Becca

Methods and limits

How Becca scores

This protocol is original. It does not reproduce copyrighted questionnaires. Items are written in adult, thirty-and-over language and scored against the structure of DSM-5-TR and ICD-11, with adjustments that those manuals themselves now recognise: camouflaging, later manifestation when demands exceed capacity, and the legality of dual autism–ADHD diagnosis since DSM-5.

What this instrument is not

This item bank has no published sensitivity, specificity, or concordance against DIVA-5, ADOS-2, MIGDAS-2, or clinician consensus. Subdomain “met” at mean ≥ 2.5 / 4 is a designer cut-off, not a ROC analysis. Papers cited below describe adjacent constructs (camouflaging, adult overlap). They do not validate Becca’s 63 items. Use the report as a structured notebook before a qualified assessment.

The sample report is a composite late-identified profile, not proof that the masked-presentation flag is calibrated. That flag is clinically motivated, not ROC-tested.

Why thirty and over

Childhood instruments over-weight motor hyperactivity and under-weight inner restlessness, time blindness, and workplace camouflage. By the thirties, many people have a career, a partnership, or children; the scaffolding of school is gone. Compensation collapse, a child’s diagnosis, and — for people assigned female at birth — perimenopause are well-documented routes into late identification (Young et al., 2020; Lai & Baron-Cohen, 2015). After 65, cognitive, sleep, and medication differentials must be ruled out; Becca flags that explicitly.

Autism (DSM-5-TR)

Criterion A requires persistent differences in all three social-communication subdomains: reciprocity, nonverbal communication, and relationships. Criterion B requires at least two of four: stereotyped or repetitive behaviour, insistence on sameness, restricted interests, sensory hyper- or hyporeactivity. Symptoms must have been present in the early developmental period but “may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life.” That sentence is why a thirty-plus screen without camouflaging is incomplete. It is not permission to skip Criterion A: all three social-communication subdomains still have to be met. High camouflage is not autism.

Becca treats a subdomain as met when the mean is at least 2.5 of 4 or enough items are endorsed at Often / Very often. “Screening indicated” additionally requires childhood evidence and multi-domain impairment. High camouflaging with restricted/sensory signs can raise a masked-presentation flag when social self-ratings look quieter than the rest of the profile (Hull et al., 2019; Lai et al., 2017).

ADHD (DSM-5-TR adult)

Nine inattention features and nine hyperactivity-impulsivity features. For ages 17 and over the threshold is five of nine in either list (not six). Several symptoms must have been present before age 12, occur in more than one setting, and interfere with functioning. Adult hyperactivity is scored as an inner motor, not as climbing on furniture. Without usable childhood recall, Becca will not issue an “indicated” ADHD band — it will say elevated and ask for informant history. That is conservative on purpose.

De novo adult-onset inattention does not meet DSM-5-TR ADHD. Late identification of childhood symptoms still can. Apparent adult-onset cases in research are mostly missed childhood ADHD or mimics (sleep, mood, anxiety, substances, TBI, thyroid). After 65, new inattention or rigidity is medical until proven otherwise. If you cannot remember childhood, use Cannot recall. Guessing those items manufactures onset.

The WHO ASRS-5 (Ustun et al., 2017) is a six-item screener; a construct-validity study in 2025 supported a cutoff of 14 on unweighted 0–24 scoring (Christensen et al., 2025; Kessler 2023 note on overestimation from weighted DSM-5 scoring). Becca is not the ASRS-5. A clinician may still administer it.

AuDHD

DSM-5 removed the prohibition on diagnosing both in 2013. AuDHD is co-occurrence, not a third disease. Pooled estimates of current ADHD in autistic samples sit around 38–40% (Rong et al., 2021); community figures of 50–70% are often quoted and likely mix traits with diagnoses. In adult ADHD clinics, autistic traits are common (Adamis et al., 2025). Shared polygenic risk and overlapping frontostriatal and default-mode findings do not imply a single condition. Waldren et al. (2024) show the adult overlap is multi-method and not reducible to one factor. Becca therefore scores an interaction block: sameness versus novelty, hyperfocus versus switching, social exhaustion versus impulse.

Neuroscience in one page

ADHD is most consistently linked to catecholamine signalling in fronto-striatal loops that support inhibitory control, working memory, and the valuation of delayed reward. Autism is more distributed: differences in predictive processing, sensory gain, social-cognitive networks, and restricted-interest circuitry. The overlap is genetic and network-level, not a third disease entity. Camouflaging is effortful social prediction — it loads executive systems already taxed in ADHD, which is one reason AuDHD burnout is not “just anxiety.”

What NICE names

NICE CG142 (adult autism) and NG87 (ADHD) were last reviewed 23 July 2026. AQ-10 is a referral aid (cutoff ≥6, or clinical judgement plus informant history), then a comprehensive assessment with early history where possible and direct observation. NICE names AQ-10, ADOS/ADI-R, RAADS-R, and AAA. Not Becca. Not MIGDAS-2.

Allison’s AQ-10 development sample looked strong. In clinic-referred adults, specificity collapses (Ashwood et al., 2016, specificity ~0.29). NICE still uses it as a gate to assessment, not a test of truth. Becca is not trying to match AQ-10. MIGDAS-2 is a real sensory-based clinic interview for fluent adults; CG142 does not list it. DIVA-5 is the correct name for a structured adult ADHD interview (childhood, adulthood, informant). NG87 does not make it mandatory.

What a high score cannot do

  • It cannot observe you. ADOS-2 Module 4 is for verbally fluent older adolescents and adults. It is weaker when masking is high. Observation is still required.
  • MIGDAS-2 is a sensory-based qualitative interview used with fluent adults. It is a real clinic tool. It is not in CG142.
  • It cannot interview your parent. DIVA-5 and school records still matter. No self-report can invent informant childhood history or multi-setting impairment.
  • It cannot rule out OCD, trauma, personality disorder, sleep apnoea, thyroid disease, grief, substance use, or a current mood episode.
  • It cannot measure intellect or language. Those are specifiers, not the screen.
  • Online self-selection inflates prevalence. Treat bands as hypotheses.

How to use this screen

Take it once. Use Cannot recall when memory is gone. Download the file. Take it to a clinician with informant history. Read the confounder notes (sleep, mood, substances, TBI, age 65+).

Do not treat Indicated as a diagnosis. Do not send the PDF to an employer, insurer, school, or court. Do not retake it daily. That is the use the manuals, NICE, and this page all allow.

Selected sources

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision. 2022.
  2. World Health Organization. ICD-11.
  3. NICE. CG142 Autism spectrum disorder in adults: diagnosis and management. Last reviewed 23 July 2026.
  4. NICE. NG87 Attention deficit hyperactivity disorder: diagnosis and management. Last reviewed 23 July 2026.
  5. Ustun B, et al. The World Health Organization Adult ADHD Self-Report Screening Scale for DSM-5. JAMA Psychiatry. 2017.
  6. Christensen KS, et al. Construct validity of the Adult ADHD Self-Report Scale for DSM-5. J Atten Disord. 2025.
  7. Hull L, et al. Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). J Autism Dev Disord. 2019.
  8. Lai M-C, et al. Quantifying and exploring camouflaging in men and women with autism. Autism. 2017.
  9. Rong Y, et al. Prevalence of ADHD in autism: a meta-analysis. Research in Autism Spectrum Disorders. 2021.
  10. Waldren LH, et al. Unpacking the overlap between autism and ADHD in adults. Cortex. 2024.
  11. Adamis D, et al. Coexistence of ASD traits in adults diagnosed with ADHD. Irish Journal of Psychological Medicine. 2025.
  12. Young S, et al. Females with ADHD: consensus statement. BMC Psychiatry. 2020.
  13. Raymaker DM, et al. “Having all of your internal resources exhausted”: autistic burnout. Autism in Adulthood. 2020.
  14. Ashwood KL, et al. Predicting the diagnosis of autism in adults using the Autism-Spectrum Quotient (AQ) questionnaire. Psychol Med. 2016.

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