More and more, our adult clients are asking a question that would have rarely come up 20 years ago: “Could I have ADHD or Autism?”
In some cases, they’re the parent of a child who was diagnosed early, and they’re starting to recognize similar patterns in themselves. In others, they’ve moved through major life shifts — COVID being a common backdrop — and are realizing they need more than coping skills and surface-level strategies to keep things sustainable.
And increasingly, clients are coming in with language already in place. Terms like masking or executive dysfunction aren’t new to them — they’ve seen it, read it, and in many cases, recognized themselves in it before ever sitting down in a therapy session.
So the question isn’t just more common — it’s more informed, more specific, and often more loaded.
We now know that a significant portion of adults with ADHD were never diagnosed in childhood, with prevalence estimates around 4 to 5%.
Autism is following a similar trajectory, with increasing recognition of adults who were previously overlooked due to more nuanced or masked presentations.
For therapists, this creates a specific kind of tension. You’re sitting with someone whose history clearly points to something deeper — but when you reach for traditional tools, the results don’t fully reflect what you’re seeing clinically.
This isn’t a failure of the therapist. It’s a limitation of the tools.
Most standardized ADHD and Autism instruments were developed with children in mind. They weren’t designed for adults who have spent decades adapting to environments that didn’t account for how their brains work.
In this blog, we’ll look at why those tools fall short — and why structured clinical interviews offer a more accurate way to assess adult neurodivergence.
The Mismatch Between Tools and Adult Presentations
Traditional tools are designed to identify observable symptoms. That works when symptoms are unfiltered and externally visible.
But adult neurodivergence rarely presents that way.
By adulthood, most clients have developed ways — often highly effective ones — to manage or conceal the very traits being assessed. What shows up in session is not the raw presentation, but the result of years of adaptation.
A client may appear organized because they’ve built rigid systems to compensate. Another may appear socially fluent because they’ve spent years studying and rehearsing interactions. On paper, these clients may not “score high enough.” In reality, they may be exerting significantly more effort than their peers just to maintain baseline functioning.
Traditional tools capture the outcome. They don’t capture the cost.
Masking Isn’t Peripheral — It’s Central
Masking isn’t a secondary factor in adult assessment — it’s often the primary reason presentations are missed.
Many clients have spent years learning how to meet expectations by observing, adjusting, and compensating. Over time, this creates a version of functioning that looks stable from the outside but is exhausting and often unsustainable underneath.
What looks like competence may involve constant pre-planning. What looks like emotional regulation may rely heavily on avoidance or rigid structure.
If masking isn’t explicitly assessed, clinicians are left evaluating the success of the compensation — not the underlying pattern.
The Cost of Missing It (for Clients and Clinicians)
By the time most adults seek assessment, they’re rarely asking a neutral question like “Is this possible?” It’s usually closer to: “I think this explains a lot — how do I actually find out?”
We often see clients coming in after years of trying to understand patterns that have had a real and often negative impact on their lives. Careers that feel harder to sustain than they “should” be. Relationships shaped by overwhelm, shutdown, or misattunement. Chronic stress that begins to show up physically.
Many have already been in therapy. They’ve developed insight, addressed anxiety, explored past experiences — and yet something still doesn’t fully account for what’s happening.
From the client’s perspective, it can feel like they’ve done everything “right” and are still missing a key explanation.
From the therapist’s side, there’s often a sense of circling something important without having the right framework to confidently name it.
The issue isn’t that the pattern is unclear. It’s that, for a long time, our assessment tools weren’t designed to capture the pattern → name it → understand it → include it in treatment.
Why Structured Clinical Interviews Change the Game
In complex adult presentations, we can’t rely on predefined thresholds or scores to rule neurodivergence in or out.
Structured clinical interviews allow for something more clinically useful. They make it possible to follow patterns across time, context, and development rather than evaluating symptoms in isolation.
Instead of asking only whether a symptom exists, the clinician can explore:
- When the pattern first emerged — and how it evolved over time
- What strategies the client developed to compensate or adapt
- How different contexts (work, relationships, environment) shape presentation
- Where symptoms overlap with — or diverge from — other conditions
- What the functional cost of “coping” actually is for the client
This is where adult assessment becomes more precise — not by adding more tools, but by asking better questions.
The Cherry AADI Method in Practice
The Cherry Adult ADHD-Autism Diagnostic Interview (AADI) was developed specifically to address the gaps clinicians encounter when assessing adults.
At its core, the method recognizes that child-focused tools aren’t sufficient for adults with decades of layered experiences. It builds in space to account for late identification, masking, and the influence of individual and cultural context.
The Cherry AADI integrates ICD-11 and DSM-aligned criteria while supporting differential diagnosis across ADHD, Autism, and co-occurring traits. It also includes practical tools — such as accommodations documentation — that help translate diagnosis into meaningful, real-world support.
The goal is not just diagnostic accuracy. It’s clinical usefulness — and, often, long-overdue clarity for clients.
Our Cherry AADI training equips licensed clinicians to confidently assess adult ADHD and Autism using a structured, clinically grounded approach. We offer online courses (8 CEs) and select in-person trainings throughout the year.
Check out our upcoming courses and events here, or send us an email if you have questions!