Personal evidence for diagnostic purposes

this page is designed for diagnostic purposes much of the information might also apply to creating an impact statement for legal purposes as in most cases particular nuerodiversity proof of diagnosis is proof of disability

Evidence for diagnostic purposes and/or disability

Use the checklists information below to create a list of examples of evidence you can produce to meet diagnostic expectations in ICD 11 for the diagnosis you are being assessed for

In many cases the earliest evidence is helpful in diagnosis as if you can show symptoms or signs that pre-date mental health issues (anxiety or depression amongst others), trauma or other physical illnesses this will simplify the diagnostic process.

Have in written form, or ideally as a witness, evidence from 3rd parties to confirm your personal evidence. This is particularly important if there is suggested doubt as to the validity of your evidence in conditions where masking is common 3rd partie can often offer a more objective picture of the symptoms/signs particularly when mask slip than person themselves.

Checklist: personal evidence across life stages

This checklist brings together the types of evidence that can support both diagnosis and proving disability under the Equality Act. You do not need all of these, but the more consistent the pattern across time, the stronger your case will be.

Childhood (before age 12)

• School reports – comments on concentration, behaviour, reading/writing, organisation, social interaction.
• SEN or IEP records – evidence of extra help or referrals for learning/behaviour.
• Early health or therapy records – speech and language therapy, occupational therapy, paediatrics.
• Work samples – early exercise books or test papers showing spelling/handwriting/organisation difficulties.
• Family recollections – written statements from parents/siblings about early patterns.
• Third-party observations – teacher, coach, or youth group leader notes.
• Behaviour/discipline records – detentions, exclusions, notes of impulsivity or inattention.

Adolescence (secondary school, college, university)

• Exam adjustments – evidence of extra time, readers, scribes, or quiet rooms.
• SEN/DSA records – Disabled Student Allowance, access arrangements, or support plans.
• Teacher/tutor reports – ongoing attention, learning, or social difficulties.
• Peer/social records – evidence of isolation, bullying, or social struggles.
• Health records – CAMHS, psychological or occupational therapy input during teenage years.

Adulthood (workplace, training, daily life)

• Workplace performance reviews – notes on organisation, deadlines, or written reports.
• Occupational health assessments – adjustment recommendations.
• Adjustment requests at job interviews or training courses.
• Professional/academic exams – adjustments granted and their effect.
• Manager/colleague feedback – reminders, forgetfulness, time management issues.
• Access to Work or disability benefits – official recognition of disability impact.
• Personal impact diaries – notes on strategies, breakdowns under stress, or masking.
• Daily living examples – missed bills, lost appointments, difficulty maintaining routines.

Key points

• Consistency across stages (childhood → adolescence → adulthood) strengthens both diagnostic and legal arguments.
• Evidence should show the condition is **long-term** and has a **substantial effect** (more than minor or trivial) on day-to-day life.

Masking, underreporting, and underdiagnosis

Concerns are sometimes raised about people exaggerating symptoms to obtain a diagnosis or adjustments. However, research and lived experience suggest that **underreporting and masking are at least as common, and often more likely** in neurodevelopmental conditions.

Many people with ADHD, autism, dyslexia, or auditory processing disorder (APD) minimise their symptoms, sometimes without realising it, for several reasons:

• **Masking and compensation** – neurodivergent individuals often learn from childhood to hide or manage behaviours (e.g. suppressing fidgeting, forcing eye contact, memorising text to hide reading difficulty, or avoiding noisy environments). Over time, these strategies become automatic, so they may understate their difficulties on self-assessment forms. Studies show masking can lead to exhaustion, misdiagnosis, or delayed diagnosis (Hull et al., 2022; Pearson et al., 2021).
• **Family normalisation** – heritability rates for ADHD and autism are around 70–80%. Many people grow up in families where neurodivergent traits are common, so they view their experiences as “normal” and underreport them. Similar effects are seen in dyslexia and APD, where children raised in families with learning or sensory differences may assume their struggles are typical.
• **Intelligence and coping strategies** – higher-ability individuals often develop workarounds (e.g. using rigid routines, over-reliance on reminders, or re-reading text repeatedly). When asked about difficulties, they compare themselves only to peers of similar ability, leading to minimisation of impairment.
• **Unawareness of observable behaviours** – people may not notice their own behaviours even when others do. For example, one individual reported “occasional” fidgeting on a self-report, while their spouse observed it five or more times every day. In dyslexia, a child may claim “I can read fine” while relying on memorisation strategies that mask decoding difficulties.

Evidence from research

• **ADHD underdiagnosis** – NHS England acknowledges that current ADHD prevalence data “significantly underrepresents” true need (NHS England, 2024).
• **Masking in autism** – qualitative studies show autistic adults frequently camouflage their traits, leading to delayed or missed diagnoses and increased stress (Hull et al., 2022; Pearson et al., 2021).
• **Gender differences in ADHD** – women and girls are systematically diagnosed later than men, in part due to masking and atypical presentation. One study found an average delay of almost four years (Hamed et al., 2023).
• **Dyslexia concealment** – research shows that students with dyslexia often hide or mask their difficulties in higher education to avoid stigma (West, 2023; Mortimore, 2022). Children may also use behaviours (e.g. acting out, clowning, or appearing disinterested) to disguise reading struggles (Child Mind Institute, 2019).
• **Auditory Processing Disorder (APD)** – reviews note that awareness of APD remains limited, diagnostic standards vary, and many cases likely go unrecognised (Wilson & Arnott, 2023; Musiek & Weihing, 2023).
• **Risks of undiagnosed conditions** – underdiagnosis of ADHD, autism, dyslexia, or APD is associated with poorer mental health, social exclusion, and academic underachievement (Shaw et al., 2023).

Implications for diagnosis and law

• Self-report is often an **underestimate**, not an overestimate, of symptoms.
• **Collateral evidence** (school reports, family accounts, teacher observations, third-party assessments) is essential to balance the picture.
• **Masking itself creates disadvantage**: even if outward difficulties are hidden, the cognitive load of sustaining compensation demonstrates substantial impact under the Equality Act.
• Late or missed diagnosis should not be taken as evidence that the condition is less real; it often reflects under-recognition and masking, not absence of impairment.

References

• NHS England. ADHD Programme Update (2024). NHS England
• Hull, L. et al. (2022). Experiences of Masking in Autistic and Nonautistic Adults. PMC8992921
• Pearson, A. et al. (2021). A Conceptual Analysis of Autistic Masking. PubMed 36601266
• Hamed, A. et al. (2023). Hidden in plain sight: delayed ADHD diagnosis among girls. Wiley Online Library
• West, S. (2023). Masking ADHD, Autism, and Dyslexia: Burnout in Neurodivergent Individuals. ResearchGate
• Mortimore, T. (2022). Dyslexia concealment in higher education: Exploring students’ lived experience. Wiley Online Library
• Child Mind Institute. (2019). When Problem Behavior Masks a Learning Disability. Child Mind
• Wilson, W.J., & Arnott, W. (2023). Understanding Auditory Processing Disorder: A Narrative Review. PMC10634468
• Musiek, F., & Weihing, J. (2023). Auditory Processing Disorder: Issues and Controversies. LWW Journal
• Shaw, P. et al. (2023). Risks Associated With Undiagnosed ADHD and/or Autism. SAGE Journals

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