Why a Holistic Approach is Essential in ADHD and Autism Diagnosis
For many years, ADHD and autism assessments have been built around standardised tests and symptom checklists. While these tools have their place, they often fail to capture the full complexity of neurodivergent individuals, particularly those who mask, internalise their traits, have above-average IQs, or come from minority backgrounds—groups that are statistically more likely to be misdiagnosed or overlooked entirely.
A holistic approach to ADHD and autism assessment acknowledges that neurodivergence presents differently in every individual. It requires looking beyond rigid diagnostic frameworks to understand how a person experiences the world, navigates their daily life, and compensates for challenges that might not be obvious in a clinical setting.
Why Standardised Tests Alone Are Not Enough
Traditional assessment tools rely heavily on observable behaviours and symptom criteria that were largely developed based on stereotypical male, childhood presentations of ADHD and autism. This presents a critical issue for individuals who do not fit this outdated model, including:
Women and AFAB individuals, who are more likely to develop compensatory strategies that mask difficulties.
Individuals with high intellectual abilities, who often develop sophisticated coping mechanisms that conceal their challenges.
People from culturally and linguistically diverse backgrounds, where differences in communication styles, social norms, and expectations may influence how symptoms are perceived and reported.
By focusing solely on checklists and observable behaviours, clinicians risk missing the internal experiences of Autistic and ADHD individuals, particularly those who have learned to suppress traits in order to fit into a neurotypical world.
The Shift to a Holistic Assessment Philosophy
A holistic approach to ADHD and autism diagnostic assessment recognises that every individual has a unique neurocognitive profile. Instead of trying to fit clients into predefined diagnostic boxes, clinicians must adopt an inquisitive, contextual, and affirming perspective. This means considering:
The individual’s lived experience rather than just outwardly observable traits.
The impact of social conditioning and minority stress on their presentation.
Their unique strengths and challenges, rather than focusing solely on deficits.
Rather than asking, “Does this person display the textbook traits of ADHD or autism?”, clinicians should be asking:“How does this person navigate the world, and experience these constellation of traits?”
Key Considerations in a Holistic Approach
1. Understanding the Influence of Masking
Masking is a learned survival strategy that allows neurodivergent individuals to mimic neurotypical behaviour in order to blend in. Many clients—particularly autistic women and late-diagnosed adults—report significant burnout, anxiety, and identity confusion as a result of prolonged masking.
A holistic assessment must:
Create a safe space where clients feel comfortable dropping their mask.
Ask about their experiences in different environments—how they behave at work or school may be vastly different from how they feel internally.
Recognise that the absence of obvious traits does not mean they are not struggling.
2. Recognising Internalised Traits
Many Autistic and ADHD do not exhibit the externalising behaviours traditionally associated with these diagnoses. Instead of hyperactivity or outward social difficulties, they may experience:
Severe mental exhaustion from constant self-monitoring.
Chronic anxiety or depression as a result of unmet needs.
A strong desire for routine and predictability, but without externalising their distress.
Clinicians must look beyond visible behaviours and explore how the individual experiences emotions, sensory input, and executive functioning challenges internally.
3. Considering the Impact of IQ and Coping Strategies
Individuals with above-average intelligence may develop highly effective workarounds that allow them to function well academically or professionally—yet struggle immensely with daily life tasks, emotional regulation, and social interactions. These individuals are often dismissed because they appear "too successful" to be Autistic or have ADHD.
A holistic approach:
Assesses real-world functionality rather than academic or career success.
Looks at the mental and emotional toll of maintaining a façade of competence.
Acknowledges that intelligence does not negate disability.
4. Addressing the Higher Rates of Missed Diagnoses in Minority Groups
Studies show that racial, ethnic, and culturally diverse groups are far less likely to be diagnosed with ADHD or autism, even when experiencing similar levels of disability to their white peers. A combination of cultural stigma, systemic bias, and differences in communication styles contributes to these disparities.
A holistic, culturally responsive assessment should:
Account for cultural differences in behaviour, communication, and expectations.
Recognise systemic barriers to diagnosis and adjust assessment strategies accordingly.
Use trauma-informed, affirming approaches that acknowledge intersectional challenges.
Why Psychologists Need ADHD and Autism Assessment Training
For psychologists to provide accurate and affirming ADHD and autism diagnoses, they must move beyond rigid, outdated diagnostic frameworks. ADHD and autism assessment training should equip professionals with the skills to:
Identify masked and internalised presentations.
Conduct contextual, strengths-based assessments.
Understand the disability and impact to functioning that the individual experiences because of their neurotype.
Recognise the impact of social, cultural, and gender factors on diagnosis.
Engage in neurodiversity-affirming, client-centred practice.
Final Thoughts
A holistic approach to ADHD and autism assessment is about understanding the individual, not just ticking diagnostic boxes. By prioritising qualitative data, personal narratives, and an intersectional lens, clinicians can provide more accurate, meaningful, and affirming diagnoses.
For psychologists seeking to learn or refine their diagnostic assessment skills, my ADHD and autism assessment training provides practical, in-depth guidance on recognising masked, internalised, and high-IQ presentations, ensuring you can confidently identify and support neurodivergent individuals who might otherwise go undiagnosed.
Want to elevate your ADHD and autism assessment skills? Enrol in my ADHD and autism assessment training today and learn how to conduct truly holistic, affirming, and insightful assessments.
