Do you, or your partner, believe that neurodiversity is causing   conflict in your relationship? Is the “ neurodiverse “ partner unwilling to engage in a diagnostic  assessment, or  have  they had a screening assessment  that indicated criteria were not  met?  Is a  couple intervention assessment a practical alternative?

So what  are the different benefits and  limitations of   a formal diagnosis process, or a  couple  intervention  assessment?  These processes can be interconnected, but have  different starting points. This post deals with adult diagnosis or  assessment.

Neurodiversity in Couple work

What does Neurodiversity mean? It is the concept that neurological differences in conditions such as autism, ADHD, and dyslexia, are natural variations of the human brain. This perspective advocates for acceptance and inclusion, emphasising that neurodiverse individuals should be appreciated for their unique strengths rather than having a “pathology”. However Neurodiversity can have negative impacts on relationships, employment, education, emotional regulation, finance, health and wellbeing. In  relationships it can generate conflict  in communication,   patterns of behaviour, and  problems of mood. What  is the  best approach to   resolve  such conflicts ?

Diagnosis of  Neurodiversity

Diagnosis of neurodiversity seeks to  identify if  the  symptoms that an individual has, meets   the   diagnostic criteria  specified in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) or the ICD-11 (International Classification of Disease).

Neurodiversity conditions are on a spectrum. The diagnostic process for ASD and ADHD results in a judgement, usually by a psychiatrist, or sometimes a psychologist, on whether  the diagnostic criteria are met. This judgement is generally based on one or more interviews, documentation, and  input  from other professionals , caregivers, or partner

 A diagnosis can help individuals, couples and their families, to understand the underlying reasons for certain behaviours, challenges, or strengths. It may lead to specialised services, including prescription of   medication, work based  accommodations, and  therapeutic interventions.

 Receiving a diagnosis can be a validating experience, confirming that the experiences and challenges for an individual are the result of a   real condition. A diagnosis may lead to membership of communities   with shared identities, such as “Aspies” or “ADHDer“

Diagnosis is not an objective measure of   neurodiversity. Many learn to “mask “ symptoms  and there are  reports on ADHD/ASD  forums of this not  being taken into account in  assessment.The diagnostic process entails subjective judgments, which will vary between professionals and  be based on differing  sources of  evidence. ADHD and ASD can therefore be misdiagnosed  or  undiagnosed.

In the NHS there are long   waiting lists for diagnostic assessments of neurodiversity.  Many adults pay for assessment by a private clinic. A 2023   BBC undercover investigation into ADHD found the reporter was assessed by an NHS psychiatrist  as not  meeting the  diagnostic  criteria. However, three private clinics diagnosed   ADHD, and offered prescriptions for  ADHD medication.

An assessment and  diagnosis of neurodiversity  which does  not take account of the impact  of symptoms  on a relationship will  not help, and may  hinder progress in couple therapy. Some ADHD medications  may make anger or mood, worse, increasing  points of conflict in a relationship.

In the UK, if a diagnosis of ADHD/ASD is  made  by a private clinic, this is not automatically accepted  by many health authorities in the UK. So access to services   may  not  be available. ADHD   medication may be available only via private prescription.

 Intervention Assessment and  Planning:

Interventions are  based upon an assessment of each individual in a couple, and  also the interactions   between them.  The Gottman Couple Method of therapy  starts   with an in depth assessment of  each partner to give an individual profile, and also an assessment of  their interactions  as a couple.

When there  are beliefs that one or both  partners display symptoms of neurodiversity  which impact negatively upon the relationship, additional assessments are  undertaken to identify what  ASD or ADHD  symptoms are present, including  strengths and limitations. The purpose is not to give a formal label, but to give  a basis for intervention  to understand, and then  reduce the impact of symptoms. This may include education  for both  partners about   what   changes  in  the relationship  can be  achieved . For a “ neurodiverse” Partner , coaching interventions based  on  recognition of the impact on  a non neurodiverse partner, as well as strengths  identified via assessment lead to improved couple dynamics.

Intervention assessment   recognises  that other  conditions  can give rise  to similar  symptoms  as ASD/ADHD. These  include  OCD, trauma, depression or a combination which may be present together. Many males  suffer trauma and depression  as a result of being subjected  to, but  also  expected   to live up  to, patterns of patriarchy. Many females in heterosexual relationships  experience    negative male patterns of behaviour, rooted in such trauma and depression,  which have  major impacts upon them and their dependents .

No medication can be prescribed for ADHD without a formal diagnosis. ASD is not treated with medication, although associated  conditions  such as anxiety  may be.

Interventions require   sustained work from both partners  to move  into more healthy  patterns of  interaction and reduce conflict arising from  neurodiversity.

Intervention assessment will not give  a  definitive   answer  to the question “Am I  ASD/ADHD?” For some individuals the  answer to this question is  central to making sense of their  lives.

Understanding the differences between diagnosis in neurodiversity and therapeutic support planning is important for providing effective and compassionate support to neurodiverse individuals. Diagnosis provides a foundation for the individual by identifying the specific condition and facilitating access to necessary resources. Therapeutic support planning considers symptoms within  a couple context, providing interventions that empower both partners  to thrive. By appreciating the distinct roles of each process, we can better support the diverse needs and potential of neurodiverse individuals, fostering a more inclusive and understanding society.