Season 1, Episode 2: Getting a Diagnosis
Let’s dive into the process of exploring an Autism or ADHD diagnosis.
In this episode, we cover:
Michelle’s 3-part diagnostic process for Autism and ADHD
Assessment measures for Autism & ADHD
How to begin the assessment process
First appointment prep
Self-diagnosis & diagnosticians
What we look for in the diagnostic assessment of Autism and ADHD
Autism: Communication, Social World, Special Interests, Trauma, Family History, and Sensory Processing
Assessing ADHD: an overview of the three presentations
ADHD: Executive Functioning, Rejection Sensitivity Dysphoria, and Dopamine
Michelle’s 3-part diagnostic process for Autism and ADHD
Key Takeaways:
As a clinical neuropsychologist, Michelle sees a lot of diagnostic clients and she works through a particular process.
Her diagnostic process follows a three-session model: clinical interview, assessment session, and feedback session.
The clinical interview explores a person’s life history, what brought them to assessment, patterns of behaviour in childhood and adolescent patterns, and current experiences.
The assessment session includes formal diagnostic interview and testing (with the specific tools used depending on what is being explored specifically).
In the final session, Michelle brings everything together, goes through the results, and talks through what she’s thinking diagnostically.
[00:03:30] Assessment measures for Autism & ADHD
Key Takeaways:
Behavioural questionnaires are used as part of the diagnostic process. These are not the same as online quizzes but validated measures that compare what you’re experiencing with what’s considered typical for people demographically similar to you.
Diagnosis for Autism and ADHD is based on information provided during clinical interview, responses on behavioural questionnaire (from the person themselves and others who know them well), and performance on formal testing.
The ADOS one assessment tool for Autism, and it is very communication-based. It is a useful tool for kids, but Michelle finds it often underdiagnoses adults, especially women, because they’ve usually learned strong masking strategies.
The MIGDAS is another assessment tool for Autism. It is a long, structured interview that can give a much more holistic picture for adults, particularly women, by exploring interests, sensory experiences, communication style, relationships, and how someone processes information.
The DIVA is one tool for diagnosis of ADHD, and it is a structured interview.
ADHD can’t be diagnosed based on cognitive testing, but Michelle sometimes uses cognitive testing to look for ‘markers’ of an ADHD brain, like difficulty with working memory — described as your “mental bench space” — or to rule in / out other things that could be causing or contributing to executive functioning issues.
ADHD is a behavioural diagnosis, and the criteria are very focused on whether you’re ‘doing’ certain things. But women might experience ADHD more internally, without outwardly showing those behaviours (this is known as ‘masking’ and often takes a lot of effort), so they often get missed or dismissed.
“Many women are underdiagnosed with ADHD, particularly in adulthood, because they’re not manifesting some of those outward expressions. Their behaviour’s not ‘bothering’ anybody else.”
[00:14:47] How to begin the assessment process
Key Takeaways:
Both psychologists and psychiatrists can diagnose Autism and ADHD. Check out the Australian ADHD Professionals Association (aadpa) guidelines for the most accurate and up-to-date information on this.
If you’re wanting to explore ADHD, and would like to trial medication, going straight to a psychiatrist can be the fastest and most cost effective route, as only psychiatrists can prescribe medication.
It’s important to be careful about who you go to - some psychiatrists are amazing and well-versed in adult ADHD and Autism, and especially how it shows up in women — but some are not. Monique reflects that one client was told by a psychiatrist, “I think you’re just feeling a bit sad because of COVID. Here’s a Disney movie I suggest you watch.”
To see a psychiatrist, you usually need a referral from your GP.
If you want to see a psychologist, look for someone who specialises in these assessments and has experience working with adults, not just children or teens.
If you want to claim a Medicare rebate for a psychology appointment, you’ll need a GP referral. If you’re funding it privately or using private health, you can usually book directly.
[00:17:13] First appointment prep
Key Takeaways:
For the first appointment, bring as much information as possible about your experiences. It’s really helpful to come in with examples.
Start writing down what you're experiencing in your day-to-day life.
Think about your experiences in high school or primary school.
Include specific examples where your neurodivergence has displayed itself or affected you in some way.
If you're going to a psychiatrist and getting a referral from a GP, especially as an adult woman, take that list with you. If you've been masking, you might appear like you're coping, even if you're not — and some health professionals might just go off what they can see on the outside.
Take time to learn about Autism and ADHD, document your experiences, and really advocate for yourself.
You deserve to be assessed if you feel like Autism and / or ADHD fits for you. Pushing for an assessment is not the same as pushing for a diagnosis.
Go in with a clear understanding of why you want to be assessed — whether it's for clarity, access to supports or services, or so your employer can offer accommodations. Pre-prepare a response in case your GP says, “You’re an adult, you don’t need it,” so you're not scrambling to advocate for yourself in the moment.
[00:21:11] Self-diagnosis & diagnosticians
Key Takeaways:
Some people can’t afford a diagnosis or the pathway is blocked for them, so it’s important to recognise that having an official diagnosis is a privilege — and self-diagnosis is often a valid form of self-understanding.
If you’ve done lots of research, read about Autism and ADHD, and it really resonates, then that’s often completely valid. But it’s also worth checking in on what’s going on in your life — sometimes distress or overwhelm is a response to circumstances, rather than a stable trait. It’s also helpful to check in on the basics - are you eating, drinking water, sleeping, and feeling supported?
If your experiences are stable and lifelong, receiving a diagnosis or finding a diagnostic category that ‘fits’ can be very validating — it can help you stop trying to pass as neurotypical and start tailoring your life to support your neurodivergence.
Understanding how your brain works lets you tailor your life to fit your brain, instead of trying to change your brain to fit life. Trying to do the latter leads to burnout and self-doubt.
Women are often insightful about what’s going on with them, but have been trained to doubt themselves. If an “expert” gives you a diagnosis that doesn’t align with your lived experience, it’s okay to reject it or seek a second opinion — you know yourself best.
[00:27:48] What we look for in the diagnostic assessment of Autism and ADHD
Key takeaways:
Even as a therapist, Monique didn’t always recognise signs of Autism or ADHD in clients until she did further training in neurodivergence in women — now she knows what to look for, she actively screens and gently raises it if assessment feels right for the person.
[00:28:48] Autism and Communication
Key takeaways:
For Autism assessments, one key thing Michelle looks at is the purpose that communication serves.
For neurotypicals, communication is often driven by importance, social inclusion, and a desire for social cohesion (this can look like ‘conformity’).
For neurodivergent people, it’s often driven by interest and passion.
In people with an Autistic neurotype, communication is often used to convey information about something they’re interested in or focused on. Michelle observes how someone's communication style shifts when discussing an interest versus casual small talk or non-interest based topics.
Neurotypicals are heavily resourced in the brain areas responsible for picking up micro-expressions on the face, tone, and nonverbal communication. They often understand implied meaning, while Autistic people may not naturally pick up on these cues.
In childhood, Autistic girls often mimic others — like YouTubers, friends, or role models — copying their speech or mannerisms to fit in. This mimicry is a learned strategy to navigate an aspect of social communication that doesn’t always come naturally.
Girls may appear to make appropriate eye contact, but it’s often effortful and masked. They may overdo it, fake it, or mentally narrate when to look away or how to arrange their faces. When professionals rely on visible eye contact to rule out Autism, it shows a misunderstanding of masking.
[00:36:57] Autism and Social World
Key takeaways:
Michelle often sees that adult Autistic women, if they have a partner, have usually met them quite early in their adulthood and stayed with that person through adulthood. They often don’t have many friends — sometimes they don’t like that, and sometimes they’re totally fine with it.
Michelle encourages people to think about how they actually feel about their social connections, not how they think they’re supposed to feel. For some, a small close circle feels full; for others, past social trauma may make them reluctant to try again.
Some women have been traumatised by past social experiences — always feeling as though they are saying the wrong thing, not understanding why people are mad at them, or being taken advantage of.
That reluctance to engage socially is often a valid response to repeated harm. Michelle notes that diagnostic criteria can be misleading — a person might not show “deficits” in social reciprocity if they’re socially content and not in a state of distress.
As women get older, they may learn social skills through intense effort or special interests in people or psychology. But that learning often happens later and takes much more conscious work than it might for neurotypicals.
[00:40:28] Autism and Special Interests, Trauma, Family History
Key takeaways:
Intense and special interests and differences in sensory processing are also part of the diagnostic criteria for Autism. While these criteria technically don’t have to be met for a diagnosis of Autism, it is rare and unusual for them not to show up in Autistic folk in some way.
It’s important to distinguish whether intense interests are related to Autism or are a response to trauma. Looking at family history helps clarify whether a genetic neurodivergent component might be present, especially if traits show up across multiple relatives.
Sometimes it’s both — a person can have complex trauma and an Autistic and/or ADHD neurotype. Interests may begin as an escape, but for Autistic people, they often persist into adulthood as a key feature of their organisation of self.
[00:44:01] Autism and Sensory Processing
Key takeaways:
Differences in sensory processing are part of the Autistic experience, but they show up differently in each individual — from sensory avoidance to sensory-seeking behaviours like craving firm pressure or fiddling with certain fabrics.
Research has shown that when Autistic people go through trauma therapy like EMDR, it reduces distress and traumatic stress symptoms like hypervigilance — but the sensory issues remain.
Many clients say things like, “I really hate going to the grocery store. It's really overwhelming. The lights. The noise.” Screening all clients for sensory issues is really helpful.
[00:47:41] Assessing ADHD: an overview of the three presentations
Key takeaways:
ADHD has three presentations: inattentive, hyperactive / impulsive, and combined. The combined presentation is most common, inattentive second, and purely hyperactive / impulsive is more rare, and most commonly seen in childhood when life is more ‘supported’ (meaning that the inattentive traits are less obvious for some at this stage of life).
ADHD is about difficulty with self-regulation of thoughts, emotions, and behaviour.
Thoughts might zip off in different directions,
emotions can escalate quickly, and
behaviour may be driven by external stimuli, like clicking a pen because it’s there or replying instantly to an email without pausing to think, ‘Oh, do I need to answer that right now?’.
The ‘Inattentive’ presentation of ADHD is more common in girls and women. Because the diagnostic criteria focused more on outward behaviour, people who struggle mostly with regulating their internal thought processes can be overlooked. Young girls often can’t articulate what’s happening internally, even though it’s very real.
ADHD traits in bright kids, especially girls, can go unnoticed in early childhood because the demands of the environment haven’t yet exceeded their internal capacity. It's not until later — in grade 11, 12, university, or the workforce — that those issues become more apparent, as the external demands begin to outstrip their internal resources.
Some girls appear to be doing fine in school because anxiety drives them to complete tasks, but they’re melting down at home.
All their energy is spent trying to appear neurotypical, leaving no space for anything else, especially if the subject isn’t interesting or doesn’t offer immediate reward.
[00:58:24] ADHD and Executive Functioning
Key takeaways:
Executive functioning is like the brain’s admin team — responsible for prioritising, organising, planning, and delaying gratification. For ADHDers, it’s like their team is underfunded (those resources have been used elsewhere).
In an ADHD assessment, it’s not just about whether someone can do something or not — it’s about what it costs them to do it. That cost might be a panic attack, a full down day afterwards, or dropping the ball on other things just to get one thing done.
People often don’t realise they’re having executive functioning difficulties. They wonder why they can’t do things others seem to do easily, and they start thinking they’re lazy or broken — especially after years of negative feedback from others.
🧠 We have an entire episode on Executive Function that you can listen to here or read through here.
[01:01:01] ADHD and Rejection Sensitivity Dysphoria
Key takeaways:
“Rejection Sensitive Dysphoria” isn’t an official diagnosis. Monique and Michelle see it more as a term people use to describe the impact of repeated negative social feedback, especially starting in early childhood.
When someone hears constant criticism like, “Why can't you sit still?” or “Why are you always disrupting the class?”, it makes sense that they'd become hypervigilant to rejection and disapproval — that’s a trauma response, not necessarily something that's part of ADHD itself.
Michelle raises the question of where a label is helpful and where it over-pathologises a normal or expected response.
Monique adds that it’s not necessarily part of having ADHD, but part of being in a world where ADHD isn’t recognised or supported.
ADHD and Dopamine
Key takeaways:
One of the key differences in an ADHD brain compared to a non-ADHD brain is differences in the production and transmission of dopamine (which is a neurochemical that motivates us to action and helps us feel ‘rewarded’ when we achieve or get something).
Non-ADHDers tend to have a more regular and consistent supply of dopamine, meaning that the process of doing things that aren’t intrinsically interesting or fun is still rewarding, at a biochemical level (think: putting a load of washing on, replying to emails etc.).
ADHDers rely only on external triggers to produce dopamine (think: eating chocolate, winning a video game, a creative hobby), meaning that it’s much easier for them to engage in tasks that are interesting, passion-driven, and intrinsically motivating.
This means that tasks that are boring but important (like scheduling an appointment or answering work emails) don’t release dopamine for ADHDers, so doing them is physically harder — not a sign of laziness or a moral failing.
Non-ADHDers also get a dopamine release in anticipation of a future reward, but ADHDers tend to only get that dopamine kick when the reward actually happens, which makes delayed gratification more difficult.
Michelle suggests working in small time blocks with built-in rewards — even something like “I’ll do 10 minutes, then have a lolly” — to help grease the wheels of motivation and work with your neurology, not against it.
Rewards don’t have to be big — even a song you like or a visual tracker can help. The strategy is about breaking tasks into small, manageable pieces and layering in frequent, tangible dopamine boosts.
Things We Mentioned and Extra Resources:
Related episodes:
What Does an Autistic ADHDer Brain Look Like? – listen here or read through here
Early Identification with Josephine Barbaro – listen here
Executive Functioning – listen here or read through here
Relationships and Communication – listen here or read through here
Special Interests and Creativity – listen here or read through here
Neurodivergence and Trauma – listen here or read through here
Further reading:
EMDR and Autism (mentioned in the episode when discussing that trauma therapy reduces hypervigilance but not sensory issues for Autistic people)
Dopamine and ADHD
Volkow, N.D., et al. (2009). “Motivation deficit in ADHD is associated with dysfunction of the dopamine reward pathway.”
Despite the medical model language, this is a foundational paper because it used PET imaging to show that adult ADHDers had lower dopamine receptor and transporter availability in key brain regions tied to motivation and reward. It helped ground the idea that ADHD is a neurobiological condition, not just “laziness” or “lack of willpower.”
The caveat: both of these studies were not conducted through a neurodivergent-affirming lens. They frame Autism and ADHD purely through deficit-based medical language — and did not integrate lived experience, identity-based insight, or strengths-oriented neurodiversity perspectives.
Looking to explore Autism for yourself? The Embrace Autism website is a fantastic resource.
For Licensed Clinical Professionals:
Want more on the Essentials of Neurodiversity Affirming Practices? Try this training with Monique through Divergent Futures.
Want to learn how to conduct neurodiversity affirming and evidence-based Autism and ADHD Assessments from Dr Michelle Livock? Try this training set.
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