Recently there has been increased media focus on Neurodiversity in adults. With the Christine McGuinness and Chris Packham documentaries looking at autism in adulthood and the recent documentary by BBC Journalist Ben Moore, focusing on late diagnosis of neurodivergence, including his own journey with late life diagnosis of ADHD (Attention Deficit Hyperactivity Disorder).
So, what exactly is Neurodivergence? There are a range of conditions included in this description. The term Neurodivergence is not a clinical term or diagnosis in itself, but a term used to describe conditions including autism, ADHD, Tourette’s and Dyslexia. These conditions can be diagnosed in childhood but there are many people who receive a diagnosis much later in life. For some they have never been assessed or even realise that they have these conditions.
There are several issues to consider in relation to later life diagnosis of neurodivergent conditions, including how these conditions present and are understood by others. Differential diagnosis is an important concept here. It refers to distinguishing a particular condition from others that may present similarly. In the case of autism and ADHD there can be overlapping similarities. Autism and ADHD can also be confused with Social Anxiety, generalised anxiety disorder, obsessive compulsive disorder, Personality Disorder (avoidant and Borderline and Schizoid Personality Disorders) Sensory Processing Disorder, Reactive Attachment Disorder, Developmental Delay and Speech and Communication Problems. It is also worth discussing the fact that for many individuals may present with mental health issues such as lowered mood and anxiety. These presentations can often overshadow looking at the wider global picture in respect to an individual’s presentation.
These factors can often lead to an individual not being considered as neurodivergent resulting in many entering adulthood without being recognised as neurodivergent.
Many adults report that they have felt ‘different’ and ‘not fitting in’ throughout their childhood/adolescence and beyond. This can exert a profound effect on their emotional wellbeing. Hence the frequency of adults who experience mental health issues which are often the reason for them accessing support or coming to the attention of services. When it comes to gender, there is a body of research indicating that there can be gender differences in the way that some of these Neurodivergent conditions present, which can mean that they are more frequently missed in females. Autism being a key player here. Autism in females can be harder to spot and there for lower rates of diagnosis. The role of ‘masking’ in females contributes to this. Females are shown to be more likely to mask their symptoms compared to males. Assessment methods are also heavily weighted to male characteristics of autism which historically has therefore led to misdiagnosis in females being assessed using these methods. Male characteristics are often more ‘visible’ or overt compared to females and these characteristics are overly relied on as needing to be present in females. Many females report being continually told “you can’t have autism” because of presentation that is usually found in males is rigidly applied to them. It’s therefore not surprising that females are often misdiagnosed with other conditions such as social anxiety or OCD.
In summary- the assessment process is complex, and a robust formulation is necessary in order to fully consider all aspects of an individual’s presentation. it is important to consider the full profile not just current presentation. This includes developmental history, schooling, family history and completing specific questionnaires, tests, and observations. This should be done by an appropriately qualified and regulated professional.
The impact of late diagnosis can be significant. Many report feeling a sense of tremendous relief when they are supported to understand their presentation. It can provide relief from years of masking, social fatigue, and sensory overload. Many struggle with additional issues such as shame and overwhelm in respect to the demands of everyday living. We need to address this in a better way.
Educating the public and those in both the education and clinical settings can begin to make a better impact on how neurodivergence is considered and assessed.