Learning the Cherry AADI: ADHD and Autism Assessment for Adults

Assessment Duration:

• A minimum of 180 minutes of comprehensive assessment with the client
• Clinical documentation time and consultation (as needed)
• 30-minute follow-up session with client to review results and determine next steps

("Part 1") Core Assessment Components: All based on ICD-11 and DSM-5-TR criteria

• ADHD Assessment: Attention regulation patterns, hyperactivity-impulsivity presentations, and executive function variations
• Autism Assessment: Social communication differences, behavioral patterns, sensory processing, and special interests
• AuDHD Recognition: Assessment of co-occurring presentations (research shows 50-70% overlap)

("Part 2") Advanced Clinical Components:

• Masking and Camouflaging Assessment: Based on L. Hull, et al.'s research and CAT-Q concepts, addressing how social performance obscures underlying traits
• Pathological Demand Avoidance (PDA) Evaluation: Recognition of autonomy needs and demand responses within neurodivergence
• Late Identification Factors: Gender, sex, cultural, and environmental influences on delayed recognition
• Strengths and Environmental Optimization: Focus on individual neurological profile and support needs versus "deficits."

("Part 3") Differential Diagnosis Components:

• Anxiety Disorders Screening: GAD-2 (Ultra-Brief)
• Depression Disorder Screening: PHQ-2 (Ultra-Brief)
• Obsessive-Compulsive Disorder Screening: OCI-R-Brief (modified from the Obsessive-Compulsive Inventory-Revised)
• Bipolar Disorder Screening: MDQ-Brief (modified from Mood Disorder Questionnaire)

("Part 4") Clinical Integration and Summary:

• Core Neurodevelopmental Presentations Identified
• Differential Diagnosis Considered
• Overall Evidence Strength
• Professional Consultation Utilized
• Clinical Confidence Level
• Professional Recommendations

Core Framework and Diagnostic References

ICD-11 and International Standards

Reed, G. M., First, M. B., Kogan, C. S., Hyman, S. E., Gureje, O., Gaebel, W., Maj, M., Stein, D. J., Maercker, A., Tyrer, P., Claudino, A., Garralda, E., Salvador-Carulla, L., Ray, R., Saunders, J. B., Dua, T., Poznyak, V., Medina-Mora, M. E., Saxena, S., & Kessler, R. C. (2019). Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry, 18(1), 3-19. https://doi.org/10.1002/wps.20611

World Health Organization. (2022a). International Classification of Diseases, 11th revision (ICD-11). https://icd.who.int/en

World Health Organization. (2022b). Attention deficit hyperactivity disorder (6A05). In ICD-11 for mortality and morbidity statistics. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/821852937

World Health Organization. (2022c). Autism spectrum disorder (6A02). In ICD-11 for mortality and morbidity statistics. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/437815624

DSM-5-TR Framework

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association Publishing.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association Publishing.

Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM-5: Classification and criteria changes. World Psychiatry, 12(2), 92-98. https://doi.org/10.1002/wps.20050

ADHD in Adults Research

Assessment and Diagnosis

Adamou, M., Arif, M., Asherson, P., Cubbin, S., Leaver, L., Sedgwick-Müller, J., Müller-Sedgwick, U., van Rensburg, K., & Kustow, J. (2024). The adult ADHD assessment quality assurance standard. Frontiers in Psychiatry, 15, Article 1380410. https://doi.org/10.3389/fpsyt.2024.1380410

Asherson, P., Buitelaar, J., Faraone, S. V., & Rohde, L. A. (2016). Adult attention-deficit hyperactivity disorder: Key conceptual issues. The Lancet Psychiatry, 3(6), 568-578. https://doi.org/10.1016/S2215-0366(16)30032-3

Cortese, S., Bellgrove, M. A., Brikell, I., Franke, B., Goodman, D. W., Hartman, C. A., Larsson, H., Levin, F. R., Ostinelli, E. G., Parlatini, V., Ramos‐Quiroga, J. A., Sibley, M. H., Tomlinson, A., Wilens, T. E., Wong, I. C. K., Hovén, N., Didier, J., Correll, C. U., Rohde, L. A., & Faraone, S. V. (2025). Attention‐deficit/hyperactivity disorder (ADHD) in adults: evidence base, uncertainties and controversies. World Psychiatry, 24(3), 347–371. https://doi.org/10.1002/wps.21374

Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., ... & Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789-818. https://doi.org/10.1016/j.neubiorev.2021.01.022

Kooij, J. J. S., Bijlenga, D., Salerno, L., Jaeschke, R., Bitter, I., Balázs, J., Thome, J., Dom, G., Kasper, S., Filipe, C. N., Stes, S., Mohr, P., Leppämäki, S., Brugué, M. C., Bobes, J., Mccarthy, J. M., Richarte, V., Philipsen, A. K., Pehlivanidis, A., ... & Asherson, P. (2019). Updated European consensus statement on diagnosis and treatment of adult ADHD. European Psychiatry, 56, 14-34. https://doi.org/10.1016/j.eurpsy.2018.11.001

Sibley, M. H., Rohde, L. A., Swanson, J. M., Hechtman, L. T., Molina, B. S. G., Mitchell, J. T., Arnold, L. E., Caye, A., Kennedy, T. M., Roy, A., & Stehli, A. (2018). Late-Onset ADHD Reconsidered With Comprehensive Repeated Assessments Between Ages 10 and 25. American Journal of Psychiatry, 175(2), 140–149. https://doi.org/10.1176/appi.ajp.2017.17030298

Young, S., Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, G., Hill, P., Hollingdale, J., Kilic, O., Lloyd, T., Mason, P., Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., ... & Woodhouse, E. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/hyperactivity disorder in females. BMC Psychiatry, 20(1), Article 404. https://doi.org/10.1186/s12888-020-02707-9

Young, S., Bramham, J., Gudjonsson, G., & Cocallis, K. (2024). Sex differences in the severity of ADHD symptoms across the lifespan: A systematic review and meta-analysis. Psychological Medicine, 54(14), 3219-3235. https://doi.org/10.1017/S0033291724001399

Executive Function and Time Perception

Barkley, R. A. (2012). Executive functions: What they are, how they work, and why they evolved. Guilford Press.

Ptacek, R., Weissenberger, S., Braaten, E., Klicperova-Baker, M., Goetz, M., Raboch, J., Vnukova, M., & Stefano, G. B. (2019). Clinical implications of the perception of time in attention deficit hyperactivity disorder (ADHD): A review. Medical Science Monitor, 25, 3918-3924. https://doi.org/10.12659/MSM.914225

Weissenberger, S., Klicperova-Baker, M., Zimbardo, P., Schonova, K., Akotia, D., Kostal, J., Goetz, M., Raboch, J., & Ptacek, R. (2016). ADHD and present hedonism: Time perspective as a potential diagnostic and therapeutic tool. Neuropsychiatric Disease and Treatment, 12, 2963-2971. https://doi.org/10.2147/NDT.S116721

Autism in Adults Research

Assessment and Late Identification

Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281-3294. https://doi.org/10.1007/s10803-016-2872-8

Happé, F. G., Mansour, H., Barrett, P., Brown, T., Abbott, P., & Charlton, R. A. (2016). Demographic and cognitive profile of individuals seeking a diagnosis of autism spectrum disorder in adulthood. Journal of Autism and Developmental Disorders, 46(11), 3469-3480. https://doi.org/10.1007/s10803-016-2886-2

Huang, Y., Arnold, S. R., Foley, K. R., & Trollor, J. N. (2020). Diagnosis of autism in adulthood: A scoping review. Autism, 24(6), 1311-1327. https://doi.org/10.1177/1362361320903128

Leedham, A., Thompson, A. R., Smith, R., & Freeth, M. (2020). 'I was exhausted trying to figure it out': The experiences of females receiving an autism diagnosis in middle to late adulthood. Autism, 24(1), 135-146. https://doi.org/10.1177/1362361319853442

Loomes, R., Hull, L., & Mandy, W. P. L. (2017). What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 56(6), 466-474. https://doi.org/10.1016/j.jaac.2017.03.013

Stagg, S. D., & Belcher, H. (2019). Living with autism without knowing: Receiving a diagnosis in later life. Health Psychology and Behavioral Medicine, 7(1), 348-361. https://doi.org/10.1080/21642850.2019.1684920

Sensory Processing

Crane, L., Goddard, L., & Pring, L. (2009). Sensory processing in adults with autism spectrum disorders. Autism, 13(3), 215-228. https://doi.org/10.1177/1362361309103794

Robertson, C. E., & Baron-Cohen, S. (2017). Sensory perception in autism. Nature Reviews Neuroscience, 18(11), 671-684. https://doi.org/10.1038/nrn.2017.112

Tavassoli, T., Miller, L. J., Schoen, S. A., Nielsen, D. M., & Baron-Cohen, S. (2014). Sensory over-responsivity in adults with autism spectrum conditions. Autism, 18(4), 428-432. https://doi.org/10.1177/1362361313477246

Masking and Camouflaging Research

Core Masking Studies

Cage, E., & Troxell-Whitman, Z. (2019). Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 49(5), 1899-1911. https://doi.org/10.1007/s10803-018-03878-x

Cook, A., Ogden, J., & Winstone, N. (2018). Friendship motivations, challenges and the role of masking for girls with autism in contrasting school settings. European Journal of Special Needs Education, 33(3), 302-315. https://doi.org/10.1080/08856257.2017.1312797

Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M. C., & Mandy, W. (2017). "Putting on my best normal": Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519-2534. https://doi.org/10.1007/s10803-017-3166-5

Hull, L., Petrides, K. V., & Mandy, W. (2020). The female autism phenotype and camouflaging: A narrative review. Review Journal of Autism and Developmental Disorders, 7(4), 306-317. https://doi.org/10.1007/s40489-020-00197-9

Livingston, L. A., Shah, P., & Happé, F. (2019). Compensatory strategies below the behavioural surface in autism: A qualitative study. The Lancet Psychiatry, 6(9), 766-777. https://doi.org/10.1016/S2215-0366(19)30224-X

Perry, E., Mandy, W., Hull, L., & Cage, E. (2022). Understanding camouflaging as a response to autism-related stigma: A social identity theory perspective. Journal of Autism and Developmental Disorders, 52(2), 800-810. https://doi.org/10.1007/s10803-021-04987-w

Masking in ADHD

Young, S., Bramham, J., Gray, K., & Rose, E. (2018). A phenomenological analysis of the experience of receiving a diagnosis and treatment of ADHD in adulthood: A partner's perspective. Journal of Attention Disorders, 22(12), 1168-1178. https://doi.org/10.1177/1087054716646451

AuDHD and Co-occurring Presentations

Co-occurrence Research

Antshel, K. M., Zhang-James, Y., & Faraone, S. V. (2013). The comorbidity of ADHD and autism spectrum disorder. Expert Review of Neurotherapeutics, 13(10), 1117-1128. https://doi.org/10.1586/14737175.2013.840417

Hours, C., Recasens, C., & Baleyte, J. M. (2022). ASD and ADHD comorbidity: What are we talking about? Frontiers in Psychiatry, 13, Article 837424. https://doi.org/10.3389/fpsyt.2022.837424

Lai, M. C., Kassee, C., Besney, R., Bonato, S., Hull, L., Mandy, W., Szatmari, P., & Ameis, S. H. (2019). Prevalence of co-occurring mental health diagnoses in the autism population: A systematic review and meta-analysis. The Lancet Psychiatry, 6(10), 819-829. https://doi.org/10.1016/S2215-0366(19)30289-5

Polderman, T. J., Hoekstra, R. A., Posthuma, D., & Larsson, H. (2014). The co-occurrence of autistic and ADHD dimensions in adults: An etiological study in 17,770 twins. Translational Psychiatry, 4(9), Article e435. https://doi.org/10.1038/tp.2014.84

Rong, Y., Yang, C. J., Jin, Y., & Wang, Y. (2021). Prevalence of attention-deficit/hyperactivity disorder in individuals with autism spectrum disorder: A meta-analysis. Research in Autism Spectrum Disorders, 83, Article 101759. https://doi.org/10.1016/j.rasd.2021.101759

Sokolova, E., Oerlemans, A. M., Rommelse, N. N., Groot, P., Hartman, C. A., Glennon, J. C., Claassen, T., Heskes, T., & Buitelaar, J. K. (2017). A causal and mediation analysis of the comorbidity between attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Journal of Autism and Developmental Disorders, 47(6), 1595-1604. https://doi.org/10.1007/s10803-017-3083-7

Pathological Demand Avoidance Research

PDA Assessment and Understanding

Egan, V., Linenberg, O., & O’Nions, E. (2018). The Measurement of Adult Pathological Demand Avoidance Traits. Journal of Autism and Developmental Disorders, 49(2), 481–494. https://doi.org/10.1007/s10803-018-3722-7

Gillberg, C., Gillberg, I. C., Thompson, L., Biskupsto, R., & Billstedt, E. (2015). Extreme ("pathological") demand avoidance in autism: A general population study in the Faroe Islands. European Child & Adolescent Psychiatry, 24(8), 979-984. https://doi.org/10.1007/s00787-014-0647-3

Newson, E., Le Maréchal, K., & David, C. (2003). Pathological demand avoidance syndrome: A necessary distinction within the pervasive developmental disorders. Archives of Disease in Childhood, 88(7), 595-600. https://doi.org/10.1136/adc.88.7.595

Clinical Interview Methods

Evidence Base for Clinical Interview Approaches

First, M. B., Williams, J. B., Karg, R. S., & Spitzer, R. L. (2015). Structured Clinical Interview for DSM-5—Research Version (SCID-5 for DSM-5, Research Version; SCID-5-RV). American Psychiatric Association.

Monteiro, M. J., & Stegall, S. (2018). MIGDAS-2 : Monteiro interview guidelines for diagnosing the autism spectrum (Second edition.). WPS Publishing.

Rogers, R. (2001). Handbook of diagnostic and structured interviewing. Guilford Press.

Summerfeldt, L. J., Ovanessian, M. M., & Antony, M. M. (2020). Structured and semistructured diagnostic interviews. In M. M. Antony & D. H. Barlow (Eds.), Handbook of assessment and treatment planning for psychological disorders (3rd ed., pp. 74–115). The Guilford Press.

Differential Diagnosis Screening Tools

Anxiety Screening

Plummer, F., Manea, L., Trepel, D., & McMillan, D. (2016). Screening for anxiety disorders with the GAD-7 and GAD-2: A systematic review and diagnostic metaanalysis. General Hospital Psychiatry, 39, 24-31. https://doi.org/10.1016/j.genhosppsych.2015.11.005

Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-1097. https://doi.org/10.1001/archinte.166.10.1092

Depression Screening

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2003). The Patient Health Questionnaire-2: Validity of a two-item depression screener. Medical Care, 41(11), 1284-1292. https://doi.org/10.1097/01.MLR.0000093487.78664.3C

OCD Screening

Abramowitz, J. S., & Deacon, B. J. (2006). Psychometric properties and construct validity of the Obsessive-Compulsive Inventory-Revised: Replication and extension with a clinical sample. Journal of Anxiety Disorders, 20(8), 1016-1035. https://doi.org/10.1016/j.janxdis.2006.03.001

Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The Obsessive-Compulsive Inventory: Development and validation of a short version. Psychological Assessment, 14(4), 485-496. https://doi.org/10.1037/1040-3590.14.4.485

Bipolar Screening

Hirschfeld, R. M., Williams, J. B., Spitzer, R. L., Calabrese, J. R., Flynn, L., Keck Jr, P. E., Lewis, L., McElroy, S. L., Post, R. M., Rapport, D. J., Russell, J. M., Sachs, G. S., & Zajecka, J. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: The Mood Disorder Questionnaire. American Journal of Psychiatry, 157(11), 1873-1875. https://doi.org/10.1176/appi.ajp.157.11.1873

Weber Rouget, B., Gervasoni, N., Dubuis, V., Gex-Fabry, M., Bondolfi, G., & Aubry, J. M. (2005). Screening for bipolar disorders using a French version of the Mood Disorder Questionnaire (MDQ). Journal of Affective Disorders, 88(1), 103-108. https://doi.org/10.1016/j.jad.2005.06.010

Cultural Competency and Bias Reduction

Cultural Considerations in Assessment

Burkett, K., Morris, E., Manning-Courtney, P., Anthony, J., & Shambley-Ebron, D. (2015). African American families on autism diagnosis and treatment: The influence of culture. Journal of Autism and Developmental Disorders, 45(10), 3244-3254. https://doi.org/10.1007/s10803-015-2482-x

Dababnah, S., Shaia, W. E., Campion, K., & Nichols, H. M. (2018). "We had to keep pushing": Caregivers' perspectives on autism screening and referral practices of Black children in primary care. Intellectual and Developmental Disabilities, 56(5), 321-336. https://doi.org/10.1352/1934-9556-56.5.321

de Leeuw, A., Happé, F., & Hoekstra, R. A. (2020). A conceptual framework for understanding the cultural and contextual factors on autism across the globe. Autism Research, 13(7), 1029-1050. https://doi.org/10.1002/aur.2276

Norbury, C. F., & Sparks, A. (2013). Difference or disorder? Cultural issues in understanding neurodevelopmental disorders. Developmental Psychology, 49(1), 45-58. https://doi.org/10.1037/a0027446

Sue, D. W., & Sue, D. (2019). Counseling the culturally diverse: Theory and practice (8th ed.). Wiley.

Gender and Sex Differences

Gender Differences in Presentation

Gould, J. (2017). Towards understanding the under-recognition of girls and women on the autism spectrum. Autism, 21(6), 703-705. https://doi.org/10.1177/1362361317706174

Kreiser, N. L., & White, S. W. (2014). ASD in females: Are we overstating the gender difference in diagnosis? Clinical Child and Family Psychology Review, 17(1), 67-84. https://doi.org/10.1007/s10567-013-0148-9

Lai, M. C., Lombardo, M. V., Auyeung, B., Chakrabarti, B., & Baron-Cohen, S. (2015). Sex/gender differences and autism: Setting the scene for future research. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 11-24. https://doi.org/10.1016/j.jaac.2014.10.003

Milner, V., McIntosh, H., Colvert, E., & Happé, F. (2019). A qualitative exploration of the female experience of autism spectrum disorder (ASD). Journal of Autism and Developmental Disorders, 49(6), 2389-2402. https://doi.org/10.1007/s10803-019-03906-4

Neurodiversity-Affirming Practice

Strengths-Based and Affirming Approaches

Bottema-Beutel, K., Kapp, S. K., Lester, J. N., Sasson, N. J., & Hand, B. N. (2021). Avoiding ableist language: Suggestions for autism researchers. Autism in Adulthood, 3(1), 18-29. https://doi.org/10.1089/aut.2020.0014

Chapman, R., & Botha, M. (2023). Neurodiversity theory and its discontents: Autism, schizophrenia, and the social model of disability. In S. Tekin & R. Bluhm (Eds.), The Bloomsbury companion to philosophy of psychiatry (pp. 371-389). Bloomsbury Academic.

Dwyer, P. (2022). The neurodiversity approach(es): What are they and what do they mean for researchers? Human Development, 66(2), 73-92. https://doi.org/10.1159/000523723

Kenny, L., Hattersley, C., Molins, B., Buckley, C., Povey, C., & Pellicano, E. (2016). Which terms should be used to describe autism? Perspectives from the UK autism community. Autism, 20(4), 442-462. https://doi.org/10.1177/1362361315588200

Leadbitter, K., Buckle, K. L., Ellis, C., & Dekker, M. (2021). Autistic self-advocacy and the neurodiversity movement: Implications for autism early intervention research and practice. Frontiers in Psychology, 12, Article 635690. https://doi.org/10.3389/fpsyg.2021.635690

Russell, G., Kapp, S. K., Elliott, D., Elphick, C., Gwernan-Jones, R., & Owens, C. (2019). Mapping the autistic advantage from the accounts of adults diagnosed with autism: A qualitative study. Autism in Adulthood, 1(2), 124-133. https://doi.org/10.1089/aut.2018.0035

Trauma-Informed Assessment

Trauma and Neurodivergence Intersection

Haruvi-Lamdan, N., Horesh, D., & Golan, O. (2018). PTSD and autism spectrum disorder: Co-morbidity, gaps in research, and potential shared mechanisms. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), 290-299. https://doi.org/10.1037/tra0000298

Haruvi-Lamdan, N., Horesh, D., Zohar, S., Kraus, M., & Golan, O. (2020). Autism Spectrum Disorder and Post-Traumatic Stress Disorder: An unexplored co-occurrence of conditions. Autism, 24(4), 884–898. https://doi.org/10.1177/1362361320912143

Kerns, C. M., Newschaffer, C. J., & Berkowitz, S. J. (2015). Traumatic childhood events and autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(11), 3475-3486. https://doi.org/10.1007/s10803-015-2392-y

Peterson, J. L., Earl, R. K., Fox, E. A., Ma, R., Haidar, G., Pepper, M., Berliner, L., Wallace, A. S., & Bernier, R. A. (2019). Trauma and autism spectrum disorder: Review, proposed treatment adaptations and future directions. Journal of Child & Adolescent Trauma, 12(4), 529-547. https://doi.org/10.1007/s40653-019-00253-5

Rumball, F., Happé, F., & Grey, N. (2020). Experience of trauma and PTSD symptoms in autistic adults: Risk of PTSD development following DSM-5 and non-DSM-5 traumatic life events. Autism Research, 13(12), 2122-2132. https://doi.org/10.1002/aur.2306

Telehealth and Digital Assessment

Virtual Assessment Validity

Dahiya, A. V., McDonnell, C., DeLucia, E., & Scarpa, A. (2020). A systematic review of remote telehealth assessments for early signs of autism spectrum disorder: Video and mobile applications. Practice Innovations, 5(2), 150-164. https://doi.org/10.1037/pri0000121

Sutherland, R., Trembath, D., & Roberts, J. (2018). Telehealth and autism: A systematic search and review of the literature. International Journal of Speech-Language Pathology, 20(3), 324-336. https://doi.org/10.1080/17549507.2018.1465123

Valentine, A. Z., Hall, S. S., Young, E., Brown, B. J., Groom, M. J., Hollis, C., & Hall, C. L. (2021). Implementation of telehealth services to assess, monitor, and treat neurodevelopmental disorders: Systematic review. Journal of Medical Internet Research, 23(1), Article e22619. https://doi.org/10.2196/22619

Identity and Self-Advocacy

Neurodivergent Identity Development

Cooper, K., Smith, L. G., & Russell, A. (2017). Social identity, self-esteem, and mental health in autism. European Journal of Social Psychology, 47(7), 844-854. https://doi.org/10.1002/ejsp.2297

Crane, L., Batty, R., Adeyinka, H., Goddard, L., Henry, L. A., & Hill, E. L. (2018). Autism diagnosis in the United Kingdom: Perspectives of autistic adults, parents and professionals. Journal of Autism and Developmental Disorders, 48(11), 3761-3772. https://doi.org/10.1007/s10803-018-3639-1

McDonald, T. A. M. (2020). Autism identity and the "lost generation": Structural validation of the autism spectrum identity scale and comparison of diagnosed and self-diagnosed adults on the autism spectrum. Autism in Adulthood, 2(1), 13-23. https://doi.org/10.1089/aut.2019.0069

Burnout and Mental Health

Autistic Burnout

Higgins, J. M., Arnold, S. R., Weise, J., Pellicano, E., & Trollor, J. N. (2021). Defining autistic burnout through experts by lived experience: Grounded Delphi method investigating #AutisticBurnout. Autism, 25(8), 2356-2369. https://doi.org/10.1177/13623613211019858

Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., & Nicolaidis, C. (2020). "Having all of your internal resources exhausted beyond measure and being left with no clean-up crew": Defining autistic burnout. Autism in Adulthood, 2(2), 132-143. https://doi.org/10.1089/aut.2019.0079

ADHD and Mental Health

Solberg, B. S., Halmøy, A., Engeland, A., Igland, J., Haavik, J., & Klungsøyr, K. (2018). Gender differences in psychiatric comorbidity: A population-based study of 40,000 adults with attention deficit hyperactivity disorder. Acta Psychiatrica Scandinavica, 137(3), 176-186. https://doi.org/10.1111/acps.12845

Professional Ethics and Standards

Ethical Considerations in Assessment

American Association for Marriage and Family Therapy. (2015). Code of ethics. https://www.aamft.org/Legal_Ethics/Code_of_Ethics.aspx

American Counseling Association. (2014). ACA code of ethics. https://www.counseling.org/resources/aca-code-of-ethics.pdf

American Mental Health Counselors Association. (2020). AMHCA code of ethics. https://www.amhca.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=24a27502-196e-b763-ff57-490a12f7edb1&forceDialog=0

American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. https://www.apa.org/ethics/code

International Association of Marriage and Family Counselors. (2017). Ethical standards for the International Association of Marriage and Family Counselors. http://www.iamfconline.org/public/department47.cfm

National Association of Social Workers. (2017). NASW code of ethics. https://www.socialworkers.org/About/Ethics/Code-of-Ethics

National Board for Certified Counselors. (2023). NBCC code of ethics. https://nbcc.org/Assets/Ethics/NBCCCodeofEthics.pdf

Additional Methodological Resources

Clinical Assessment Standards

Angold, A., Costello, E. J., & Egger, H. (2012). Structured interviewing. In M. Rutter, D. Bishop, D. Pine, S. Scott, J. Stevenson, E. Taylor, & A. Thapar (Eds.), Rutter's child and adolescent psychiatry (5th ed., pp. 408-427). Blackwell Publishing.

Hunsley, J., & Mash, E. J. (2018). A guide to assessments that work (2nd ed.). Oxford University Press.

Youngstrom, E. A., Choukas-Bradley, S., Calhoun, C. D., & Jensen-Doss, A. (2015). Clinical guide to the evidence-based assessment approach to diagnosis and treatment. Cognitive and Behavioral Practice, 22(1), 20-35. https://doi.org/10.1016/j.cbpra.2013.12.005

Types of Clinical Assessment Tools

Psychometric Instruments

What they are: Standardized tools with fixed items that produce numerical scores

• Examples: ADOS-2, CAARS, Beck Depression Inventory, PHQ-9
• Characteristics: Fixed scoring protocols, established norms, statistical reliability/validity data
• Evaluation criteria: Require validation studies, norming samples, peer-reviewed research
• Purpose: Provide standardized scores for comparison to population norms

Semi-Structured or Structured Clinical Interviews

What they are: Systematic clinical methods for exploring diagnostic criteria

• Examples: SCID (Structured Clinical Interview for DSM), Cherry AADI, clinical mental status exams
• Characteristics: Framework-based, flexible clinical exploration, qualitative data gathering
• Evaluation criteria: Based on diagnostic criteria adherence and clinical utility
• Purpose: Support clinical judgment and diagnostic decision-making

Assessment Protocols

What they are: Comprehensive frameworks that may include multiple tools plus clinical processes

• Examples: Hospital intake protocols, comprehensive diagnostic protocols
• Characteristics: Broad clinical procedures incorporating tools, interviews, observations, records review
• Evaluation criteria: Clinical outcomes, practical utility, professional standards compliance

Addressing Common Misconceptions

❌ "All assessment tools need validation studies"

✅ Reality: Only psychometric instruments require their own validation studies. Clinical interviews are validated through their adherence to established diagnostic criteria (such as the ICD and DSM, which have already been validated) and clinical outcomes.

❌ "Clinical tools need to be peer-reviewed"

✅ Reality: Peer review applies to research publications, not clinical practice tools. Clinical methods are evaluated through professional standards and outcomes.

❌ "Assessment methods need to be 'normed'"

✅ Reality: Only scored instruments need population norms. Clinical interviews gather qualitative information for clinical judgment, not quantitative data for numerical comparison.

❌ "Newer tools are less legitimate than 'established' ones"

✅ Reality: Clinical innovation is essential for addressing gaps in current practice. Many "gold standard" tools started as clinical innovations.

❌ Evidence-based practice does NOT require:

• Every clinical method to have research validation studies
• All tools to be decades old before being considered legitimate
• Abandoning clinical judgment in favor of only scored instruments

✅ Evidence-based practice in clinical assessment includes:

• Using established diagnostic criteria (e.g., DSM-5-TR, ICD-11)
• Applying systematic clinical methods
• Incorporating clinical expertise and judgment
• Considering client values and cultural context
• Demonstrating positive clinical outcomes

❓ "How does it compare to standardized tests?"

• Clinical interviews and standardized tests serve different purposes. Interviews allow for individualized, culturally responsive assessment that standardized instruments cannot provide.

❓ "Shouldn't it be based only on the DSM because that's what we use?"

• The DSM, developed by the American Psychiatric Association and currently in its 5^th edition text revision (DSM-5-TR), is primarily used in the United States but was originally based on the ICD. The ICD, developed by the World Health Organization, is used by 194 countries worldwide and is currently in its 11^th edition. While ADHD and autism are recognized in both frameworks with very similar diagnostic features, ICD-11 allows for more nuanced clinical judgment, which is ideal for complex adult presentations. It covers the same conditions as the DSM with equivalent accuracy but provides greater flexibility for adult presentations.

Scope of Practice Clarity

Licensed Mental Health Clinicians (LCMHCs, LCSWs, LPCs, LMFTs, psychologists, psychiatrists) within most U.S. states are fully qualified to diagnose ADHD and autism within their scope of practice.
The misconception that only psychologists can provide these assessments has been definitively addressed through professional standards and regulatory review.

Remember: Licensed mental health clinicians are trained and qualified to:

• Conduct clinical interviews
• Apply diagnostic criteria
• Use clinical judgment in assessment
• Innovate within their scope of practice
• Develop clinical methods that serve their clients

Understanding Development

For Clinicians: The Cherry AADI offers a comprehensive, evidence-based method that enhances your ability to serve adult neurodivergent clients while maintaining full professional compliance.

For Clients: This assessment provides the thorough, affirming evaluation needed to understand your neurological profile and access appropriate accommodations and supports.

The Cherry Adult ADHD-Autism Diagnostic Interview exemplifies appropriate clinical tool development:

• Foundation: Built on ICD-11 and DSM-5-TR diagnostic criteria and current research on adult presentations
• Method: Structured clinical interview with flexibility for individual presentations
• Integration: Can incorporate psychometric tools (such as ASRS-O and CAT-Q) when clinically indicated, but is not required
• Validation: Demonstrated through clinical outcomes and professional acceptance
• Innovation: Addresses specific gaps in adult neurodivergent assessment

Evidence-Based Method: The Cherry AADI represents established clinical practice combining:

• ICD-11 diagnostic criteria (internationally recognized)
• DSM-5-TR diagnostic criteria (domestically recognized)
• Structured clinical interview techniques (gold standard approach)
• Differential diagnosis protocols (essential for accuracy)
• Cultural competency frameworks (preventing bias and misdiagnosis)
• Adult-specific assessment considerations (addressing developmental masking)