We are living through an unprecedented moment in the world of neurodiversity. Over the past decade, assessments and diagnoses for conditions like Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) have surged.
As a parent and advocate who lives and breathes this space – particularly through the lens of Developmental Coordination Disorder (DCD/Dyspraxia) – I celebrate much of this shift. For generations, neurodivergent individuals were written off with dismissive adjectives. Millions of people spent decades feeling profoundly broken simply because their brains were wired differently. The rise in diagnoses has brought validation, accommodation, and self-understanding to countless lives. The BBC’s excellent All Kinds of Minds series is an example of how the media’s coverage has helped drag neurodivergence into the mainstream.
Undeniably, neurodivergent conditions were historically under-diagnosed, particularly in girls and women. My partner and I support a guy in his 60s who was only diagnosed autistic in 2019, despite a lifetime of visible social difficulties, communication differences, and a whole host of rigid, repetitive behaviours and ways of thinking. His autism has profoundly affected him, ultimately leading him to living in appallingly unhealthy circumstances – though no longer, thankfully.
My lifelong passion for psychology
My journey with psychology stretches back to 1996 when I began studying it at A Level. I was actually due to study for a psychology degree as a young man, right up until the point where a record contract unexpectedly pulled me down a completely different path into the music industry. (Long story for another time!)
Though my career took that detour, my fascination with human neurobiology and developmental psychology never waned. Over the years, I've kept one foot firmly in that world – helped along by a clinical circle of friends that includes a clinical psychologist, a mental health occupational therapist, and her consultant psychiatrist husband. My bookshelves are peppered with books on psychology. One of my heroes is Dr Daniel Siegel; he’s up there with Brian Wilson, Margaret Atwood and Simon Schama in the list of those people I most admire. I’ve devoured several of his popular books, as well as his seminal clinical textbook, The Developing Mind.
It’s Siegel’s work that keeps popping into my head as I observe the current landscape. Alongside the very welcome rise in neurodivergence recognition, a new conversation is quietly emerging in clinical and academic circles. It is a conversation we need to be brave enough to have: Is it possible that a small subset of current diagnoses are, in fact, misdiagnoses – behaviours better explained by environmental factors’ impact on the developing mind, such as chronic stress and Adverse Childhood Experiences (ACEs)?
I appreciate this is sensitive territory. Addressing this question isn't about invalidating anyone's lived experience. It is about protecting the integrity of diagnostic pathways, restoring public confidence, and – most importantly – ensuring people get the right support for the true root of their distress.
Understanding ACEs: beyond the extremes
When clinicians speak of Adverse Childhood Experiences (ACEs), public attention often defaults to severe, criminally prosecutable harms like physical abuse. However, as physician and former Surgeon General of California Dr Nadine Burke Harris pioneered in her groundbreaking research on toxic stress, ACEs encompass a far broader spectrum of relational and household adversity occurring before age 18.
As Burke Harris demonstrates, chronic, ambient stress directly alters the body's neurobiology, biological stress response, and developing brain architecture. Crucially, ACEs include pervasive forms of emotional adversity and household dysfunction that rarely result in police – or even social services – intervention, yet profoundly shape a child's nervous system:
Emotional Abuse & Relational Stress: Being repeatedly shouted at, sworn at, humiliated, belittled, or made to feel that one is unwanted, defective, or unsafe by a caregiver.
Household Dysfunction: Growing up in a home with parental alcohol or drug addiction; witnessing domestic conflict between caregivers; living alongside a caregiver’s mental illness; or enduring the sudden instability of parental separation, particularly when the separation is ‘messy’ or wrapped up in visible anger.
As described in great depth in Siegel’s The Developing Mind, a young brain is subjected to this chronic unpredictability and instability, it adapts to survive. And those adaptive survival strategies can look remarkably familiar on a diagnostic checklist.
Swimming Dr Siegel's river: chaos vs rigidity
To understand how environmental trauma can so convincingly mimic neurodivergence, it helps to look at Dr Siegel's brilliant metaphor: the River of Integration.
Siegel describes mental well-being as travelling down the central flow of a river, where our minds are flexible, adaptive, coherent, energised, and stable. Where our emotions are regulated. But when our environment becomes chaotic, unsafe, or unpredictable – such as living through household dysfunction or other types of ACEs – our nervous system gets pushed out of the central flow and grounded on one of two dysfunctional banks:
The bank of chaos: Here, the system is overwhelmed by reactive emotions, intrusive sensations, and hyperarousal. Executive functioning goes offline; the ‘lower’ brain is in charge. The person becomes restless, impulsive, and emotionally volatile – a state that can mirror aspects of ADHD.
The bank of rigidity: Here, the system locks down to guard against uncertainty. The person clings to unyielding routines, exhibits emotional numbing, seeks hyper-control over their immediate environment, and represses unexpected changes – a state that can easily mirror aspects of autism.
The outward behaviours can appear virtually identical on a standardised diagnostic checklist. But the underlying neurobiology is vastly different. One is a fixed, innate way of processing the world; the other is a dynamic, protective shield raised to survive an unsafe environment. Clinicians in England’s West Midlands, for example, have developed the Coventry Grid questionnaire as a supplementary tool used in some autism-diagnosis assessments. The tool is designed to differentiate between autism and attachment disorder, which, on the face of it, can result in similar-looking symptoms.
Mimicking traits in diagnostic assessments: food and the ADOS
How does this play out during formal assessments? Standardised tools like the face-to-face Autism Diagnostic Observation Schedule (ADOS) rely heavily on evaluating cross-sectional social communication, emotional reciprocity, and behavioural flexibility in a single clinical window.
When a person has adapted to severe emotional abuse, their protective survival responses can mirror key ADOS scoring metrics:
1. Social reciprocity and affective expression on the ADOS
During an ADOS interview, clinicians observe eye contact, facial expressions, gesture, and the natural "give-and-take" of conversation. They drop ‘social breadcrumbs’ and observe how the person reacts.
The autistic profile: Differences reflect a baseline neurotype – processing language, social cues, and sensory input in an atypical, often monotropic way.
The emotional abuse shield: A child who grew up being repeatedly sworn at, mocked, or unpredictably yelled at learns early on that eye contact, spontaneous facial expressions, and emotional openness are dangerous. They invite attack or criticism. To survive, the child adopts a hyper-vigilant defence: reduced eye contact, flat affect, monosyllabic answers, and emotional withdrawal (an "appease" or "freeze" state). On an ADOS scoring sheet, this guarded stance can easily be miscoded as a deficit in "spontaneous social overtures" or "restricted range of facial expressions."
2. Environmental control and food rigidity
Consider a child who grows up in a household characterised by chronic unpredictability starting around age eight or nine – after early developmental milestones have naturally established. In response to this emerging dysfunction, they develop an extreme, unyielding food-based rigidity – eating only two or three specific items – to establish a single domain of felt control. If evaluated years later through a standard symptom checklist, that food rigidity might easily be ticked off as an autistic "insistence on sameness".
Yet, if that same individual later enters a safe, stable environment and their food rigidity naturally softens – if they become curious, open, and willing to try new foods without distress – it may suggest the rigidity was a state of defence (a stay on Siegel’s bank of rigidity) rather than a fixed form of innate processing. State, not trait.
The academic wave: the search for differential-diagnosis clarity
This diagnostic overlap isn't just theoretical; it's driving a growing wave of academic literature.
In a paper published this year in Frontiers in Psychiatry, entitled "Diagnostic inflation in autism spectrum disorder", Italian researchers explicitly examine how diagnostic inflation and the reliance on cross-sectional symptom checklists and observation tools can lead to the misinterpretation of trauma-related responses. The authors warn of the clinical costs when early relational trauma or complex post-traumatic stress – which often produce state-dependent sensory hyperreactivity and emotional regulation difficulties – are misread as structural, innate neurodevelopmental traits. Again: state vs trait.
This reflects a broader trend across recent literature. For instance, a 2024 review in Advances in Autism, "Trauma or autism? – understanding how the effects of trauma and disrupted attachment can be mistaken for autism", directly explored how attachment disruptions produce trans-diagnostic behavioural features that mimic autistic traits during cross-sectional clinical assessments like the ADOS. A paper published this year by the University of Huddersfield, analysing British adults‘ neurodiversity assessments, concluded that ACEs can result in presentations that mimic autism and ADHD. And another 2026 study – this time by King‘s College London, focused on autism assessments – reached similar conclusions about the impact of childhood adversity. They stated “Our findings support closer connections between adult autism clinics and trauma and mental health specialists, both for diagnosis and for support options”.
And now it seems that the discussion has reached the publishing world. I read today on Twitter that clinical psychologist Dr Naomi Fisher, an expert on both trauma and autism, is publishing a book in February 2027 named This Explains Everything, which will explore some of these issues.
Rebuilding public confidence through methodical practice
We currently face a wave of public cynicism regarding the rise in neurodivergence diagnoses. Headline-writers and online commentators frequently throw around terms like "over-diagnosis" or "social media trends".
In my humble opinion, the best way to answer this scepticism isn't to dismiss it or double down defensively. It is to champion clearer, more methodical, and rigorously documented differential diagnoses.
When an assessment thoroughly disentangles early developmental history (looking closely at those foundational early years) from environmental context – when it checks for early infant markers, explores family dynamics, evaluates sensory baselines, and considers ACEs – it does something powerful:
It builds public and clinical confidence: It reassures society that a diagnosis is a precise, meaningful, and carefully considered conclusion, not a casual label handed out after a brief consultation. And not an example of confirmation bias.
It guarantees appropriate support: Treating an autistic individual with neuroaffirmative environmental accommodations works brilliantly. But using those same accommodations for a person whose traits stem from unresolved relational trauma might inadvertently lock them onto the bank of rigidity, leaving the underlying trauma unaddressed.
My daughter’s recent dyspraxia assessment is a case in point. Trauma isn’t relevant here in terms of differential diagnosis, but neurological conditions are. The assessor clearly screened for these, concisely establishing that the only plausible explanation for my daughter’s motor-skills presentation was dyspraxia.
Holding both truths
We do not have to choose between acknowledging the historical under-diagnosis of neurodivergent conditions and admitting that misdiagnoses happen. Both truths exist simultaneously.
Neurodivergence is real, beautiful, and fundamentally structural. Trauma is real, protective, and deeply adaptive. By using frameworks like Siegel's River of Integration, incorporating Dr Nadine Burke Harris' insights on ACEs, and demanding high-quality, trauma-informed differential assessments, we honour both. We give neurodivergent people the validation they deserve, while ensuring those carrying the heavy shields of childhood trauma are helped off the banks of rigidity and chaos, and guided back into the flow of their own lives.
