Background: Research has demonstrated that both Attention Deficit Hyperactivity Disorder (ADHD) and experience of trauma are associated with executive dysfunction (Antshel et al., 2014; Polak et al., 2012). Additionally, individuals who have ADHD are at higher risk of experiencing trauma, compared to peers who do not have ADHD (Antshel et al., 2013; Brown et al., 2017; Spencer et al., 2016). Evidence-based treatment approaches specifically target ADHD (Australian ADHD Guideline Development Group, 2022; Caye et al., 2019) or focus on trauma processing (Bohus et al., 2020; Hodgdon et al., 2022). The intersection between ADHD and trauma, and current evidence-based treatment approaches, require clinicians to be skilled at determining whether executive dysfunction is associated with ADHD or with experienced trauma; however, to date, research has not defined or differentiated these experiences.

Methods: This presentation will: 1) quantitatively and qualitatively describe executive dysfunction among adults who have ADHD and who have experienced trauma; and 2) define and differentiate executive dysfunction to inform diagnostic assessments and evidence-based treatment selection for ADHD and trauma. Study participants (n=40) were aged 18 years and older and were seeking a comprehensive diagnostic assessment for ADHD at a private clinical psychology practice in Canberra, Australia. Participants provided informed consent for their quantitative and qualitative data to be used for research. All participants completed the Behaviour Rating Inventory of Executive Function – Adult Version (BRIEF-A; self-report) (Roth et al., 2005) and a three-hour clinical interview with a clinical psychologist, informed by the Diagnostic Interview for ADHD in Adults (DIVA-5) (Kooij et al., 2019) and including discussion of trauma and lived-experience of executive dysfunction.

Results: Participants’ BRIEF-A Global Executive Composite t-scores ranged from 70 (97th percentile) to 85 (>99 percentile). Participants’ experience of executive dysfunction related to ADHD was described as pervasive and persistent across contexts, and a daily frustration that contributed to negative self-concept. Their experience of executive dysfunction related to trauma was: situational or periodic; often precipitated by a known trigger; associated with feeling fear; could be perpetuated by dissociation (e.g. depersonalisation and derealisation); and resulted in significant psychological distress.

Clinical implications: Contextualising executive dysfunction has enormous potential to increase the accuracy of diagnostic assessment of ADHD and trauma. Given client engagement in, and favourable client outcomes of, evidence-based treatment are highly reliant on appropriate approaches being selected by clinicians, contextualising executive dysfunction could also improve the uptake and efficacy of evidence-based treatments.

The road to diagnosis for undiagnosed adults is often prompted by a lifetime of difficulties that have deeply afflicted the individual’s sense of self. Feeling different, left out, and misunderstood can sometimes create a negative lens that significantly impacts the individual’s self-worth, confidence, and self-acceptance. Receiving a diagnosis as an adult is a pivotal life-changing moment that has the potential to free the individual from years of turmoil and assist them in creating a new internal dialogue that celebrates their differences. While many adults seeking diagnosis may have already suspected they were on the spectrum, for some, the diagnosis may come as a shock with complete rejection of being ‘labeled’ due to their limited understanding of the spectrum of autism and fears of stigma. These experiences spotlight the critical need for skilled clinicians who can provide adult assessments and psychoeducation that breaks down the stereotyped views of autism and removes the stigma.

This presentation explores the critical need for clinicians to upskill in their ability to provide adult assessments that are affirming and provide adequate support that assists the individual to embrace their diagnosis. It is important for clinicians to reframe difficulties shared in the assessment in a way that decreases shame and reattributes their challenges to autism as opposed to self. Guiding adults on the spectrum to embrace their neurodivergence is incredibly empowering and has the potential to ameliorate loneliness through a sense of belonging to a community and improve quality of life through accessing the right supports to overcome challenges. This presentation will provide a guide to high-quality assessments that are affordable and empowering.