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Starting point ADHD or autism

Have you started wondering whether you might have ADHD and/or autism? This is your starting point. Let's walk through the important questions and check-ins that come with that, together.

Note: this page describes the Belgian (Flemish) healthcare, education and support system specifically. Diagnosis costs, funding routes and referral options will look different elsewhere.

We start with three questions:

  • Is it really ADHD or autism?
  • Is a diagnosis worth it?
  • I have a diagnosis. Now what?

STEP 01

Is it really ADHD or autism?

It's important to know that a neurodivergent presentation can, after diagnostic clarification, turn out to be explained by a different diagnosis instead, or be complicated by another diagnosis being present at the same time.

ADHD and autism presentations can sometimes be better explained by:

  • Deep emotion-regulation patterns and coping/defenses for dealing with stress and triggers. For instance, a cPTSD presentation can look like both ADHD and/or autism.
  • Giftedness can closely resemble an autism or ADHD presentation.
  • A low socio-emotional age can mimic nearly all autism traits. This is most relevant in young adults and clients with severe chronic trauma.
  • Anxiety, OCD and depression need to be ruled out as a differential diagnosis or comorbidity.
  • Dependency on certain substances can also mimic a neurodivergent presentation.

This list is a non-exhaustive example of why thorough diagnostics matter. Because of this complexity, an immediate conclusion that someone has ADHD or autism isn't possible.

STEP 02

Is a diagnosis worth it?

Advantages

  • Access to care: a diagnosis is necessary for requesting certain (specialized) forms of care.
  • Clarity: gives deep insight into where the difficulties come from.
  • Clarifying the picture: helps determine whether the difficulties might be better explained by a different diagnosis.
  • Therapeutic impact: can positively contribute to self-image and helps make better sense of the past.
  • Certification: provides an official statement within one's own context (and specific settings) to communicate needs and limits.

Disadvantages

  • Cost: diagnostics can be expensive; prices sometimes run above €1000.
  • Unnuanced diagnostics: the assessment isn't always fully accurate or specific enough to the unique individual.
  • Follow-up care: once the diagnosis is made, the actual care and treatment structure still needs to be built up from scratch.
  • Risks in specific contexts: sharing the diagnosis isn't always advisable (for example in certain work settings), where a label like ADHD or autism can, in some cases, work against the client.

If the advantages weigh more heavily, a referral to a diagnostic center is the next step: The Landscape (Dutch) shows where that's possible.

The Landscape (NL)transfer · diagnostics & clarification

STEP 03

Fine-tuning care and treatment

Building up care involves a lot. Everything needs to be tailored to the individual. The domains below show what's possible; it's up to the patient, their context and the practitioner to judge what adds value.

Essential for everyone with ADHD and/or autism

  • Attention to explaining things to the client and their system (psycho-education).
  • Parenting support (where applicable).
  • Investing in self-care: good sleep, food, movement, daily structure, pacing and rest.
  • Explicit attention to energy sources and enough time to decompress.
  • Learning to gauge, recognize and communicate one's own limits and needs.

Sometimes indicated: medication

  • Always in close consultation with a doctor or psychiatrist to weigh up pros and cons.
  • Treating comorbid psychiatric symptoms (such as internalizing complaints).
Specific to autism

There's no medication for autism itself, only supportive treatment of certain symptoms or of comorbidity.

Specific to ADHD

ADHD does have medication, with a strong treatment effect. I consider it a medical error if I don't offer it myself to my patient, though conversely there's of course no obligation for the client to use it. Treatment can also be very effective when entirely non-pharmacological.

Daily activity & participation

  • Starting a GTB (employment support) track, or targeted consultation with the employer, to jointly work out what's workable within the job.
  • Volunteer work as a low-threshold, meaningful daily activity and stepping stone to more.
  • Accommodations for students in their studies (via student support services / facilities / a VLOR-form request, among others).
  • Hobbies and leisure activities (e.g. (w)onderweg, a Belgian activity network).
  • The Recovery Academy ("Herstelacademie"): low-threshold courses on recovery and resilience, no referral needed, open to everyone.
  • Psychosocial rehabilitation centers focused on (re)integration into work and society, such as De Keerkring in the Antwerp region.
  • Generally accessible outpatient/mobile support: CAW (outpatient or mobile guidance), and the social work service at the OCMW also offers mobile support at home.
  • Transport support (Minder Mobielen Centrale, disability parking card).
Specific to autism
  • BUSO type 9 (special-needs secondary education, available up to age 21).
  • Day centers (e.g. the guidance center for people with autism in Mechelen).
  • Autism-specific outpatient/mobile support via RTH (Directly Accessible Support) or non-RTH (paid via PVB or PAB), e.g. Katrinahof, Mobilant and Oikonde offer both forms.
Find daily activities & social contact on The Landscape (NL) →transfer · daily activitiesschool & work (NL) →transfer · school & work

Financial support

Worth considering for both ADHD and autism:

  • Application to the Federal Public Service for Social Security: IVT (Income Replacement Allowance) and IT (Integration Allowance), based on the impact on functioning.
  • Increased Growth Package ("Groeipakket") child benefit (for parents of a child with a support need).
  • Reimbursements and allowances via the health insurance fund (mutualiteit).
Mainly for autism (and other recognized conditions)
  • Recognition as a person with a disability by the VAPH (Flemish Agency for Persons with Disabilities), and from there a Person-Following Budget (PVB) or Personal Assistance Budget (PAB) and the Care Budget for people with a disability.
  • Note: a PVB relies on recognition as a person with a disability, and a condition from a limited list. Autism (ASD) is generally included; ADHD as a standalone psychiatric condition typically does not, on its own, grant entitlement to a PVB. Where there's comorbidity, each condition is assessed separately.