Dr. Suzanne Simpson:

If your child is struggling and you’re trying to figure out whether it is ADHD, autism, anxiety, or trauma, this video is for you. Your child’s behaviour is not a moral verdict. It is information. Understanding what that behaviour is actually communicating starts with getting the right diagnosis. I am walking you through three realities about how the mental health assessment process actually works, and two questions every parent needs to ask in the room before a diagnosis is made.

Stay until the end, because those two questions could change what door gets opened for your child. Almost no parent knows to ask them.

I’m Dr. Suzanne Simpson. I’m an educator. I am not a psychologist, I’m not a psychiatrist, and I am not the one making these diagnoses, but I’ve spent five and a half years working on a psychiatric unit. Today I work alongside public mental health agencies advocating for families.

Here’s what I have seen over and over. I’ve had so many students who showed no signs of ADHD as young children, no indicators of autism, and no signs in those early years that anything was significantly different. Then something might have happened: a serious trauma, substance use that started in adolescence, or a brain injury. Suddenly a practitioner is seeing this young person right now, and making a diagnosis based entirely on what is in the room in front of them.

If your teenager is struggling and someone’s telling you maybe it’s ADHD or autism, stop and listen to this. ADHD doesn’t suddenly appear at 15 years old. The signs are generally present much earlier, even if they weren’t recognized at the time. And autism doesn’t suddenly emerge in grade 10. The underlying traits were there earlier, even if they were missed or misunderstood. When the early years are not part of the picture, we have a problem. So let me walk you through why.

Here’s reality number one. This is something we don’t talk about enough, and it matters enormously for your family. ADHD, autism, anxiety, and trauma can look almost identical on the surface. There’s silence, withdrawal, inattention, difficulty connecting with other people. A child who has been through significant trauma can check nearly every box on a screening tool for ADHD or maybe autism. A child with severe anxiety can look like they have attention issues. A child who has experienced a brain injury, or who has started using substances, can present in ways that look entirely neurodevelopmental when they are not.

Inattention is one of the primary markers of ADHD, but it’s also a core symptom of anxiety, depression, and trauma. A teenager who cannot concentrate may be doing so because they have ADHD, or because they are carrying something so heavy that their nervous system simply cannot settle. From the outside, those two kids can look identical. The difference is in the history, and in whether anyone took the time to ask.

Here is where the process gets complicated. The DSM-5, the diagnostic and statistical manual, does not require a practitioner to formally rule out other conditions before landing on one. The language is “not better explained by another disorder.” That is a judgment call for that practitioner, the psychiatrist or psychologist, and not a required step by step process. In a system under enormous pressure, that judgment call can happen in a fifty minute window. So that is reality: the symptoms overlap, and the process does not automatically protect against that.

Here’s reality number two. This one tends to catch people off guard, because it is simply not something that comes up in the conversation around diagnosis. If your child breaks an arm, an X-ray confirms it. If your child has diabetes, a blood test confirms it. But unlike a broken bone or diabetes, there is currently no blood test or brain scan that we use in public care that can independently confirm ADHD, autism, anxiety, or a trauma related disorder. These are diagnosed entirely through behavioural observation: what a clinician sees in the time that they have, based on the information in front of them. The diagnosis is only as good as the information the clinician has access to. That’s reality number two. No scan, no test. It’s behavioural observation only.

Here’s reality number three, and this is the one I see playing out most often in my work, because it lives inside a system that was never designed to be transparent about its own limitations. Our public mental health system is under enormous strain. A 2024 report confirmed backlogs, staffing shortages, and uneven funding. Nearly one in five young people who need mental health support face unmet needs, and families are waiting months, sometimes well over a year, even two. When that appointment finally arrives, there is not always time to do this thoroughly. This is not the clinician’s fault. This is a system problem. But the consequence lands on your child.

If your child is being assessed for autism, there’s one piece of evidence that is almost never requested that could change everything. The diagnostic criteria require that symptoms were present in early childhood, which means if no one is looking at those early years, a critical part of the assessment is simply missing. Early school records, kindergarten teacher observations, grade one and grade two report card comments: this is some of the most reliable evidence of who your child was before these symptoms appeared. A teacher who had your child in kindergarten saw them every day for a year. Their observations are documented evidence, and in my experience, those records are rarely requested.

Your child’s behaviour right now is communicating something, but understanding what it is communicating depends entirely on knowing who your child was before. The early years are not background noise. They are evidence.

Before your child’s assessment, here’s what I want you to do. First, ask the school. Pull early school records: report cards from kindergarten through grade three, and grade four through seven as well, into high school. Second, write down the timeline. When did you first notice your child was struggling? Was there a transition, a loss, a trauma, a change in the family? Third, document who your child was before. If the current symptoms are relatively recent, if this is not the child you knew at seven or eight, write that down and bring all of it with you.

The clinician is doing their best in a system that does not give them enough time. A diagnosis can be incredibly helpful when it accurately explains what is happening and opens the door to the right support. So the goal is not to avoid a diagnosis. The goal is to make sure it reflects the whole story. You’re not challenging the clinician. You are being the parent your child needs you to be.

Question number one, and I told you to stay to the end for this: how are you ruling out the other possibilities? Ask that to the clinician. If your child is being assessed for autism, how is the practitioner differentiating that from ADHD, anxiety, trauma, anything else going on? What is the process for making sure this diagnosis fits, and not just the symptoms?

Here’s question number two. How are you investigating the early years? What records are you requesting? These are the most important questions you can bring into that room. They ensure your child’s full story, not just today’s story, is part of the picture. Because you cannot understand what a child’s behaviour is communicating today if you don’t know who that child was before. The early years are the evidence, and your child deserves a process that includes them.

If this was helpful, grab my free guide, “8 Ways to Get on Your Kids’ Turf,” at drsuzannesimpson.com, and follow me here for more tools to help you get on your kids’ turf and show up as the parent your teenager needs right now. I’ll see you next time.