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Comparative analysis of diagnostic expectations between adults referred for ADHD and autism assessment: a thematic
Marios Adamou1, Lydia Wharton2
1School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom.
Background:
Recent trends in neurodevelopmental services promote joint assessment pathways combining ADHD and Autism services. However, no study has systematically compared diagnostic expectations between adults seeking ADHD versus Autism assessment.
Methods:
This comparative qualitative study analysed expectations from 100 adults referred for ADHD assessment, comparing findings with published Autism data (n=60) from the same Trust. Both samples were of adults referred for assessment rather than diagnostically confirmed cohorts. Two open-ended questions during face-to-face appointments: "What do you hope to gain from the assessment?" and "How do you think receiving a diagnosis would help you?" ADHD responses underwent reflexive thematic analysis using Braun and Clarke's six-phase framework, with comparison against published Autism themes.
Results:
Analysis revealed fundamentally divergent expectation patterns organised around contrasting meta-themes: "Seeking Legitimisation and Practical Solutions" (ADHD) versus "Understanding Self and Explaining Difference" (Autism). Five conceptual dichotomies distinguished pathways: (1) pharmacological versus psychosocial intervention paradigms (47% ADHD mentioned medication versus 1.7% Autism); (2) diagnostic certainty versus depth of understanding (31% ADHD versus 75% Autism seeking understanding); (3) passive hope for understanding versus active educator positioning (3% ADHD versus 63% Autism expecting to explain to others); (4) deficit versus difference self-concepts (15% ADHD used harsh self-descriptors versus 1.7% Autism); (5) internal overwhelm versus social-environmental mismatch phenomenology (10% ADHD described "racing mind" versus 0% Autism). These differences persisted across demographic subgroups.
Conclusions:
Adults seeking ADHD versus Autism assessment hold fundamentally different expectations requiring differentiated clinical responses. Findings provide empirical evidence for separate rather than combined diagnostic pathways, with condition-specific pre-assessment counselling, post-diagnostic support, and clinical expertise development. Generic 'neurodevelopmental' provision risks meeting no one's actual needs.
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