Diagnostic criteria are prerequisites for a diagnosis: in the case of neurodivergence, they are the presentations and traits an assessor is looking for when diagnosing a person with a neurodivergent condition.
What happens during an assessment?
During an autism or ADHD assessment, the diagnostic physician should perform a holistic, in-depth overview of the person’s life, going back to childhood, and covering how they feel and what their goals are.
While the initial assessment before a referral to a specialist often includes tests, the in-depth assessment uses varied tools. These can be interviews with the person, questionnaires, or talking to people who’ve known them from childhood.
The assessor should also have an overview of all neurodivergent conditions, not the ones they are assessing, as there are many overlaps. 1 2
Are the diagnostic criteria biased?
The diagnostic criteria for autism are built around two domains: differences in social communication and interaction, and restricted repetitive behaviours — a category that encompasses a much wider range of experiences than the stereotype of “lining things up” suggests, including sensory needs, routines, focused interests, and verbal patterns.
The diagnostic criteria for ADHD are organised around three presentations — inattentive, hyperactive, and impulsive —, but the lived experience extends well beyond those categories into executive dysfunction, emotional dysregulation (including rejection sensitivity), time blindness, and difficulties with working memory, none of which appear in the formal criteria despite being some of the most disabling and recognisable parts of daily life with ADHD.
Not all diagnostic processes are as thorough and affirming, unfortunately.
In many countries, “suffering” as a result of a condition is a prerequisite for getting a diagnosis when the neurodivergent experience is more nuanced than that.
Neurodivergent people, especially women, also often go undiagnosed because masking and adaptations go unnoticed or are not taken into consideration. Outdated (and honestly, often ableist) views also prevent people from getting diagnosed, as some doctors still think that if someone has a job, they can’t have ADHD, or if they are in a relationship, that immediately rules out Autism.
Furthermore, many autistic and ADHD traits that are required for a diagnosis are often simply how a neurodivergent individual experiences distress when their needs are not met.
Assessment questions also have a tendency to overvalue how the individual’s presentation might be disturbing or uncomfortable for their peers, as if someone’s needs are only worthy of support if that means their environment will be less bothered by them.
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