Introduction: Compared to their neurotypical peers, children and adolescents with neurodevelopmental disorders (NDs) experience worse mental health outcomes, including greater service use and functional impairment. Few studies, however, have examined the neurodevelopmental contributions to mental health complexity among those seeking community-based mental health services. Methods: Archival data from a publicly-funded mental health center was used to test the generalizability of a path model predicting service use among those with (n = 66) and without (n = 97) NDs. Results: Those with NDs were found to experience more symptoms and had greater service use than those without NDs, and there were notable differences in the predictive pathways across groups. Specifically, the paths from internalizing challenges, early life adversity, and biological sex were only significant among the ND group. Conclusions: These findings indicate that neurodevelopmental status is an important moderator of mental health outcomes that warrants consideration when treating complex cases.