Understanding a late diagnosis of ASD or ADHD

Over the past few years, I have found myself working with a growing number of clients who have been recently diagnosed with autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD) in adulthood. These are individuals who, for most of their lives, felt that something was different about the way they experienced the world. 

Many of them spent years navigating challenges in relationships, work, education and day-to-day functioning, without a clear understanding of why things often felt harder for them than for others. Some were mislabelled as lazy, difficult, too sensitive, or disorganised. Others became expert maskers, hiding their distress and differences to fit in socially and professionally.

For most of these clients, receiving a formal diagnosis has been nothing short of life-changing. Whether it came through the NHS after a long and emotionally draining wait or privately, the diagnosis often brings an enormous sense of relief. It puts a name to lifelong struggles and provides a framework to understand experiences that previously felt isolating or inexplicable. But it can also bring complex and sometimes painful emotions. There is joy and validation, but also grief for a life that could have been different with earlier understanding and support.

Counselling can help clients to process this post-diagnosis period, which is often marked by a deep reflection on the past. Once someone receives a diagnosis, they tend to look back through a new lens. Suddenly, childhood memories, school struggles, social difficulties and even relationship breakdowns begin to make more sense. The shame or confusion that once surrounded these experiences often starts to lift. But this can be a tender and emotionally charged process. Clients may grieve lost opportunities, unkind labels they internalised, or support they never received.

It is also important to recognise that the experience of ASD and ADHD can differ significantly between men and women. Many of the women I work with were missed entirely by earlier diagnostic criteria that were based largely on how these conditions present in boys. Women and girls are more likely to mask their traits, often internalising their struggles rather than expressing them outwardly.

Hormonal fluctuations play a major role in this experience. For instance, many women report that their ability to cope or mask becomes much harder around their menstrual cycle, when oestrogen levels drop. During perimenopause and menopause, this can become even more intense. The sharp hormonal changes can affect mood, memory, emotional regulation and sensory processing, making it even harder to maintain the strategies they once used to fit in. For some, the masks they have worn for years begin to crack. 

Alcohol also has an impact. Some clients describe using alcohol to manage social anxiety or sensory overwhelm, only to find it heightens emotional sensitivity or worsens executive dysfunction over time. These are not just physical experiences, but they deeply affect how someone navigates relationships, work, and their sense of self. Counselling can provide a non-judgemental space to explore these intersections and help clients understand that these challenges are real, valid and deserving of care.

Counselling offers a safe space to do this important work. Together, we unpack the past, piece by piece, gently reframing experiences with compassion and understanding. Clients are invited to revisit their personal history with curiosity rather than judgement. They begin to understand why they responded in certain ways, why they may have burnt out so often, or why they have always needed more recovery time after social interactions. Counsellors can explore the narrative they have carried about themselves and whether it still fits. This can be a powerful and transformative part of their journey.

But counselling is not just about the past. It is equally about supporting clients as they look forward. A diagnosis is just the beginning of a new chapter. 

The question then becomes: 

• How do I live well with this knowledge? 
• What changes do I need to make in my life, my work and my relationships? 
• What tools and strategies will help me thrive?

This is where neurodiversity-affirming counselling plays a crucial role. The aim is not to change or fix the individual, but to understand and work with the way their brain is wired. Together, you can explore practical tools for managing overwhelm, navigating sensory sensitivity, building routines, setting boundaries and improving communication. Counselling also works on self-acceptance and self-advocacy, helping clients express their needs clearly and confidently.

It is essential that clients find a counsellor who understands the nuances of neurodivergence. This means more than just a theoretical knowledge of ASD or ADHD. It means understanding what masking is and the cost it takes on the nervous system. It means knowing that what might look like procrastination could actually be executive dysfunction. It means being flexible with communication styles, offering sensory-friendly sessions where possible, and understanding that eye contact or sitting still may not be comfortable or necessary.

Certain therapeutic approaches are especially effective when working with neurodivergent clients. Person-centred therapy creates a space where the client is truly heard and accepted. Psychoeducation can help clients understand how their brain works. Cognitive behavioural therapy (CBT), when adapted appropriately, can offer useful tools for managing anxiety or navigating unhelpful thinking patterns. Mindfulness, when introduced gently and without rigid structure, can support emotional regulation. But the key is flexibility. Therapy must adapt to the client, not the other way around.

Ultimately, a late diagnosis can be both a revelation and a reckoning. With the right therapeutic support, it becomes an opportunity for healing, growth and self-discovery. Counselling can help clients honour the past with compassion and look to the future with hope, equipped with tools and insights that support their well-being.