NEURODIVERSITY-AFFIRMING AUTISM ASSESSMENTS and ADHD ASSESSMENTS:WHAT'S DIFFERENT?

Introduction:

Whether or not to be formally assessed for autism or ADHD is a big decision. It is a large expense. There are often wait lists. The process and the outcome can be very emotional. The benefits are not always clear. Some people think, “I already know that I am autistic/ADHD-er, what will the assessment add to this?” Yet, some people want a data-based, objective confirmation of their suspicions. They might be interested in getting formal accommodations at work, or they might feel that they will be more confident in explaining their differences to family and friends if their diagnosis was confirmed by a professional.    

Whatever the reasons, getting an autism or ADHD assessment can be a deeply emotional and even life-changing experience. I can lead to insight, clarity, validation, and access to accommodations.  But in many cases, the assessments can also be based on outdated, deficit-based models of these conditions. The assessment process can feel confusing, inadequate, invalidating, and even traumatizing.

Many individuals, even if they receive a diagnosis, can struggle with how it was given. Individuals whose presentations are less traditional or less obvious to an outside observer can have difficulty finding a professional who will recognize them as neurodivergent and therefore can struggle to be identified/receive a diagnosis. This includes individuals who are high-masking, female/assigned female at birth, gender diverse, gender non-conforming, or transgender, as well as BIPOC individuals.

In this blog, I discuss autism and ADHD assessments, focusing on neurodiversity-affirming assessments. I will discuss how they differ from more traditional assessments in terms of the goals, process and outcome. Hopefully, this blog will help you decide if you want to get an assessment, and how to go about finding an assessor who fits your needs.  

A Philosophical Divide: Medical/Deficit Model vs. Neurodiversity-Affirming Approach

At the core of the difference between traditional and neurodiversity-affirming assessments is the worldview guiding the clinician’s lens. Traditional assessments are often based on the medical or deficit model, which frames autism and ADHD as disorders that should be identified by pinpointing what’s “wrong.” This model often treats neurotypical development as the gold standard, and anything that diverges from it is pathologized. The focus is on observable behaviors and “impairments”: what skills are lacking, what behaviors deviate from the norm, and what functional limitations exist in the domains of work, school, or relationships. The behaviors and skills are evaluated in comparison to the neurotypical norm. Recommendations are often focused on how the individual being diagnosed can become less different and move closer to the neurotypical norm.

By contrast, neurodiversity-affirming assessments start from the premise that neurodivergent brains are not broken, they're just different. The goal is not to diagnose a disorder in order to fix it, but to understand the person’s unique experiences, processing style, and support needs. This approach still uses diagnostic frameworks like the DSM-5-TR, especially for those seeking formal diagnosis for access reasons, but it also integrates information on internal experiences such as masking, as well any system that an individual puts in place in order to minimize visible differences and compensate for challenges.

Therefore, a neurodiversity-affirming assessment does not focus on how someone compares to neurotypical norms. It seeks to understand how someone relates to their environment. What happens when there is a mismatch between individual’s needs and the environments they find themselves in? What environments are easy for the individual to function in, and why? Why does the individual need to do to maintain the way they are functioning with their family, friends, at work or at school?  What strategies have they developed to cope—often invisibly—with a world that wasn’t designed for them? What are the internal costs of the effort it takes to navigate the world?

A neurodiversity-affirming autism assessment focuses on describing each individual’s strengths and challenges. The recommendations are framed to support individual’s best functioning while acknowledging and accommodating their differences. Recommendations are focused on factors such as changes to the environment, scheduling, adding sensory tools, and adjusting the way others communicate with the individual. Recommendations for therapies and other supports are focused on developing skills and capacities without changing who the neurodivergent individual is.

The Assessment Process: Expert-centered vs. Collaborative

My clients who have had traditional assessments often report that they felt disempowered and not “seen” or understood as the input they wanted to provide was often dismissed. Even though the assessor described themselves as an expert in autism and ADHD, often my clients received no accommodations during the process. They often felt that the process was not explained to them, and the assessments used contained confusing or offensive language. My clients often report that they did not trust the results of the assessment because of these factors. They felt that they might have not answered the confusing questions well, or that their life experience was not represented the in the way they understand it.

Neurodiversity-affirming assessments are more relational and collaborative. They often begin with an extensive intake process, not just to collect data but to begin understanding the person’s life context and their one understanding of their experience. For example, my assessment process includes clinical interviews, self-report measures, a 2–3-hour neurodiversity-affirming sensory-based structured clinical interview, and feedback from people who know the individual well (called "collaterals"). This can include friends, partners, or even coworkers—not just parents or teachers—acknowledging that support networks come in many forms, especially for adults. It is also understood that some people might not have a collateral as neurodivergent experience can at times lead to family estrangement and life-long challenges in making other connections.

Another difference is allowance for accommodations. For example, in my process I proactively ask my clients to list any accommodations they might need during the interview. Before we start the interview, I check on safety in the space, whether actual or virtual, and whether the client has their sensory tools and any comfort items readily available. I monitor my clients for regulation during the interview and encourage use of any regulation tools needed as well as breaks. I do not require the client to face me or make eye contact. My clients are welcome to move around or sit where and how they feel comfortable. My observations of the clients’ regulation and use of strategies help me understand my clients and formulate recommendations.

While I prefer to use neurodiversity-affirming standardized measures, there are, unfortunately, not enough of them out there. When I use measures that contain confusing or deficit-based language or limit gender options, I let my clients know in advance, so that they are prepared for the experience and understand that it will not change my neurodiversity-affirming approach to the assessment.  

The Experience of the Person Being Assessed

The difference between the traditional approach and neurodiversity-affirming approach can be profound. Traditional assessments, especially those still steeped in outdated stereotypes, can leave individuals feeling judged, misunderstood, or even dismissed. When someone undergoes a neurodiversity-affirming evaluation, the experience is more likely to feel validating and empowering.

Even if they do not meet the exact criteria for a diagnosis, a client walks away with a deeper understanding of their brain, their life experience, and the steps they can take to live better with the brain they have. They may gain clarity about why certain environments are challenging, what accommodations might help, and which strategies are no longer sustainable. In short, the process is not just about answering the question, “Am I autistic or ADHD?” It is about understanding who you are and how to support your unique needs.

The Report: Labels & Deficits vs. Understanding

In a traditional assessment, the outcome is often a report that focuses on what the person can’t do or how they fall short of neurotypical expectations. These reports can be lengthy but impersonal, full of clinical jargon, and primarily aimed at satisfying insurance requirements.

A neurodiversity-affirming report is more than a diagnostic label. It is a nuanced portrait of the person’s life experience, strengths, support needs, and values. It includes narrative summaries, interpretations of test scores in context, recommendations for accommodations, and guidance for navigating school, work, or therapy settings. The report doesn't reduce a person to their deficits. It integrates the reported experiences with standardized score results to tell their whole story and offer an in-depth understanding of their neurodivergent experience.

Even in cases where no formal diagnosis is made, a neurodiversity-affirming assessment can identify mismatches between a person's environment and their needs. That information can be used in making lifestyle changes or advocate for supports that improve quality of life. Your time and effort is not wasted even if you are not identified as autistic or ADHD because you will still gain self-understanding and recommendations for strategies you can use to life life better, on your terms.

What to Ask When Looking for a Neurodiversity-Affirming Assessor

If you decide that getting a formal autism assessment or ADHD assessment is the right move for you, choosing the right assessor is one of the most important steps in this journey. Considering the emotional investment, as well as the time and the expense connected to the assessment, it’s worth being thoughtful and deliberate in your search.

You’ll want to understand the assessor’s philosophy. Do work within the neurodiversity paradigm? Are they trained specifically in identifying autism and ADHD in populations that are frequently overlooked—like high-masking individuals, adults, or people from marginalized communities?

It’s also important to know about their approach to testing. Do they use tools specifically developed with neurodivergent individuals in mind, like the MIGDAS-2, or do they only rely on standardized tests developed for neurotypical populations? How do they interpret those results?

You would want to find out about accommodations. Are your sensory and regulation needs going to be considered? Will you be able to stim during the assessment, take breaks, or avoid eye contact?

Another critical area to explore is how the assessor delivers feedback and writes reports. Will you be getting a detailed, personalized summary that makes sense to you? Will the assessor help you connect the dots between your experiences and your diagnosis?

Finally, you want to know how collaborative the process is. Will the assessor see you as the expert on your own life? Are they open to self-advocacy, and do they support self-identification even when a formal diagnosis isn’t made?

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If you're seeking an autism or ADHD assessment for yourself or a loved one, know that you deserve to be seen fully and compassionately. The right assessor can make all the difference, not just in the diagnosis you receive, but in how you feel about it, and more importantly, about yourself.

If you are interested in learning more about the assessments I offer, you can find exhaustive information on this page.