Accessing ADHD medication isn’t just about filling a prescription—it’s a constant battle. Unlike many other mental health challenges where medications are more readily available, ADHD medication is burdened with extra hoops to jump through. These barriers disproportionately affect those who rely on stimulant medications, leaving many without the treatment they need to function.
The process is exhausting: prior authorizations, frequent refill requirements, and the stigma surrounding stimulant medications all contribute to the problem. Add to that the ongoing stimulant shortage, and what should be a simple, routine healthcare matter becomes a frustrating and even disabling ordeal.
ADHD Medication Shortages: A Crisis with No End in Sight
For several years now, the U.S. has been experiencing a shortage of medication like Adderall and Ritalin. The reasons are complex, involving manufacturing limits, increased demand, and regulatory constraints. But the outcome is simple: ADHDers are left scrambling to find their prescribed medication, often having to switch to alternatives that may not work as well or even going without entirely.
Imagine needing medication daily to function, only to be told month after month that your pharmacy is out. For many, this can lead to worsened executive dysfunction and a severe drop in quality of life.
Insurance and Prescription Barriers
Even when ADHD medication is available, insurance restrictions can create additional roadblocks. Many ADHDers must navigate:
Prior authorizations, where doctors have to prove the necessity of ADHD medication before insurance covers it.
Quantity limits, requiring multiple pharmacy visits for a single prescription.
Frequent reassessments, even for adults who have had a stable diagnosis for years.
These barriers assume that ADHD medication is inherently more dangerous or prone to abuse than other mental health treatments, reinforcing stigma and making care unnecessarily difficult.
The Call for ADHD Medication Parity
Other mental health conditions do not face these same restrictions. If someone with anxiety, depression, or bipolar disorder can access their medication without excessive red tape, why should ADHDers be treated differently?
Parity means equal treatment. It means that ADHD medication should be covered and dispensed as easily as any other psychiatric medication. It means that stimulant shortages should be taken seriously as a public health issue, not dismissed as a minor inconvenience.
What Can We Do?
The fight for ADHD medication parity starts with awareness and advocacy. Here’s how we can push for change:
Call on policymakers to enforce parity laws and remove unnecessary restrictions on ADHD medication.
Raise awareness about the impact of ADHD medication shortages and advocate for improved pharmaceutical regulations.
If you’ve struggled to access ADHD medication, you’re not alone. It’s time for healthcare systems to recognize ADHD as a legitimate medical challenge deserving of equal treatment. Let’s demand ADHD medication parity—because no one should have to fight this hard for basic care.
Essy Knopf is a therapist who likes to explore what it means to be neurodivergent and queer. Subscribe to get all new posts sent directly to your inbox.
What if survival meant becoming someone else—every thought filtered, every gesture rehearsed, every word chosen to match what others expect of you?
That’s the world Shayan lives in. He’s the protagonist of Nepo, my new YA sci-fi novel. But for many of us—especially those of us who are autistic or ADHD—it’s not fiction. It’s our lived experience.
Nepo is the book I needed as a teen. It’s also the book I needed as an undiagnosed neurodivergent (ND) adult—someone trying desperately to understand why the world felt like it wasn’t made for me.
The Mask We Wear to Survive
Like many NDs, I learned early that being “different” meant being misunderstood. I walked funny. I spoke differently. I was obsessed with bugs, then words, then fiction. Social cues felt like an invisible game with constantly changing rules—and I was always one move behind.
I learned to mask. Masking meant smiling when I was in sensory overload. It meant pretending not to care when I was excluded. It meant hiding the parts of me that didn’t “fit.”
So when I sat down to write Nepo, I wasn’t just creating a sci-fi story—I was creating a mirror. One where a character like Shayan, forced to perform for his survival, could give voice to something deeply personal: the unbearable weight of never being allowed to just be.
From Hollywood Glamor to Dystopian Control
I spent seven years in Los Angeles, working in film and media. I saw the curated personas, the constant pressure to stay “on brand.” Celebrities weren’t just people—they were products.
That’s what inspired Nepo‘s world. Shayan isn’t just any clone—he’s bred to replicate a long-dead Hollywood icon. His every move is scripted. One misstep, and he’s discarded.
Fame in Nepo is a cage. And for NDs, the pressure to perform—to meet neurotypical (NT) standards—is often a cage, too. One lined not with gold, but with shame, anxiety, and burnout.
A Future That Feels Familiar: Enter Neuropunk
I call Nepo “neuropunk.” It’s a subgenre I’m helping shape—one that centers ND experiences in speculative fiction. Think cyberpunk, but instead of focusing on tech, neuropunk focuses on how ND minds resist systems built to control or erase them.
In Nepo, society is split between the privileged “enclavers” and the oppressed “endis”—a mostly neurodivergent underclass whose labor sustains the city but whose identities are erased.
It’s dystopian, yes. But let’s be honest—it’s not far from reality.
Shayan’s Realization: The Egg Cracks
Shayan doesn’t know he’s “endi.” He just knows he feels…wrong. Like something doesn’t add up. That feeling of disconnection? Of not knowing why you’re always the odd one out? That’s familiar to many ND readers.
Eventually, Shayan discovers the truth—he’s not broken. He’s just different. ND.
It’s the “egg crack” moment. The moment so many of us experience when we finally get the language to describe our brain. When the mask starts to slip and we realize—maybe we never needed it in the first place.
That realization is liberating. But it’s also complicated. Because unmasking doesn’t erase years of shame. It doesn’t instantly rebuild your identity. And it doesn’t stop the world from demanding conformity.
Masking Hurts—But So Does Being Real
One of the questions Nepo asks is: What happens when the mask becomes who you are?
That’s what makes masking so insidious. Over time, it erodes our self-concept. We lose track of where the performance ends and where we begin. We internalize the idea that our real selves are unacceptable. That survival means self-erasure.
I’ve seen this pain in my clients. I’ve lived it myself.
And I wanted Nepo to hold space for that grief. To say: You’re not alone. You’re not broken. You’re reacting to a world that hasn’t made space for you.
Storytelling as Resistance
Speculative fiction gives us the distance we need to tell the truth.
Nepo isn’t just about one clone’s rebellion. It’s about systemic oppression, identity, and the radical act of self-acceptance. It’s about choosing authenticity in a world that punishes it.
And at the heart of the story is a plea: Let us be real. Let us be whole. Let us be seen.
Representation That Goes Beyond Stereotypes
I didn’t see myself in books growing up. Autistic characters, if they existed, were usually emotionless geniuses or comic relief. Rarely were they nuanced, messy, real.
I wrote Nepo for the readers like me. For the weird kids. The hyper-focused teens. The stimmers. The ones who got in trouble for being “too much.” The ones who’ve spent years trying to figure out why they feel alien on their own planet.
Shayan isn’t a trope. He’s a full person—conflicted, hopeful, and worthy of belonging. Because all of us are.
A Free Gift (And a Small Request)
If this story resonates with you, I’m offering Nepo as a free digital download for a limited time. All I ask is that you leave a review—let me know what spoke to you, what challenged you, what stayed with you.
I wrote Nepo because I believe stories can heal. And I hope it helps you feel just a little more seen, understood, and unmasked.
Have you ever felt like your life was a performance? Have you had your own “egg crack” moment?
Essy Knopf is a therapist who likes to explore what it means to be neurodivergent and queer. Subscribe to get all new posts sent directly to your inbox.
When I decided to pursue an autism diagnosis, I was hoping for clarity, self-understanding, and maybe even a bit of support. What I wasn’t expecting was to have my neurodivergence compared to a fatal, degenerative disease.
The psychologist I spoke with didn’t offer validation or encouragement. Instead, he presented a hypothetical scenario involving Huntington’s disease, a terminal neurological condition. “Would you even want to know?” he asked, as if discovering I was autistic would be akin to receiving a death sentence.
My stomach sank. I wasn’t calling for a philosophical debate—I was trying to book an appointment for my autism diagnosis.
The Harm of Medical Ableism
Experiences like mine are, unfortunately, not uncommon. Many autistics face skepticism, dismissal, and outright ableism from medical professionals when seeking an autism diagnosis, especially later in life. This can take the form of:
Gatekeeping autism diagnoses by making the process unnecessarily difficult or discouraging individuals from seeking answers.
Invalidating autistic experiences by questioning the legitimacy of self-identification or framing autism as an inherently negative condition.
Perpetuating harmful stereotypes that paint autism as a tragedy rather than a natural variation of neurodivergence.
The psychologist’s comparison to Huntington’s disease wasn’t just offensive—it was wildly inaccurate. Autism is not a degenerative illness. It is not a death sentence. It is a different way of experiencing and interacting with the world. Yet, the way some medical professionals handle autism diagnoses can make it feel like a burden rather than an empowering revelation.
Why an Autism Diagnosis Matters
For many, receiving an autism diagnosis is not about seeking a label—it’s about gaining access to understanding, accommodations, and community. Knowing I was autistic allowed me to:
Identify my sensory sensitivities and social communication differences as valid, rather than as personal failings.
Advocate for my own needs in work and social settings.
Connect with other autistics who shared similar experiences.
Not knowing, on the other hand, often leads to years of struggling with unidentified challenges, self-doubt, and unnecessary hardship. An autism diagnosis can be a transformative moment, allowing individuals to understand their experiences in a new light.
The Importance of Perseverance
After my frustrating encounter, I didn’t give up. I kept calling around until I found a professional who was willing to listen. Eventually, I got my autism diagnosis—and it was life-changing. It validated what I had known deep down but had struggled to articulate.
If you are seeking an autism diagnosis and face similar roadblocks, don’t let one dismissive professional deter you. Your experiences are real, and your struggles deserve recognition. Keep pushing forward. The right support exists—you just have to find it.
The Need for Change
That said, medical professionals must do better. They need to:
Approach autism diagnoses with compassion and respect.
Recognize that autistics are the best experts on their own experiences.
Dispel outdated, harmful misconceptions about autism.
Autistics shouldn’t have to fight for their autism diagnoses, nor should they be made to feel like their existence is a tragedy. Neurodivergence is a part of human diversity, and it’s time the medical field treated it as such.
Final Thoughts
An autism diagnosis is not a label—it is a tool for empowerment. It helps autistic people navigate the world with greater understanding and access to the support they need. By fostering a more inclusive and neuroaffirming approach, medical professionals can ensure that autistics are met with dignity, respect, and the care they deserve.
If you have been met with resistance or ignorance in your pursuit of an autism diagnosis, know that your experience is valid. Your struggles are real, and you are not alone. Keep advocating for yourself, seek out supportive professionals, and remember—your neurodivergence is not a flaw. It is a part of who you are, and you deserve to be seen and heard.
Have you faced challenges in getting an autism diagnosis? Share your story in the comments.
Essy Knopf is a therapist who likes to explore what it means to be neurodivergent and queer. Subscribe to get all new posts sent directly to your inbox.
For many autistics and ADHDers, stepping outside isn’t a simple task—it’s an exercise in endurance. From unpredictable noises to overwhelming crowds, the world outside can be exhausting and even painful. Here’s why sensory overwhelm makes going out so difficult, and how it impacts daily life.
The Unseen Battle of Going Outside
For neurotypicals, stepping outside might seem effortless. For me, it’s a calculated risk. The moment I leave my house, I brace myself for a wave of sensory overwhelm—the bright, flickering lights, honking cars, and the endless chatter of people.
It’s not just annoying. It’s exhausting.
Every sound, smell, and visual detail seems to crash into my brain at once, with no filter. My ADHD means I struggle to tune out irrelevant stimuli, and my autism makes everything feel too much, too fast, too loud. The result? I burn out before I even reach my destination.
The Chaos of Public Spaces
Public spaces are an unpredictable sensory minefield. One moment, I’m fine. The next, a sudden noise—an ambulance siren, a child screaming, or harsh sunlight—sends my nervous system into overdrive.
Shops, train stations, and crowded streets all come with their own brand of overstimulation. The sheer number of people moving unpredictably about can be stressinducing.
I’m constantly on edge, trying to manage the discomfort while also masking—pretending I’m “fine” so I don’t stand out. But masking takes energy, and before long, I’m mentally and physically drained.
The Exhaustion of Social Expectations
Going outside also means navigating unspoken social rules. Eye contact, small talk, dodging people on sidewalks—it’s all an exhausting mental game. Unlike neurotypicals, who instinctively follow these social norms, I have to consciously process every interaction.
If I miscalculate—speak too bluntly, react too slowly, or misread a situation—I risk being judged. The stress of trying to “act normal” adds another layer of exhaustion on top of the sensory overwhelm.
Why Staying Inside Feels Safer
At home, I control my environment. I can keep the lighting soft, the noise minimal, and avoid unpredictable social interactions. There’s no pressure to mask, no overwhelming sensory input, and no need to constantly adjust to a world that wasn’t built for me.
But the downside? Isolation. Avoiding the outside world means missing out on experiences, friendships, and opportunities. It’s a constant tug-of-war between self-preservation and the desire to engage with life.
Finding Ways to Cope
While I can’t change the world, I can adapt. Here are a few ways I manage:
Noise-canceling headphones – Blocking out overwhelming sounds helps me focus and stay calm.
Sunglasses or tinted lenses – Bright lights are a major trigger, so I reduce the strain however I can.
Planned outings – Knowing exactly where I’m going, when, and for how long helps me prepare mentally.
Going outside as an autistic/ADHDer isn’t a simple task—it’s a sensory endurance test. From chaotic public spaces to social expectations, every outing requires energy that I don’t always have.
If you relate to this struggle, know you’re not alone. It’s okay to set boundaries, to take breaks, and to advocate for environments that support neurodivergent needs. When feeling dysregulated, consider trying some of these self-care techniques.
Do you experience sensory overwhelm when going outside? How do you cope? Let’s talk in the comments!
Essy Knopf is a therapist who likes to explore what it means to be neurodivergent and queer. Subscribe to get all new posts sent directly to your inbox.
Autistic/ADHD individuals learn early on that if they want to survive in a society shaped by systemic ableism, they have to mask their true selves.
But over time, masking damages our self-worth. And it may fuel internalized ableism. So why then do we persist in doing it?
While accommodations are sometimes made for people with disabilities/who are neurodivergent (ND), they are by far the exception to the rule.
In the case of autism and ADHD, accommodations can be even less likely, due to what clinicians call “disguised presentation”. That is, neurodivergence isn’t always that obvious, in some cases because the autistic/ADHDer is working very hard to keep their struggles hidden.
Neurotypicals (NTs) as a result may expect NDs to meet the same standards as people just like them, setting the bar for acceptance impossibly high.
When NTs expect ND folk to think and behave as they do, the moment the ND individual drops their mask—for example, by being overly direct or failing to read social cues—the NT will attribute that lapse to another cause, such as them being “selfish” or “rude”.
They may even respond by criticizing, judging, punishing, and excluding the ND.
Systemic ableism & microaggressions
The issue here is not merely that NTs are intolerant of neurodiversity and the differences it presents. It’s that NTs, in general, operate from baseline expectations that are ableist.
Most are oblivious to the extent to which this ableism informs their thinking, resulting in microaggressions: the “commonplace daily verbal, behavioral or environmental slights, whether intentional or unintentional, that communicate hostile, derogatory, or negative attitudes toward stigmatized or culturally marginalized groups” (see Microaggressions in Everyday Life).
Microaggressions can happen even within the families of ND folk. For instance, I remember my own parents calling me “antisocial” for my tendency to choose the company of books and computers over that of other human beings.
They also play out at school, with kids slapping all kinds of hurtful labels upon their ND peers.
I recall even teachers telling me that I lacked “common sense”, and that my handwriting was “poor” and “sloppy”. Turns out, all of these traits were part and parcel of my being ND.
But even having a diagnosis doesn’t necessarily guarantee understanding and compassion.
Shortly after I was told I was autistic, I had a friend suddenly touch me from behind. When I reacted with shock and explained my reasons, this friend responded by cussing out my “Asperger syndrome”. (Note: This was my diagnosis at the time. It is now considered to be an outdated term and no longer exists in the Diagnostic and Statistical Manual of Mental Disorders).
Rather than apologizing for having startled me, this friend did what so many NTs did and called out my autism as being the problem.
Miscommunications & Theory of Mind
These misunderstandings are compounded by issues related to a skill called “Theory of Mind”.
Theory of Mind (ToM) has been defined as: “the ability to recognize and understand thoughts, beliefs, desires and intentions of other people in order to make sense of their behaviour and predict what they are going to do next”.
Researchers have claimed many ND folks have impaired ToM. What I’ve noticed however is that our unusual thinking style and behavior can also general a kind of temporary ToM impairment among NTs.
That is, NTs tend to ascribe NT motives to everyone, but doing this to ND folk can lead to confusion and misunderstanding. Turns on, there’s a name for this: the double empathy problem.
To give an example: when I got into trouble as a child, I would usually be upfront about the truth, believing that my confession would be taken at face value.
But protesting my innocence or admitting to my naivety would rarely win me favors. In one case, an adult suggested I was “stupid” for expecting them to believe my story.
What happened here was that this individual couldn’t fathom my intentions, and thus concluded my being honest had to be an act of deception.
Another example of this misattribution occurred during a visit to my parents. My mother told me she was going to fetch a can of tomatoes to make pasta sauce. With her fingers, she indicated that the can would be about the size of a bucket.
Knowing my mother had a tendency to bulk-buy, I assumed she indeed meant the can would be the size she suggested. Because of my impaired ToM, I interpreted her gesture literally.
When I expressed my confusion over why she wanted to use such a big can, it didn’t occur to my parents that I was genuinely confused. Instead, they accused me of being a smart aleck.
We mask because authenticity is risky
As I’ve mentioned, this tendency of NTs to not adjust expectations when dealing with an ND individual can sometimes be the result of the disguised presentation.
Specifically, when NDs present themselves as NT. In some cases, this camouflaging is deliberate, with the ND trying to mask their struggles for fear of being judged, attacked, or marginalized.
Like NTs, autistics want above all to be accepted for their authentic selves. But when ND authenticity collides with ableist expectations, as in the situations I’ve described, disaster can result.
Due to the double empathy problem, it can be hard to understand NTs and anticipate how they might react to our actions. So we become master imitators and concealers.
We mask, knowing that by hiding our neurodiversity, we are shielding ourselves against a perplexing and often hostile world.
Sometimes these compensations can be positive and adaptive, such as wearing headphones whenever out in public to compensate for sound sensitivities.
Other times, they are maladaptive. For example: avoiding talking about one’s interests, for fear of misreading social cues and rambling on.
But masking is self-defeating
NDs will often tell themselves that they need to change in order to fit NT expectations. But this really is an expression of internalized ableism.
Furthermore, ignoring your needs and hiding your differences as an ND is almost always self-defeating.
Years ago I had a friend who would invite me to the movies. Personally, I find sitting in a movie theater to be sensory torture, with people constantly rustling bags and crunching on popcorn.
Rather than explaining this to my friend, I went along with her invitations, usually at great discomfort to myself.
Feeling shame over my sensory problems, I refused to tell her about the issue. Eventually, I started making excuses for not being able to join my friend, who came to believe I was intentionally avoiding her.
Difficulties with executive function are common among ND folk. Personally, in the past, as a result of my ADHD, I have struggled with self-organizing, managing my time, and staying on track.
One time, a manager unloaded on me over this, accusing me of being self-absorbed and irresponsible.
Rather than reacting defensively, I admitted my mistakes and asked this manager how I could improve certain executive function skills. She replied by telling me that my request was “beyond the scope of her role”.
It was one thing to turn professional feedback into a personal attack, but to then deny me support was quite another.
This is, unfortunately, a common experience for NDs. Often we’re told that we have done wrong, without being told how to course correct.
Systemic ableism creates internalized ableism
Until I was diagnosed as autistic and ADHD, I didn’t have a framework by which to explain or defend my difference. Having long been challenged and attacked over my ND traits, defenses have usually felt necessary.
Of course, even without having fully understood the whys and hows of my challenges, I could have still spoken up and tried to negotiate accommodations.
What stopped me, however, was the belief that I was somehow choosing to be difficult. Having internalized ableism, I had come to feel inferior and ashamed of my differences.
My self-esteem consequently became conditional upon the approval of others. This led to me adopting a workaholic lifestyle in a bid to prove my worth to myself, and to others.
Personal boundaries blurred, to the point that I feared I was always somehow responsible when something went wrong.
Such was my shame that even after my diagnosis, I shied from the company of other NDs.
I convinced myself that the people who frequented autism and ADHD support groups weren’t like me, that I was somehow more “high functioning”—a term I’ve since realized is ableist.
What I feared—but dared not acknowledge—was that to be in their company might make me “one of them”.
Ableism creates so much stigma around disability/neurodivergence, that despite everything I knew, I still believed my autism and ADHD to be a kind of flaw or personal shortcoming.
Wrap up
Systemic ableism oppresses NDs by demanding we abandon our identities and silence our needs.
We can start countering it by leaning into authenticity, the practice Brené Brown defines as “letting go of who we think we’re supposed to be and embracing who we are”.
One immediate way we can embrace our authentic ND selves is by seeking out fellow NDs around whom masking isn’t necessary.
The ND community exists to normalize individual experiences and to combat the stigma that can make being disabled/neurodivergent such an isolating experience.
ND readers, how does ableism show up in your life? Do you recognize any of the forms of internalized ableism I’ve described here? Drop a comment below.
Essy Knopf is a therapist who likes to explore what it means to be neurodivergent and queer. Subscribe to get all new posts sent directly to your inbox.
Many of the messages we get as neurodivergents (NDs) living in an ableist society remind us that we’re different. And this difference, more often than not, is treated as a negative—at the cost of our self-esteem.
When confronted with the unique traits and behavior of NDs, many neurotypicals (NTs) typically respond with discomfort, annoyance, hostility, and even vilification.
Sometimes they do it out of ignorance—a knee-jerk reaction to something they don’t understand. They may also simply view autism and ADHD as a “deficit” or “fault” that needs to be corrected.
Acknowledging areas for growth
There is a tendency within the ND community to react defensively to the “neurodiversity-as-deficit” paradigm by casting being ND exclusively as a strength.
Given many of us feel that being ND is an intrinsic part of our identity, it makes sense that we should feel compelled to defend it.
Personally speaking, I would much sooner rather celebrate my strengths than look at myself through the lens of inferiority.
At the same time, I recognize that being ND can come with some downsides. For example, I find my various sensory sensitivities to be a nuisance. And I wish I could form and sustain relationships with the ease enjoyed by many NTs.
Should I treat these downsides as a reflection of my worth? Definitely not. That said, I do think there is value in recognizing our personal areas for growth. For me, this is developing stronger social skills.
Self-esteem starts withacknowledging strengths
Areas of growth aside, I think there is merit in focusing on strengths. Being autistic, for example, can convey quite a few. For example:
We enjoy peer relationships characterized by absolute loyalty and impeccable dependability
We are free of sexist, “age-ist”, or culturalist biases; able to regard others at “face value”
We are willing to share our mind, irrespective of social context or adherence to personal beliefs
We have an ability to pursue personal theory or perspective despite conflicting evidence
We seek an audience or friends capable of enthusiasm for unique interests and topics
We take consideration of details and spend time discussing a topic that may not be of primary interest
We listen without continual judgment or assumption
We are interested primarily in significant contributions to conversation, preferring to avoid “ritualistic small talk”, or socially trivial statements and superficial conversation.
We seek sincere, positive, genuine friends with an unassuming sense of humor
And as employees, we are also known to be: reliable, persistent, perfectionists, easily able to identify errors, technically able, and to have a sense of social justice and integrity.1
We are also willing to question protocols, can be highly accurate, attentive to detail, logical, conscientious, knowledgeable, original in problem-solving, honest, and likely to thrive on routine and clear expectations.
In a majority of situations, these qualities are quite beneficial. They also contradict the ND-as-deficit paradigm.
Are you ‘strengths blind’?
Strengths vary from individual to individual, and may manifest physically, mentally, emotionally, socially, or spiritually.2
We may not be aware of those strengths and how they may have helped us to cope with the challenges of day-to-day life. But they’re still there, regardless.
Firstly, there’s a lack of awareness of said strengths, resulting from not practicing self-awareness or feeling disconnected from our identity.
Secondly, we may not see our strengths as meaningful. Thirdly, we may downplay them as ordinary, rather than extraordinary.
And fourthly, we may overuse our strengths to the point that they create problems. One commonly overused autistic strength for instance is passion.
To elaborate: autistics can have something of a reputation for wanting to share knowledge about their areas of interest, even with the most casual of acquaintances.
If we’re not careful, we may end up talking at length and scarcely allow the other person to get a word in edge wise.
In fact, we can become so caught up in the act of sharing that we fail to take notice of the subtle—and not-so-subtle clues—that the other person is getting annoyed, or feeling frustrated and overwhelmed.
Yet in moderation, this character strength can be hugely advantageous. Passion for instance can enable us to become leading specialists in our chosen fields.
Putting our strengths into practice
So, how do we overcome strength blindness? By increasing awareness of our strengths. We can start doing this by reaching out to our closest friends and family members and asking them what they like most about us.
Some common strengths or qualities are creativity, curiosity, judgment, love of learning, perspective, bravery, perseverance, honesty, zeal, love, kindness, social intelligence, teamwork, and fairness.
Other qualities are leadership, forgiveness, humility, prudence, self-regulation, appreciation of beauty, and excellence, gratitude, hope, humor, and spirituality.
The great thing about character strengths is that most are not in any way shaped by our being ND.3 (Small caveat: many autistics may struggle with social intelligence and teamwork, and yet we also love to learn and are very curious.)
Once you’ve identified our strengths, select your topmost three. Now ask yourself, what activities do you do in service of those strengths?
Chances are when you do those activities, you’ll feel great about yourself. Why? Because they are impactful, and because they provide satisfaction.
Strengths-based habits improve self-esteem
If you’re struggling with self-esteem issues, make a conscious plan to do at least one of the three activities when you feel down or like you’re struggling. Not only will this affirm your strengths, but it will also improve your self-esteem.
If love is one of your strengths, perform a kind act for someone, such as buying a friend a gift. If appreciation of beauty is a strength, visit an art gallery or public garden.
If creativity is a strength, pick up a pen or paintbrush and start creating.
Of course, doing the occasional activity can only take you so far. If we really want to grow our self-esteem, we should make these activities into habits.
Set aside a regular time in which to do each of the activities you identified. Incorporate them into your daily or weekly schedule, until they become habitual.
Wrap up
Why is making activities into habits important? Because habits create a powerful snowball effect.
The more we exercise our strengths, the more they feel like a part of our character. The more we orient our character around our strengths, the more capable we feel.
The more capable we feel, the greater our sense of self-worth. The greater our sense of self-worth, the more likely we are to embrace our strengths. And so the cycle goes.
What are some of your strengths, and how do you express them?
And what’s one new habit you could commit to over the coming week to develop awareness of your strengths? Share your responses in the comments.
Essy Knopf is a therapist who likes to explore what it means to be neurodivergent and queer. Subscribe to get all new posts sent directly to your inbox.
Living within an ableist society, neurodivergent (ND) folks often experienced marginalization. But to experience it within the ND community is not something most of us would expect.
Consider young autistics and ADHDers who go in search of community online, only to have a total stranger blast them for using terminology some have deemed inappropriate.
Any sense of belonging and acceptance this person might have found is suddenly withdrawn the moment they express themselves.
This was my experience, and one I believe is shared by many. The policing of ND identities is a very real phenomenon, and one I think requires further discussion.
The people responsible for this behavior—I’m going to call them “gatekeepers”—have a tendency to treat our community as monolithic.
According to these gatekeepers, only their worldview is endorsed, while all others are incorrect and subject to harsh criticism.
Knowing that one could be punished by such folk for speaking “out of turn” creates a chilling effect in online discussions. And so it’s the voices of the gatekeepers that usually end up being the loudest—to the exclusion of all others.
Some disclaimers
I want to make it clear that many advocates within the ND community do important work. And I’d like to believe that most of them are motivated by genuine compassion. Yet the gatekeeping approach to advocacy raises a number of concerns.
Full disclosure: I am speaking today as someone who is autistic and has ADHD. Any opinions I share here are entirely my own.
I acknowledge that my ability to speak out in the first place is a privilege. Not everyone in our community enjoys this privilege.
I also want to acknowledge that NDs have been marginalized and oppressed throughout history.
Widespread ableism means that the status quo largely exists to serve the interests of neurotypicals (NTs). This is why challenging the status quo and fighting for ND empowerment are so crucial.
Gatekeeping in the ND community feeds toxic shame
That said, I believe some gatekeepers challenge for the sake of challenging in and of itself. What doesn’t help is when they behave in a way that can be dogmatic, if not militant.
These gatekeepers appoint themselves the authority, defining what is “good” and “bad”, “right” and “wrong” for everyone else.
Typically, they take a very strong stand on hot-button topics, like the use of person-first language, the term “Asperger”, or the naming of autism and ADHD as pathological disorders.
Yes, these are important topics worthy of discussion, but discussion can’t happen so long as one party feels they have a monopoly on the truth, as gatekeepers so often do.
Believing in their own righteousness, many gatekeepers will label those who disagree with them as ignorant, ableist, and oppressive.
Demonizing people in this fashion feeds shame. In the words of Brené Brown:
“Shame is the fear of disconnection—it’s the fear that something we’ve done or failed to do, an ideal that we’ve not lived up to, or a goal that we’ve not accomplished makes us unworthy of connection. I’m not worthy or good enough for love, belonging, or connection.”
Nobody likes to feel this way. Everyone—and I mean everyone—wants to feel worthy of love and belonging.
Worse still, if the intention of gatekeepers is to create shape, when they shame others, they undermine their capacity for change. As Brown goes on to explain:
“Shame corrodes the very part of us that believes we can change and do better… In fact, shame is much more likely to be the cause of destructive and hurtful behaviors than it is to be the solution.”
There is a history of NTs weaponizing shame against ND folk. So when ND folks shame both NTs and other NDs, it is—to say the very least—problematic.
Gatekeeping drowns out other voices
Gatekeepers claim there is a consensus within the various ND communities, one again that usually aligns with their own personal beliefs.
But in fact, no such consensus exists. These communities comprise diverse individuals who identify and express themselves in a variety of ways.
No one has the right to speak for every member, just as no one has the right to silence those who don’t agree with their points of view.
One example of this is when gatekeepers whitewash autism, painting it exclusively as a positive while failing to acknowledge that it may be experienced by others with mixed feelings, or as a negative.
Similarly, many gatekeepers frame autism as a mere social challenge caused by systemic ableism. This social model of autism has been adopted as an alternative to the medical model, which has sometimes been used to oppress autistic folk.
But romanticizing autism in this fashion dismisses the reality of those individuals who experience autism as a debilitating disability.
Likewise, gatekeepers who insist that autism is an intrinsic part of our identity fail to admit that this isn’t the case for everyone.
By dominating discussions about autism, gatekeepers fail to hold a space for other community members and even compromise their right to self-expression.
Gatekeeping ignores privilege
What a lot of gatekeepers don’t realize is the ability to advocate is a privilege that not all ND folk get to enjoy.
For example, many individuals on the autism spectrum experience some form of intellectual disability and/or are nonspeaking.
These individuals may not have the opportunity to express how they feel. And so, their wishes go unheard, and their needs unaddressed.
If the inclusion of all ND individuals is our priority as a community, why then are so many of us assuming the right to speak for others?
Again, by virtue of being the loudest, gatekeepers get to decide what issues receive the most attention.
Their advantages allow them to privilege their own voices, rather than elevating those more disadvantaged than them.
Gatekeeping undermines coalition-building
The final issue I want to address is the “us vs. them” attitude gatekeepers take towards the medical community and parents of ND folk.
We know, for example, that ND folks have been treated horrifically in the past. The Nazi regime for example actively murdered our forebearers, so it stands to reason that many of us might treat medical authorities with suspicion.
The problem begins when some gatekeepers claim all researchers want to “cure” autism—an action compared to eugenics. This is a smear campaign.
Consider those autistic individuals living in full-time care who are prone to frequent seizures, meltdowns, self-injury, and violence. They undoubtedly experience autism in a way that differs vastly from that of privileged gatekeepers.
Many researchers are working to enhance the quality of life for such individuals, and yet gatekeepers continue to accuse these professionals of endorsing ableism.
Similarly, when desperate parents of autistic folk reach out to the community seeking understanding, insight, and support, often they are shut down and declared the enemy.
Instead of building coalitions with community allies, some gatekeepers sideline them.
Gatekeeping is not social justice
Gatekeepers may be part of a social justice movement, but there can be no justice so long as one party assumes the moral high ground, dominates the discourse, and bullies both allies and NDs alike.
I gave up my previous career to enter social work with the hope of serving the ND community. Yet I’m troubled by the knowledge that should I ever fail to measure up to the demands made by ND gatekeepers, I’ll be judged and shamed.
This leads me to wonder, are these individuals truly invested in serving the ND community? Or are they just traumatized individuals who are now inflicting that trauma upon others?
Gatekeepers often point out that words can oppress, only to themselves use words in an oppressive way.
The result, more often than not, is not dialogue, or mutual understanding, but very public social media attacks upon someone’s intelligence, knowledge, values, or character.
Wrap up
Have you experienced some form of ND gatekeeping? Or do you completely disagree with the points I’ve raised here? Let me know in the comments.
Essy Knopf is a therapist who likes to explore what it means to be neurodivergent and queer. Subscribe to get all new posts sent directly to your inbox.
Childhood autism and ADHD aren’t always obvious…except perhaps for the neurodivergent (ND) child themselves, who comes to the realization early on that they’re different.
It usually begins with other kids calling out our behaviors, telling us that we’re weird, or implying we’re inferior.
People clearly found me strange, but in my view, I was just unique and misunderstood. These two words perfectly summarized what it was like being an undiagnosed autistic and ADHDer in an ableist world.
They also describe why I often felt driven to mask my ND traits, and perhaps why many of them went overlooked.
But suppose I hadn’t masked. Suppose I made no attempt to conceal my supposed weirdness. Would I have received a diagnosis and received the necessary support sooner than I actually did?
Possibly—but possibly not. The lack of general awareness and education about autism and ADHD meant my traits would have continued to have been misattributed to my personality or (apparent lack of) intelligence.
This also comes down to the fact that autism and ADHD manifest quite differently for each individual. It thus requires a discerning eye to identify its presence.
Here’s how autism and ADHD showed up in my childhood.
Stimming: a common sign of childhood autism and ADHD
For years after receiving my autism (and later ADHD) diagnosis, I convinced myself that I had never stimmed. It was only upon hearing the accounts of other autistic people that in fact I did.
When I was living in the tropics, my favorite thing to do on a hot day was to chew on ice. Sure, it was refreshing, but the crunchiness of it was also deeply satisfying.
Another thing I loved to do was to play with chewing gum. Countless hours were spent blowing bubbles or pulling long strings of the stuff out of my mouth.
During long car rides, I would beatbox—it was a practice I never seemed to grow tired of.
When I was 12, I also went through a period of sucking obsessively on a certain toy. (By “toy”, I’m referring here to a balloon stuffed with flour, with a pair of googly eyes and a cap of yarn hair.)
It was a kind of sensory ball, and it lasted all of a few weeks before suddenly exploding and spraying flour all over me. Imagine having to explain this development to my parents!
Another big stimming activity for me was delivering a series of DoggoLingo-style monologues to animals, such as the family dog, in a made-up accent.
For days, weeks, months, and even years afterward, I’ve felt the urge to recite DoggoLingo phrases of affection to myself, at random, for no clear reason, over and over again.
This behavior I previously thoughtwas echolalia, though I’ve since learned the correct term for this is palilalia: the delayed repetition of words or phrases.
As a child, I was fanatical about animals.
Obsessive interests
My childhood autism/ADHD was perhaps most evident in my obsession with insects and spiders. Collecting factoids about each species proved a source of great delight.
In my teen years, my area of interest shifted to fiction writing. The fantasy worlds I created provided an escape from my confusing and often overwhelming reality.
Where previously I collected bug-related factoids, I started collecting new words, memorizing them straight out of the thesaurus.
There was a certain pleasure to be found in this mastery of meaning. To me, acquiring words represented the acquisition of some kind of secret, important knowledge.
Many of these words had a delicious quality to them. Consider for instance “lignite”. No idea what it means, but pronouncing it aloud just feels satisfying.
More than a decade later, riffling through a box of keepsakes, I would find ratty little lists of words I’d picked out from books, preserved since my teenagehood.
If you asked me to explain why I was keeping them, I’d be at a loss for…well, words. Even now, the very idea of throwing them away evokes pain.
The obsessive collecting didn’t stop there. At one point I received a pocket organizer with a digital address book, which I felt compelled to fill with phone numbers.
Despite the unusualness of my request, many of the people I asked at school obliged me by providing their own. I even worked up enough courage to ask my math teacher—of all people—for her details.
Suffice it to say, my teacher was not all too impressed, and I became the laughingstock of the class.
Social, environmental, and animal rights activism
An interest in environmental and social causes was one trait that’s typical of childhood autism.
I remember being age six and penning a handwritten letter to the Australian prime minister asking him to increase foreign aid to famine-stricken Sudan.
In fifth grade, I used my valuable show-and-tell time to lecture my peers about Captain Planet and climate change. While almost everyone rolled their eyes at me, I of course now have the satisfaction of knowing I was right all along!
My interest in animals also led to me adopting vegetarianism, a phase that lasted all of one year….before my mother tricked me into believing there was no meat in lunch meat.
Taken during one of my childhood bug-catching expeditions. There was always a part of me that felt deeply embarrassed about my passion and suspected that others were laughing at me behind my back.
Fixing things and the problem-solving mindset
When any of my toys broke or stopped working, I worked obsessively to try and fix them.
The most memorable example of this was a special doll that could pee when “fed” milk. At some point, the doll stopped peeing. Concluding that there must be some kind of internal blockage, my six-year-old self decided to clear this blockage using a reed.
Granted, this was not exactly ideal behavior for a would-be future parent, and yet this ability to hyper-fixate—a quality that appears in both ADHDers and autistics—would later prove quite advantageous, especially when it came to problem-solving.
The same probably couldn’t have been said of my tendency to always try and set things right. In second grade, my homeroom teacher one day warned my peers that someone had been stealing food and money from backpacks.
Our school didn’t have lockers. Students instead had to leave their backpacks on racks. Given most of my peers were leaving their bags unzipped, the temptation to would-be thieves naturally was great,
I thought long and hard about what I could do to fix this problem, then spent the following lunch break methodically zipping up every bag I could get my hands on.
I was a self-appointed Good Samaritan, but that wasn’t how two of my classmates saw it. They reported my apparently suspect behavior to the teacher, bringing a sudden end to my brief career as a school crimefighter.
Sensory sensitivities
As a child, I was accused of being a “picky eater”. What the adults around me didn’t understand was that I found certain foods extremely repulsive, usually because of their appearance, texture, taste, or a combination of all three.
One of these foods was yogurt. Another was a traditional Iranian stew my mother would make which contained red kidney beans and lamb shoulder called ghormeh sabzi.
Ghormeh sabzi was one of the few foods I devotedly ate, due to the delicious umami flavors, and yet I was extremely averse to doing so until the beans and lamb had first been removed.
Certain sensations could also make me very uncomfortable. Feeling my toenails against the surface of a pilling bedsheet was one of them. To avoid the possibility of contact, I became a stomach sleeper.
As for sleep, that was an activity that felt next to impossible unless I was under a sheet or blanket. Another requisite was that I needed to have a fan blowing on me—no matter the temperature.
Tags inside my clothes bugged me, and sometimes even my own underwear felt too tight.
One time, a teacher caught me trying to adjust my briefs through my pants and assumed I was having some kind of bladder problem.
Without a diagnosis, my autistic traits were often misattributed to other causes.
Wrap up
As perfectly natural as these preferences and behaviors felt to me, the downside was often obvious and immediate: alienation.
In the eyes of my parents, peers, and teachers, I was either too finicky, too stubborn, too sensitive, too clueless, or too weird. And without a diagnosis, what cause did I have to disbelieve them?
But to view our authentic ND selves in such a light can leave a legacy of shame.
It’s only now, years later, that I realize the problem was less my difference than the ableist system that defined that difference as a problem.
So to all my fellow autistics and ADHDers experiencing self-doubt: don’t shy from authenticity. Embrace it as your fundamental right.
What were your ND traits as a child, and how did others react to them? Let me know in the comments.
Essy Knopf is a therapist who likes to explore what it means to be neurodivergent and queer. Subscribe to get all new posts sent directly to your inbox.
As an undiagnosed autistic and ADHD child, my favorite part of primary school was the weekly show-and-tell sessions.
It wasn’t so much the storytelling aspect of this activity that appealed to me, as it was the occasional chance to present.
But whatever the focus of my presentation might happen to be—dinosaurs, guinea pigs, insects—there was always a good chance it wasn’t shared by my peers.
This was a detail nevertheless lost on me. For all that truly mattered was the presence of a captive audience, bound by convention to listen.
In other settings, explaining to my classmates the, say, minutiae of insect classification, usually earned me a look of bemusement.
To hear someone use the term “bug” to describe a spider for example almost always led to a correction.
Spiders, I would note, were arachnids. What set them apart from insects was that their body had two rather than three segments. They also had eight legs instead of six.
No one else lived for such factoids, and this was a source of perplexity. Worse still, my sharing of them was not meant to be received as criticism…and yet often was.
And perish the thought that it might be interpreted as intellectual showboating. Yet the pearls of knowledge I so casually strew before my peers were received with indifference—or worse.
My childhood had many moments of joy. But these memories are clouded by the prevailing sense was I was out of sync with the rest of humanity.
How autistic folks’ attempts to connect can backfire
Friendless as I was, I would tend the fires of my passion in quiet solitude, sometimes for weeks, if not months.
The merest of kindnesses—a “hello”, a smile, a polite question—had the effect of kerosene, sending flames bursting outwards.
It seemed irrefutable that others should prize the tender morsels of information I dispensed as much as I did. It didn’t even enter into my mind that the case might be quite the opposite.
Words would rush forward in great exuberant billows, and in my naivete, I would fail to read the blank looks I was inevitably met with.
These attempts to connect ironically had the inverse effect of creating disconnection.
And so the distance between me and other kids would only grow, until we stood upon different hilltops, regarding one another warily through binoculars of mutual unease.
A ‘disastrous’ deed
While my show-and-tell sessions rarely drew more than polite applause, the desire to infect others with my passion remained.
Maybe what was required, I thought, was something of more obvious value. I set my eyes on one of my mother’s rings: a silver band set with a single, brilliant sapphire.
I asked to borrow it, explaining that my purpose was to use it as a show-and-tell prop. Yes, I promised, I would bring it home that afternoon, and reluctantly, my mother agreed to lend the ring.
Arriving at school early the next day, I sat on the steps of my demountable classroom, toying with the ring and the idea of the warm reception that must surely await.
A classmate appeared, depositing her backpack on the rack that passed for school lockers. Accompanying her was a woman I assumed must be her mother.
Joanna was transferring to another school, and today was to be her last day. I considered this tidbit. Joanna wasn’t exactly a friend, but wouldn’t it be nice if I offered her the ring?
After all, this was a special occasion. And wasn’t it considered normal to present gifts on special occasions?
Indecision wracked my mind. I had given my word that I would return it to my mother.
Yet if there was anything I understood about human relationships, it was that they were transactional. If I wanted people to like me, I would need to take the initiative.
My mind made, I stood up.
“Hey, Joanna.” She turned. “This is for you.” Joanna considered the ring, shyly teasing a blonde curl. Not understanding. “It’s a going-away gift,” I added.
“Well, that’s very nice you.” This response came not from Joanna, but her mother. A smirk eased onto her face. It was an expression I could not read, and which nevertheless made me uneasy.
“Joanna, what you say?” Joanna’s blank expression split into a smile.
“Thank you,” she said. And took the ring from me.
I was never really “people-oriented”. Yet over time, my negative experiences led me to actively avoid others’ company.
Stupidity, not disability
Less than an hour later, however, my doubt had deepened, becoming a dead weight upon my conscience.
Having had the time to consider my impulsive act, I realized that there would inevitably be consequences.
But when I returned home, hangdog, there was no blame and no bluster. Instead, my faltering explanation was met with silence.
It was as if my mother had all along suspected that something like this might happen.
The absence of a reaction stung. It felt like an affirmation of an unspoken truth: that I was stupid.
I promised my mother that I would try to get the ring back. But when I returned to school the next day, Joanna was gone, and my attempts to reach her through one of her friends came to nothing.
The wounds of systemic ableism
This memory remains enshrined not as an act of shameless exploitation by an adult who had undoubtedly known better, but as one of the most disastrous acts of my youth.
When I reminded my mother of the incident more than two decades later, she couldn’t recall ever having the ring, let alone my blunder.
Yet how could she not? Was this possession not as precious as I had long imagined it to be?
To me, this incident reflected a longstanding habit of socially inappropriate behavior, which I would later learn was all too common among those with autism and ADHD.
Yet for something so poignant as this to have had no lingering significance to the one person it should have, surprised me.
Just like the casual dismissals, the way people ignored me or cut in line ahead of me on the handball court, I had notarized this event as just one more proof of my inferiority.
It was a lonely existence, but it was safe, in that it was largely unpeopled by those who seemed to so scorn me on the basis of who I was.
In my mid-20s, I received a diagnosis of autism, and later ADHD at the age of 35, and this would crystallize for me that it was not so much who, as what.
At last, the faultline that ran through the foundations of my social life had a source. At last, I knew that I was not broken, but a survivor of a society grounded in systemic ableism.
Me in my favorite pair of pajamas.
The catch-22 of being autistic
Yet until the moment of my diagnosis, I had no choice but to stumble my way through the intricate dance of social connection.
This dance was a necessary precursor to the embrace of friendship. And yet to me, it seemed frivolous and a waste of effort and time.
Others did not share this view. Nor did they see the virtues of my info-dumping, my dispensing with social niceties, and my papercut directness.
Without their friendship, there was often no socially acceptable basis for the sharing of interests I longed for.
But I persevere, storming the dancefloor, shirtfronting potential partners, and treading all over on their toes.
With my prospects of friendship on the rocks, I was deprived of the emotional support many individuals who are neurodiverse (ND) need in order to navigate a world built for neurotypicals (NTs), also referred to in some NT circles as “normies”.
I also missed out on the social coaching that might have otherwise helped prevent my missteps.
Without the ND label, my only frame of reference was the one bestowed on me: a belief that I was a person whose lack was the result of choice or some personal flaw.
The allure of the life interior
While I can see now that autism and ADHD were the source of my social cluelessness, memories of my school years continue to pain me today.
One of the earliest and most enduring was being invited to join a game of prisoner’s base in kindergarten.
“Tagged” by a member of the opposing team, I was taken prisoner and deposited in an imaginary cell under the jungle gym. Here I was expected to remain, awaiting rescue.
In my imagination, this did not simply represent a return to play, but rather an acknowledgment that I was worthy. Evidence that someone—anyone—cared about me. But that rescue never came to pass. I was left forgotten until the bell for class rang.
Hurt and confused, I took a vow of social abstinence, using my lunch break to play make-believe on my own or to read.
This solidified my status as an outsider, denying me the warmth of others’ company, of which my own fire was but a weak imitation. Still, what else was there?
When fiction-based escapism was not jostling for my attention, I tended to various projects of my own devising.
The first involved catching and cataloging the myriad insects living in my backyard. This was followed by a compulsive desire to write sprawling portal fantasy novels.
During another period, I populated a length of green marble A1 card stock with designs for an adventure board game of my own devising.
The game was meant to be played with at least four friends; that I was entirely lacking this requisite was a consideration I chose not to dwell on.
It was, for the most part, a life interior. But eventually, it became a prison of self-narration.
“You are worthless. You are unloveable,” went the familiar refrain, a refrain seemingly substantiated by my continued isolation.
Social awkwardness and the feeling of being apart only grew throughout my teen years.
Freedom by diagnosis
My life is sharply divided between two very distinct periods: before I came into my ND identity, and after.
“Before” resembled a black-and-white etching. But in the months and years that followed, this etching became saturated with color, slowly assuming the richness and depth of an oil painting.
Liberated of one label—being a “bad” person—and awarded another—”neurodiverse”—I began to consider myself in a new light.
The critical dictator in my head was dethroned, his antique reign gave way to a democracy of thought grounded in self-compassion.
I came to understand that the shame I carried was undeserved. That I was not at fault for the unusual architecture of my mind. That I was a person of value. That I needn’t live a life sentence of “if only”.
The skills I lacked could be learned. As for the friendships that had failed to take seed—these could be nourished into new life.
With enough effort and persistence, the connection I had once craved when standing before my class during show-and-tell could be mine.
Essy Knopf is a therapist who likes to explore what it means to be neurodivergent and queer. Subscribe to get all new posts sent directly to your inbox.
What is autism spectrum disorder? To fully understand this phenomenon, we have to employ the medical model.
Big disclaimer: the medical model is far from perfect.
According to this model, there is something inherently wrong with autistics. Historically, this rationale has also been used to marginalize and oppress us.
For most people, the social model is preferable, as it argues that the issue lies not with neurodiversity, but with society’s failure to accommodate it.
The social model aims to destigmatize autism, whereas the goal of the medical model is to diagnose and treat.
Pathologizing aside, getting an ASD diagnosis can open the door to disability-related legal protections, supports, and services. This is one example of how the medical model can be of use to those with autism, and their loved ones.
So, what is autism spectrum disorder?
According to the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), autism spectrum disorder (ASD) is a neurological developmental disability.
Autism is characterized by ongoing deficits in social communication and social interactions in a range of contexts. Other criteria for autism include “restricted, repetitive patterns of behavior, interests, or activities”. 45
Autism symptoms manifest in the early development period and typically cause clinically significant impairment in key areas of functioning.
To receive a diagnosis of ASD, these symptoms must not be better explained by the presence of intellectual disability or global developmental delay.
A diagnosis of ASD is typically accompanied by a severity measurement of “Level 1”, “2”, or “3”. Level 1 means the individual requires some support, Level 2 substantial support, and Level 3 very substantial support.
(Remember how I mentioned the medical model is pathologizing? An example of this is the DSM-5 terminology I just used, such as “disability”, “deficits”, “symptoms”, “impairments”, and “severity”.)
Autism often appears alongside other conditions, such as epilepsy, attention-deficit/hyperactivity disorder, sleep problems, gastrointestinal symptoms, anxiety, and depression.
Who gets diagnosed with autism spectrum disorder?
Males are diagnosed with autism at three times the rate of females, but this doesn’t necessarily mean autism isn’t as common among females.6
One study found that autistic females as a population are better than males at hiding their autistic traits. This results in fewer diagnoses, later diagnoses in life, and misdiagnoses.
It’s also been argued that autistic females may present autism in a way different from their male counterparts.7 And due to many measurements being male-centric, females may be overlooked by current diagnostic measurements.8
Additionally, autistics from racial minority groups are typically less likely to receive a diagnosis of ASD.9 Instead, they are more likely to receive other diagnoses such as ADHD and conduct and adjustment disorders.10
Many conclude that reflects medical disadvantages experienced by minority groups as a result of structural inequality.11 But it’s important to note that autism traits can also go overlooked or can be misinterpreted, depending on the sociocultural context. 12
Why are some people autistic and others not?
There are no clear answers here, however, some studies point to a range of environmental risk factors and protective factors.
These include advanced parental age, low birth weight,1314 fetal exposure to the epilepsy medication valproate,15 intake of certain vitamins,16 maternal autoimmune disorders, environmental toxins, and breastfeeding.17
Links have been made between unique gut microbiota compositions and the development of autism. Other studies have indicated strong genetic influences, concluding that autism is highly inheritable.181920
How does one get an autism spectrum disorder diagnosis?
To get an autism spectrum disorder diagnosis, you need to be screened by a trained professional.
For children, there’s a range of tools. For example, the Modified Checklist for Autism in Toddlers Revised, the Ages and Stages Questionnaire, and the Screening Tool for Autism in Toddlers and Young Children.212223
For older adolescents and adults, the gold standard for autism diagnoses is the Autism Diagnostic Observation Schedule (ADOS-2) module 4.24 Professionals typically use this tool alongside direct observations and taking patient history.
The Autism Diagnostic Interview-Revised (ADI-R) is another gold standard autism diagnostic tool that is suitable for both children and adults.25
Again, I want to point out here that these diagnostic tools may be gender-biased and thus more likely to detect male autistics than female autistics.
When seeking out a diagnosis, it is worth checking to see that the person doing the assessment is using the most current, research-backed screening measures.
If seeing a professional is not an option, adults can also use self-reporting tools such as the Social Responsiveness Scale, Second Edition: Adult form (SRS-2).26
Additional tools are available for assessing how autism is impacting one’s activities of daily living and quality of life.
How is autism spectrum disorder “treated”?
There is no biomedical treatment for autism spectrum disorder, however, psychotropic medications are available and often prescribed for those who are experiencing symptoms such as anxiety or depression.272829
For autism specifically, there is a range of therapies, the most commonly used being Applied Behavior Analysis (ABA).30
ABA is designed to help autistic children with the development of social, communication, and expressive language skills.
The dominant strain of ABA has been heavily criticized by autism advocates for violating individual autonomy and even doing direct harm to clients.31
Critics have also pointed out that there are conflicts of interest among researchers who publish scientific literature in support of ABA as an autism intervention.32
Clearly, there is room for improvement when it comes to current ABA intervention. However, ABA is one of the few treatments that remain widely accessible.
In many US states, health insurance providers are required to cover ABA-related expenses under the Patient Protection and Affordable Care Act.
One alternative to mainstream ABA is Naturalistic Developmental Behavioral Interventions (NDBI). NDBI is more child-directed and provides intrinsic rewards for learning and participating.33
Other available interventions support the development of core skills among autistic children, such as social communication.34
Additionally, programs exist for young adults, such as the Program for the Education and Enrichment of Relational Skills (PEERS®).35
For autistic young people and adults, psychotherapies such as Cognitive Behavioral Therapy are recommended for those who experience comorbidities such as anxiety and depression.3637
These are available in both individual and group formats.38
Wrap up
So there you have it, my brief introduction to autism spectrum disorder.
Again, I want to stress that much of the content I shared is presented using the medical model.
But remember: viewing autism exclusively through this lens is not only limiting—it also fails to give consideration to some of the strengths of being neurodiverse.
Essy Knopf is a therapist who likes to explore what it means to be neurodivergent and queer. Subscribe to get all new posts sent directly to your inbox.
