Gatekeeping and Neurodivergence: The diagnostic dilemma.

For those of us on the neurodivergent spectrum, we struggle our entire lives with being told there is something wrong with us. Told that we are weird or we just need to be more like (insert whatever neurotypical human we are being compared to.). As adults on the neurodivergent spectrum there is the expectation that we mask to navigate the neurotypical world, and when we finally cross the threshold of deciding to seek diagnosis and treatment, there is a profound sense of relief that finally we may have answers.

Then we hit a reality that is all too common and distressing to those of us seeking answers. We encounter the clinical gatekeepers of neurodivergence. The stigma associated with ADHD and Autism is a painful reality that cannot be taken for granted, and not simply among others in our lives, but providers as well. In my last post, I talked about a consequence of learning to mask being exhaustion and burnout. This however can impact our ability to receive treatment as well. With permission, I am going to share the story of a friend of mine who experienced this clinical neurodivergent gate keeping first hand. After years and years of hesitance, she decided to seek an assessment with a psychiatrist. She made the appointment, and went back and forth about her anxieties. When she went into the assessment and told her story and listed her symptoms, the response caused her to leave the office in tears. "You have functioned like this for 28 years and succeeded, why do you think you have this disability now." The level of invalidation that a medical doctor with a specialty in psychiatry was devastating. Neurodivergence isn't a disability, it's a difference in how our brains function and that is absolutely valid. Similar horror stories are everywhere in support groups and within our peers. Autism is sadly not much different. "You don't look autistic", "you can't be autistic you are successful and can make eye contact." For those of us who have spent a lifetime exhausting ourselves and burning ourselves out to fit in, this blow when we let our mask down and seek treatment can be impossible to overcome.

For myself when I was formally diagnosed, the entire ride to the therapists office, who I have known for years, I was a nervous wreck. I cried telling my partner who went with me for solidarity "what if I'm not neurodivergent. What if I'm just this fucked up and broken and there is nothing wrong with the way my brain works?" Logically I knew this wasn't true, but the emotional pain of even the POSSIBILITY of being told once again that I was just thinking wrong or was just weird or broken was almost too much to take.

Sadly, those thoughts are distressingly common amongst those of us who are seeking treatment. I don't know that if my partner wasn't with me, or I didn't have a great relationship with the therapist, that I would have walked through the doors. After all, I lived my whole life "getting by". What would be so wrong with doing so now? Being diagnosed, treated, and medicated has been life changing for me. I know how fortunate I am to have both a compassionate therapist as well as wonderful PCP who believes in the validity of the diagnosis and is willing to prescribe medication that has transformed my life. Gatekeeping the diagnosis of ADHD and/or Autism is real. Please don't let this discourage you from seeking help. Ask questions to the provider(s) are seeking to meet with. Ask your psychiatrist or PCP what their prescription philosophy is should a diagnosis be rendered? Just because someone will diagnose you, doesn't mean they are willing to treat you. Do your homework, use your existing supports or locate a community for support (FB groups, Discord Servers, and TikTok are a few great options). You aren't alone, and just because some providers will gatekeeper these diagnoses, doesn't make them, or you, any less valid.