When the Puzzle Pieces Don’t Fit
Here is something I have seen more times than I can count in my therapy office: a client walks in convinced they are broken. They have tried everything. Therapy. Medication. Self-help books stacked so high they could build a fort. They have been told they are anxious, depressed, maybe even “difficult.” And yet nothing quite sticks. The puzzle pieces are all there, but they don’t seem to fit the box they came in.
Then, sometimes in their thirties, forties, or even fifties, someone finally says the words: “Have you ever been evaluated for ADHD?” or “Has anyone ever mentioned autism to you?”
This is one of the most important missing pieces I have found in my years of working with trauma clients. Not everyone who is stuck is stuck because of what happened to them – some are stuck because nobody ever understood how their brain was wired in the first place. And when you are trying to heal a wound you cannot see, using tools designed for a brain you do not have, you are going to feel like a failure. You are not. You just had the wrong map.
So What Exactly Is Neurodivergence?
Neurodivergence is a term coined by sociologist Judy Singer in the late 1990s. It simply means that a person’s brain develops and functions differently from what is considered “typical.” It is not a diagnosis itself – it is an umbrella concept that includes conditions like ADHD (Attention Deficit Hyperactivity Disorder), Autism Spectrum Disorder (ASD), dyslexia, dyspraxia, Tourette syndrome, and others.
The key word here is different, not deficient. As Dr. Temple Grandin – the renowned animal scientist who is herself autistic – has said:
“The world needs all types of minds.”
That said, “different” does not mean “easy.” Neurodivergent brains come with genuine challenges, especially in a world designed for neurotypical people. And when those challenges go unrecognized for decades, the psychological toll can be devastating.
ADHD: More Than Just “Can’t Sit Still”
If you think ADHD is just about hyperactive little boys bouncing off the walls, you are working with an outdated picture. ADHD is a neurodevelopmental disorder that affects executive function – the brain’s CEO, if you will. It impacts planning, organization, time management, emotional regulation, working memory, and impulse control.
Dr. Russell Barkley, one of the foremost ADHD researchers in the world, has been saying for decades that ADHD is fundamentally a disorder of self-regulation, not attention. He describes it as a problem with the brain’s ability to use what it knows in the moment it needs to use it.
The Three Presentations
| Presentation | Key Features | Who Gets Missed |
|---|---|---|
| Predominantly Inattentive | Difficulty focusing, forgetfulness, losing things, daydreaming | Girls and women, quiet kids, high-IQ individuals who compensate |
| Predominantly Hyperactive-Impulsive | Restlessness, talking excessively, interrupting, acting without thinking | The “classic” presentation – usually caught in boys |
| Combined | Features of both inattentive and hyperactive-impulsive | Depends on which symptoms are most visible |
For decades, the research was done almost exclusively on hyperactive boys. The quiet girl staring out the window, losing her homework, and feeling like she was drowning while everyone else seemed to swim effortlessly? She was called “spacey,” “lazy,” or “not living up to her potential.” She was not diagnosed. She was blamed.
Dr. Edward Hallowell, a psychiatrist who has ADHD himself and co-authored Driven to Distraction, puts it this way:
“ADHD is not about knowing what to do, but about doing what you know.”
Autism Spectrum Disorder: The New Classification
Before 2013, the diagnostic manual (DSM-IV) had several separate categories: Autistic Disorder, Asperger’s Syndrome, PDD-NOS, and Childhood Disintegrative Disorder. The DSM-5, published in 2013, collapsed all of these into one diagnosis: Autism Spectrum Disorder (ASD). Asperger’s Syndrome as a separate diagnosis no longer exists.
The Three Levels
| Level | Description | What It Looks Like |
|---|---|---|
| Level 1 | Requiring Support | Difficulty initiating social interactions, inflexible behavior. Roughly equivalent to what was previously called Asperger’s. |
| Level 2 | Requiring Substantial Support | Marked deficits in communication, limited social interactions, difficulty coping with change. |
| Level 3 | Requiring Very Substantial Support | Severe deficits in communication, very limited social initiation, extreme difficulty coping with change. |
The name “Asperger’s” itself became controversial when historical research revealed that Hans Asperger had cooperated with the Nazi regime’s child euthanasia program. Many in the autism community actively reject the term for this reason.
A new category was also added: Social Communication Disorder, for individuals who have social communication difficulties but do not meet the full criteria for ASD.
Dr. Tony Attwood notes that many autistic individuals, particularly women, develop extraordinarily sophisticated social masks that can fool even experienced clinicians.
The Misdiagnosis and Under-Diagnosis Crisis
For decades, neurodivergent people – especially women, people of color, and anyone who did not fit the narrow stereotype – were missed. They were not just missed; they were actively misdiagnosed.
A woman with undiagnosed ADHD might be told she has anxiety and depression. She gets put on an SSRI. It helps a little with the mood, but the executive dysfunction, the time blindness, the feeling of drowning in daily tasks – that does not change. Because you are treating the smoke, not the fire.
The Numbers Tell the Story
- Autism diagnosis rates in large US health systems rose by 175% between 2011 and 2022 (JAMA Network Open, 2024). Adults ages 26-34 saw a 450% increase.
- Over 50% of adults with ADHD have at least one co-occurring psychiatric condition.
- 42% of autistic adults meet criteria for an anxiety disorder, and 37% for depression.
- Autistic females are consistently diagnosed later than males, with the majority receiving their diagnosis in adulthood.
- ADHD rates are 10 times higher among adults with autism compared to the general population.
The Grief of Late Diagnosis
When someone gets diagnosed with ADHD or autism in their thirties, forties, or fifties, the initial reaction is often relief. Finally. An explanation. I’m not broken. I’m not lazy. I’m not defective. That relief is real and it matters.
But then comes the grief. And it hits like a freight train. The grief is for the lost years. The marriages that fell apart. The careers that stalled. The friendships that withered because social masking was so exhausting. The childhoods spent being punished for behaviors that were neurological, not behavioral.
“To live decades without knowing you are neurodivergent is to live in a fog of misinterpretation.”
Strategies that help include naming the grief explicitly, connecting with late-diagnosed communities, working with a neurodivergence-informed therapist, and – critically – allowing yourself to mourn without rushing to “get over it.”
The Self-Diagnosis Epidemic: “Doesn’t Everybody Have That These Days?”
Now, I need to talk about something that makes my blood boil, because it directly harms people like my daughter.
My daughter has an autism diagnosis. A real one. With all of the debilitating symptoms that come with it. And yet, when she tells someone she is autistic, she increasingly gets one of two responses: a skeptical look, or the devastating, “Doesn’t everybody have that these days?”
No. Everybody does not.
A March 2026 study from the University of East Anglia found that 52% of ADHD-related TikTok videos and 41% of autism-related videos contained inaccurate information. The APA noted in 2025 that psychologists have observed an upsurge in autism evaluation cancellations – people who were properly diagnosed now questioning their diagnosis because the internet told them “everyone’s a little autistic.”
Let me be clear: everyone is NOT “a little autistic.” That is like saying everyone is “a little pregnant.” You either meet the diagnostic criteria or you do not.
The self-diagnosis trend devalues the experiences of people who genuinely have these conditions and keeps some from seeking proper assessment. If you genuinely suspect you are neurodivergent, please seek a proper evaluation.
Movies, Documentaries, and the Faces of Neurodivergence
Temple Grandin (2010, HBO) – Claire Danes delivers an Emmy-winning performance as Dr. Temple Grandin. Grandin herself has said, “I am different, not less.”
Life, Animated (2016) – The extraordinary story of Owen Suskind, an autistic boy who learned to communicate through Disney animated films.
Inside Our Minds (BBC) – An award-winning documentary series letting neurodivergent people tell their own stories.
Atypical (Netflix) – A series about an autistic teenager navigating high school that brought autism into mainstream conversation.
Medication: Why One Size Does NOT Fit All
Prescribing medication to a neurodivergent person the same way you would prescribe to a neurotypical person can be ineffective at best and harmful at worst.
A woman with undiagnosed ADHD goes to her doctor because she is anxious and depressed. The doctor prescribes an SSRI. It might help somewhat with the mood symptoms. But the core problem – the ADHD – remains untreated. She might even feel worse because now she has just enough emotional stability to clearly see everything she still cannot do.
A 2025 study in BMC Medicine recommended that for patients with co-occurring autism and ADHD, medications like buspirone and mirtazapine may be preferable to SSRIs. 30% of autistic adults were prescribed an antidepressant in 2023, compared to 14.7% of non-autistic adults.
Treatment: What Actually Helps
For ADHD:
- Stimulant medication (methylphenidate, amphetamine-based) remains the most effective treatment, with response rates around 70-80%.
- Behavioral strategies adapted for ADHD brains – external scaffolding, body doubling, breaking tasks into micro-steps.
- Exercise – Dr. John Ratey, author of Spark, calls exercise “like taking a little bit of Prozac and a little bit of Ritalin.”
For Autism:
- Occupational therapy for sensory processing challenges.
- CBT adapted for autism – standard CBT often needs significant modification.
- Environmental modifications – reducing sensory overload, creating predictable routines.
For Both:
- Therapy with a neurodivergence-informed clinician – a therapist who does not understand neurodivergence can inadvertently do harm.
- Community and peer support – connecting with other neurodivergent people can be profoundly healing.
- Self-compassion work – as I wrote about in my post on shame, shame is not your friend.
The Big Hats: Experts Who Changed the Conversation
Dr. Temple Grandin – Perhaps the most famous autistic person in the world. Her books include Thinking in Pictures and The Autistic Brain.
Dr. Russell Barkley – The leading authority on ADHD. His research on executive function has fundamentally changed how we understand the condition.
Dr. Tony Attwood – Particularly influential in identifying autism in women and girls.
Simon Baron-Cohen – Director of the Autism Research Centre at Cambridge, developed the empathizing-systemizing theory.
Dr. Gabor Mate – Author of Scattered Minds, draws powerful connections between ADHD, trauma, and emotional development.
Dr. Devon Price – Author of Unmasking Autism, a powerful voice on the cost of masking.
Dr. Edward Hallowell – Co-authored Driven to Distraction, one of the most influential books on ADHD.
Uta Frith – A pioneer in cognitive approaches to autism research.
The Neurodivergence-Trauma Connection
When you grow up with an undiagnosed neurodivergent brain, the world is constantly telling you something is wrong with you. That is trauma. Not a single catastrophic event, but the slow, relentless erosion of your sense of self that Judith Herman would recognize as complex trauma. Pete Walker would call it the breeding ground for the Fawn response.
For more on the trauma side, visit my posts on what healing actually looks like and the power of EMDR.
If any of this resonated with you – if you read this and thought, “Wait, that sounds like me” – please seek a proper evaluation from a qualified professional. And if you are a parent reading this, thinking about your child – trust your gut. Advocate for them. Because the earlier we find the missing piece, the less grief there is to carry later.
References
- Barkley, R. A. (2012). Executive Functions. Guilford Press.
- Hallowell, E. M., & Ratey, J. J. (2011). Driven to Distraction. Anchor Books.
- Grandin, T. (2006). Thinking in Pictures. Vintage Books.
- Attwood, T. (2006). The Complete Guide to Asperger’s Syndrome. Jessica Kingsley.
- Price, D. (2022). Unmasking Autism. Harmony Books.
- Mate, G. (1999). Scattered Minds. Vintage Canada.
- Lundstrom, S., et al. (2024). Autism diagnosis among US children and adults. JAMA Network Open, 7(10).
- Hollocks, M. J., et al. (2019). Anxiety and depression in adults with ASD. Psychological Medicine, 49(4).
- Katzman, M. A., et al. (2017). Adult ADHD and comorbid disorders. BMC Psychiatry, 17.
- Manter, M. A., et al. (2025). Pharmacological treatment in autism. BMC Medicine.
- Hull, L., et al. (2017). Social camouflaging in adults with autism. JADD, 47(8).
- Carter, A., et al. (2026). Accuracy of ADHD and autism content on TikTok. University of East Anglia.
- APA. (2025). Correcting misinformation about autism. APA Monitor.
- Ratey, J. J. (2008). Spark. Little, Brown.
Heleen Woest is a Licensed Professional Counselor specializing in trauma, EMDR, and neurodivergence at Life Solutions Counseling. To learn more or schedule a consultation, visit lifesolutions.io.