Neurodiversity Series: Why Your Autism or ADHD Assessment Experience Matters

An autism or ADHD assessment is about much more than reaching a diagnostic conclusion. The way you experience the assessment process matters too.

As a Clinical Psychologist, I've worked with many adults seeking an assessment for autism, ADHD or both (sometimes referred to as AuDHD). Of course, an important part of my role as a clinical psychologist is gathering and carefully considering information to establish whether someone meets the relevant diagnostic criteria. However, something I feel equally strongly about is ensuring that the assessment process itself is a positive, supportive and meaningful experience.

For many people, particularly those seeking an autism or ADHD diagnosis in adulthood, an assessment can be an important opportunity to understand themselves and their experiences in a different way. How that process is approached can make a significant difference, not only to the quality of the assessment, but also to how someone understands and relates to the outcome.

More than a diagnosis: An opportunity to understand yourself

A comprehensive neurodevelopmental assessment involves exploring your experiences across your life, from childhood through to adulthood. This includes understanding the things you've found difficult, the ways you've adapted and developed strategies to cope, and the strengths and resilience you've demonstrated along the way.

For many adults, particularly those who have spent years feeling different without really understanding why, this can be the first time they've had the space to reflect on their experiences in such a detailed and structured way. It can be an opportunity to slow down and consider aspects of yourself that you might previously have overlooked, dismissed or simply accepted as being 'just the way you are'.

This can be particularly important for people who have spent much of their lives masking or camouflaging their autistic or ADHD characteristics, adapting to others' expectations, or working exceptionally hard to manage things that seem to come more easily to other people. Although a neurodevelopmental assessment is not therapy, the process of exploring and making sense of your experiences can, in itself, be valuable.

Creating opportunities for shared understanding

Where appropriate, autism and ADHD assessments often involve gathering information from someone who knows you well, such as a parent, partner or another person who has been important in your life. When loved ones are involved in assessment interviews, this can sometimes create opportunities for new understanding.

I've had many experiences where someone supporting an assessment has responded to what they've heard with comments such as, "I never knew you felt like that" or "I had no idea all of that was going on for you underneath the surface". These moments can be quite powerful.

For the person wondering about autism and/or ADHD, there may be an opportunity to explain experiences they've struggled to communicate or perhaps haven't fully understood themselves. For their loved ones, it can offer a window into experiences that haven't always been visible from the outside.

Of course, facilitating shared understanding isn't the primary purpose of a diagnostic assessment, and not everyone will want or benefit from involving someone close to them in this way. However, when approached thoughtfully, these conversations can encourage curiosity, reflection and new ways of understanding one another. Sometimes, an assessment can be the starting point for conversations that continue long after the process has finished.

Why the way assessment interviews are conducted matters

I tend to think of assessment interviews as guided conversations.

There is, of course, a clear structure. A thorough and reliable autism or ADHD assessment needs to explore particular areas of a person's development, experiences and current functioning. Clinicians need to gather sufficient evidence, consider diagnostic criteria and carefully explore other factors that might contribute to someone's experiences. However, this doesn't mean the assessment should feel like a rapid series of questions designed simply to tick diagnostic boxes.

People need time to think, reflect, recall experiences and find ways to explain things that might be quite difficult to put into words. This is particularly relevant when assessing autistic adults and people with ADHD, who may experience differences in processing information, recalling autobiographical memories, recognising internal experiences or communicating their thoughts and feelings. Some people may need additional processing time. Others may find it easier to explain something through examples, or remember important information later in the conversation. A good assessment needs to allow space for this.

In my experience, helping someone feel comfortable, listened to and able to communicate in their own way supports the gathering of richer, more meaningful clinical information. The assessment experience isn't separate from the quality of the assessment. The two are closely connected.

When assessment experiences undermine confidence

I'm sometimes asked to provide second-opinion autism or ADHD assessments. There can be several reasons for this. Sometimes someone has new information about their developmental history or a different understanding of their experiences that they'd like to explore. At other times, however, the person has lost confidence in their original assessment because of how the process was conducted, even when they received a diagnosis.

Over the years, I've heard some quite concerning accounts. People have described feeling that their assessor wasn't really listening, being asked rapid questions without sufficient opportunity to explain their experiences, or receiving inconsistent information from different clinicians involved in their assessment. I've also heard from women who felt that their experiences of ADHD were dismissed because they didn't fit a clinician's expectations of what ADHD typically looks like. Others have described being questioned about why they would want an autism or ADHD assessment in their 50s or 60s, as though there were little value in understanding themselves later in life.

For someone who may already have spent years questioning their experiences, feeling misunderstood or struggling to have their difficulties recognised, an assessment like this can be particularly unsettling. It can also leave someone uncertain about the reliability of the outcome, whether that outcome was a diagnosis or a conclusion that they didn't meet the diagnostic criteria.

This doesn't mean that a good assessment will always result in a diagnosis, or that disagreement with an outcome necessarily indicates a poor assessment. Sometimes a thorough, carefully conducted assessment will conclude that autism or ADHD doesn't provide the best explanation for someone's experiences.

What matters is that the person feels their experiences have been properly explored, that the clinical reasoning is clear and that they understand how the conclusion was reached.

Feeling safe, comfortable and understood during an assessment

On the other hand, I've had many clients reflect positively on aspects of the assessment process that might seem relatively small, but which made an important difference to their experience.

For example, people have appreciated being welcomed into a calm, comfortable environment and being asked about their sensory needs, including whether adjustments to lighting, temperature or seating might help. Others have valued being encouraged to take breaks, move around, use fidget resources or take additional time to process questions. Some have told me they hadn't expected to feel as comfortable or safe as they did while talking about experiences that were sometimes quite personal, emotional or difficult to revisit.

For me, these things aren't simply nice additions to an assessment. They are part of providing a thoughtful, accessible and neuroaffirmative assessment experience. When someone feels at ease, they may find it easier to reflect, recall relevant information and communicate their experiences openly. This is particularly important because many neurodivergent adults have previously experienced difficulties accessing healthcare or communicating effectively with professionals.

Sensory demands, anxiety, processing differences, previous experiences of feeling dismissed and the pressure of trying to explain yourself can all influence how someone engages with an assessment. Taking time to understand these needs, and making appropriate adjustments, can help reduce unnecessary barriers.

Importantly, a neuroaffirmative approach doesn't mean assuming someone is autistic or has ADHD, or working towards a particular diagnostic outcome. It means approaching the person with curiosity, respect and an understanding of neurodevelopmental differences, whilst maintaining the clinical rigour needed for an accurate assessment.

Your assessment experience matters, whatever the outcome

So, why am I sharing this?

Because if you're considering a private adult autism assessment, ADHD assessment or combined autism and ADHD (AuDHD) assessment, I want you to know that how you experience the assessment process matters.

A good assessment should provide opportunities for you to feel listened to, ask questions, reflect on your experiences and communicate in ways that work for you. You should feel able to tell your assessor if something isn't working well, whether that's the pace of the conversation, the environment, the way questions are being asked or something else entirely. You are also entitled to give feedback about your experience, both positive and negative.

Ultimately, a high-quality neurodevelopmental assessment needs to be clinically thorough, thoughtful and carefully considered. But it also needs to recognise that there is a person at the centre of the process, often someone who has spent many years trying to make sense of their experiences.

Whether the assessment results in a diagnosis of autism, ADHD, both, or neither, my hope is that the person leaves feeling that their experiences have been taken seriously, that the conclusions have been clearly explained and that they've gained something valuable from the process.

Because the way we reach an understanding matters, not just the conclusion we arrive at.

Autism, ADHD and AuDHD assessments at Join Psychology

At Join Psychology, we provide comprehensive, neuroaffirmative autism, ADHD and combined autism and ADHD (AuDHD) assessments for adults and young people aged 16 and over. Our assessments are informed by clinical psychology and focus on understanding the whole person, including their developmental experiences, strengths, challenges and individual needs.

If you're considering an assessment, you can find out more about our approach and assessment services at www.joinpsychology.co.uk.