I understand how it feels to have doctors and therapists dismiss your concerns that you may be autistic. For example, “no, there’s no way you’re autistic because:

• you would have been diagnosed as a child, or

• you have empathy for people

• you use humour sometimes

• you make eye contact with me sometimes

• you are employed

• you have a romantic partner”

Comments like these often accompany a refusal to refer for assessment; it’s awful. There’s a regrettable amount of ignorance and stereotyping toward autistic adults in the medical community.

Instead, I approach the assessment process with an open mind, treating clients with dignity, compassion, and trust. There’s always more to learn, and I try to keep up with relevant recent research as well as regularly participate in a variety of communities for autistic adults. I view and (try to) discuss neurodiversity from a stance of empowerment, acceptance, understanding, and respect. Unfortunately, a key part of a formal assessment is to seek a medicalized diagnosis, and given current definitions, the DSM-5-TR criteria focus on “deficits” and “disorders” which is negative and disempowering. I try to only include a minimal amount of medicalized language, but it’s a balance. I encourage you to view a diagnosis as just one part of your journey of self-discovery.

While I’m generally supportive of self-identification for autistic adults, for many people, there can be significant value in seeking a thorough assessment:

• Autism is complex to diagnose due to the likelihood of co-occurring conditions and the challenge of a differential diagnosis. There are many conditions that often co-occur with autism: approximately 50% of autistic people have alexithymia, ~30% have ADHD, as well as possible histories of trauma, OCD, anxiety, bipolar disorder, and so on. Only a thorough diagnosis will detect this. These numerous similar conditions can lead to misdiagnoses, if the assessment isn’t thorough and conducted by a clinician with substantial relevant expertise.

• Medical staff are more likely to believe that an adult is actually autistic if you’re officially diagnosed, thus taking things more seriously in relation to accommodations or related health concerns (this is an ugly truth about the stereotypes and ignorance related to autism and their continued prevalence in the medical system, particularly for late-diagnosed adults and women)

• Access to academic or work accommodations—aiding sensory sensitivities and/or executive functioning issues

• Increased sense of confidence in understanding your own experience and identity (vs imposter syndrome)

• Some adults in the autistic community without an official diagnosis say that they feel periodic self-doubt about whether or not they are autistic. An official diagnosis can help reduce this doubt and help people feel they are “allowed” to make/ask for more accommodations for their neurodiversity. This diagnostic validation leads to concrete, positive changes for many people

• Allows a person to more accurately focus their efforts toward acceptance where necessary and change where possible

• Get specific about what social issues, sensory difficulties, comorbidities, strengths/weaknesses and so on are present

• Modify your environment (home, work, relationships, etc) in a more targeted way to better accommodate for your needs

• Help people close to you better understand your differences and needs

The Clinical (and Human) Importance of Accurate Diagnosis

Diagnostic overshadowing is a significant risk when an autistic person remains undiagnosed. This occurs when physical or mental health symptoms are incorrectly attributed to a person’s existing (and sometimes incorrect) psychiatric labels, leading to medical neglect. The stakes of clinical literacy are high; when a clinician doesn't understand the autistic profile, the resulting misdiagnosis can prevent life-saving medical intervention. As one of my clients shared several years after I diagnosed them as autistic:

“My high masking autism being misdiagnosed in the past as bipolar had a direct physical impact on the care I received. I have been found to have a brain tumour (usually treatable, which is the good news), but seeing as I had to fight the last 9 months just to get them to believe something was physically wrong, it delayed the [tumour’s] diagnosis and some physical effects may be permanent.”

An accurate diagnosis can change the trajectory of one’s medical care. This same client noted that being correctly identified as autistic finally allowed them access to appropriate treatment:

“I was able to be prescribed a medication for my anxiety, and I had never not had anxiety. That medication was never accessible to me due to its potential for inducing mania [under the previous bipolar misdiagnosis]. Being able to treat my anxiety has been a game changer and allowed me to better integrate the work I had been doing with my therapist over the years… Words cannot express how grateful I am to have had the chance to know who I truly was in time to enjoy life authentically.”

As a member of the autistic community myself, I believe that an accurate understanding of our neurology is a matter of safety, dignity, and the right to be seen clearly by the medical system.