Comparative analysis of diagnostic expectations between adults referred for ADHD and autism assessment: a thematic analysis

Background Recent trends in neurodevelopmental services promote joint assessment pathways combining ADHD and Autism services. However, no study has systematically compared diagnostic expectations between adults seeking ADHD versus Autism assessment. Methods This comparative qualitative study analysed expectations from 100 adults referred for ADHD assessment, comparing findings with published Autism data (n=60) from the same Trust. Both samples were of adults referred for assessment rather than diagnostically confirmed cohorts. Two open-ended questions during face-to-face appointments: “What do you hope to gain from the assessment?” and “How do you think receiving a diagnosis would help you?” ADHD responses underwent reflexive thematic analysis using Braun and Clarke’s six-phase framework, with comparison against published Autism themes. Results Analysis revealed fundamentally divergent expectation patterns organised around contrasting meta-themes: “Seeking Legitimisation and Practical Solutions” (ADHD) versus “Understanding Self and Explaining Difference” (Autism). Five conceptual dichotomies distinguished pathways: (1) pharmacological versus psychosocial intervention paradigms (47% ADHD mentioned medication versus 1.7% Autism); (2) diagnostic certainty versus depth of understanding (31% ADHD versus 75% Autism seeking understanding); (3) passive hope for understanding versus active educator positioning (3% ADHD versus 63% Autism expecting to explain to others); (4) deficit versus difference self-concepts (15% ADHD used harsh self-descriptors versus 1.7% Autism); (5) internal overwhelm versus social-environmental mismatch phenomenology (10% ADHD described “racing mind” versus 0% Autism). These differences persisted across demographic subgroups. Conclusions Adults seeking ADHD versus Autism assessment hold fundamentally different expectations requiring differentiated clinical responses. Findings provide empirical evidence for separate rather than combined diagnostic pathways, with condition-specific pre-assessment counselling, post-diagnostic support, and clinical expertise development. Generic ‘neurodevelopmental’ provision risks meeting no one’s actual needs.