Barriers and facilitators of vaccination uptake for neurodivergent children and young people: A systematic narrative literature review

Background: Neurodivergent (ND) children and young people, including those with autism spectrum disorder (ASD) and intellectual disability, experience lower routine vaccination uptake than their neurotypical peers. However, the barriers to immunisation for this population are poorly understood.

Methods: A systematic narrative review was conducted across five databases (1995–2025) to identify studies on barriers and facilitators of vaccination uptake in neurodivergent populations aged 5–18 years. Of the seventy four papers returned from the initial search, fifteen met inclusion criteria.

Results: Thematic analysis informed by the COM-B framework indicated that barriers included: (1) capability (e.g., misinformation, safety concerns), (2) opportunity (e.g., sensory, logistical and system-level barriers), and (3) motivation (e.g., distrust, emotional coping). Facilitators included provider trust, tailored communication, and person-centred service adaptations. Vaccine- and age-specific patterns were observed, and higher support needs posed additional procedural challenges.

Conclusion: Improving uptake in neurodivergent populations requires addressing both hesitancy and structural access barriers. Interventions that combine flexible, sensory-aware delivery models with relational communication hold promise for reducing disparities.