Why the Mental Health System Fails Autistic & ADHD Adults—And How We Can Fix It
Bridgette Hamstead
The mental health system is meant to provide support, guidance, and intervention for those struggling with psychological and emotional well-being. Yet, for autistic and ADHD adults, it is often an inaccessible, ineffective, and even harmful system. Despite increasing awareness of neurodiversity, most mental health services remain rooted in neurotypical frameworks, failing to accommodate the unique needs of neurodivergent individuals. Misdiagnosis, a lack of neurodiversity-affirming care, systemic biases, and the pathologization of natural neurodivergent traits all contribute to a crisis in mental health support for autistic and ADHD adults. If we are to create a truly inclusive and effective mental health system, we must rethink how services are designed, delivered, and understood.
Misdiagnosis and the Medical Model of Mental Health
One of the primary ways the mental health system fails autistic and ADHD adults is through misdiagnosis or delayed diagnosis. Many neurodivergent adults, particularly women, nonbinary individuals, and people of color, go undiagnosed until adulthood—or never receive a diagnosis at all. Instead, they are often misdiagnosed with anxiety, depression, bipolar disorder, borderline personality disorder, or other mental health conditions that do not fully explain their experiences.
This is largely because the diagnostic criteria for autism and ADHD were historically based on observations of young, white, cisgender boys. As a result, those who do not fit this narrow profile often have their neurodivergence overlooked, leaving them to navigate a mental health system that treats their symptoms in isolation rather than understanding their experiences through a neurodivergent lens.
Additionally, because many autistic and ADHD adults experience anxiety and depression as a result of long-term masking, sensory overwhelm, and systemic barriers, they are often treated for these secondary conditions while their underlying neurodivergence remains unrecognized. This leads to ineffective treatment plans that do not address the root causes of their distress.
The Harm of Pathologizing Neurodivergence
The traditional medical model of mental health views autism and ADHD as disorders—conditions to be managed, controlled, or “treated” rather than natural variations of human cognition. This perspective leads to therapeutic approaches that focus on suppressing neurodivergent traits rather than supporting neurodivergent well-being.
For example, autistic individuals are often encouraged to undergo behavioral interventions that push them to mimic neurotypical social norms, reinforcing the harmful expectation that they must mask their natural behaviors to be accepted. Similarly, ADHD individuals are frequently told that their struggles with executive dysfunction, sensory regulation, or time blindness are personal failings rather than valid cognitive differences that require accommodations and support.
Rather than perpetuating a deficit-based view of neurodivergence, the mental health system must shift toward a neurodiversity-affirming approach—one that acknowledges the legitimacy of autistic and ADHD experiences and prioritizes support over normalization.
Barriers to Accessible and Effective Care
Even when autistic and ADHD adults do seek mental health support, they face numerous systemic barriers that prevent them from accessing effective care. These include:
A Lack of Neurodivergent-Affirming Therapists: Many therapists and mental health professionals have little to no training in neurodiversity. As a result, they may unintentionally invalidate neurodivergent experiences, misinterpret behaviors, or use therapeutic techniques that are ineffective or even harmful for neurodivergent individuals.
Sensory and Executive Function Challenges: Traditional therapy settings often fail to accommodate sensory sensitivities and executive function differences. Bright lighting, rigid appointment structures, and overwhelming environments can make it difficult for neurodivergent clients to engage fully in therapy.
Cultural and Financial Barriers: Mental health care is already inaccessible for many people due to financial constraints, but these barriers are even greater for neurodivergent individuals, who may struggle with employment stability due to a lack of workplace accommodations. Additionally, people of color and LGBTQ+ individuals face additional layers of discrimination and systemic neglect, making it even harder to find affirming, competent care.
How We Can Fix the Mental Health System
Fixing the mental health system to better serve autistic and ADHD adults requires a fundamental shift in both practice and perspective. This begins with rejecting the pathology-based model of neurodivergence and replacing it with approaches that prioritize accessibility, autonomy, and neurodivergent well-being.
Training Mental Health Professionals in Neurodiversity-Affirming Care: Therapists, counselors, and psychiatrists must receive training on neurodivergent experiences, including the impact of masking, sensory sensitivities, executive dysfunction, and the intersection of neurodivergence with other identities. Neurodiversity-informed therapy should focus on validating and supporting neurodivergent individuals rather than trying to make them conform to neurotypical norms.
Expanding Diagnostic Criteria and Screening Tools: Mental health professionals must work to develop diagnostic tools that account for the diverse ways neurodivergence presents across different genders, racial backgrounds, and life experiences. More inclusive diagnostic frameworks would help ensure that neurodivergent adults—especially those who have been historically overlooked—receive the recognition and support they deserve.
Making Therapy More Accessible: The mental health system must adapt to the needs of neurodivergent individuals by offering flexible therapy formats, such as text-based or asynchronous therapy, sensory-friendly office spaces, and alternative communication methods. Additionally, sliding-scale fees and insurance reforms are necessary to ensure that mental health care is financially accessible to all.
Prioritizing Self-Advocacy and Peer Support: Traditional therapy models often place the therapist in a position of authority over the client. A neurodiversity-affirming approach, however, recognizes the value of self-advocacy and peer support. Neurodivergent-led therapy groups, community networks, and lived-experience-informed models of care must be integrated into the mental health system to provide neurodivergent individuals with spaces where they feel truly understood.
Ending the Stigma Around Neurodivergence in Mental Health Care: Society must move away from the idea that autism and ADHD are mental illnesses to be “treated” and instead recognize them as cognitive differences that require respect and accommodation. The mental health field must work toward dismantling ableist assumptions and ensuring that neurodivergent individuals receive care that honors their identities and needs.
Conclusion: A Mental Health System That Works for Neurodivergent Adults
The mental health system, as it currently stands, is failing autistic and ADHD adults. From misdiagnosis and inaccessibility to the pathologization of neurodivergence, systemic barriers prevent neurodivergent individuals from receiving the support they need. It is time to move away from an outdated, deficit-based approach and toward a mental health system that recognizes, respects, and affirms neurodivergent experiences.
A reformed mental health system must be built with neurodivergent voices at the forefront. By prioritizing accessibility, inclusivity, and affirming care, we can create a world where neurodivergent individuals no longer have to fight for recognition and support, but instead have access to mental health care that truly works for them.