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Module 7 — Diagnosed, Self-Identified, or Still Wondering
Optional. The session where we find out where each of you is on the question, weigh each option, and, if you want, take a set of screeners home.
This part of the program is about bringing up autism or ADHD between the two of you. This module is the session where we find out where each of you is on the question and, if one of you wants to look further, how that is done. Looking into your own neurotype is completely optional; if you are not interested, feel free to skip this one.
From wanting an answer to not wanting the question
Summary: what happens in the session
1 Your therapist asks where you are on the question. Picture a line: “I want a diagnosis” at one end, “not interested at all” at the other. Where are you today?
2 Whatever you answer is taken at your word. Nobody is asked for paperwork first, and your therapist says why.
3 Your therapist lays out the pluses and minuses of each option. What a diagnosis gets you, what it costs you, and what it leaves untouched.
4 The decision is yours alone. Not your partner’s and not your therapist’s. Nobody is steered toward an answer.
5 An optional set of screeners to take home. Only if you want them. Usually four, done on your own, in your own time.
6 In a later session, going back through them. Not to hand you a diagnosis. To say what each question was actually asking.
7 Whether any of it points to a full assessment. Only if you want to go further, alone or together.
Step 1. Where you are on the question
People talk about this as if there were two answers: diagnosed and not. There is really a line. At one end, I want a diagnosis and I want it in writing. At the other, I am not interested in this question at all. Your therapist asks each of you where on that line you are today. Every point along it is a real place to be.
Most people land on one of five. 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. Still wondering. Considered it and decided no. Not interested at all.
Quite often the two of you are in different places on that line, and that is fine.
Asking each of you. From ‘I want a diagnosis’ at one end to ‘not interested at all’ at the other — where are you today? I would like to hear it from each of you, and I am not going to argue with either answer.
Put a date on yours. Positions move, and partners often argue with where the other one stood a year ago.
Step 2. Taken at your word
Who got missed. Many adults now recognizing themselves were children nobody looked at: girls, who 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 Autistic adults without a clinical diagnosis name cost, access and being disbelieved.2 That is why nobody here is asked to prove anything first.
If one of you says self-identified. That is enough for me. I will not ask you for paperwork before I believe you.
A label tells us who was looked at as a child, and by whom. It does not tell us who is autistic.
Step 3. The pluses and minuses of each option
There are three things a person can do with this question. Your therapist goes through each, good and bad, leaning on none of them.
Get a diagnosis. A diagnosis is always formal; there is no informal kind. It is the only thing that opens certain doors: adjustments an employer is obliged to make, legal protection if they refuse, support in education, a prescription if ADHD medication is wanted. For many people the certainty alone is worth it. The cost is money and months, and on the Monday after the report arrives the traits are exactly what they were.
Self-identify. Free, and true from the moment you say it. It is enough for almost everything the two of you do in this program, but it will not make an employer act or get a prescription written.
Two of the three cost nothing, and one of them is what most of this program runs on.
Leave the question open. This closes nothing off. People who choose it are not procrastinating; some have thought hardest of all.
Two reasons people give for wanting an answer, and both are personal. To know yourself for sure.
A clearer path for the two of you, because an answer names the differences you are working on.
Nothing in this program is on the bottom list. The top list is the one a couple actually spends its time on, and it is open to you this month, diagnosis or not.
Step 4. The decision is yours alone
This is not a joint decision, and your therapist says so out loud. The person the question is about is the person who answers it. Your partner may have an opinion, and may say it once, but does not get a vote. Nobody is steered toward a direction here, and nobody is talked out of one.
Putting it to the one person. I am asking you, not the two of you. Nothing needs deciding today, and ‘not yet’ is a complete answer.
Step 5. An optional set of screeners to take home
If, and only if, you want to look further, your therapist offers a set of screeners to take home. Not one: a set, so no single number carries the weight. You do them on your own, in your own time.
A single number is something to argue about.
Four screeners, read item by item, are a description.
A screener is a mirror, not a diagnosis.
The autism set. Four of them. The AQ-50 is the best-known autism questionnaire and the RAADS-14 a short one 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. All four sit in our self-discovery section.
The ADHD set. The ASRS v1.1, from the World Health Organization, plus the SAAST, the Copeland checklist and the AAMM, which cover the day-to-day and the masking side of adult ADHD. They are in the same place, explained the same way.
If the set sits untouched on the kitchen table for a month, that is information too, and worth saying out loud rather than apologizing for.
Step 6. In a later session, going back through them
Because you take the set home, the reading happens the next time you meet. Your therapist does not add the screeners up or hand you a diagnosis. You go back through them question by question, and your therapist says what each one was asking about and why it is there at all. Totals are what people argue over; the questions are what you live with. Your partner listens for what they recognize, not to grade you.
Going back through the set. I am not going to add these up. Tell me which questions made you stop, and I will tell you what each one was getting at. And to you: which of those did you recognize?
You can always say it. If any of this starts to feel like too much, you can say I am uncomfortable. That is a complete sentence. Nobody has to explain it or defend it. We stop, we look together at what is happening, and we decide as a group whether to stay with it or to understand first what is getting in the way.
Going back through the questions is the part people find hardest, especially hearing which ones your partner recognized. If that is too much on the day, it can happen on your own first.
Step 7. Whether any of it points to a full assessment
What you have at the end is a fuzzy picture. Screeners were never built to settle anything; at best they say whether going further is worth it. So, later and only if you want to, you and your therapist look at the picture and ask whether it points toward a full assessment. That can happen in an individual session or a couple session, whichever suits you.
Four things say an assessment makes sense, any one of them enough. You want certainty rather than 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.
A hunch from your couples therapist is not an assessment, and neither is a screener.
An assessment is a different piece of work: an assessor, several hours, a report. A number of our therapists are trained assessors, so it can often be done alongside the couples work by someone you already know. Otherwise we hand you to another assessor on our team.
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: 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.
After the session
The workbook below asks where each of you is on the line, which questions made you stop, and what an answer would 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, and cost is the usual barrier.
The one thing, if that is all you have. If you have no interest or no capacity for this right now, say so. 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 on the question
Both of you fill this in separately. None of these is a stage on the way to another.
On the line from 'I want a diagnosis' to 'not interested at all', 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 questions.
Which have you taken? — The autism set, The ADHD set, Both sets, Something online, on my own, Not yet
Which questions made you stop? Name the screener and say the question 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 interviewed about not having a clinical diagnosis described cost, clinical access and being disbelieved: barriers, rather than 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, Chvasta K, Tan CD (2025) Self-identification of autism: Why some autistic adults lack a clinical diagnosis and why this matters for inclusion. Autism, 29(9), 2344-2355. https://doi.org/10.1177/13623613241297222 Qualitative interviews with 65 queer and transgender autistic adults, some self-identified and some formally diagnosed. Participants described barriers and deterrents to being diagnosed, including cost and clinical access, and invalidation both as a barrier to diagnosis and as something that followed it. Limitation: a small, self-selected US sample, all queer or transgender, so it describes what stands in the way and cannot say how common any of it is.
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 a Diagnosis Changes, and What It Doesn't