Ageing Into Understanding

With thanks to our member, Evelyn Barron Millar, for this article.

In the same working week, I can find myself having two very different conversations about neurodivergence.

One might be with a young adult who already has an extensive vocabulary for their experience. They know about masking, sensory overload and executive functioning. They have spent time in neurodivergent spaces online, read other people's accounts and may have arrived at counselling with a clearer understanding of their neurotype than many professionals would have had a generation ago.

Another might be with somebody in their fifties or sixties who has only recently begun to wonder whether autism or ADHD could explain parts of their life that have never quite made sense. Perhaps it began with their child's assessment. Perhaps menopause, burnout, retirement or another major life transition made strategies that had worked for decades suddenly less effective. Suddenly, they are looking back at things that happened 20, 30 or 40 years ago and wondering whether they understood them correctly at the time.

The presenting difficulties can overlap. Exhaustion, anxiety, relationships, work, identity. Yet the meaning attached to them can be completely different.

The more I work with neurodivergent adults of different ages, the more I think we need to pay attention not only to whether somebody is neurodivergent, but to when in their life they came to understand themselves that way.

Two fields that have not always spoken to each other

My interest in this partly comes from an unusual overlap in my own professional life. My academic background is in healthy ageing, while my clinical work now brings me into contact with neurodivergent adults at very different stages of life. Working across both areas has made me notice some of the assumptions we make about ageing and neurodivergence.

Traditional models of “successful ageing” have tended to emphasise avoiding disease and disability, maintaining high levels of physical and cognitive functioning, and remaining socially and productively engaged. Rowe and Kahn's influential model is perhaps the best-known example.

These ideas have contributed a great deal to our understanding of later life, but they also raise an obvious question: who defines success?

If somebody has spent decades using enormous amounts of energy to stay employed, maintain relationships and look as though they are coping, asking them to keep doing exactly that for as long as possible seems an odd definition of ageing well.

At the same time, much of our thinking about neurodivergence has historically concentrated on children and young people. We have become more familiar with conversations about diagnosis in school, educational adjustments and supporting neurodivergent children into adulthood. Far less attention has been paid to what happens when those children become 50, 60 or 70, or to adults who reach those ages without ever having been identified at all.

That is beginning to change. Recent research with middle-aged and older autistic adults has found that understanding and accepting their autism, adapting to age-related changes, maintaining supportive relationships and having access to autism-informed services can all shape how positively ageing is experienced.

For counsellors, this creates a useful challenge. We need an age-aware understanding of neurodivergence, but also a neurodivergence-aware understanding of ageing.

Growing up with the language

Many younger neurodivergent clients arrive in counselling already knowing this language. That isn't true of everyone. Access to diagnosis, information and supportive communities remains very uneven. But terms such as stimming, masking, sensory seeking and executive dysfunction are far more available than they were to previous generations.

Sometimes clients have a formal diagnosis. Sometimes they are waiting for assessment. Sometimes they are exploring whether a neurodivergent framework fits their experience.

Either way, I am often struck by how readily younger clients can say things that an older client might take months to formulate.

“I can't cope with that environment because it is too overstimulating.”

“I think I am masking when I do that.”

“I need more processing time.”

There is something genuinely valuable in this. Previous generations were often given much harsher descriptions for the same experiences: lazy, oversensitive, difficult, rude, scatty, dramatic, antisocial.

Having a less moralising vocabulary can remove an enormous amount of shame.

It changes the therapeutic work too. With a neurodivergence-literate younger client, my role is rarely to explain what autism or ADHD is. The work is more often about making sure neurodivergence doesn't have to explain absolutely everything.

A 20-year-old may know an enormous amount about ADHD and still be 20.

They are negotiating intimacy, separation from family, education, work, money, sexuality, friendship and questions about who they want to become. Those are developmental questions as well as neurodivergent ones.

There can be another tension too. Some younger people worry that they aren't “neurodivergent enough” to ask for adjustments, while simultaneously worrying that acknowledging how much they struggle will make other people lower their expectations of them.

Having the language helps. But therapy still has to get beyond knowing the right terminology and into the messier question of what any of it actually means for this particular person.

When the language arrives decades later

The conversation often feels very different when somebody begins exploring neurodivergence in midlife or later.

Here, new language does not simply describe the present. It can rewrite the past.

A late diagnosis, or even the growing suspicion of one, can send somebody mentally back through decades of memories.

School reports. Friendship difficulties. The job they could do brilliantly until they suddenly couldn't. The relationship in which they were repeatedly told they were too sensitive, too distant or too much. The years spent being treated for anxiety or depression without ever quite understanding why ordinary life seemed to require so much effort.

Research into late diagnosis of autism and ADHD reflects this complexity. Adults describe diagnosis as providing an explanation and an opportunity to understand themselves differently, but also the potential burden of a new label and the importance of being psychologically ready for what that reinterpretation can bring.

Counsellors need to allow room for both.

There can be tremendous relief in finally having an explanation.

But relief does not cancel grief.

Sometimes understanding why something happened makes the loss attached to it more visible.

What would school have been like if somebody had noticed? Would I have chosen the same career? Would my marriage have been different? Why did nobody help me?

There isn't always a neat answer to those questions, and I don't think therapy should hurry people towards one. We can be so keen for neurodivergent-affirming practice to feel positive that we forget how destabilising this process can be.

If somebody has spent 40 or 50 years building a life that works, even imperfectly, discovering that much of it involved masking does not automatically make “unmasking” feel liberating.

The strategies we describe as masking may also have helped that person survive school, sustain employment, build relationships and negotiate environments that offered very little accommodation. Some strategies may now be exhausting or unnecessary. Others may remain useful.

The client gets to decide which is which.

The wider system around them has not changed simply because their understanding has. A person can recognise that a busy workplace overwhelms them and still need the job. They can recognise a need for more solitude while having family responsibilities. They can begin communicating more directly while their partner is still adjusting to a relationship that suddenly seems to have acquired a new vocabulary.

Self-understanding can change faster than a life can.

When ageing changes the equation

Midlife introduces another complication: the strategies that have made life manageable do not always remain equally available.

Energy changes. Caring responsibilities change. Parents age. Children leave home. Workplaces restructure. Retirement removes routines that may have quietly organised someone's life for decades.

For some autistic people, menopause can be particularly significant. A small qualitative study by Moseley and colleagues found participants describing increased sensory, emotional, social and executive difficulties during the menopausal transition, including a reduced ability to maintain previous masking strategies.

The evidence base remains limited, so we should be wary of presenting this as a universal experience, but it is a useful reminder that neurodivergence does not exist separately from the ageing body.

This is probably where my ageing-research background shows up most clearly in my clinical work. It is easy to see somebody struggling with something they previously managed and assume that the goal should be to restore their previous level of functioning.

That may be exactly what they want. But I have become more interested in another question: do they actually want to go back to functioning in the way they did before?

If the previous version involved enormous effort, constant self-monitoring and recovery periods nobody else saw, perhaps the breakdown of that strategy is not simply a failure to be repaired.

It may also be information.

A second adolescence?

I keep coming back to the idea of a second adolescence.

I don't mean a return to teenage turmoil or rebellion. I mean finding yourself asking surprisingly adolescent questions again.

Who am I? How much of the person I have presented to other people is actually me? Which expectations do I still want to meet? What do I need? What happens to my relationships if I change?

Younger clients may be asking these questions at roughly the point in life when we expect identity formation to occur.

Late-identified adults can find themselves asking them while simultaneously managing mortgages, careers, ageing parents, long-term relationships and children of their own. It is identity development, but with considerably more at stake.

The irony is that conventional accounts of midlife and ageing often assume increasing consolidation of identity. By this point, the person is supposed to know themselves.

For some neurodivergent adults, the opposite is happening. They are discovering that one of the most fundamental organising explanations of their life has been missing.

Far from ageing out of identity development, they may be ageing into it.

What this changes in the counselling room

Age does not divide neurodivergent clients into two tidy groups. There is enormous variation within generations, and a diagnosis tells us surprisingly little about how somebody actually understands themselves. But when and how that understanding developed can tell us a great deal.

With younger clients, I find it helpful to respect the expertise they may already have in neurodivergent language while remaining curious about the person underneath it. We do not need to spend therapy proving their neurodivergence back to them.

With adults coming to this understanding later, the pace may need to be different. There can be decades of experience to revisit. Anger, relief and grief can sit alongside one another. Long-established coping strategies deserve curiosity before we categorise them as unhealthy.

One question I hear in various forms is: “But isn't this just who I've always been?”

Often, yes. That is rather the point.

A diagnosis does not manufacture a new person. Ideally, it offers another way of understanding the person who was already there.

Neurodivergence matters enormously, but it should not eclipse the rest of the client's life. The 19-year-old autistic client is not simply an autistic person learning to manage autism. They are also becoming an adult.

The 58-year-old newly identified client is not simply processing a diagnosis. They may be renegotiating decades of identity, relationships and expectations while simultaneously moving into another stage of life.

Good therapeutic work has to hold both.

Rethinking what it means to age well

My understanding of “successful ageing” has changed considerably since I first encountered the concept academically.

I am less convinced now that we can define it primarily through what a person continues to do.

For a neurodivergent person, ageing well might occasionally involve doing less.

Fewer relationships, but safer ones. Less masking. A smaller working life that is actually sustainable. Greater awareness of sensory needs. Permission to stop forcing themselves through environments they have tolerated for years.

It may involve finally understanding why apparently ordinary things have never felt ordinary.

This is also where I think neurodivergent people's experiences have something important to say to the wider conversation about ageing. They challenge the idea that ageing well means continuing to approximate an ideal version of “normal” functioning for as long as possible.

Recent research with older autistic adults points in a similar direction. Participants' accounts of ageing well included acceptance, adaptation, meaningful relationships and access to support that understood autism rather than asking people to fit themselves into services designed around different assumptions.

That feels much closer to the version of healthy ageing I now find useful.

It is less about maintaining the same performance indefinitely and more about knowing yourself well enough to recognise what helps, being able to change what you can, and having enough connection that you do not have to work everything out alone.

For some people that understanding begins in childhood. For others it arrives at 25, 45 or 65.

Counsellors are going to meet more adults discovering their neurodivergence later in life. We need to be prepared not simply to recognise autism and ADHD in adults, but to understand what it means to discover a new explanation for yourself after decades spent living without one.

There is no age by which somebody should have finished becoming themselves.

Key points for practitioners

• Avoid assuming that clients of different generations will understand or relate to neurodivergence in the same way.
• With younger neurodivergent clients, look beyond diagnostic language to the ordinary developmental tasks taking place underneath it.
• With late-identified adults, make room for grief, anger and reinterpretation of the past as well as the relief that diagnosis can bring.
• Treat established coping strategies with curiosity. What looks like masking from the outside may have served important purposes, and it is for the client to decide what they want to change.
• Ask what “functioning well” actually means to the individual rather than automatically treating a return to previous levels of productivity or social engagement as the goal.