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Brenna Schulte

Professor Cutler

English 1201.506

26 April 2022

How do you diagnose neurodivergence?

The Neurodivergent Movement commenced in the 1990s and has brought awareness to

the neurodivergent community. With this and the advancement of technology, we now have

access to more information when recognizing disorders. This research paper will explain the

importance of the criteria listed in the DSM-5, assessment tests, and analyzing behaviors in

different settings when diagnosing neurodivergence.

Neurodivergent refers to the brain's processing of information in a way that differs from

the majority. The United Kingdom charity ADHD Aware states that about 40% of the world

population are neurodivergent (Villiness). The opposing term of neurodivergent would be

considered neurotypical. Neurotypical behavior is demonstrated by sharing similar progress

within your age group, the ability to endure sensory differences, and focus when necessary in a

given situation. Observing the differences between the two can help form symptoms used to

diagnose.

The word neurodivergent can have a negative connotation with it. It's labeling one as

being different compared to the population. Historically, neurodivergent people were treated

poorly in the medical field. Unethical approaches led to the misconception of being perceived as

only negative. However, now advantages have been linked to being neurodivergent. They have

been labeled “out-of-the-box” thinkers with their creativity. Compared to neurotypical people,
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they excel at visual processing, and they can surpass musical and artistic abilities (Bruise). Over

time the negative misconceptions surrounding neurodivergence are slowly disappearing.

Fig. 1 Demonstrates the rise of Neurodivergence over time “Autism Statistics.” The

Autism Community in Action (TACA), 28 May 2020, https://tacanow.org/autism-statistics/.

The term neurodivergent originated from Judy Singer, an active advocate in The

Neurodivergent Movement. This movement aimed to expand the definition of what was

considered normal. It desired a community that viewed those with neurological differences as

humans rather than disabled. It brought awareness to other disorders related to autism, including

others like ADHD and Dyslexia. Harvard Health states the importance of this movement for the

framework of neurodivergent research and diagnoses to help all neurodivergent people,

especially in the future (Baumer).

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has made it easier

today to diagnose neurodivergent-related disorders based on the criteria provided. The American

Psychiatric Association states this provides a universal way for doctors to communicate and stay

consistent with their diagnosis (“DSM”). Within the DSM, it lists organized explanations and

symptoms regarding different mental disorders, making it easy to navigate. However, no method
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is provided to treat them. The physician's job is to interpret the DSM and the patient's symptoms

to form a verdict. The DSM remains up to date with its new versions and helps provide

guidelines for all doctors to follow.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) lists the criteria

needed for Autism Spectrum Disorder (ASM). The three main requirements are recurring

problems in the three areas of social interactions and speaking and two out of the four types of

controlled, repeated behavior. A lack of social communication can involve an absence of

social-emotional reciprocity, nonverbal communication, and relationships. Behaviors consist of

repeated movement, fixation on order, extreme interest, and unusual sensory problems. The

symptoms have to be expressed during development and effects functioning ( “Autism Spectrum

Disorder”). However, symptoms can become more apparent over time with the demand of

different roles as you grow up. The information within the DSM helps diagnose patients with

ASD based on the knowledge in the DSM.

Attention deficit hyperactivity disorder (ADHD) is another disorder categorized in the

DSM-5. It further breaks down ADHD into three subcategories, listing the guidelines for each.

Signs of ADHD can arise from early childhood to adulthood. The criteria listed are recurring

intention or hyperactivity that interferes with daily life. It can range from being unable to pay

attention in class to constant fidgeting. How many symptoms or behaviors from each list depend

on the age. For adults to be diagnosed, only five of the six symptoms from the DSM-5 need to be

present. This is due to symptoms being expressed differently with age. The Center for Disease

Control and Prevention recommends professionals follow the regulations provided in the DSM-5

(“Symptoms and Diagnosis of ADHD”).

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Dyslexia categorizes as a learning disorder under the DSM-5. It consists of four criteria,

recurring difficulties in reading, writing, arithmetic, or mathematical skills, below-average

grades, signs that begin showing in early years and can’t be explained by other disorders.

Symptoms are slow reading, failure to remember numbers, and spelling issues. Dyslexia can

cause issues in school or work environments and usually show signs early on. (“Clinical

Characteristics of Learning Disabilities”). The information in the DSM makes it easier to notice

and categorize dyslexia.

While the DSM provides a universal up-to-date knowledge, it still receives criticism.

Arguments have been made it’s too simplistic on human behavior and can lose what makes us

special. What’s considered abnormal or normal behavior? With multiple versions of the

DSMcreated over the years, it’s constantly changing. Disorders begin fusing, and criteria

changes cause mis or over-diagnosing. An incorrect diagnosis can lead to serious long-term

effects for the patients and the future of neurodivergence research.

A misdiagnosis could lead a patient to receive incorrect treatment, causing their problems to

potentially worsen (Fritscher). The criteria provided could be used to stereotype the person and

as labels rather than a medical disorder. Attaching a label gives them a new identity that doctors

could fixate on.

Neurodivergence relates to the brain functioning ability, and due to the inability to have

normal lab tests done, assessment tests provide data to analyze. In 2022 a study was conducted in

England to assess the Autistic Population without learning difficulties using the General Health

Questionnaire (GHQ-12). The results showed good “psychometric properties” and data to

support it being a strong assessment test to be utilized (Mayhew). This study provides research to

back up the use of assessment tests to provide information when diagnosing. The information
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provided from assessment tests allows pediatricians to tap into the mind of the patient to get a

better understanding.

Assessment tests have been incorporated into school environments in the hopes of

noticing early signs of neurodivergence. A common association of neurodivergence is learning

disabilities. Learning disabilities are one of many signs of early neurodivergence. The United

Nations Children's Fund states that about 150 million children under 18 have some form of

disability (Hayes). The use of assessment testing at a young age can help provide early

diagnoses. Testing for a school environment can break into intelligence, achievement,

visual-motor integration, and language tests (Logsdon).

Intelligence testing is commonly known as IQ testing and primarily focuses on using the

Wechsler Preschool and Primary Scale of Intelligence (WIPPSI), Wechsler Intelligence Scale for

Children (WISC), and the Wechsler Adult Intelligence Scale (WAIS). The Wechsler Intelligence

Tests were measures in four categories, Verbal Comprehension Index, Perceptual Reasoning

Index, Working Memory Index, and Processing Speed Index, and then compares to the total

population (Logsdon). If results fall below average in specific categories, it can indicate the

presence of a learning disability.

Achievement tests focus on the academic areas of math, writing, and reading. The

Woodcock-Johnson Tests of Achievement (WJ) are used for individual assessment for checking

the progress made by the individual. The fourth version consists of 40 minutes to 6 standard

subtests, 20 for writing tests and 10 for the remaining tests. Results presented that 155 students

with Autism Spectrum Disorder showed lower performance regarding in the categories of

Reading, Writing, and Math (“Woodcock-Johnson IV Tests of Achievement”). Low results in

categories can be signs one may be neurodivergent.

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Testing motor coordination and visual cues make up the Visual-Motor Integration Tests.

According to the encyclopedia, The Bender Visual-Motor Gestalt Test is one of the

psychological assessments used. It tests visual-motor functioning, visual-perceptual skills,

neurological impairment, and emotional disturbances. It has nine individual 3*5 images and is

presented by a doctor while the test taker is required to replicate the image. It lasts about 20

minutes but has no time limit. The results are discord based on accuracy and organization

(“Bender-Gestalt Test''). These can help dictate whether there are neurological deficits present

and can be used with other tests to form a diagnosis.

Language assessment tests focus on the ability to comprehend language and to verbally

respond. The Clinical Evaluation of Language Fundamentals - Fifth Edition (CELF-5) is

designed for ages 5-21 and used to see if a child needs more testing to identify a language

disorder. It includes Sentence Completion, Linguistic concepts, Word Structure, Word Classes,

Following Directions, Formulating Sentences, Recalling Sentences, Understanding Spoken

Paragraphs, Word Definitions, Sentence Assembly, Semantic Relationships, Reading

Comprehension, Structured Writing, Pragmatics Profile, and a Pragmatics Activity Checklist.

The fourth version of this test proved to be significant in noticing language problems related to

Autism Spectrum Disorder, with a reliability coefficient of .97 (“Clinical Evaluation of Language

Fundamentals - Fifth Edition”). Language Assessment provides inside into the brain's language

processing and can show symptoms of Neurodivergence.

Autism utilizes both assessment tests and screening tests when diagnosing a patient. The

American Academy of Pediatricians (AAP) recommends screening during doctor visits around 9,

18, and 30 months. If the child is a high risk, additional screening should be done at 18 and 24

months. If a screening is positive, it would be followed by an assessment. There is a wide range

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of options for assessing autism, including questionnaires, scales, and checklists involving

common symptoms related.

Ages and Stages Questionnaires (ASQ) are for one month to five and a half-year-olds

going through development. It can take anywhere from 10 to 15 minutes and involves the parents

answering questions regarding their child's development. For children and adults, the Autism

Diagnosis Interview focuses on behavior in 3 categories, reciprocal social interaction,

communication, and associated behaviors (“Screening and Diagnosis of Autism Spectrum

Disorder for Healthcare Providers”). No one test can assess Autism. Rather it’s a combination of

many to help rule out other related disorders and specify what form you are experiencing.

Attention deficit hyperactivity disorder (ADHD) focuses on assessment tests involving

the patient using questions involving rating scales. However, symptoms are shown differently

among different ages and sexes. This requires multiple test options needed to accommodate

everyone. The Vanderbilt Assessment Scale is an example of a tool used to help access a child

between the ages of six and twelve. It involves fifty-five questions listing different symptoms

demonstrated by ADHD, and the patient is required to rate it zero to three, being very often. The

Connor -Well’s Adolescent Self-Report Scale is designed to assess teenagers with ADHD (ages

11-17) using self-reported ratings. The ADHD Rating Scale-IV With Adult Prompts

(ADHD-RS-IV) consists of 18 rating scales. The first nine focus on inattentive symptoms, and

the other look on hyperactive-impulse symptoms(Johnson). ADHD assessment tests primarily

focus on targetting different age groups with the proper scale questions to get the best results to

help diagnose.

Dyslexia focuses on the neuro differences in the brain with speaking, reading, and writing

skills. Therefore no screenings or blood tests can detect it. Instead, assessment tests are
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commonly used to diagnose dyslexia. Within these tests, there are components to look at:

decoding, oral language skills, spelling, vocabulary, and others similar. Based on these tests,

doctors can detect where there might be a difference neurologically and diagnose (“Dyslexia”).

The performance of the test itself can help distinguish between the disorders and provide inside

into what’s happening to the brain.

The criticism surrounding assessment tests is too time-consuming, the timing of the

assessment with your academic timeline, and some haven’t been updated to fit current standards.

Assessment tests can last anywhere from 10 minutes to 60 minutes, depending on the test. This

causes it to be too time-consuming and sometimes hard to schedule. You also need an

administrator to be available to be given the test, and properly scored. The timing of an

assessment of the patient's academic progress is crucial. The material provided in the tests can be

difficult if not taught the information yet. Schools follow their curriculums and don’t always line

up with the same schedule. Assessment tests have been around for a long time ,and with the

constant new research done, it’s hard to stay up-to-date (“Assessment Types – Pros and Cons”).

Critics argue whether assessment tests are valid with new information and if they take up too

much time for the patient and administrator.

Paying attention to behavioral patterns in different environmental settings can provide

information that correlates with a neurodivergent-related disorder. The National Institute of

Stroke and Neurological Disorder lists early symptoms demonstrated in both younger and older

children. An absence of pointing before twelve months, no two-word phrases by two, and low

social interaction are all indicators of Autism (Bruise). Noticing certain behaviors can help a

doctor distinguish what a patient might be experiencing. Different actions shown can be
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symptoms or early indicators of one being neurodivergent. Knowing symptoms can help provide

a diagnosis.

Autism spectrum disorder (ASD) is the most common associated term related to

neurodivergence. Spectrum Disorder refers to the ability to be further broken down. It includes

autistic disorder, Asperger's syndrome, childhood disintegrative disorder, and others. The 2018

comprehensive review showed in a group of fifty- nine eights years olds, one suffers from ASD,

an increase of 1.7%. The increase was due to the awareness and greater research done in the

process of diagnosing ASD ( “Autism Spectrum Disorder”). Being aware of symptoms

diagnosed with ASD can help form the connection to diagnose the disorder.

Attention deficit hyperactivity disorder (ADHD) has noticeable behaviors when placed in

different settings. At school behaviors indicating the presence of ADHD includes the inability to

remain focused in class, can’t remain still, or constantly getting up from your chair.

When forming a diagnosis, a pediatrician will contact teachers, parents, or anyone close to the

patient that's able to observe everyday behaviors. They’ll ask to keep a checklist of behaviors

shown, and at the next doctor's appointment, they’ll be able to use that information to diagnose

the patient (Villians). Knowing what behaviors are expressed within these different environments

can help show the doctor what happens outside the office.

Dyslexia behavior can be demonstrated within settings that involve the use of reading,

writing, or spelling. Someone with dyslexia would avoid situations involving these skills,

including reading in public situations or for example performing in spelling bees at school.

Including showing no interest in songs or words, learning the alphabet, and talking later than the

average child (Bruise). When a child comes in with her parents, the doctor will focus on asking

the parents about behaviors the child has shown and use this to help form a diagnosis.
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There is no one way to diagnose someone as being neurodivergence. Diagnosing involves

the use of multiple available research tools working together. With neurodivergence affecting the

brain, doctors have created ways to analyze the processes. The DSM is a resource categorizing

disorders for all doctors to follow and base their decisions. It remains up to date and available to

everyone, helping form a common diagnosis process. Combining this with the use of assessment

tests, allows doctors to assess where issues might lie. The results can show symptoms that

correlate to a disorder located in the DSM. With the use of the DSM, assessment test, and

analyzing behavioral patterns in different environments together, we can get a better diagnosis of

neurodivergence in a patient.
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Works Cited

“Assessment Types – Pros and Cons.” Forefront Education, 21 Sept. 2021,

https://forefront.education/assessment-types-pros-and-cons/.

"Autism Spectrum Disorder." Gale Opposing Viewpoints Online Collection, Gale, 2021. Gale In

Context: Opposing Viewpoints,

link.gale.com/apps/doc/PC3010999051/OVIC?u=dayt30401&sid=bookmark-OVIC&xid

=3d844c56. Accessed 23 Apr. 2022.

“Autism Statistics.” The Autism Community in Action (TACA), 28 May 2020,

https://tacanow.org/autism-statistics/.

Baumer, MD Nicole, and MD Julia Frueh. “What Is Neurodiversity?” Harvard Health, 23 Nov.

2021, https://www.health.harvard.edu/blog/what-is-neurodiversity-202111232645.

Bhandari, Smitha. “ADHD/ADD Tests for Diganosis: Medical Testing, Scales, & Psychological

Criteria.” WebMD, WebMD, 14 June 2021,

https://www.webmd.com/add-adhd/childhood-adhd/adhd-tests-making-assessment.

Brusie, Chaunie, and Dannell Roberts. “Neurotypical: All You Need to Know and More.”

Healthline, Healthline Media, 15 Nov. 2021,

https://www.healthline.com/health/neurotypical.

Clinical Characteristics of Learning ... - Ncbi.nlm.nih.gov.

https://www.ncbi.nlm.nih.gov/books/NBK332886/.
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“Diagnostic Criteria.” Centers for Disease Control and Prevention, Centers for Disease Control

and Prevention, 6 Apr. 2022, https://www.cdc.gov/ncbddd/autism/hcp-dsm.html.

“DSM.” Psychiatry.org - DSM, https://psychiatry.org/psychiatrists/practice/dsm.

Fritscher, Lisa. “Can the Diagnostic Manual for Mental Health Do More Harm than Good?”

Verywell Mind, Verywell Mind, 19 June 2020,

https://www.verywellmind.com/dsm-friend-or-foe-2671930.

“." Gale Encyclopedia of Medicine, 3rd Ed.. . Encyclopedia.com. 25 Apr. 2022 .”

Encyclopedia.com, Encyclopedia.com, 28 Apr. 2022,

https://www.encyclopedia.com/medicine/divisions-diagnostics-and-procedures/medicine/

bender-gestalt-test.

Hayes, Anne M. Learning Disabilities Screening and ... - NCBI Bookshelf. Apr. 2018,

https://www.ncbi.nlm.nih.gov/books/NBK545498/.

Johnson, Jon. “ADHD Rating Scale: Checklists, Symptoms, and Diagnosis.” Medical News

Today, MediLexicon International, 21 May 2018,

https://www.medicalnewstoday.com/articles/321867#adhd-rating-scale-tests.

Logsdon, Ann. “How Tests Can Determine If Your Child Has a Learning Disability.” Verywell

Family, Verywell Family, 10 July 2020,

https://www.verywellfamily.com/learning-disability-tests-in-public-schools-2161894#:~:t

ext=Common%20achievement%20tests%20used%20to,reading%2C%20writing%2C%2

0and%20math.
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Mayhew, Emese, et al. “An Assessment of the Psychometric Properties of the GHQ-12 in an

English Population of Autistic Adults without Learning Difficulties.” Journal of Autism

and Developmental Disorders, Springer US, 11 July 2022,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985123/.

Resnick, CNC Ariane. “What Is Neurodivergence and What Does It Mean to Be

Neurodivergent?” Verywell Mind, Verywell Mind, 6 Oct. 2021,

https://www.verywellmind.com/what-is-neurodivergence-and-what-does-it-mean-to-be-n

eurodivergent-5196627.

“Screening and Diagnosis of Autism Spectrum Disorder for Healthcare Providers.” Centers for

Disease Control and Prevention, Centers for Disease Control and Prevention, 6 Apr.

2022, https://www.cdc.gov/ncbddd/autism/hcp-screening.html.

“Symptoms and Diagnosis of ADHD.” Centers for Disease Control and Prevention, Centers for

Disease Control and Prevention, 23 Sept. 2021,

https://www.cdc.gov/ncbddd/adhd/diagnosis.html.

Tslat. “Woodcock-Johnson IV Tests of Achievement.” TSLAT,

https://www.txautism.net/evaluations/woodcock-johnson-iv-tests-of-achievement.

Villines, Zawn. “What Does Neurotypical and Neurodivergent Mean?” Medical News Today,

MediLexicon International, 3 Feb. 2022,

https://www.medicalnewstoday.com/articles/what-does-neurotypical-mean.
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