By John Mackessy
Psychotherapist & Integrative Counsellor
John Mackessy
MA, Adv Dip Counselling, Dip Clinical Supervision, MBACP (Accred,)
John Mackessy is a psychotherapist specialising in neurodivergence, ADHD and autism in adults, including people exploring a possible late diagnosis.
What do we mean by neurodivergence?
Neurodivergence is a broad term, most often used by doctors, psychologists and others working within what is sometimes called the medical model to refer to certain neurodevelopmental ‘disorders’ such as Autism Spectrum, ADHD, dyslexia, dyspraxia and Tourette’s.
However, this is not the whole picture by any means.
Over time, we have seen a shift in perspective. Many people, including clinicians, began to talk about these differences as conditions rather than disorders. Neurodivergent communities and activists have gone further still. In relation to autism, for instance, some people say:
“This is not a condition to be viewed in terms of deficits. This is a valid part of who I am — my identity.”
These different perspectives quickly lead us into deeper questions about diagnosis.
Do I want or need a diagnosis?
What might it do for me other than give me, and others, a label to hang on me?
These are complex and highly individual questions that depend on many factors relating to each person’s life, situation and needs.
Making the decision that is best for ourselves, and those around us, can be challenging.
In my experience, the support of someone who has a good understanding of neurodivergence, and who can help a person work through their own situation and needs, can be key. That is the role I have had with many of my clients. Below I will lay out a few aspects of this work to give some idea of what it can involve.
Common forms of neurodivergence
Some of the most commonly recognised forms of neurodivergence include:
Autism Spectrum
ADHD (Attention Deficit Hyperactivity Disorder)
Dyslexia
Dyspraxia
Tourette’s syndrome
People may recognise traits of neurodivergence at different points in life. Some people are diagnosed in childhood, while many others begin exploring the possibility of neurodivergence later in adulthood.
Understanding neurodivergence (ND)
For the sake of simplicity, I will refer to neurodivergence / neurodivergent as ND below.
We can think of ND as any form of neurological functioning, or neurotype, that is notably different from ‘the norm’. In other words, it is not neurotypical.
Importantly, neurotypical does not necessarily mean good or better.
For example, having a very high IQ is not the norm. Recent research suggests that this type of giftedness can relate to significant differences in neurological structures and functioning, in other words, a form of ND.
“I sense that I function differently — do I need a diagnosis?”
This question often involves a cost–benefit analysis.
If someone is leading a happy life and these issues are not disrupting or intruding too much, then a reasonable question might be:
What is the benefit of pursuing a diagnosis?
At this stage in my work with clients, I might begin some screening, using tools that give us a picture of how far autistic or ADHD traits may be present, in what areas of life they appear, and what impact they may be having.
This helps inform any decisions a person might need to make.
Much of this process can be quite straightforward. However, it can also involve considerations that are difficult to explore on one’s own.
In my own case, it was only during this kind of process that I began to understand that I was viewing certain things from angles that were different from those around me.
“Understanding my ND, with or without diagnosis, involved realising that I saw, thought about and experienced the world differently from neurotypical people.”
Understanding my ND, with or without diagnosis, involved realising that I saw, thought about and experienced the world differently from neurotypical people.
This meant that I was often not quite on the same page as those around me. They might not always “get me”, and vice versa.
Each of us — neurotypical or ND — has our own blind spots and biases.
So a question for me became not only how does ND affect me, but also how does it impact my relationships and those around me that I care about?
Many of my clients report something similar.
Gaining insight into ND often helps both the individual and the people around them. It opens up choices and strategies that were not previously visible.
This process usually involves exploration, communication and understanding. Conversations with family, friends, colleagues or partners can play a significant part in this.
When screening suggests significant ND traits
Let’s imagine that a person comes to the point where they understand that they have a significant level of ND traits. They may have screened positive for Autism Spectrum or ADHD.
What next?
For some people, that level of understanding is enough. It provides a clearer sense of what they are dealing with and helps them decide what support or resources they might want or need.
Again, a therapist with a good understanding of ND can be helpful with this.
For others, however, a formal diagnosis may be beneficial.
A diagnosis can help in several ways:
It can provide more detailed insight into ND traits and help identify useful strategies and resources.
It can open up access to reasonable adjustments in the workplace or in education. Under the Equality Act (2010), employers and educational institutions may have obligations to make reasonable adjustments for someone with a recognised condition.
It may open up access to medical treatment, where appropriate, including potentially treatment through the NHS.
Reasonable adjustments at work or in education
Having worked in university settings and for disability charities, I have seen directly that access to certain types of support often requires a formal diagnosis as a starting point.
Once a diagnosis is established, an employer or educational institution can begin a formal needs assessment.
Sometimes there is also funding available to support these needs, for example through schemes such as:
Access to Work
Disabled Students’ Allowance
These schemes can help fund things such as mentoring or specialised equipment.
A needs assessment can also uncover helpful adjustments that might otherwise never have been considered.
For example, a person may gain insight into how they process information, or even sensations and emotions, and what might help them to handle these more comfortably.
Sometimes relatively small changes can make a very significant difference.
One autistic client of mine agreed with their employer to move away from a noisy, brightly lit open-plan office into a quieter space where they had greater control over lighting and environment. The difference this made to their wellbeing and productivity was substantial.
Often we simply do not know what might help until an assessment like this takes place.
Neurodivergence and treatment
The question of treatment can be a knotty one.
How far do you, and those around you, see ND traits as part of your identity, and how far might they be viewed as something to be treated like a condition or disorder?
There is no one-size-fits-all answer.
There are neurotypes, such as autism, for which there is no recognised treatment as such, even within a medical framework.
However, many autistic people experience related challenges such as heightened stress responses, anxiety, or obsessive and compulsive traits. In these cases, people may consider whether medication or talking therapies might be helpful.
For other neurotypes, ADHD for example, medication is often recommended by clinicians.
At the same time, people may have questions such as:
If medication reduces my ADHD traits, will I lose some of my creative or dynamic energy?
What might the side-effects be like?
As we can see, ND and treatment form a complex landscape.
Clinicians may offer important expertise, particularly in relation to pharmacology. But the person advising on medication is not always the person someone can speak to about the bigger picture of how ND affects their life.
These questions are not simply medical. They are deeply personal and relational, potentially affecting many areas of life.
Late diagnosis and making sense of the past
One dimension that can sometimes be overlooked is that a person does not simply “have ADHD” or “have autism”.
They have lived an entire life before diagnosis, and often before even wondering whether they might be neurodivergent.
What was that experience like?
How has ND shaped their life, relationships and sense of self?
Much of my work is with late-diagnosis adults.
Receiving a diagnosis can bring mixed feelings. For many people it is part relief, now I know what I am dealing with. But it can also involve a sense of loss or grief, now I understand why certain things may not have worked out as I hoped.
People may also need to process how their differences were experienced and responded to by others over the years, within families, at school, in relationships or at work.
There can be shame and many labels to make sense of.
In situations like this, practical coaching or mentoring (how do I manage things now?) may need to be accompanied by a therapeutic dimension (what does this mean to me?).
The potential for positive change
I hope the above does not sound too daunting.
While these questions can certainly be challenging, working through them has the potential to be deeply transformative in a positive way.
I have seen many clients develop a grounded sense of pride in themselves, reshaping parts of their lives in ways that serve both them and their relationships much better.
One client said to me:
Late diagnosis of ADHD or autism in adults
Many people first begin to wonder whether they might be neurodivergent later in life.
It is increasingly common for adults to explore the possibility of ADHD or autism after many years of sensing that they experience the world somewhat differently from those around them.
Sometimes this realisation arises when a child in the family receives a diagnosis. At other times it may come through reading about ADHD or autism and recognising certain traits in oneself. For some people it emerges when challenges at work, in relationships, or in daily life lead them to look more closely at their patterns of thinking, attention or behaviour.
A late diagnosis of ADHD or autism can bring a mixture of feelings.
For many people there is a strong sense of relief — a feeling that something about their lifelong experiences finally makes sense. Difficulties with focus or organisation, feeling overwhelmed in busy environments, or finding certain social expectations confusing may begin to fall into place in a new way.
At the same time, a later diagnosis can also lead to reflection about the past. People sometimes find themselves wondering why these differences were not recognised earlier, or how certain parts of their life might have unfolded if they had understood their neurotype sooner.
Questions of identity can also arise. If neurodivergence has been present throughout one’s life, what does it mean to understand this about oneself now?
These are often thoughtful and deeply personal questions. Many people find it helpful to explore them with someone who understands neurodivergence and the experience of late diagnosis in adults, and who can help them make sense of what this understanding might mean for their life going forward.
Many adults exploring neurodivergence find it helpful to speak with a therapist who understands ADHD, autism and late diagnosis in adults.
Therapy for neurodivergent adults
For many people exploring neurodivergence, having space to think through these questions with someone who understands ND can be extremely helpful.
Therapy can provide a place to explore:
whether diagnosis might be helpful
how neurodivergence affects relationships and work
strategies that support wellbeing
how to make sense of past experiences
If you would like support exploring neurodivergence, ADHD or autism, My Therapist Online can help match you with an experienced therapist.
About the Author – John Mackessy
John Mackessy is an experienced psychotherapist and integrative counsellor specialising in neurodivergence, ADHD and autism, particularly supporting adults who are exploring a possible late diagnosis.
Through his work with clients, John helps people:
understand how their neurotype shapes their experiences
explore whether a diagnosis might be helpful
process the emotional impact of late diagnosis
develop practical strategies that support relationships, work and wellbeing
John’s approach combines therapeutic exploration with practical insight, helping people make sense of their experiences and develop a clearer understanding of themselves.
Many of John’s clients are adults who have spent years feeling that they see or experience the world differently, and are now seeking clarity, understanding and direction.
Book an appointment with John Mackessy
If you are exploring questions about neurodivergence, ADHD or autism, you may find it helpful to speak with a therapist who has experience in this area.
You can book a free 15-minute introductory session with John to explore whether working together would feel helpful.