Gustaf Waxegard, Linnaeus University, Sweden Hans Thulesius, Lund University, Sweden Abstract Building care pathways for the expansive, heterogeneous, and complex field of neurodevelopmental disorders (ND) is challenging. This classic grounded theory study conceptualizes problems encountered and resolved by professionals in the unpacking—diagnosis and work up—of ND. A care pathway for ND in children and adolescents was observed for six years. Data include interviews, documentation of a dialogue-conference devoted to the ND care pathway, 100+ hours of participant observations, and coding of stakeholder actions. Trust testing explores whether professional unpacking collaboration can occur without being “stuck with the buck” and if other professionals can be approached to solve own unpacking priorities. ND complexity, scarce resources, and diverging stakeholder interests undermine the ability to make selfless collaborative professional choices in the care pathway. ND professionals and managers should pay as much attention to trust issues as they do to structures and patient flows. The trust testing theory may improve the understanding of ND care pathways further as a modified social dilemma framework. Keywords: Care pathways; neurodevelopmental disorders; ADHD; autism; social dilemma. Background In spite of evidence for the need of a more holistic, integrated care pathways for children and youth with neurodevelopmental disorders (ND), including autism spectrum disorders and attention deficit hyperactivity disorder, putting inter-agency care pathways into practice has proved problematic (Evans & Baker, 2012; Kirby & Thomas, 2011; Salmon & Kirby, 2008). Support for the necessity of cooperation and coordination between professional stakeholders with regard to ND comes from multiple sources such as the experiences of parents and families (King, Cathers, King, & Rosenbaum, 2001; Miller, Condin, McKellin, Shaw, Klassen, & Sheps, 2009; Singh et al., 2010), behavioral genetics, which shows a great deal of overlap between different ND diagnoses (Posthuma & Polderman, 2013; Rommelse, Franke, Altink, et al., 2009; Rommelse, Franke, Geurts, Hartman, & Buitelaar, 2010; Ronald, Larsson, Anckarsäter, & Lichtenstein, 2014; Ronald, Simonoff, Kuntsi, Asherson, & Plomin, 2008), research on comorbidity (Gillberg et al., 2004; Leyfer et al., 2006; Yoshida & Uchiyama, 2004), the framework of developmental psychopathology (Rutter, 2013c; Schmidt & Petermann, 2009), preventive research and increased awareness of the need for early identification of ND (Daniels, Halladay, Shih, Elder, & Dawson, 2014; Gillberg, 2010; Halperin, Bédard, & Curchack-Lichtin, 2012), high and increasing prevalence rates (Baron-Cohen et al., 2009; Gillberg, Cederlund, Lamberg, & Zeijlon, 2006; Polanczyk, De Lima, Horta, Biederman, & Rohde, 2007; Willcutt, 2012), and the chronicity and multiple life domains affected by ND (Barkley, 2002; Barkley, Fischer, Smallish, & Fletcher, 2002; Rutter, 2013a; Turgay et al., 2012; Wolraich et al., 2005). The formation of integrated care pathways is no new phenomenon (Campbell, Hotchkiss, Bradshaw, & Porteous, 1998) and is encouraged by governments and health care policymakers across the world. Various theoretical frameworks have been invoked to deal with challenges to integrating care, among these stakeholder theory (Agle et al., 2008; Phillips, Freeman, & Wicks, 2003), complex adaptive systems theory (Brown, 2006; McDaniel Jr, Lanham, & Anderson, 2009), theories of organizational culture (Dodek, Cahill, & Heyland, 2010; Schein, 2006), health care system ecology (Ahgren, 2010), network theory (Mur-Veeman, Hardy, Steenbergen, & Wistow, 2003; Scott & Hofmeyer, 2007), resource dependence theory and institutional theory (Guo & Acar, 2005; Van Raak, Paulus, & Mur-Veeman, 2005). To our knowledge, few of these theories have been employed to analyze ND care pathways. As to ND, different scholars propose different vehicles as the best integrating force to achieve successful care pathways, such as locally agreed professional guidelines (Blew &...