When the Framework Fails: Diagnostic Blind Spots and the Urgency of Inclusion.

The New Normal By Dr Miriam

About This Series: The New Normal

This ongoing series—The New Normal—explores how neurodivergence is recognised, misrecognised, and framed within systems of power. Drawing on personal, clinical, and cultural insight, it interrogates who gets to be seen, who gets missed, and what happens when diagnostic and social frameworks fail to hold the full complexity of human experience.

Each entry follows a three-part structure: Reckoning. Disruption. Reframing. This arc is both conceptual and political—it invites readers to engage not just in critique, but in transformation.

Reckoning calls us to name historical and ongoing exclusions: the people left out, the assumptions left unchallenged.
Disruption challenges the systems—clinical, cultural, and internal—that reinforce narrow definitions of difference.
Reframing offers new ways to understand, relate to, and honour neurodivergence—on our terms, in our language, with our rhythm.

The series centres those who have been historically overlooked in both mental health discourse and diagnostic practice: Black, neurodivergent, gender-diverse, and working-class individuals whose experiences do not conform to dominant narratives or checklists.

Rather than asking for inclusion into flawed systems, The New Normal asks:

What if the diagnostic model was never built to see us?
What would it mean to rebuild it from the margins inward?
What becomes possible when we stop waiting to be validated and start trusting our own knowing?

This is not just about visibility. It is about justice.It is about re-authoring our stories—and reshaping the frameworks that were never made with us in mind.

Understanding the Structure: Why This Blog is Framed in Three Parts

Each piece in The New Normal series follows a three-part structure—Reckoning, Disruption, and Reframing. This arc is not just narrative—it reflects the deeper psychological and systemic processes required to meaningfully understand and reimagine neurodivergence.

Reckoning acknowledges and names systemic patterns of exclusion and misrecognition.
Disruption challenges accepted norms and diagnostic conventions that maintain those exclusions.
Reframing offers an alternative lens—one that centres context, complexity, and lived experience.

This structure helps to move us from critique to clarity, from problem-naming to possibility-building. It invites us to question how we know what we know, and what becomes possible when we widen the frame.

Introduction: From Narrative to Systemic Critique

In Part 1 of this series, we explored how dominant cultural narratives have shaped—and limited—the public understanding of neurodivergence. We looked at who gets to be recognised, who remains mislabelled or overlooked, and why certain forms of neurodivergence are seen as more legitimate than others.

In this second piece, we turn our focus to the diagnostic frameworks themselves. We explore how these systems—while often presented as objective—carry embedded biases that profoundly shape who is diagnosed, how they are interpreted, and what support they are offered.

This is not just about individual clinician decisions or isolated oversights. It is about the structural consequences of a framework built on narrow foundations—one that consistently misses, misreads, or mistrusts neurodivergence in people who do not fit its original design.

Part I: Reckoning with the Limits of the Diagnostic Gaze

Diagnostic tools such as the DSM and ICD are often perceived as neutral instruments—clinical, evidence-based, and reliable. But they are, in fact, deeply contextual. They were developed within a Western, often white, male-dominated paradigm, and the criteria reflect that lens.

This matters. Because what is recognised as a “symptom” or “clinical feature” is shaped by who was in the room when the framework was written—and who was not.

For many Black, Indigenous, and racialised people, especially women and gender-diverse individuals, the consequence has been consistent diagnostic misrecognition:

Black children are more likely to be labelled as oppositional or disruptive rather than autistic.
Black women are disproportionately diagnosed with personality disorders over complex trauma.
ADHD, particularly in high-achieving or emotionally contained individuals, is frequently missed or mistaken for anxiety.

These are not outliers. They are patterns. They reflect a diagnostic gaze that is more likely to recognise distress when it conforms to a familiar profile—and more likely to dismiss or pathologise it when it does not.

This is the reckoning: the system was not built to see everyone. And its so-called neutrality has created very real forms of exclusion.

Part II: Disruption—When Criteria Become a Cage

Diagnosis should be a gateway to understanding and support. Yet too often, it functions as a filter—rewarding certain kinds of distress with validation, and rejecting others as non-clinical, non-severe, or not credible. Many neurodivergent individuals, particularly those from racialised or marginalised backgrounds, report hearing variations of the following in clinical settings:

“You’re doing well academically, so I’m not sure this applies.”
“You seem very self-aware—people with [this condition] usually aren’t.”
“You’ve developed great coping skills; I don’t see significant impairment.”
“You express yourself clearly—most people with autism struggle with that.”
“You have a full-time job and a family, so it doesn’t quite fit the criteria.”
“That’s a trauma response, not neurodivergence.”
“You’re very composed—this doesn’t look like ADHD to me.”
“You’ve learned to manage. That’s not clinical.”
“You’re very articulate; it doesn’t quite fit.”
“You’re too empathetic; people with autism usually struggle with that OR lack empathy.”

These statements, while often well-intentioned, reveal a diagnostic lens constrained by stereotype. When clinicians are trained to expect neurodivergence in a particular form—often white, male, and overt—they are more likely to miss those who present differently.

They may fail to see the masking.They may misread culturally rooted communication styles.They may interpret adaptation as resilience, rather than as survival.

This is not clinical neutrality—it is cultural default. And when diagnostic tools don’t account for structural and social context, they stop serving the people who need them most.

This is the disruption: questioning not just who we diagnose, but how we’ve come to define what counts as “real” neurodivergence in the first place.

Part III: Reframing Diagnosis as an Ethical, Contextual Practice

To move forward, we need more than critique—we need new diagnostic imagination. This doesn’t mean abandoning structure, but deepening it. Making it more responsive to context, more curious about complexity, and more accountable to those historically excluded.

This reframing involves several shifts:

From deficit to context. Not every difference is a disorder, and not every adaptation is dysfunction. Understanding behaviour through a social, cultural, and trauma-informed lens helps us move beyond simplistic labels.
From checklists to curiosity. Diagnostic criteria are guides—not gospel. When they are used rigidly, they risk flattening nuance. A more relational and exploratory approach allows space for the client’s lived experience to shape the assessment.
From cultural add-on to cultural core. Cultural competency must be embedded into the diagnostic process, not tacked on as an afterthought. This includes understanding how race, class, gender, and trauma intersect with neurodivergent expression.

Reframing diagnosis in this way doesn’t dilute clinical standards. It strengthens them. It affirms that ethical practice involves seeing people in their full context—not just through the lens of pathology.

A Call to Clinicians: Reflection, Responsibility, and Possibility

Clinicians hold enormous power—not just to diagnose, but to define what is seen and what is missed. To recognise, or to reject. With that power comes responsibility. Not to be perfect, but to be reflective.

Whose distress do I instinctively validate?
Whose differences do I question?
What cultural assumptions inform my understanding of “normal,” “impaired,” or “functioning”?

It is not enough to be trauma-informed if we are not also power-informed. It is not enough to be diagnostic if we are not also culturally and historically literate.

This is not a call for guilt—it is a call for growth. To move from gatekeeping to witnessing. From narrow frameworks to expansive seeing.

Conclusion: The Framework Didn’t Fail Us Because We Were Too Complex. It Failed Because It Was Too Narrow.

The future of diagnosis must be more than inclusive—it must be accurate. That means recognising the structural biases baked into the systems we use, and committing to transforming them. The “new normal” is not a utopia. It is a reality already being lived by those who have always existed outside traditional diagnostic boundaries. It is neurodivergence expressed through the lens of culture, survival, and adaptation. It is messy, layered, and deeply human. Our work—whether as clinicians, advocates, or people with lived experience—is to ensure the framework evolves to meet that reality. Because we were never the problem. We were simply never the template. And now, we’re rewriting it.