Late Diagnosis: ADHD and Autism in Adults
Most people who come to me about a late diagnosis have known something for a long time. Maybe a child’s assessment held a mirror up. Maybe it was burnout, or a year where the coping just stopped working. Maybe it was a quiet 3 a.m. realisation, reading something that described your inside life a little too exactly to be a coincidence.
By the time you’re booking, you’re usually not asking whether something is different. You’re asking why it took this long to have a name for it.
The people who were never going to be caught as children
The adults I see for this are often the ones the system was never built to notice. The bright girl who was anxious and conscientious instead of disruptive. The boy who ran on raw ability until the scaffolding of school fell away. The person who built a whole personality out of compensating, and did it so well that no one, including them, saw what it cost.
A lot of them are women. A lot of them have spent years being treated for the anxiety or the depression that grew on top, without anyone asking what was underneath.
Why it gets missed (and why that isn’t your fault)
There are real reasons this goes unseen, and none of them are a failing on your part. ADHD and autism were first described, and for decades mostly studied, in boys. The diagnostic criteria, and even some of the standard assessment tools, were built and normed largely on males, so the quieter, more internal, more camouflaged presentations slip straight through.
And masking, the constant low-level work of performing “fine,” makes the traits harder for anyone to see while quietly driving up the anxiety, the low mood, and the burnout. Often, the better you masked, the later you were found.
Usually it isn’t just one thing
Autism and ADHD travel together far more often than the old, tidy categories suggested, what more people now call AuDHD, and both sit close to anxiety, OCD, and mood. The trouble is that from the inside they can be very hard to tell apart.
Part of my job is to hold the whole picture at once, with you, instead of letting you settle on a single label from a late-night search and miss half of what’s actually going on. Here, complexity is the norm, not the exception. It’s the work I’m built for.
Before you name yourself, one thing worth hearing
I find myself saying this often, because it matters. A lot of adults arrive certain they’re autistic, and what we find together is ADHD carrying a heavy load of rejection sensitivity. That raw, wired feeling where one small slight can level you for the rest of the day. The years spent scanning every room for the first sign you’ve let someone down.
It can look and feel a great deal like the social exhaustion people associate with autism. Sometimes it is autism as well. Often it’s ADHD and rejection sensitivity, which is real, which is exhausting, and which responds well to the right help.
I’m not here to tell you what you are from a website. I’m telling you that the only way to actually know is to look at it properly, with someone, instead of alone at 3 a.m.
Let me be straight with you about autism
You deserve to know what I do and don’t do before you book. In my training at Duke I learned from people doing autism research at the highest level, and one thing has stayed with me ever since: the most accurate autism evaluations aren’t done by one clinician working alone. They’re done by a coordinated team, looking from several angles at once.
So I don’t run a solo, formal autism diagnostic work-up, and I won’t pretend a single afternoon with me can settle that question. What I do is assess for ADHD properly, help you understand the whole picture, including whether autism really is the question for you, and treat the anxiety, the mood, and the rejection sensitivity that so often sit on top.
If it becomes clear that a full autism assessment is your right next step, I’ll tell you plainly, point you to the right team, and stay in your corner while you get there. You won’t leave empty-handed either way.
You do not need your parents in the room
Here’s the practical worry I hear most: “I can’t ask my parents, and I don’t have my old school reports.” You don’t need them.
For ADHD, adult assessment doesn’t hinge on a parent in the room or a childhood report card. It rests on:
| Validated adult measures | Standardised questionnaires designed and normed for adults. |
|---|---|
| A structured diagnostic interview | A careful, methodical conversation rather than a checklist. |
| A developmental history, taken from you | Your own account of how this has run across your life. No childhood report card required. |
| Input from someone who knows you now | A partner or close friend, only if you want it and only if it adds something. |
If childhood collateral exists and you’d like to use it, we can. If it doesn’t, the assessment still stands on its own.
What a late diagnosis actually gives you
People often arrive braced for a verdict and leave holding something closer to a key. There’s usually grief in it, for the years spent assuming you were lazy, or too much, or not enough, and relief, often in the same breath.
A late diagnosis is not a sentence, and it isn’t an excuse. It’s an accurate map. With it, the work gets specific: the accommodations that actually fit your brain, treatment for the anxiety or mood that built up over the years, and a different, kinder story about why some things were always harder than they looked.
If you’re wondering what kind of room you’d be walking into, I’ve answered the neurodivergent-affirming question plainly, on its own page.
How to start
Most people begin with the free 15-minute Meet & Greet, then a first consultation where we map what’s bringing you in and decide together whether a formal assessment, therapy, or both is the right next step. My aim for that first session is that you leave having already learned something real about yourself, even if we decide I’m not the right person for the ongoing work.
If an assessment makes sense, I’ll tell you exactly what it involves and what it costs before we begin. (Fees are all on the fees page; payment is due before each session.)
Who this is for, and who it isn’t
This is the right starting point if you’re an adult who suspects ADHD, autism, or AuDHD in yourself, whether you were missed entirely or misdiagnosed along the way, and you want to start making sense of it with someone who’ll be honest with you.
If what you specifically need is a formal, standalone autism diagnosis, I’ll still be glad to meet you, point you toward the right team, and support the parts I’m built for. And if what you need most urgently is medication management or crisis care, I’ll say so early, help you find the right person, and I’m glad to work alongside a prescriber.
Not sure yet? Read how I think about fit.