Its hard to be discrete

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My 16 year old brother still wears diapers. He has issues with knowing when to go and he wears them so that he is always dry. But now, that he is in 10th grade it embarasses him.

He hates how the top part is sometimes visible. Sometimes its bulgey as well. He also hates how he has to go to the nurses office to get assistance with changing. He knows he needs to wear them though. The last time he didnt wear one he had an accident.

My parents have always been concerned about being discrete. He wears pants that are a bit big and they always pull him aside when he needs a change. They are worried about school though. He is in a special education class for 3 classes of the day

I know it's hard on a smart kid when he has to wear diapers.

What is it that causes him "not to know when he has to go?" Is it some kind of neurological issue?