’s coming up, which is always a bit too late, because it takes a long time to do the whole process.”

What insurance pays for depends on the insurer and the plan. According to Solstice, most plans cover children’s assessments, with clinicians requesting new ones every two or three years as a child develops. But insurers do not cover the administrative report needed for exam accommodations and typically do not cover full adult assessments. The Reading Clinic offers bursaries for learning and reading assessments, though not for every developmental condition. Families can also ask their public school whether an assessment is available.

For families without coverage, the options narrow quickly. And while they wait, their child is still going to school, still trying to learn, and still living with whatever difficulty prompted the need for an assessment in the first place.

That matters because, for a schoolchild, a diagnosis can be a key that unlocks support. Exam accommodations, such as extra time, have to meet the relevant exam board’s criteria and generally require a full assessment, including objective testing. A diagnosis can help explain how a child experiences the world. It can also become the document that determines whether they receive help.

Laura Thomas, director clinical psychologist at Solstice, argues that support should not have to wait for that document.

“Schools should not need a formal diagnosis to provide effective support to children,” she said.

Of course, understanding a child’s needs still matters. That understanding can come from school learning-support services, government assessments or private clinicians. But teachers can begin adapting their approach before a diagnosis arrives. And two children with the same diagnosis may need very different things.

Dr Ray describes children in what he calls “academic purgatory”: not struggling enough to become the squeaky wheel, but not excelling, either.

Think of the bright child who cannot seem to organise their thoughts or work. The quiet one who needs instructions repeated or rephrased before they can put them into action. The pupil with average marks who takes twice as long to complete homework, then comes home physically and mentally exhausted.

It is because they are “managing”, or just barely managing, that perhaps we assume that they are coping. But managing, surviving and thriving are not the same thing.

I remember the comments on my own report cards: “excels”, “does very well”, “exceeds expectations” and then elsewhere, “fails to live up to his potential” or “does not complete work on time”. Looking back, I wonder what the common denominator was. For me, it often had something to do with the bond I had formed with the teacher, the effort they put in, and whether I perceived that effort as a sign that they cared.

Dr Ray sees Primary 3 to Primary 5 as a particularly important window. By middle school, the expectation of independence can mean that a child whose needs were missed earlier finds support harder to access.

So, what if we started somewhere else?

What if the starting point in a classroom was not a child’s diagnosis, but what that child needs? One may need extra time to process instructions, or to hear them worded differently. Another may need a quieter corner or movement breaks. Another may need targeted reading help. A child who absorbs material quickly may need more challenging work to stay engaged.

Needs also change as children grow. Support should change with them. Teachers need the training and resources to respond, and parents should be partners in that process.

This is not an argument for lowering standards or designing a separate curriculum for every pupil. It is about giving every child a fair chance to meet the standards expected of them. Nor does it mean that a diagnosis is unnecessary. Some children will need specialist assessment and more intensive support. A big difference can be made when help begins once a need is seen, not when the paperwork is complete. Crucially, needs-led support cannot mean asking already stretched teachers to do more with the same resources.

As Ms Madeiros puts it: “If you’re going to start ethically doing assessments on children, you should have the resources to then help them.”

There is no official figure for ADHD in Bermuda. The only one that I could find was a private clinic’s 2019 estimate, quoted in the Senate in 2023. How can you design and resource an inclusive system without knowing how many children need support?

None of this is new. In 2013, the education minister said Bermuda had moved towards inclusion without becoming truly inclusive. The policy intended to close that gap was still under review in 2020. Despite searching, I could find no public update since.

Earlier this month, an independent review commissioned by the UK Government recommended moving towards a “needs-led plus diagnosis” system: support should begin when the need is identified, while careful, high-quality diagnosis remains available. It is an idea worth taking seriously in Bermuda.

The timing matters. October is ADHD Awareness Month, and the Education Authority Bill has been tabled in the House of Assembly. If passed, the new board will spend its first 18 months designing the authority’s structure and consulting on it. The minister has identified inclusive education among the reforms the authority will deliver, and the board is to include expertise in supporting vulnerable students. The authority’s remit covers public schools.

This framework is welcome. But two things need to be built-in: genuine learning and neurodevelopmental expertise, alongside the experience of teachers and families; and needs-led support that is part of the design from Day 1, not an after-thought.

The minister calls the authority a foundation. Anyone who has built a house knows that foundations matter, but so does what you put into them. We must put the rod and rebar in before the concrete sets.

I want to reinforce something else: diagnosis matters. For many people, including me, it can help make sense of a lifetime of learning and experience. But no child should have to wait for one before we respond to a need we can already see. And no child should have to fall through the cracks before we notice them.

In the next piece in this series, I want to look at what happens when young people’s needs go unrecognised, not as an exercise in blame, but to ask what happens when children feel excluded, where they turn for belonging, and whether the community is doing enough to keep their options open.

• Paolo Odoli is a former aide-de-camp to two governors of Bermuda and a former government communications officer. He is living in northern Italy with his family