On The Milburn Review Response

The Milburn interim report acknowledges that young people who are not in education, employment or training are not simply lazy, unmotivated or deficient in aspiration. It recognises that disability, health, autism, ADHD, school absence, mental distress and benefit claims are now central to the question of youth inactivity.

That recognition is important, but it is not enough.

The deeper problem is that the report continues to separate neurodivergence from the wider body. It repeatedly names autism and ADHD, and it repeatedly discusses co-existing mental health problems, but it does not meaningfully examine the physiological, metabolic, autonomic, connective tissue, neurological, immune and sensory conditions that often coexist with neurodivergence. In doing so, it reproduces the same fragmentation that has harmed divergent people for decades.

I gave extensive evidence on this that apparently contributed to this review, yet I see no sign of that.

Many autistic and ADHD people are not simply autistic or ADHD. They may also be epileptic, hypermobile, dysautonomic. Chronically fatigued, Migraine-prone, Gastrointestinally vulnerable. Immune-sensitive, MCAS, Medication-sensitive. Sleep-disrupted. Sensory-injured. In pain. Living with POTS, connective tissue disorders, inflammatory conditions, endocrine disruption, trauma physiology, mitochondrial stress, or fluctuating capacity that cannot be captured by a simple employability pathway.

Yet policy continues to speak as if neurodivergence exists only in the brain, behaviour, school performance and mental health. This is biologically inadequate and politically dangerous.

If a young person is autistic, ADHD, epileptic, hypermobile, chronically fatigued and dysautonomic, their inability to sustain conventional education or employment cannot be explained by confidence, motivation, aspiration, anxiety, or poor transition planning alone. Their body is part of the evidence and their physiology is part of the policy question. Their health cannot be reduced to a mere psychological barrier.

The report fails to see this.

Instead, it appears to absorb autism and ADHD into a familiar administrative frame: neurodevelopmental diagnosis plus mental health difficulty plus benefit dependency plus labour-market detachment. That frame is neat, convenient, measurable, and it is also incomplete.

A young person may be absent from school because the sensory environment is intolerable. They may be unable to work because standing triggers tachycardia, pain, dizziness or collapse. They may avoid employment not because they lack ambition, but because previous attempts led to seizures, shutdown, burnout, immune flares, injury, trauma or total functional deterioration. They may appear inactive in economic terms while fighting daily to remain alive, regulated and minimally functional.

This is why the language of co-existing mental health problems is not sufficient.

Of course mental health matters. Anxiety, depression, trauma, distress and suicidality are real, but when mental health becomes the default explanatory container for everything that happens to neurodivergent people, it becomes a form of erasure. It allows the state to avoid asking what is happening to the body. It allows physical suffering to be psychologised, systemic harm to be individualised, and multisystem disability to be collapsed into emotional difficulty.

That pattern is familiar to many disabled people. Autistic and ADHD people are told they are anxious when they are overloaded, depressed when they are exhausted, avoidant when they are in pain, behavioural when they are dysregulated, difficult when they are neurologically complex and unmotivated when they are physiologically unable.

The Milburn report heavily risks reproducing that same error at national policy level.

There is also a striking asymmetry in how autism and ADHD are discussed compared with other recognized disabilities. Autism and ADHD are named repeatedly as rising categories within youth inactivity, welfare claims and school difficulty. Would the same policy language be used so casually about Down's syndrome? Epilepsy? Diabetes? Multiple sclerosis? Visible physical disability? Schizophrenia?

Would a government report imply that young people with epilepsy are being channelled too easily into inactivity? Would it discuss Down's syndrome primarily through benefit pathways and labour-market participation? Would it separate diabetes from its complications, then treat the remaining diagnosis as a work-readiness issue?

No, it would likely not.

At least not yet.

Autism and ADHD are treated differently because they are still widely misunderstood as invisible, behavioural, flexible and socially correctable. They occupy a current politically convenient space. They are now recognised enough to appear in statistics, but not always respected enough to be treated as embodied disability. They are serious enough to explain rising claims, but still framed as potentially manageable through the right support, the right attitude, the right job coach, the right pathway.

It allows policymakers to speak about autism and ADHD as though they are categories of labour-market risk, while avoiding the full reality of divergent bodies. It permits the state to ask why autistic and ADHD young people are not working, without asking why so many are becoming medically complex, physically exhausted, systemically unsupported and environmentally overwhelmed.

This matters because the policy response depends on the diagnosis of the problem.

If the problem is understood as young people with autism, ADHD and mental health difficulties drifting away from work, the proposed solution will be employment support, early intervention, workplace adjustments, attendance monitoring, benefit reform and transition pathways.

If the problem is understood as divergent young people carrying complex multisystem physiological burdens inside hostile educational, medical, sensory and economic environments, the solution has to be different. It has to include protected income, specialist healthcare, proper SEND support, flexible education, sensory-safe spaces, non-punitive welfare, recognition of fluctuating capacity, and the possibility that some people cannot work in modern environments.

Not everyone can work; not everyone can be made employable through support. Not every disabled person has unused economic capacity waiting to be unlocked by the state. Some people are too ill; some people fluctuate too severely. Some people have already worked until their body broke. Some people can contribute in meaningful ways that capitalism cannot measure, employ, fund or monetise.

The recent Milburn report response appears unwilling to confront that in its entirety. It recognises that the system has failed, but its centre of gravity remains economic participation. Young people are still discussed primarily in relation to work, productivity, welfare cost, dependency, future labour supply and system efficiency.

This is a narrow moral universe. It treats paid employment as the highest proof of participation and risks treating those outside employment as unresolved policy problems.

Human value is not the same as labour-market value. A person may be a brilliant researcher, artist, carer, thinker, writer, technologist, animal handler, community builder or system-mapper, and still be unable to convert that capacity into a conventional job. That is not because the person lacks value - it is because the economy only recognises value when it can be extracted, priced, taxed or institutionalised.

This is where the report’s silence on capitalism matters.

The crisis is not only that young people are outside work. The crisis is that work itself has become a narrow gateway through which human legitimacy is granted. If your skill cannot be monetised, it is treated as irrelevant. If your body cannot tolerate the workplace, your contribution becomes invisible. If your capacity is nonlinear, your value is doubted. If your intelligence exists outside credentialed institutions, it is ignored.

This is especially damaging for divergent people, whose strengths are often deep, uneven, context-dependent and difficult to standardise. Many neurodivergent and disabled people can produce extraordinary work under the right conditions, but collapse under conventional demands: commuting, noise, fluorescent lighting, arbitrary hierarchy, social masking, unpredictable schedules, attendance rules, open-plan environments, punitive management and bureaucratic assessment.

The problem is not lack of ability; the problem is mismatch.

That mismatch begins early. Mainstream schools are often rigid in their processes - ironically - and often do not teach the way divergent children learn. They expect children to adapt to institutional teaching styles, rather than adapting education to cognitive, sensory and developmental diversity. Neurodivergent children are often natural learners: curious, intense, associative, visual, pattern-based, Gestalt, questioning and deeply capable of absorbing knowledge. Yet the conditions of school frequently make learning unsafe. Sensory overload, social confusion, behavioural control, bullying, lack of autonomy and rigid instruction can turn a love of knowledge into avoidance, shutdown, refusal or trauma.

Then, when those children leave school without the expected qualifications, confidence, social ease or institutional trust, the same system marks them as a future employability problem. This is a manufactured deficit, it is not individual failure. It is the predictable outcome of an education system that punished difference, then blamed the child for the consequences.

The proposed link between youth inactivity, SEND reform and welfare reform therefore requires close scrutiny. There is a risk that the Milburn report becomes a bridge between three policy agendas: reforming SEND, reducing welfare expenditure, and increasing monitoring of young people considered at risk of economic inactivity.

The language may appear benign: early support, participation, opportunity, pathways, accountability, prevention. However, these words can easily become the architecture of surveillance. School absence becomes a risk marker. SEND status becomes a risk marker. Autism and ADHD become risk markers. Health-related benefit claims become risk markers. Families become data points. Children become future economic subjects to be monitored, nudged and corrected before they become too costly.

This is how modern policy systems often operate. They identify a population, define it as at risk, attach metrics, build interventions, link agencies, monitor compliance, and call the result support.

The question is support for whom?

Support for the child’s body, needs, dignity and development? Or support for the state’s desire to reduce future benefit claims and increase labour-market participation?

The deepest question is this: why are so many young people becoming too unwell, overwhelmed, absent, disabled, distressed or unsupported to participate in the first place?

Until that question is answered - physiologically, as well as socially - the review will remain incomplete.

The final report must not use neurodivergence as a justification for tighter welfare controls, more intrusive monitoring, or SEND reforms that track children into compliance rather than protect them from harm. It must not turn disabled young people into a pipeline problem. It must not treat benefit receipt as the failure while ignoring the schools, workplaces, medical systems and economic structures that made benefit receipt necessary.

If the government is serious about youth inactivity, it must stop asking only how to move disabled young people into work and start asking what has happened to their bodies, their schools, their families, their environments, and their futures.

Because many neurodivergent people do want to work.

They also want to be safe.

No policy that forgets the second has any right to demand the first.

Photo by Grace anne bobadilla, unsplash

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