There is a particular moment that can happen in a man’s life. Perhaps he is thirty-eight, forty-five, or fifty-two, and he has spent decades believing that everybody else was given an instruction manual that he somehow missed. He watches a documentary about ADHD somehow on Youtube and something just clicks, or he reads about autism and something else clicks. He starts watching videos, reading articles, taking online screening questionnaires, and suddenly he starts looking backwards.
He remembers school, being told that he was not reaching his potential, losing homework, being obsessed with particular subjects, hating noisy classrooms, struggling with friendships, being bullied, and spending enormous amounts of energy trying to appear normal. He remembers coming home from school exhausted, his mother saying, “You’re very bright, but you just don’t apply yourself,” his father saying, “You need to concentrate,” and teachers saying, “If only he would try harder.”
And then he looks at his adult life: missed appointments, unread emails, hundreds of tabs open, a phone that is constantly in his hand, periods of extraordinary productivity followed by periods where he cannot seem to start anything, intense interests, difficulty changing plans, relationships that become complicated, problems with organisation, impulsive decisions, emotional intensity, and social exhaustion. Eventually, he asks, “Could I actually be autistic?” or “Could I have ADHD?” Sometimes the question is frightening, sometimes it is relieving, and sometimes it is both.
One of the most important things to understand is that a proper assessment is not supposed to be a search for everything that is wrong with you; it is an attempt to understand how you have been functioning across your life. NICE guidance recommends that adult ADHD assessment considers developmental history, symptoms across different areas of life, psychological and social functioning, coexisting conditions, and impairment across more than one important setting. For autism, NICE recommends a comprehensive assessment that considers developmental history, functioning at home, education and employment, social interaction and communication, repetitive behaviours or restricted interests, sensory differences, and other neurodevelopmental or mental health conditions.
So what might they actually ask you?
The first question: “Why are you seeking an assessment now?”
This can seem like a rather simple question, but it is not. A clinician may want to understand what has brought you to assessment at this particular point in your life. Perhaps your son has recently been diagnosed with ADHD, or your daughter has been diagnosed as autistic. Perhaps your partner has asked, “Have you ever thought that you might have ADHD?” Perhaps you have started therapy, are struggling at work, or your marriage is under pressure. Perhaps you are exhausted from constantly masking, have discovered autism through your own research, or have realised that the things you have always considered personality flaws may have another explanation.
For a man, it might sound like, “I have always been like this. I just thought everybody struggled in the same way.” That sentence can be extremely important because diagnosis is partly about asking whether current difficulties represent a lifelong pattern rather than something that suddenly appeared in adulthood.
“What were you like as a child?”
This is one of the most important questions in both autism and ADHD assessment. The clinician is not only interested in the man sitting in front of them today; they want to understand the developmental story. With ADHD, NICE states that symptoms should have begun during childhood and persisted into adult life, while autism assessment also places importance on early developmental history.
The difficulty for a 38-year-old man is obvious: you might not remember, your parents might not remember, your school records might be gone, and perhaps nobody ever thought there was anything unusual. You may simply have been called lazy, naughty, daydreamy, difficult, sensitive, obsessive, bright but underachieving, a class clown, quiet, shy, awkward, or stubborn. Those descriptions can sometimes contain clues, but they are not diagnoses.
“Did you have difficulty paying attention?”
For a boy with ADHD, this might have looked like staring out of the classroom window while the teacher was talking, losing worksheets, forgetting homework, missing instructions, starting an assignment and then suddenly cleaning his bedroom, reading the same page five times, being unable to remember what somebody has just said, forgetting what he was supposed to buy from the shop, or walking into a room and immediately forgetting why he went there.
As an adult, it might look like opening an email, reading it, thinking, “I’ll respond later,” and then completely forgetting it exists. It might look like having 47 unread emails, repeatedly losing keys, forgetting birthdays, starting five projects and finishing one, or needing enormous pressure before beginning something.
This is important: ADHD is not simply an inability to pay attention. Many people with ADHD can pay extraordinary attention to something that is interesting, novel, urgent, or rewarding. The difficulty can be regulating attention rather than simply lacking it. But please please remember that everyone with ADHD is different. Two family members can have the same presentations but it can feel very different for each
“Did you struggle to organise yourself?”
A clinician might explore planning and organisation. For a boy, this might have meant forgetting his PE kit, losing his school books, leaving revision until the night before an examination, forgetting deadlines, or needing his mother to remind him repeatedly.
For an adult man, it can become: “I know exactly what I need to do. I just cannot seem to get myself to do it.” He may have a calendar, a diary, three productivity apps, a whiteboard, and a notebook, yet still miss the appointment. That can produce an enormous amount of shame, especially when everyone around him appears to think, “But you know what you need to do.” The problem may not be knowledge; it may be executive functioning.
“Were you impulsive?”
For a boy, impulsivity might have looked like shouting out answers, interrupting, running into the road, taking unnecessary risks, acting before thinking, or getting into trouble because an idea seemed exciting.
As an adult, impulsivity can look very different. It might mean buying something expensive because you suddenly want it, sending a message while angry, interrupting people, changing jobs suddenly, making spontaneous decisions, taking unnecessary financial risks, starting a business without fully considering the consequences, making a sexual decision in the moment that you later regret, or saying something and thinking, “Why the hell did I just say that?”
Context matters. Everybody does these things occasionally. The assessment is looking for a persistent developmental pattern that causes meaningful impairment. NICE specifically states that ADHD diagnosis should involve a full clinical and psychosocial assessment rather than relying solely on rating scales. Unfortunately for you, this may mean going to a qualified professional, which is the last thing you may want.
“Were you hyperactive?”
This is where many adult men misunderstand ADHD. They think, “I’m not running around the room, so I cannot have ADHD.” But adult hyperactivity can look different:
- Constantly moving your leg, tapping your foot, or fidgeting.
- Needing background noise or feeling uncomfortable sitting still.
- Talking excessively or interrupting conversations.
- Working while watching television or constantly needing stimulation.
- Feeling restless when doing nothing or becoming uncomfortable during long meetings.
- Driving around simply because you do not want to sit at home.
- Repeatedly reaching for your phone whenever there is a moment of silence.
Sometimes the hyperactivity becomes internal, a man’s body may look calm while his mind feels like twenty browser tabs are open simultaneously.
“Did you have intense interests?”
Now we move into an important area of autism assessment. Perhaps as a boy you became obsessed with dinosaurs, trains, football statistics, World War II, computers, a particular band, a religion, cars, bodybuilding, psychology, or cryptocurrency. You could talk about it for hours, knew facts nobody else knew, researched everything, and became frustrated when other people did not share your enthusiasm.
As an adult, the interests may become socially acceptable, you might become the person who knows everything about property, cars, fitness, business, football, technology, history, therapy, music, politics, or religion. It does not necessarily look strange, which is why adult autism can be missed. The content of the interest is not necessarily the important part; the clinician is interested in the pattern, intensity, rigidity, and impact.
“Do you find social situations difficult?”
This is one of the central areas of autism assessment, but the question is not simply, “Do you have friends?” An autistic man might have plenty of friends and might even be extremely sociable; the question is what social interaction requires from him.
Perhaps you have learned how to socialise through observation. You know when to laugh because you have studied other people, know roughly how much eye contact to use, know when to ask, “How are you?”, and know that the correct response is, “I’m good. How are you?” But perhaps it feels scripted, like you are performing, or you spend enormous energy monitoring yourself and replaying conversations afterwards: “Did I say the wrong thing?”, “Did he think I was rude?”, “Why did she look at me like that?”, or “Was he joking?” That is information a clinician may want to understand.
“Do you struggle to understand what other people mean?”
Autism assessment may explore social communication. For a boy, this might mean taking statements literally, a teacher says, “I want this room spotless,” and he genuinely wonders what that means, or someone says, “I’ll see you around,” and he wonders when. Sarcasm, indirect communication, and hints may be missed.
As an adult, this can become particularly complicated in romantic relationships. Your partner says, “I’m fine,” and you believe her, but later you discover she was not fine. You may think, “Why didn’t she just tell me?”, while she may think, “How could you not know?” Neither person necessarily understands why the interaction became so difficult.
“Do you find eye contact uncomfortable?”
This question can be misunderstood. Autism does not mean every autistic person avoids eye contact; some people force themselves to maintain it, some overcompensate, some stare because they have learned that avoiding eye contact is interpreted negatively, some look at a person’s forehead, and some look away while speaking because thinking and making eye contact simultaneously is difficult.
The important question is not, “Can you make eye contact?”, but, “What is the experience of making eye contact like for you?” That distinction is extremely important when assessing adults who have learned to mask.
“Do you have sensory sensitivities?”
This is another area that can be missed. Imagine a 14 year old boy in a Reading secondary school classroom with thirty children, fluorescent lights, chairs scraping, pens clicking, people whispering, someone chewing, the teacher talking, a clock ticking, or a fire alarm. To everybody else, it is simply a classroom; to him, it can feel like sensory overload.
As an adult, you might hate shopping centres, become overwhelmed in busy restaurants, struggle with fluorescent lighting, need silence after work, become furious when somebody repeatedly makes a particular noise, hate certain fabrics, have strong reactions to smells, or find crowds exhausting. Perhaps you have spent your entire life thinking, “I’m just fussy.” A diagnostic assessment may provide another possibility.
“Do you need routines?”
For some autistic people, routine provides predictability. As a boy, you might have needed to know exactly what was happening after school, or become distressed when plans changed. As an adult, perhaps you always sit in the same place, follow the same route, eat particular foods, organize your possessions in a particular way, or become disproportionately irritated when somebody changes the plan at the last minute.
Again, the question is not whether you like routine, most people like routine to some degree. The question is what happens when the routine is disrupted.
“How do you respond to change?”
This can be particularly revealing. Imagine your partner says, “I’ve made a slight change to our plans.” You might immediately feel irritated, not because you are controlling or do not care about your partner, but because you had already mentally rehearsed the original plan. Your brain had created a sequence, and now the sequence has changed and you need to rebuild it. For some people, that is easy; for others, it creates significant distress. NICE guidance specifically recommends considering resistance to change, rigid routines, and restricted interests as part of autism assessment.
“Do you have repetitive behaviours?”
These do not always look like the stereotypical picture people imagine. It can include repetitive movements, but it can also include repetitive ways of doing things: repeatedly checking, organising, collecting, researching, watching the same programme, repeating particular phrases, following the same routines, using the same objects, or replaying conversations. The important thing is the broader pattern.
“Do you mask?”
This one is particularly important when assessing adults. You might have learned how to appear socially comfortable, watched other people and copied them, learned scripts, forced yourself to make eye contact, learned how to behave at work, learned not to talk excessively about your interests, learned not to stim, or learned to tolerate sensory discomfort and hide confusion.
From the outside: “He seems completely fine.” Inside: “I am exhausted.” That difference between external functioning and internal cost is clinically important.
“How do you manage everyday life?”
This question applies to both autism and ADHD. Can you manage bills, shopping, cooking, cleaning, appointments, work, relationships, driving, paperwork, planning, sleep, exercise, medication, and money?
An adult man can be highly successful professionally while struggling enormously with ordinary daily tasks. He might run a company but forget to eat, earn £100,000 but constantly lose paperwork, be brilliant at his job but unable to maintain his bedroom, or be highly educated but repeatedly miss appointments. The assessment needs to understand the whole person rather than simply asking, “Are you successful?”
“What was school like?”
This can be one of the most revealing parts of an adult assessment:
- Were you described as bright?
- Were you frequently told to concentrate?
- Did you get into trouble, get bullied, or struggle socially?
- Did you have intense interests or get lost in your imagination?
- Did you procrastinate or have uneven academic performance?
- Could you perform brilliantly when interested but poorly when bored?
- Did teachers say, “He could do much better if he tried”?
- Did you hate group work, struggle with transitions, or regularly forget equipment?
School reports, old records, and accounts from parents or relatives can sometimes help reconstruct the developmental picture.
“What about your work?”
A clinician may want to know whether difficulties occur at work:
- Do you struggle with deadlines or leave things until the last minute?
- Do you become completely absorbed in particular projects?
- Do you struggle with meetings, interrupt, or become overwhelmed by open-plan offices?
- Do you need written instructions, or find sudden changes difficult?
- Do you struggle to prioritise, or work intensely and then crash?
- Do you change jobs frequently, or become bored once the novelty disappears?
This is why diagnosis is not simply about childhood; it is about understanding how developmental characteristics affect adult functioning.
“What about relationships?”
A proper assessment can explore friendships, family relationships, and romantic relationships. Do you struggle to maintain friendships, or become intensely attached to particular people? Do you need a lot of time alone, misunderstand partners, struggle with emotional communication, or miss hints? Do you become overwhelmed during conflict, impulsively say things, withdraw when overloaded, or struggle with intimacy?
These questions matter because neurodevelopmental differences can interact with attachment, trauma, anxiety, depression, and learned relationship patterns. One explanation should not automatically replace another.
“What about your emotions?”
ADHD and autism assessments also need to consider emotional difficulties and other mental health conditions. A man might describe himself as “angry,” but the clinician may explore what sits underneath the anger: frustration, overstimulation, rejection, anxiety, shame, exhaustion, difficulty communicating, or feeling misunderstood.
ADHD can coexist with anxiety, depression, substance use, and other difficulties, and NICE recommends assessing coexisting conditions as part of the diagnostic process. This matters because not every emotional difficulty is ADHD or autism. Sometimes the answer is ADHD, autism, both, neither, autism plus trauma, ADHD plus anxiety, depression, or a combination. A good assessment should help distinguish these possibilities.
“Does anyone else in your family have similar traits?”
This is where your family history becomes particularly interesting. You might suddenly start looking at your father differently, he never talked about feelings, worked constantly, became obsessed with cars, hated social gatherings, needed everything done in a particular way, and became extremely angry when plans changed. You might have thought, “That’s just Dad,” but then you wonder, “Was Dad autistic?”
Or perhaps your mother was constantly losing things, was always late, started projects and never finished them, talked rapidly, became overwhelmed easily, and struggled with organisation. You might think, “Maybe Mum had ADHD.” You cannot diagnose your parents retrospectively simply from resemblance, but understanding neurodevelopmental conditions can give you a new framework for interpreting family patterns.
Could my children inherit autism or ADHD?
This is one reason understanding your own neurodevelopmental profile can be relevant to family life. Both autism and ADHD have substantial genetic contributions. Autism is genetically heterogeneous, involving combinations of inherited and, in some cases, new genetic variants, and large genetic studies have demonstrated substantial genetic contributions to autism susceptibility. ADHD is also strongly heritable; family, twin, and adoption research supports a major genetic contribution, and modern genomic research has identified numerous genetic risk loci.
However, genetic contribution does not mean genetic certainty. Having ADHD or autism does not automatically mean your child will have it, as these are complex traits involving many genetic variants and environmental influences. The purpose of knowing your diagnosis is not to sit there thinking, “I’ve passed this on,” but to understand that your children may potentially share some neurodevelopmental characteristics, and that recognising those characteristics early can help them receive appropriate support.
There is something else: your diagnosis might help you become a different parent. You might recognise sensory overload in your child, understand why transitions are difficult, stop interpreting executive functioning difficulties as laziness, realise that your child is not deliberately ignoring you, and become more curious, asking, “What is making this difficult for you?”, rather than, “Why are you behaving like this?” That can change a family system.
Could understanding myself help me understand my parents?
1,000%. This is one of the less discussed benefits of adult diagnosis. You may suddenly look backwards and realise, “My father wasn’t necessarily emotionally cold because he didn’t love us.” Perhaps he had enormous difficulty identifying and expressing emotion, was himself masking, or was raised in an environment where emotional expression was discouraged. Perhaps he had ADHD and had spent his entire life being criticised for things he could not easily regulate.
Perhaps your mother’s need for routine suddenly makes sense, or your sibling’s behaviour becomes easier to understand. This does not excuse harmful behaviour, understanding is not the same as absolution, but it can change the story. Instead of asking, “Why was my father like that?”, you might eventually ask, “What was happening inside my father?” Sometimes that question allows a man to understand his own childhood with greater complexity.
“Am I too old to get diagnosed?”
No. You are not too old to understand yourself. There is a particular form of resistance heard in conversations about adult diagnosis: “What’s the point now?” You are thirty-eight, forty-two, or fifty, and you think, “I’ve survived this long.” But surviving something does not mean understanding it is pointless. If anything, decades of adaptation can make understanding yourself more valuable. A diagnosis does not rewrite your childhood or give you your lost years back, but it can give you a framework for the years ahead.
“But I have managed my whole life without a diagnosis.”
Perhaps you have, but the question is: at what cost? Maybe you work twice as hard as everyone else, need three days to recover from social events, have built your entire life around avoiding situations that overwhelm you, or have developed rigid routines because they are the only way you can function. Maybe you constantly mask, your relationships repeatedly collapse because you misunderstand communication, or you rely heavily on your phone, pornography, alcohol, food, work, or exercise to regulate yourself. Maybe you have achieved a lot but feel exhausted. Functioning is not the same thing as functioning without significant cost.
“What if I do not believe in ADHD or autism?”
This is a completely reasonable question to explore. You do not have to believe in a diagnosis before being assessed; the purpose of assessment is precisely to investigate whether the evidence supports a diagnosis. You can remain sceptical, ask questions, challenge the clinician, ask what evidence they are using, and ask what alternative explanations have been considered. A good assessment should not require you to surrender your critical thinking, it should involve you in understanding the evidence. NICE recommends that people are involved in discussions and informed decisions about their care, and autism guidance emphasises respectful, collaborative, and non-judgemental assessment.
“What if the waiting list is too long?”
This is a very real barrier, and a long wait can make people give up. But the length of a waiting list does not tell you whether understanding yourself is worthwhile.
If you believe you may be autistic or have ADHD, you can discuss this with your GP and explore the assessment pathways available in your area. NICE states that adults who suspect autism should be offered an assessment, and adults presenting with suspected ADHD without a childhood diagnosis should be referred for specialist assessment when the relevant developmental and impairment criteria are met. There may also be different routes to assessment depending upon where you live and your circumstances. The important thing is not to let the existence of a waiting list become, “Therefore I will never understand myself.”
“What if I get diagnosed and nothing changes?”
This is another understandable fear, but diagnosis is not the same thing as treatment, and treatment is not necessarily medication. For some people, medication is useful; for others, environmental changes or therapy are important. For many, understanding themselves is the most important first step.
NICE recommends considering environmental modifications for adults with ADHD, as well as psychological or non-pharmacological interventions where appropriate. For autistic adults, NICE recommends support that considers communication needs, sensory environments, autonomy, and participation, specifically recognizing the role of workplace support and reasonable adjustments. Diagnosis can lead to a different question, not, “How do I make myself normal?”, but, “What environment allows me to function well?”
What are reasonable adjustments actually about?
This is one of the most important reasons diagnosis can matter. A reasonable adjustment is not an excuse, nor is it asking everyone else to reorganise their entire lives around you, it is about reducing unnecessary barriers. For an autistic or ADHD man, that might mean:
- Having instructions in writing and receiving agendas before meetings.
- Being given clear deadlines and breaking complex tasks into clearer stages.
- Reducing unnecessary sensory distractions and having a quieter workspace where appropriate.
- Having flexibility around working arrangements and taking appropriate breaks.
- Being allowed additional processing time and using reminders or predictable structures.
- Receiving communication in a format that works better for you.
NICE specifically recommends considering environmental modifications for adults with ADHD, alongside workplace adjustments and supported employment for autistic adults experiencing employment difficulties. The philosophy is important: you do not always have to change yourself to fit the environment; sometimes the environment can change to reduce an unnecessary barrier.
What if I have spent my entire life changing myself?
Perhaps you learned, “I am the problem,” so you changed yourself. You became quieter or more sociable, forced eye contact, stopped asking questions, stopped talking about your interests, learned to tolerate noise, became excessively organised, worked longer hours, and became the reliable, funny, or successful one that everybody could depend upon. Perhaps nobody ever asked, “What would make this easier for you?”
Diagnosis can sometimes interrupt that pattern by providing a framework that says, “Perhaps this difficulty is not a moral failure.” That is an extraordinarily important distinction.
Diagnosis is not the end of the story
A diagnosis does not explain everything about you, it does not explain your childhood, every relationship, every mistake, your sexuality, personality, values, or every emotional reaction. It certainly does not tell you what kind of man you should become. It is one piece of information, a potentially very useful piece, but still just one piece. You remain a human being with history, relationships, strengths, vulnerabilities, culture, family experiences, beliefs, hopes, and choices.
Perhaps the real purpose of diagnosis is not to find out what is wrong with you, but to stop spending your entire life trying to become somebody you are not. Imagine a 38-year-old man finally understanding why certain things have always been difficult. He looks back at school differently, understands his work patterns and relationships, understands why certain environments exhaust him, why his phone became such an important source of stimulation, why he needs routine, why he becomes overwhelmed or procrastinates, why he can hyperfocus for ten hours and then struggle to answer one email, why his father may have behaved the way he did, and why his own child may be struggling.
Instead of saying, “Why am I like this?”, he can begin asking, “What do I need?” That is a very different question.
What if the boy I was needed something different?
Perhaps this is where diagnosis becomes deeply human. The little boy did not need to be fixed; he needed to be understood. He needed adults who could recognise his differences, support rather than constant criticism, somebody to ask questions, listen, and say, “I can see that this is difficult for you.” He needed somebody to recognise that his brain might work differently.
Perhaps you did not receive all of that, but you are not that little boy anymore; you are an adult man. You now have an opportunity that you did not have as a child:
- You can become curious about yourself.
- You can seek an assessment and ask questions.
- You can seek reasonable adjustments and find therapeutic support.
- You can stop interpreting every difficulty as evidence of personal failure.
- You can learn how your mind works.
Most importantly, you can begin giving yourself something that you may have spent decades waiting for other people to provide: understanding.
This is not as an excuse, a label, or a way of lowering expectations, but as a framework that says: “This is how I seem to work. These are the environments in which I struggle, the things that help me function, and the things that overwhelm me. These are my strengths and my difficulties, and this is what I can reasonably ask for.”
After years of changing yourself to fit every room you entered, that knowledge gives you something you should have had much earlier, the ability to walk into a room and think, “I do not have to become somebody else to deserve to be here.”
Counselling for Men Exploring ADHD, Autism, Identity and Self-Understanding in Reading
If you are a man in Reading, Berkshire, or the surrounding areas who has spent years wondering why certain things seem harder for you than they appear to be for other people, counselling can provide a space to explore those questions without judgement. At Male Minds Counselling, I work with boys and men who are interested in understanding themselves more deeply, including men exploring possible ADHD, autism, masking, executive functioning difficulties, emotional regulation, relationships, identity, confidence and the impact of years of feeling misunderstood.
Counselling is not a substitute for a formal ADHD or autism assessment, and a counsellor cannot diagnose ADHD or autism unless appropriately qualified and authorised to do so. However, therapy can provide a valuable space to explore your experiences, understand patterns in your life, prepare for conversations with your GP or specialist assessment service, and consider how possible neurodivergence may have affected your relationships, education, work, family life and sense of identity.
For some men, the question is not simply “Do I have ADHD or autism?” It is “Why have I always found certain things so difficult?” You may be looking back at childhood, questioning years of being labelled lazy, difficult, distracted, overly sensitive, obsessive or socially awkward. You may have spent years masking, overcompensating, working harder than everyone else or developing coping strategies that are now leaving you exhausted.
At Male Minds Counselling, we can explore these experiences at your pace. We can look at ADHD and autism in adult men, masking, executive functioning, emotional regulation, sensory overwhelm, social communication, relationships, self-esteem, childhood experiences and the psychological impact of feeling different.
You do not need to arrive with all the answers. You can simply arrive with the question.
“I want to understand myself.”
Whether you are considering an ADHD or autism assessment, have recently received a diagnosis, are questioning whether neurodivergence might explain some of your experiences, or simply want to understand yourself more clearly, counselling can offer a confidential and non-judgemental space to explore what comes next.
Male Minds Counselling in Reading
Male Minds Counselling provides counselling and psychotherapy for boys and men in Reading and surrounding Berkshire areas, with online and in-person sessions available. Support can include exploring anxiety, depression, relationships, identity, sexuality, masculinity, emotional regulation, self-esteem, life transitions, neurodivergence and the impact of difficult life experiences.
If you are ready to understand yourself rather than simply continue trying to cope, get in touch with Male Minds Counselling in Reading to arrange an initial conversation.
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