There is a generation of people living in care homes today who spent their entire lives being told, in one way or another, that they were difficult. Too sensitive. Too rigid. Too much. Not enough.

They were the children who couldn't bear the school hall at lunchtime. The adults who needed routines so fixed that any deviation caused visible distress. The people who seemed rude because they didn't make eye contact, or who were labelled anxious because they couldn't tolerate the texture of certain foods.

Many of them are now in their seventies, eighties, and nineties. And many of them are living with dementia.

A Generation Without a Framework

The diagnostic frameworks for autism, ADHD, and related neurodivergent profiles are relatively recent. The DSM-III, published in 1980, was the first to include autism as a distinct category. ADHD in adults wasn't widely recognised until the 1990s. Sensory processing disorder remains contested as a standalone diagnosis today.

This means that an enormous cohort of people (those born before the 1960s, roughly) grew up without access to these frameworks. They were not diagnosed. They were not accommodated. They learned, often at great personal cost, to mask their differences and conform to neurotypical expectations.

"Masking is exhausting. It is a performance that never ends. For many neurodivergent people, it is so habitual that they are barely aware they are doing it, until something takes away their ability to perform."

Dementia takes away that ability.

When the Mask Slips

As dementia progresses, the cognitive resources required to maintain masking (remembering the social rules, suppressing the sensory responses, performing neurotypicality) begin to diminish. What emerges is not a "new" person, but the person who was always there beneath the performance.

Care staff who have not been trained to recognise this may interpret what they see as deterioration, as challenging behaviour, as a symptom of the dementia itself. The person who suddenly cannot tolerate the dining room noise. The person who becomes distressed when their routine is changed. The person who refuses to participate in group activities.

These are not mysteries. They are neurodivergent people whose lifelong coping strategies have been stripped away, living in an environment that was never designed for them.

The Research Gap

There is very little published research specifically on late-identified neurodivergence in older adults with dementia. What exists tends to be case studies, clinical observations, or extrapolations from the broader neurodivergent literature. This is one of the most significant gaps my dissertation is attempting to map.

What we do know is that the number of people in this situation is not small. If we accept conservative estimates that around 1-2% of the population is autistic, and that ADHD affects 3-5% of adults, then in any care home of 50 residents, there are likely several people whose neurodivergent needs have never been formally identified or addressed.

That is not a niche problem. That is a systemic one.

In future posts, I'll be exploring what assessment tools might be adapted for this population, and what the care sector needs to do to begin addressing this gap.