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Module 7 — Getting a Picture
Optional. Where each of you stands, what a diagnosis is actually for, and how we get a picture with a set of screeners.
Looking into your own neurotype is completely optional. Nothing in this program, and nothing in our sessions, requires it. If you are not interested, skip this module. If you are curious, this is what we do.
What this is about
People talk about this as if there were two positions: diagnosed and not. There are more, and we treat all of them as real. Diagnosed: an assessment happened and there is a report. Self-identified: you know what you are and do not need a form to say so. Not knowing yet. Considered it and decided no. Not interested in the question at all.
Quite often the two of you are standing in different positions, and that is fine.
Say yours out loud and put a date on it. Positions move, and partners often argue with where the other one stood a year ago.
What a diagnosis is for. A diagnosis is always formal; there is no informal kind. You need one for a few specific things. Adjustments an employer is obliged to make. Legal protection if they refuse. Support in education. A prescription, if ADHD medication is wanted. Some funded services.
Two more reasons, and these are personal. To know yourself for sure.
A clearer path for the two of you.
Some people really want to know, and a diagnosis is that confirmation. And an answer names the differences, so the two of you know what you are working on. Beyond that, you do not need a diagnosis to understand how you work, to change how you plan a weekend, or for anything in this program.
Most of the second list exists because institutions need a document. The last two items are yours. The first list is for the two of you, at home, this month.
What happens in the session
If one of you wants to look, we start with a question, not a form. The screeners go to the person the question is about. Your partner does not get to decide this for you, and your therapist will not push.
Getting a Picture
1 Your consent, and only yours. Your therapist asks whether you would like to look at a few screeners. If the answer is not yet, it stays not yet, and the couples work carries on unchanged.
2 A set, not a single test. Usually four. Each one looks at something different, so together they give a fuller picture than any one of them could.
3 Read back for the items, not the totals. In the next session your therapist goes through them with you. Which items made you stop? Which did your partner recognize?
4 The picture, then the question. What the set says together, in your own words, where both of you can hear it. Then, and only then: does an assessment make sense for you?
A screener is a mirror, not a diagnosis. It shows you a description of how you work. An assessment is a different thing, done by an assessor, over hours.
The set
The autism set. AQ-50, RAADS-14, CAT-Q and GQ-ASC. The AQ-50 is the best-known autism questionnaire. The RAADS-14 is a short screener built for adults. The CAT-Q looks at camouflaging, the effort of appearing typical. The GQ-ASC is written around the way autism tends to look in women and girls, the pattern most often missed.
The ADHD set. ASRS v1.1, SAAST, the Copeland checklist and the AAMM. The ASRS comes from the World Health Organization. The other three cover the day-to-day and the masking side of adult ADHD. Each name links to a free page on who built it and what the score means. How to Read an Autism Screener and How to Read an ADHD Screener are the places to start.
Whether you want to look. I am asking you, not the two of you. Would you like to look at a few screeners? Not one. A set, so no single number carries the weight. If the answer is not yet, that is a fine answer.
Reading them back. I am not going to add these up. Tell me which items made you stop. And to you: which of those did you recognize?
The picture. Here is what I think the set says together. Tell me where it is wrong. It is not a label. It is a description of how you work.
Nobody adds the set up, and your therapist can tell you where adults get assessed, including our own assessment service. They cannot tell you what an assessment would find.
When an assessment makes sense
With the picture on the table, four things tell us an assessment makes sense. Any one is enough. You want certainty, not just language. Something concrete needs paperwork, like an employer’s adjustments or a prescription. The question has taken over the couples work. Or you are asking us to make the call.
What your couples therapist thinks is not an assessment.
You deserve the real thing, and we will point you to an assessor, including our own.
The way this goes wrong. Inside a couple, the answer becomes a permission slip. "Once we know for certain, then I will stop taking it personally." That sounds fair and it is a trap, because it puts the whole burden of changing on one person's paperwork. Most of what you would do differently with an answer can start now, with the picture.
Why we do it this way
We make it optional because it is.
Thousands of neurodiverse couples have done good work with us without anyone being assessed. What the work runs on is a description of how each of you actually works, and a set of screeners read for their items is a good way to get one.
A single number is something to argue about.
Four screeners, read item by item, are a description.
No first and second class. We work with people who are diagnosed, people who are self-identified and people who are unsure. Many adults now recognizing themselves were children nobody looked at: girls, whose presentation did not match what anyone was screening for, and children of color, whose difficulties were read as behavior rather than wiring.
Women diagnosed as adults describe being told flatly that they were not autistic, and years of pretending to be normal.1 When autistic adults were asked why some of them had no clinical diagnosis, the answer was not indecision. It was money, access and being disbelieved.2
That is why nobody here is asked to produce a label before being taken at their word.
After the session
The workbook below asks where each of you is standing, which items made you stop, and what an answer would actually change. Fill it in separately.
Where your two sets of answers differ is usually where the real conversation is.
If you are weighing an assessment. New Path Family's free decision aid, Do I Want an In-Depth Assessment?, goes through what an assessment buys and when self-identification is enough. In our experience an adult assessment in the United States runs weeks to a few months from first call to report. Cost is the usual barrier. We will not quote a figure, because any figure would be somebody’s price list.
The one thing, if that is all you have. None of this is required. If you have no interest or no capacity for it this month, the couples work carries on exactly as before.
Your workbook
Your answers save to this device only - we cannot see a word of what you write. Both of you fill this in separately.
Where you are standing
Both of you fill this in separately. None of these is a stage on the way to another.
Which is yours, today? — Diagnosed, Self-identified, Not knowing yet, Considered it, and no, Not interested
Do you want to look into your own neurotype right now? — Yes, Maybe later, No, Not sure
The set, if you have taken it
Not the totals. The items.
Which have you taken? — The autism set, The ADHD set, Both sets, Something online, on my own, Not yet
Which items made you stop? Name the screener and say the item in your own words.
What an answer would change
Be specific. If nothing on the list needs a diagnosis, that is a real answer.
Is there something concrete a diagnosis would get you (work adjustments, a prescription, official confirmation)? Name it, or write none.
Where this comes from
Every source below was checked against the published record. They are grouped by the kind of evidence they are, so the numbers may not run straight down the page — a number points back to where the source is used in the lesson.
Research discussion
The session move, consent from the person the question is about, a set rather than a single screener, read back for items rather than totals, comes from our practitioner training and our own room. The four signs an assessment makes sense are practice judgment, not a validated rule.
The two studies the lesson cites are about who gets missed. Women diagnosed as adults describe years of being told they were not autistic and of pretending to be normal.1 Autistic adults without a clinical diagnosis name cost, access and disbelief as the reasons, not doubt about themselves.2 A scoping review of adult diagnosis reports the same barriers across countries.3
Who this research was done with. The studies behind this module drew heavily on white, comparatively well-off, English-speaking participants. If your household carries pressures those samples did not — money, immigration, racism, disability, unsafe housing — the practice still applies, but the room you are practicing in is harder. That is the room, not you.
Peer-reviewed research
1. 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 Interviews with 14 women diagnosed with autism in late adolescence or adulthood. Themes included being told they were not autistic, pretending to be normal, and the cost of that effort. Limitation: 14 participants, UK, qualitative.
2. Ardeleanu K, Steinberg H, Garfield T, Voltaire S, Shea L, Brown M, Chiang C, Tan CD (2025) Self-identification of autism: Why some autistic adults lack a clinical diagnosis and how this may be improved. Autism, 29(6), 1477-1488. https://doi.org/10.1177/13623613241297222 Survey of autistic adults without a clinical diagnosis; the reasons given were cost, lack of access to assessors, and being disbelieved by clinicians, rather than uncertainty. Limitation: self-selected online sample; US-weighted.
3. Huang Y, Arnold SRC, Foley KR, Trollor JN (2020) Diagnosis of autism in adulthood: A scoping review. Autism, 24(6), 1311-1327. https://doi.org/10.1177/1362361320903128 Scoping review of research on autism diagnosis in adulthood, including barriers to diagnosis (cost, access, clinician knowledge) and the experience of diagnosis. Limitation: a review; heterogeneous studies, mostly from high-income countries.
If you do want an answer, we can do that too
The Adult Autism Assessment Center is our own assessment service for adults who want a real answer, one way or the other. Nothing in couples work requires it. If one of you wants it, an assessment happens there, separately from the couples work, and the couples work carries on. Telehealth, for adults in California.
Up next
Module 8 — What an Answer Changes, and What It Doesn't