It’s not always easy for neurodiverse couples, where one partner is neurodivergent, while the other is neurotypical, to find common ground. Thankfully, neurodivergent assessments and therapy can help neurodiverse couples better understand each other’s unique strengths and bring them closer together.
Within my practice, a growing number of adults are expressing curiosity about potential neurodivergent traits, particularly about adult autism and ADHD. While I am not trained to offer a neurodivergent assessment, I do provide referrals to credentialed, licensed professionals who specialize in this area.
I sat down with Dr. Duncan Dickson, a licensed psychologist with extensive training and experience in the evaluation of neurodevelopmental conditions and psychiatric disorders and owner of NeurodivUrgent, to discuss adult autism testing. Our conversation demystifies the assessment process and offers guidance to individuals and couples.
The difference between neurodivergence and neurodiversity
Before we discuss neurodivergence assessments, it’s important to clarify the difference between two similar but different terms: neurodivergence and neurodiversity.
What is neurodivergence?
Neurodivergence refers to the state of having cognitive, neurological, or developmental conditions that differ from what is considered typical or neurotypical. These can include autism, ADHD, dyslexia, Tourette’s Syndrome, and others. Someone who is neurodivergent or has neurodivergence is someone who has one or more of these conditions.
What is neurodiversity?
Neurodiversity refers to the belief that neurological differences, such as autism, ADHD, dyslexia, and others, are simply variations in how our brains function. This concept celebrates the unique qualities of every individual and the diverse ways in which we think, learn, and process information. Those who embrace this idea consider these types of diversity as natural and beneficial forms of human difference, rather than deficiencies that need to be “fixed.”
Why would someone seek a neurodivergence assessment?
Dr. Duncan: People reach out to me for one of two main reasons. First, they have been self-reflecting and noticing that they interact with the world and experience things differently. Many of these individuals already self-identify as autistic but are looking for clinical validation as they process their neurodivergent identity.
The second reason is when someone notices they are having difficulty and suspects some neurodivergence. They are curious about how they experience the world or relate to different contexts and settings and notice some neurodivergent traits or differences. For instance, difficulty at their workplace—they were excelling in their role and then because of that they got a promotion. Yet after the promotion they find the demands of the new role very challenging and experience new difficulties with performing essential job duties.
Often, their differences aren’t negative; they show up in various ways and, depending on context, can present as strengths. In other contexts, their differences present in more challenging ways. For instance, going off to college for the first time and they are having a hard time “adulting.” For the first time, they have to rely solely on their own executive functioning rather than having more direct assistance from a family member at home. This shift may impact social relationships, friendships, or intimate relationships. For instance, differences in communication often bubble up when challenges emerge in relationships. There may be difficulties or differences in seeing other perspectives, articulating activity preferences, or feeling and expressing empathy.
Faith: Yes, I’ve seen similar scenarios when working with couples. For instance, in the workplace, one partner gets praised for their ability to be laser-focused until task completion; however, that same quality is a source of conflict in their relationship. The other partner describes feeling lonely and unimportant when that same intense focus goes toward a hobby and not toward quality time together. We spend a lot of time on perspective-taking and expressing understanding.
You offer an online self-screen assessment on your website. How do you find that helpful to people seeking answers about their differences?
Dr. Duncan: The NeurodivUrgent tool was created by researchers to help people easily compare their results to neurotypical and autistic adults. This tool can be appropriate for anyone curious about their own neurotype: Could I be autistic? Is it possible I have ADHD? It’s not a diagnostic tool, but it’s good at examining some of the most common traits of neurodivergence. It can help explain, “Are we seeing things that are consistent with an autistic experience?”
Can you provide an overview of the assessment process for adults seeking to understand if they are neurodivergent?
Dr. Duncan: There are four steps. The first step is a conversational 20-30 minute virtual consultation. During this time, I get information about why they are reaching out and their goals for the evaluation. “What are you hoping to achieve with this process?” I also ask if they want someone else to be involved in their evaluation: a partner or someone who knew them during childhood (e.g., supportive parent, sibling, lifelong friend).
The second step is the psychometric portion via questionnaires. The questionnaire responses will guide the third step, the clinical interview. The questionnaires help gather a lot of information quickly using multiple choice (e.g., not at all, maybe, sometimes, very true). For example, one of the questions could be, “I enjoy going to concert venues.” Another part of this step is a longer questionnaire. This one is free-response to share in written and paragraph form. This allows the participant to upload greater detail regarding their social preferences and sensory needs, especially if they prefer written communication; they can go into as much depth as they want.
The third step is the clinical interview via a telehealth session—a neuro-affirming interview. This portion of the evaluation is conversational to clarify the original questionnaire responses. For instance, if the client indicates they don’t like going to concerts, that doesn’t tell me everything. Maybe it’s the crowds, the lines are too long, it costs too much for a beer, etc. During this portion of the interview, I ask questions to get into the details about what is causing them to not like concerts. Are the crowds too dysregulating, or is it that no good shows come to town? I can’t understand why without asking them to give me more data.
The fourth step is the feedback session via telehealth. During this time, we look at their questionnaire results and how they relate to the autism criteria. We also talk about their self-identification model of autism—do we see traits that the individual identifies with? If a diagnosis is made, I share that during this time, along with ongoing resources.
This process typically takes around two weeks, depending on the client’s availability. On average, clients invest 8-10 hours throughout the consultation and assessment period.
If the client requests a diagnostic write-up, I provide it within a week after the feedback session.
How is a formal or diagnostic write-up helpful? Why would someone request this?
Dr. Duncan: It’s a matter of preference for the client. A written report can be helpful for some clients’ processing style—it makes it easier to take in information. It can feel overwhelming or difficult to remember everything verbally shared in a 2-hour feedback session.
In addition to information retention, the write-up can be useful as supporting documents if the client is seeking workplace or academic accommodations. Regardless of whether the client requests the formal write-up, I offer either a workplace or academic accommodations letter—we discuss what accommodations they are seeking. All clients get a diagnostic verification letter.
How do you help people not weaponize a clinical validation or autism diagnosis?
Dr. Duncan: Before I schedule an assessment, I consult with the individual to gain clarity around their goals and to make sure the assessment is appropriate for what they are looking to do with the information they learn about themselves. If a partner is framing it as “You must be autistic because you don’t understand what I’m communicating to you! You need to get assessed,” the goal of getting an evaluation is very different. It can be less effective if someone feels they are forced to get an evaluation.
My hope is that the evaluation process is collaborative. It is helpful when partners are supportive and want to be part of the process in a curious way rather than trying to justify what has been going “wrong.” The language used is very important. I try to frame my language during the evaluation from a strengths-based perspective to lessen the possibility of feeling like something is wrong or that one partner is failing. More positive language can shift attitudes and perspectives.
What happens when someone gets a diagnosis? What are their next steps?
Dr. Duncan: My role is strictly focused on the evaluation process. I also do adult ADHD testing. However, it is very important to connect people with providers who are neurodiverse-affirming, social groups, or other resources that can support them.
Does insurance cover neurodivergence assessments?
Dr. Duncan: It varies widely. One of the things I’ve added to the FAQ section of my website is a sample insurance reimbursement letter. Clients can copy the information and send it to their insurance to see if the assessment will be covered before scheduling their evaluation with me.
I think that either I or my partner might be neurodivergent.
If you are curious whether you or your partner may be neurodivergent, taking that initial step to learn more about neurodiversity can be incredibly empowering. Dr. Duncan provides a free self-screening tool designed to kickstart your journey of understanding. From there, you can proceed with a consultation tailored to your needs and concerns. NeurodivUrgent offers autism testing online for adults in most of the U.S.—use this map to see if your state can receive services from Dr. Duncan.
When seeking a couples therapist, prioritize finding one who is neurodiverse-affirming and specializes in couples therapy. This ensures that you receive support and guidance that respects and values the unique aspects of neurodivergence within your relationship. Embracing neurodiversity can lead to deeper understanding, stronger connections, and a more fulfilling partnership.
Our therapists are neurodiverse-affirming and have received additional training to support neurodivergent couples. We offer in-person appointments in Charlotte, NC, and Carefree, AZ. We also have virtual sessions available for those who live in Arizona, Florida, North Carolina, South Carolina, or Texas. Contact us to get started.