This transcript was automatically generated using Whisper and may contain minor errors or inaccuracies. For complete accuracy, please refer to the original audio recording.

Hey everyone, it's Iain. Welcome to Happy Healthy Autistic, the podcast where I share my dual perspective as an Autistic Psychologist to explore an informed, empathetic, and humanized understanding of autism. Since today's the first episode, I want to talk about the purpose of this podcast and introduce myself, and then I'll define a high-masking presentation of autism. After that, I'll spend time sharing about what it was like for me to find out I was Autistic when I was 29, and I'll also discuss what that experience is often like for other people. And finally, I'll talk a bit

about being publicly Autistic and the work that I do currently. To start with, the primary goal of this podcast is to try and improve the quality of life for Autistic adults by fostering self-acceptance, encouraging positive change, and celebrating diversity within the Autistic community. And I'll try to achieve this through education, validation, and challenging misconceptions through long-form conversations with neurodivergent, healthcare professionals, and other Autistic individuals. Beyond that, I'll try to equip healthcare workers, friends, and family with insights to better understand the Autistic people in their lives. So feel free to join me and my guests over

time as we explore high-masking Autistic presentations and try to promote a more accepting society through open discussion and collaboration. It's important to understand that there are a number of different ways to think about autism. The most well-known way is probably the medical model of autism, and this is defined in a book called the DSM, which is currently in its fifth edition text revision, which came out in 2022. And so generally speaking, in North America, if somebody is diagnosed as Autistic, this is where the criteria for autism are laid out. And it focuses on deficits for

the most part, how bad are you at these kinds of things? How bad are you at those kinds of things? And it really separates the criteria mainly into two parts. There's the A-series criteria, looking at what they would call social and emotional difficulties, and then the B-series criteria of which there are four. And so that covers things like stimming, as well as a preference for routine and sameness, special interests, and sensory differences. There are a few other parts to the criteria, namely that these things happen across multiple or all contexts of a person's life, as

well as that they have always existed. They define autism as a neurodevelopmental condition, as in as far as we know present from birth. And then the final criteria is just referencing a differential diagnosis, as in, are we sure all these experiences the person just described to us or that we tested for and so on, are we sure those things aren't better explained by something else, something that's maybe in part looks like autism but isn't actually autism? So that's the medical lens on autism. And again, it's really quite deficit-based. And personally, I find it very reductionist

and quite ugly. As I said at the beginning, I'm autistic myself, and I don't think I'm some horrible, weird, embarrassing, failed neurotypical person. I'm certainly different than most people, but generally speaking, I see autism as a difference, not a deficit. So that leads us to one of the other primary ways of thinking about autism, which would be through a lens called neurodiversity. And this is an idea that tries to reframe autism and other brain differences, such as ADHD, dyslexia, Tourette's, synesthesia, and in these kinds of things. At minimum, noting these things as differences rather than

deficits, but generally going beyond that and celebrating these differences in brain function and behavior as being natural expressions of human diversity rather than flaws. So to some degree, there's a focus on adjusting the environment, reducing stigma, valuing individual dignity, and so on. And trying to get at the conditions that would help neurodivergent people flourish. And there's a pretty closely related idea as the social model of disability. So you're going to find lots of autistic people who wouldn't consider autism a disability and wouldn't really use that word. But regardless, the social model of disability basically is

suggesting that these differences aren't particularly stressful or problematic unless you're in an environment where it's a square peg round hole situation. People are refusing to allow for any accommodations and are often quite rigid and rejecting towards any differences that a person might be exhibiting. And so it's in those sort of unwelcoming type of situations where someone who does have a brain difference like autism or ADHD or what have you can start to feel like, "Hey, this doesn't really feel very comfortable. I don't really feel like I'm welcome here. And the differences that I have are

being viewed as a problem or something like that." And so that can be a very unpleasant situation to be in. And again, it's really focusing on the environment we happen to be in. Some of them are great and supportive. And we don't feel like we are-- I mean, we can notice our differences, but we don't feel like they're problematic. Whereas other environments can make us feel like, "Wow, I'm different in a way that's bad, wrong, shameful, or even disabling perhaps." And that leads to a larger point that I don't want to go into much right

now, but it's important to recognize that even within the autistic community, people tend to use quite varied language to describe their own experiences and to describe their identity and these kinds of things. So a lot of autistic people will use that term. They'll say, "I'm autistic," rather than to say, "I'm a person with autism." And this would be the difference between person-centered language, which is quite normal for a lot of medical concerns, but most people in the autistic community tend to prefer what's known as identity-first language. So that's preferring to say, "I'm autistic," rather than,

"I'm a person with autism." But beyond that, terms like Asperger's, which is not particularly in the DSM anymore, that sort of got folded into the new way of defining autism in the DSM as of 2013. This seems like a small difference perhaps, but some people would use the term "autist," like "I'm an autist" or something like that. But my personal preference is to not use that term. I just don't care for it. But there's all kinds of variety beyond that. And again, I tend to not be very bothered by it, and I'm happy to use

whatever term each individual person tends to prefer. And actually, that often is the best way to approach this kind of thing is just to ask the person in front of you what language they prefer to use for themselves. So please forgive any use of language in this episode or other episodes that becomes outdated over time, because that certainly will be true in the future. So this whole podcast is focusing on what's called a high-masking presentation of autism. So I think we need to try to define that quite carefully. And this has been written about quite

a bit by lots of people, including myself. Jenara Nernberg is a journalist who's got ADHD, and Jenara wrote a great book called Divergent Minds. And she says that "masking in autism is an unconscious or conscious effort to hide or cover one's own self from the world as an attempt to accommodate others and coexist." Masking basically is this big database of things that we learn about how to not stand out while we're in a social situation, whether that's one-on-one or in some larger group or whatever it is. Generally speaking, nobody hands you a manual when you're

a young autistic person that says, "Here's what masking is. Here's how to do it. Here's why you should do it." Instead, we are social creatures. And from a perspective of evolutionary psychology, we don't want to have experiences that make us worried that we're going to get ostracized or kicked out because that threatens our survival. So when anybody, and in this case, we're talking about autistic people. So if you're autistic and you do something unusual or unexpected to the people around you and you irritate, annoy, frustrate, upset somebody, maybe you hurt someone you care about without

meaning to or without understanding why. Regardless, if this comes to your attention, if you're aware of this feedback, whether it's implicit or explicit, we tend to have this feeling of, "Wow, that did not feel good. How can I make sure I never feel that way again, that I don't treat someone that way again?" And so we may ask people for advice. We may read books or articles about it or whatever. Seek out resources, training, and whatever you want to try to, quote, "improve that social skill." And we do these kinds of things one at a

time, situation after situation. And given enough years or decades, eventually some autistic people are masking or camouflaging a lot of their different behaviors or traits depending on the situation that they find themselves in.

A really important question to consider is what might an adult seem like if they experience many of the sort of standard autistic differences while also possessing an average or above average intelligence? There's a lot of stereotypes and maybe exaggerated media portrayals of what an autistic person is like. And these stereotypes and just sort of inaccurate pieces of information can really lead all kinds

of people to not really know what autism is or they have an idea, but their idea is wrong. I quote things all the time. It reminds me of another great quote, "The greatest threat to the human intellect is not ignorance, but being under the illusion of knowledge." And something that's particularly tragic is when you bump into a healthcare professional who should have a pretty good understanding of what autism is and they don't and then they are dismissive or these kinds of things. And this is particularly likely to happen to an autistic adult with a high

masking presentation because they just spent decades sort of inadvertently practicing how to hide their autistic traits. And through a variety of means, perhaps that's come to their attention like, "Hey, wow, maybe I might be autistic." And then you want some help. You want to seek someone's informed opinion. Who are you going to ask? Probably a therapist, a doctor, someone like that. And chances are pretty good you're going to bump into a healthcare professional who doesn't know that much about autism, at least as of the time of recording. So things are certainly getting better, but you'll

still bump into a lot of these people. They don't know that much about it. And a lot of these healthcare practitioners, when confronted with this ignorance that they will act in a dismissive or defensive manner, which I think is really sort of small-minded and frustrating. Fortunately, of course, some people are well-informed and some people who aren't will be very curious and compassionate and they'll seek resources and try to help you. And I think that again, that's becoming more and more common. To more clearly define a high masking presentation of autistic traits, you can imagine that

it's marked by internalization and extensive use of a variety of sort of social masking strategies. And these can include things like shallow or deep compensation, assimilation, and so on. Briefly, shallow compensation would be when you don't quite thoroughly understand what's going on in a social situation, but you have this sense of like, "Oh, everyone's laughing right now and I'm pretty sure that I should be laughing too. I don't know why exactly or I don't understand the humor that just occurred, but I'm almost positive if I laugh, then I'll fit in better." Or, "This is a

moment for a handshake, not a hug," or these kinds of things like when we're kind of guessing, but we often get it right, but without fully knowing why. That's sort of shallow compensation. And then deep compensation is behind a lot of high masking autistic behaviors. And it's this idea that it's not that we can't understand these social experiences, but that we're taking a quite different route to get there. And that route tends to involve a lot of analysis and time and cognitive effort and probably a fair amount of research and preparation beforehand and observation and

all these different kinds of things that people may do to try to better understand these social situations. So that's deep compensation. It's sort of arriving at what might be the expected behavior in that moment from a group of non-autistic people. And if you're trying to mask, then you're trying to aim at that. A couple other aspects of a high masking presentation would be having interests that align more closely with peers of a similar age and gender as you and a socialization process that emphasized agreeableness and refined social skills to avoid punishment. A couple of things

that can further augment a high masking presentation would be a person having superior language skills and a high IQ. And so the more superior either one or both of those is that tends to lead to a sort of higher and higher masking presentation of autism.

I should note very clearly that a high masking presentation of autism is not necessarily a desirable thing. And if someone's saying, "Oh, you have this high masking presentation," or if I say that to you, generally speaking, that's not a compliment. If anything, it's quite well understood that masking tends to lead

to--at minimum, it leads to exhaustion and over the longer term, it tends to lead to burnout for sure and also quite regularly will cause identity confusion or self-esteem issues or these kinds of things. We could debate for probably a long time about the utility of masking. Personally, I think that it's definitely useful to understand what's going on around you socially, whether you choose to participate at all or how you choose to participate in return to what's going on around you socially is up to you. But I think, at least from a safety point of view,

it can be quite useful to try to get a bit of a better social understanding just of what's happening, which can be somewhat tiring to do that observation and analysis, but it's quite a bit more tiring to additionally perform in this high-masked manner, which I typically wouldn't recommend, but lots of autistic people might tell you that at times or in very short bursts, let's say a couple of seconds or a couple of minutes, it might be preferable for them to mask their autistic traits just for that moment because not doing so in a particular situation

might seem to have a higher cost to them in that moment. But that really relates back to the social model of disability and stigma and these kinds of things. Ideally, we'll live in a society where exhibiting autistic differences doesn't attract attention or especially negative attention from people. So a lot of these things I'm talking about, it's the reality right now. It's these strategies that people who are autistic sometimes choose to use. So I don't know that it's good or bad, but it's certainly what they're choosing. And I think each autistic person certainly is welcome to

make their own decisions about these kinds of things. On the subject of high-masking presentations, people will very quickly wonder about or ask me about a "female" presentation of autism or perhaps non-stereotypical presentations. Those are important to consider. It's a very complicated question. Broadly speaking, I think the current revision of the DSM-5, as it always has in the past, represents autism in a pretty reductionist manner, it seems to have taken this more important idea of an autistic cognitive style and tried to crystallize that into specific behaviors, particularly those that were observed in young boys historically when

this was first being conceptualized or attempted to be defined. And to some degree, I think people make the mistake of thinking, "If your autistic cognitive style isn't being enacted in this exact manner, then maybe you're not autistic." Whereas again, those happen to be just some of the ways that this can show up for people, hence this idea of a female presentation. The point is that autism, this autistic cognitive style can show up in many, many different ways. And some of those ways are starting to be recognized differently. And this female presentation idea is one of those manners.

Regardless, Devin Price is a fantastic psychologist and publicly autistic person. And they wrote an excellent book, I think it came out in 2022, called Unmasking Autism. And I just want to quote a paragraph or so from Devin because I think that they put it very, very well. And of course, I would suggest you read that book if you have additional interest. So Devin said, "There's a significant problem with the concept of female autism. It's a label that doesn't properly account for why some autistics mask their autistic qualities or have their needs ignored for

years. First, not all women with autism have the female autism subtype." And then Devin goes on to explain that a little more. But to return to quoting them, "Autistic women aren't overlooked because their symptoms are milder. Even women with really classically autistic behaviors may elude diagnoses for years, simply because they are women and their experiences are taken less seriously by professionals than a man's would be. Additionally, not everyone who has their autism ignored and downplayed is female. Many men and non-binary people have our autism erased too. To call the stealthy, more socially camouflaged form of

autism a female version of the disorder is to indicate that masking is a phenomenon of gender or even of assigned sex at birth rather than a much broader phenomenon of social exclusion." So I think Devin is insightful and a fascinating person and excellent writer. You'll notice even just in that brief paragraph that I read, Devin using quite a bit of language that I'm quite specifically not using. So I know a lot of autistic people like or don't mind the term "autist" or "autistics" as like a noun. I don't really love that. But some people, it's

their preference. And then calling autism a disorder is something I generally avoid. I'm not perfect, but for the most part, I try very hard not to use that term because I just don't see autism as pathology for the most part. I see it as a difference, not a deficit. I'm different than other people. I'm not broken or I'm not a failed neurotypical person. I'm certainly different than most people in some ways, but these are differences, not deficits in my opinion. And again, I have these differences, but I don't have a disorder regardless of what somebody

happened to write down in a book that they happened to call the DSM. If you weren't aware, I think until 1980, being homosexual was in the DSM, which of course is ridiculous. And until 2013, you absolutely were not allowed to be diagnosed both with ADHD and autism at the same time. Whereas now it seems very, very clear that not only is there a huge amount of overlap between those two diagnoses, it varies a little bit by research, but lots of research show that at least 30%, 3-0, 30% of autistic people meet the full criteria for

ADHD. And most autistic people, even if they don't meet the full criteria for ADHD, we do tend to still meet some of the criteria for ADHD, which basically is a condition of executive functioning differences. And so to put that a little differently, almost all autistic people have some level of executive functioning differences. And the question you just need to ask is, does this person have enough executive functioning differences to meet the full criteria of ADHD? So the reason I bring that up, the homosexuality until 1980 in the DSM, and then this co-occurrence problem until 2013

is to basically discredit the DSM. Like I know it's people's best efforts, people work very, very hard on it, but those are some staggering examples of its failability. So we do our best, but I think we need to be careful about how seriously we take these current definitions because as I've said earlier, these kinds of things continue to evolve in their understanding. So to return to the idea of non-stereotypical or female presentations of autism, for now, I'll just say that this is a complicated subject. It's been covered quite extensively by many different people. So I

encourage you to check that out. Of course, starting with Devin Price's book could be a good choice, but there are many other options and I've written some brief articles about this kind of thing as well. So next up, I wanted to try to give people a sense of who I am, both generally for any listeners, so they know what they're getting into and beyond that for my clients or potential clients, because it can be particularly helpful for them to have a better sense of what I'm like, how I sound, and my perspective on these kinds

of related issues. Because when people are going to sit down with me to do clinical work, that can be pretty intimidating, especially given the likelihood for a medical trauma. So giving people a bit more exposure to me ahead of time, I have found can be very, very helpful to people's level of comfort. Beyond that, a more specific purpose for the podcast is to provide, well, some form of ongoing support to past clients, as well as anybody who's exploring autism and wondering if they're autistic or has self-identified or has been diagnosed by someone else. This reminds

me of a really important old quote that I'm going to paraphrase poorly, but it says that it's much more important to know what kind of person has a condition rather than what condition a person has. And when I first got into working in mental health, I worked in what's known as community mental health. So I was working very directly with adults, many of whom had conditions like schizophrenia or bipolar disorder and these kinds of things. And at the time, I didn't really know that much about these kinds of diagnoses. So working very closely with these

people and getting to know them quite deeply over a number of years quickly had the effect of humanizing this experience of, quote, mental illness for me. And I found that to be incredibly powerful and life-changing. And the focus was really on dignity and wellness and connection and building just a caring community. And that's really come with me later into my work as a psychologist and providing assessments these days. I never let go of and I never want to let go of that humanized sense of these things and seeing the depths and complexity that each person

has and really trying to take the time to understand and respect that in each person. It's really become a cliche for therapists and healthcare workers and so on to say that they're honored to work with their clients and to sit with people as they're experiencing or sharing these kinds of things. But I definitely do feel that way. I've learned vastly more about mental health and health and love and care and human relationships and values and these kinds of things. I learned far more about that from these people that I was trying to help, whether you're

calling them patients or clients or whatever word you want to use, they're human beings we're connecting with. And they taught me so much about being a person and what we need to be well as compared to academia. And I don't want to be disparaging towards academia. It was useful in its own way, but I think without this human element, it's not worth very much. So I feel a lot of gratitude for the people that I've connected with and learned from over the years and now decades through this whole career of mine.

Now I'm going to spend a few minutes talking about who I am, just a little bit about my youth, and then getting into more detail through my journey of becoming a psychologist and then in particular, how I found out that I am autistic. So I mean, very briefly, as a child, I was a pretty quiet person. I had a small number of friends throughout. I always found school very easy, typically quite boring. I mean, elementary and high school. I was lucky enough to have many incredible teachers. So that really helped. Even so, I just didn't find much of it

very engaging, which led to the classic experience at some point in your university career. You face for the first time, a real academic challenge, and you have no real skills for studying or working on a project as hard as you need to. And you also have no experience with actually needing to persevere in an academic challenge, which is important. And I just didn't, so I had really bad habits for a long time, which I'm sure my executive functioning differences played a role in. Regardless, I had some psychoeducational testing done when I was younger, probably around

grade five. And that kind of thing is actually very, very common for autistic children. Even if they're undiagnosed, we tend to have somebody has some reason to get us to interact with the mental health system like that, or often with a speech language pathologist or these kinds of things. It's very typical to see in a history, but anyways, that's a tangent. So through high school, I never really knew what I wanted to do, but I did enjoy reading and writing a lot, and always had been sort of ahead with those kinds of things. And again,

there's another one, that hyperlexia, which is very common for autistic people. So in some ways, I had considered doing an undergraduate degree in something related to that writing and so on. But for other reasons, I originally went to undergrad for music composition, and then I think I changed my major or sort of added a minor, became a double major and so on, I think five times before I finally finished. And so ultimately, my first degree I finished in English Lit, but by the time I finished it, I was certainly ready to leave. After that, I

mean, I took about a year off of school and I worked and traveled and did a lot of rock climbing and sort of just camping and things like this, living sort of as cheaply as possible and experiencing the world and just sort of wandering and not knowing what I wanted to do. I had grown up sort of near Toronto, but due to a relationship I was in at the time, we both moved to Calgary. And then I very quickly was just working and didn't know what I wanted to do. And I found that very uninspiring.

And ultimately, I found a graduate degree in counseling psychology, which appealed to me very greatly. And at the same time, I started doing a bunch of volunteering at different mental health organizations, crisis phone lines, these kinds of things. And then that volunteering experience allowed me to get my first job in community mental health, which I talked about earlier. And I worked there from 2012 until maybe 2016. And then going through graduate school and still working. And then I had an eight months long internship, which is typical. I found my undergraduate years to be, especially early

on, very socially challenging and confusing. In retrospect, I did a lot of coping and sort of tried to make things easier by drinking a lot of alcohol, which is a pretty typical kind of approach, both to ease the difficulty, but also to, as sort of a social lubricant people sometimes say. Later in my third and fourth year, I did a lot of rock climbing and I worked at a really unusual restaurant on campus. So through both of those activities, I met all kinds of wonderful and strange people that I got along really well with and

have continued to be friends with. Many of them even many years later at this point. By the time I got to graduate school, I was so much more interested in the work I was doing compared to my English lit classes or philosophy or music composition and things like that from undergrad. So I did find it much easier to focus and work hard and just put in the effort that was required because I knew why I was doing it. And it felt very important to me. But I will say that at this time, I still didn't

know I was autistic and the focus was so deeply on therapy and how to do good therapy. What were the mechanics of building rapport and structuring a session and all these different potential mental health concerns a person can have and what they look like, what they feel like, what to do about them, how to try to help people. And this felt very foreign to me. All of it felt very foreign to me. And I didn't really take note of that at the time. I just thought, "Hey, I don't know how to be a therapist and

here's 10 million facts that I need to learn about how to do that." And in retrospect, I think a lot of it was a lot more intuitive to most of my peers. Whereas for me, it was like this mechanical learning and then mechanical practice. But now in hindsight, with the benefit of having done many, many assessments and met hundreds of autistic people and spoken to them in depth, I found these experiences, I mean, I found them very stimulating and interesting because that's how I tend to approach things. I'm very curious and at least the right

kinds of cognitive stimulation and challenge I find very, very interesting. So I just found this fascinating. And again, in retrospect, this is probably why I became a psychologist because I didn't really have a good understanding of human connection and why people did the things they did and what they were expecting from me. And my education and work experience was teaching me all those things, sometimes very directly, sometimes quite implicitly, but it was all right on that track of what's going on? Why is this going on? What should I be doing? And I just found it

very interesting. I wasn't trying to learn how to mask or anything. And I'm not sure that that's a goal that's valuable to pursue. I just had this intellectual curiosity as many people do, especially autistic people do about social experience. And I just followed that. It was very challenging for me to find myself a graduate internship. This is the eight months at the end of your master's degree, you have to go and do usually an unpaid internship. And it varies, but just a couple hundred hours of therapy over the eight months. So like, I don't know,

10 or 12 hours a week in session with people and then lots of supervision and other learning and so on. But in my school, you had to find your own. And the challenge was there was no support. And it was like my first quote, serious professional attempt to go interview somewhere that I found introduce myself face this situation that like, I am not very well equipped to face. And especially at this time, if I was, I don't know if I was 26 or 27 or something like that. Long story short on that one, it went

very poorly. And I didn't, I didn't find any, I didn't get an internship despite interviewing at a number of places, none of them wanted to have me. And it was very disappointing. It was the first time in my life I'd felt like I had truly failed at something that mattered to me. I can see on the one hand, it was a bit of that, like, I should have persevered and tried harder, but I didn't because I sort of hadn't needed to do a lot of that in the past. That was definitely like, that was my

fault. And then some of it was this was a really a significant challenge on some of these pieces that me being autistic makes quite challenging for me. So it was a bit of both. Regardless, as I said, I felt very disappointed and I rearranged my graduate program, I was doing an accelerated version of the program to finish it in two years instead of instead of three. So I that I had to let go of that goal and rearrange everything. And then I remember I got, I called this place that I ultimately ended up working for

many, many years, I called them and said, and I said, Hey, do you have a wait list for internship positions? And this administrator told me that they had one, but there were so many people on that wait list for a position that it's not worth putting my name on it. And I remember feeling sort of very desperate in that moment and said, well, like, I, and I felt like that's a ridiculous answer. Can't you just please put me, just put me on the list and we'll see like, what's the harm in putting me on the

list? And so they did. And two weeks before that internship was supposed to have started originally, had I not failed to get one, that place called me. The mythically long wait list had actually been moved all the way through and my name was next. So they offered me a position. So I rearranged my program again, and I did the internship sort of as originally planned, which was excellent. And I learned a ton. It was great. It was exhausting. And I recall, especially later near the end, as everything got busier and because I was still in

grad courses at the time, there were sort of these crunch periods where I just felt super overwhelmed. Again, in retrospect, I was obviously burned out and I didn't know it. So I remember distinctly saying to people at the time, I feel like everything that I do in my free time is in service to make sure I'm just barely okay enough to come back here again tomorrow and do this therapy thing again, which is very unbalanced and unhealthy as graduate school sometimes is.

The next step in my licensing process was to, I mean, you have to get sort of provisionally licensed, it's called by the College of Psychologists. And then you spend, I mean, roughly a year working under a senior level psychologist, getting a bunch of different kinds of hours, but mostly you're just trying to get about 900 or 1000 hours of providing therapy to people. And so I did that at the same place I had done my internship. They were a sort of highly organized, large organization that focused a lot on that postgraduate training. So it was a wonderful place to learn and grow and have a team and a great

supervisor. So I felt really lucky through that whole process. And a key point here to consider is that I was enacting a role socially, I was a therapist in these moments. And you'd think that perhaps you might think an autistic person might have quite a bit of difficulty being a therapist because of their autistic traits. And I can see why someone might say that based on the DSM criteria for autism. But I mean, first of all, autistic people can have very deep and meaningful social connections and emotional experience and emotional connection and empathy and these

kinds of things. Not the least of which based on the deep compensation that I explained earlier, but many other things as well. And so one point that I'm trying to make here is that autistic people tend to do better in roles and sort of more structured social experience. So in some ways, a therapy session can be or feel fairly structured, and you can become very familiar with being a psychologist in these therapy sessions. Anyways, I met some wonderful friends through that period, again, many of whom I still am friends with today. And eventually I wrapped

the whole process up, wrote this huge licensing test and became fully licensed as a psychologist, which was an exciting moment in a long road. At this point, it probably shouldn't surprise you that not only did that same place I had done my internship and provisional hours, they offered me a job. But because it all felt so familiar to me, of course, I was happy to take that job. So now we get to the part of this story where I find out that I'm autistic. I was 29 years old, I believe, and I had this young

client. I should note that I've changed lots of the client details here to protect client confidentiality. So I meet with this person, you know, somewhat regularly. And I recall thinking like, you know, I like this person, they seem charming and intelligent, and they're nice to spend time with. And we get along and we're laughing. And I just, I believed my client, that they were having the difficulties they were describing, but I just wasn't seeing it between us. And in retrospect, that makes a lot of sense. But it made it a very interesting experience between what

I was feeling and seeing versus being told. Regardless, we talked a lot about anxiety and these kinds of things and social experience. And periodically, this client would bring up sort of unusual seeming sensory experiences. And I had just spent many years working mostly with people with schizophrenia and bipolar disorder and these kinds of things, but, you know, who are experiencing hallucinations at times. And so this person mentioned occasionally perceiving things in a way that didn't quite match their surroundings. And they talked about it in a way that stood out to me as somewhat unusual. And

so I was immediately thinking about hallucinations. And they were within reason, they were around the age of average onset for these kinds of conditions. So I was thinking about that and sort of watching and checking all these different pieces. And it just didn't fit at all, right? Their thinking was calm, logical, linear, it just didn't make any sense. But that's all I thought about it. I thought, well, it's not a hallucination. And then in one of our later sessions, they mentioned a particular sensory experience. It doesn't matter what it was, but it reminded me of

sleeping with a weighted blanket. I'd mostly heard about weighted blankets in the context of autism. So that's where my mind went first. And then I thought about all the social difficulties this person was describing to me and immediately had the thought of like, wow, like might this charming, intelligent person in front of me be autistic? Does that make any sense? Could that be possible? And then I sort of had to confront like, oh, I know next to nothing about autism. So this totally could be true. So we wrap up our session like normal and I

go to my colleague, Steven, and I ask him about autism and I briefly tell him what's going on and basically what should I do? And he gave me a couple of suggestions and things to read and so on. One of his suggestions was, hey, there's this really common test or screening test for autism. It's called the autism quotient, the AQ. There's 50 questions. It's all over the internet. Look at the AQ test to get a sense of the kinds of questions that it asks and see how those relate to what your client's been describing. And

then you can read more about those areas as well. So I go back to my office. This is within half an hour of the session. I go back to my office, close the door, find the test, and I start answering the questions. Just going along, I think even by question six or seven, I was sort of laughing to myself about how relevant these questions felt to my own experience. But I was dismissing it. I was like, oh, this is this what a funny thing that these quirks of mine would be in the first couple of

questions of this test. And then I sort of set that aside and keep focusing on my client's potential, like what they might answer. By question 10, this kept happening. And I was like, well, this is weird. And by question 15, I gave up, I refreshed the page and was kind of not freaked out, but very confused. And I started just answering the questions for myself, which is what you would normally do with that test. I very distinctly recall the experience of filling this test out that evening, and how surreal and bizarre it felt to me

getting to question 20 and then 30. And just over and over and over thinking, what's going on? This is a collection of 50 of the things that I have to warn everybody about in my life as they get to know me. So I by the way, you should know I do this or I do things like this. I know it's quirky, but I act like this sometimes. And depending on the situation, I do X, Y, and Z. And it might seem odd, but I'm just like that. And so it was, it just didn't compute for

me. Why would a test for autism have 50 of those 50 of my quirks in it? It didn't have other things in it. It was all those things for me. And what I mean is it didn't compute as in it's like either I'm autistic or nothing. There didn't seem to be any other option. It just didn't make sense. Because the point of these kinds of tests is that they're supposed to differentiate between even very similar concepts like social anxiety versus autism, or complex trauma and autism. The people from those different groups might say yes to

lots of the same questions, but hopefully if these tests are good, not enough of them to cross the threshold. The AQ is out of 50. You get a single point for every positively keyed answer. And the threshold varies a little bit depending on what research you're looking at. But it's something like 29, I think a lot of people would settle on, you know, closer to 31, 32, or around there. And I don't have it right in front of me. But the average score for non-autistic people is typically I think around sort of 14 and a

half, 16, things like that. So quite a ways away from 30. And my score on the test that first time was I think like 43 or 44. So very high, like unquestionably beyond the threshold. So I learned a little more about autism that day. And then I just went home feeling really confused. And that persisted for me for quite some time, just this surreal feeling of like, am I autistic? And what does that even mean? Because there's this initial hurdle of like, how could I be autistic? Because everything, the very small amount that I know

about autism, which of course, admittedly, was based on, you know, movies and inaccurate social stereotypes and so on at the time, didn't fit at all with how I saw myself. I think it's really important to note that because that's true for tons of people. You know, it's improving, fortunately.

The point is, lots of people don't know very much about autism. They knew as little as I did at the time. But the weird quote weird thing is that I was a psychologist when this happened. So you would think you might hope that of anyone wouldn't a

psychologist know this stuff. I wasn't a student. I didn't work in some unrelated field. I worked in a very related field. Admittedly, at the time, I didn't work in assessments, neither did pretty much any of my colleagues that I saw on a regular basis. What I'm trying to say is, first of all, it's incredibly common for people, including healthcare professionals, to know a shockingly small amount about autism. And that was me, I was in that camp. And for a time, I felt sort of embarrassed about that. But now, it just feels like a normal experience

for healthcare workers as in autism is just not well understood really anyways. And it's not well taught in many graduate programs. So I frequently come across doctors and family doctors, psychiatrists, psychologists, social workers who know very, very little about autism, who know as little as I used to, which can be very frustrating or upsetting for lots of their clients. But I'm not really in a position to criticize people because I certainly was there myself. Anyways, in the following weeks and months, I learned way more about the autistic experience for adults. I learned about high masking

presentations. I eventually learned about things like alexithymia, this sort of difference in emotional awareness and emotional expression, which is highly relevant to me. And just these million little pieces of what it feels like to be autistic. And there's this old saying, if you've met one autistic person, then you have met one autistic person. And so as in we're all different. And I had to read, as I always do, I had to read pretty much everything about it, and then pull out the parts that really fit for me. So logically coming to know that I was

autistic really didn't take me very long. But the challenging aspect for me was the emotional labor, which because of the alexithymia, I was not well prepared to do. And unfortunately, at the time, I was extremely burned out, which makes sense because of graduate school and all these different things. But autistic people are more vulnerable to becoming burned out because we have all the quote normal stuff that contributes to anyone becoming burned out. But we have these extra pieces as well, such as our sensory sensitivities or the exhaustion that comes along with social masking and so

on. There's a bunch. So we're more vulnerable to becoming burned out. And then when we are burned out, for those same reasons, it's often quite difficult for us to recover. And all of that's made way more challenging when you're autistic, and you don't know that you're autistic, because you're not monitoring for these differences, you're not aware of them, you're not taking them into account with your decision making. Of course, over the years, lots of autistic people, even when they don't know they're autistic, they can intuitively start to recognize what some of what does and doesn't

work for them. And a lot of those pieces speak very directly to their autistic experience. And that's good. That process, again, just becomes so much easier when you know you're autistic. And then you can very specifically learn about what's going on and how all these pieces tie together and what kind of changes or accommodations would be most useful for you. Regardless, more broadly speaking, there's no wrong way to feel about finding out that you're autistic. For lots of people, it's relieving and validating. And as I was mentioning a minute ago, like from a practical point

of view, it's extremely useful to know that you're autistic. And for some people, that's all they ever feel is these positive, you know, helpful, hopeful kind of things. And that's fantastic. For some autistic people, perhaps many, they have a more complicated emotional response over time. A fairly common thing for people to feel is grief for their past self. And personally, that was the primary thing that I experienced in trying to reconcile this shift in understanding and identity. I wasn't well, there was I did feel quite a bit of stigma. And interestingly, like healthcare workers sometimes

are like the most harsh or severe people for stigmatizing someone who is autistic, whether that person's a client or in particular, if that person's a colleague. So it was pretty uncomfortable for me to go to work every day and know that I was autistic and be like, am I like, should I tell some of my coworkers? Should I tell my supervisor that was on my mind sometimes? And that's interesting because it reveals my state of mind at a time that this was something I was still struggling with. I don't want to say I was ashamed

of it, but something along those lines, it was a confusing and difficult time for me. And I wasn't getting much specific support related to it. I did seek therapy from some people who claimed to specialize in this. And most of them were entirely unhelpful, which was frustrating. I want to be really clear that I don't think that being autistic is something to feel embarrassed about or to feel ashamed of. But again, I was still in this place of basically ignorance and stereotype. And I was shifting that, I was learning about it, and then doing the

work of internalizing that different way of thinking, this neurodivergent lens. But it took me quite a while to flush out that old ingrained way of thinking that wasn't something I had devised, but was something I had sort of absorbed from our culture. And the term here partially is internalized ableism. And so that's where those feelings were coming from at the time. And they were uncomfortable and sort of took a lot of work to resolve. Regardless though, the grief wasn't about that stuff. The grief I was feeling was relating to my past experiences and just thinking,

I know I can't go back in time and change anything, but it's pretty hard to believe that nothing would have been different for me had I known I was autistic two years ago, five years ago, 15 years ago, 25 years ago. Even just thinking about trying to get my graduate internship, which went very poorly as I just explained, that probably would have gone differently for me. And I'm not saying I would have told them I was autistic and they would have taken pity on me. I just mean I would have known what I needed so

I could take care of myself and prepare differently and these kinds of things, let alone this sort of endless highlight reel of suffering and confusion and hurting people that I cared about without meaning to and without understanding what I had done or what to do differently in the future. And feeling isolated, rejected for all these things for decades and decades. And just thinking like, I mean, some of that would have gone differently for me, but it didn't. And I just feel some grief sitting with that reality. John Kabat-Zinn defines healing as coming to terms with

things as they are. And so I think that that grieving was just the emotional labor involved in shifting my understanding and then just releasing all these pieces and these feelings related to the suffering I experienced as I came to understand that quite differently. Because we are humans tend to seek meaning. And in the absence of the correct answer, I'm autistic. As I went through all these confusing or difficult or embarrassing situations in my youth, you still seek an answer. You still want to know why am I like this? Why am I acting this way? Why

do I keep screwing this up? And we tend to get feedback from other people over the years about these moments, whether it's explicit or implicit. They're letting us know they don't like it. They're letting us know they don't like us or how we're behaving or these kinds of things. And so again, in the absence of that answer, you're autistic, we can start to worry that those answers other people are suggesting might be correct. So you're acting this way because you're selfish, you're annoying, you're stubborn, you're too sensitive, you're dramatic, you're an asshole, you're a narcissist.

Returning to this idea of grief, it made me wonder, might people around me, my family, my friends, my teachers and so on, might they have been able to support me a little more accurately? It's not that these people cared about me and they tried. But again, they didn't know what my needs were specifically enough and neither did I. So it made it much more challenging to meet those needs. And I think most importantly, might I have been able to be more accepting towards myself in those moments and sitting with them after? Like I said, we

can start to worry that these other people are correct, we can start to internalize that messaging, whatever it is that you're a bad person, you're selfish, dramatic, whatever. Because then we start policing ourselves. I find that to be one of the saddest things or like the most tragic things. You can be completely by yourself, completely alone, and you have some thought. And then you start looping or internally beating yourself up in a similar manner to how other people used to criticize you or criticize you, at least when you're not by yourself. So it's sort of

like we're doing this thought police thing to ourselves, which of course is so far away from self-compassion and self-love and these kinds of things. I also looked at how hard I had worked for decades to try and change some of what I now see are autistic traits. And I didn't hate myself, but I was just like I would hurt someone by accident that I cared about and think, you know, why did that happen? Why did that happen again? I need to read a book about this or five books. I need to journal about this. I

need to do more yoga or start meditating or try this course or that course or whatever. You know, try so many different approaches for years and years and years. I just worked so hard on like personal development and integrity and these kinds of things. And lots of that work was fruitful and great, but some of it was focused very directly accidentally on my autistic traits that just can't change. And so that effort best case scenario went nowhere and more likely is going to make a person feel a lack of agency, right? You put in this

effort and it doesn't work. Go to therapy, right? And you don't know you're autistic, your therapist doesn't know you're autistic. They give you all this stuff to do. And you know, maybe some of it works, but a lot of it's not working or doesn't make sense to you and you're trying and it's not working. And you think, I guess I'm like, whatever it is, maybe I'm stupid. Maybe therapy is just not for me. Maybe I can't like why can't I figure this out? This stuff works for pretty much everyone else. But here I go again,

being too weird and too different. And this just isn't working for me. And so that's the opposite of building self-efficacy, right? You build agency by you set a small goal, you put in the effort and you meet the goal and then you feel like, hey, I can accomplish things. And so when you when the opposite happens, you feel like, oh, I guess I can't accomplish things. And I feel helpless, hopeless, kind of down. And so that's not a great cycle to be in repeatedly. So in my opinion, finding out you're autistic, particularly later in life,

one of the most important outcomes is it allows for increased self-acceptance. And you can imagine sort of three steps there. Step one is learn all about your experience of autism. Step two, use that information to reprocess your past experiences, and also how you understand yourself today. And then through that, reprocessing and emotional labor, ideally, that's leading to more self-acceptance. And then step three is the natural progression, use that knowledge and then the belief that you deserve it to change your life, as in you deserve to change your life. So that's step three is change and

accommodation. So knowledge, acceptance, change. I'll return to the idea that there's no right or wrong way to feel about finding out that you're autistic. Everybody makes peace with it in their own way. And lots of people don't feel any grief about it. I'm just saying that, you know, I did in my own way. Here we are many years later. And, you know, that that I now with the benefit of perspective in hindsight, I see that that initial emotional processing work, which felt big at the time, was a time limited experience. It was an early step

that I had to take. But on the timescale of my whole life, it was one year maybe of hopefully another like 40, 50, 60. So it was this little fraction of the experience. But of course, that can be challenging to keep in perspective while it's happening. Now I want to talk for a few minutes about the shift from my fairly general work in therapy, working with pretty much any case that was assigned to me at the agency that I used to work at, to getting into working with autistic people and other neurodivergent people, quite full

time. I mean, the very short version of part of that story is that I got a concussion. It turned into post concussion syndrome, I was also burned out at the time. So my health was impacted for quite some time. And I first I took a few months off work, generally, but ultimately, I ended up leaving and taking more time off work. And as I started to feel better, I had in the interim really wondered about, is doing a lot of therapy every week, just sort of session after session? Is that a great fit for me

given my autistic traits? And I mean, everyone's different. I know lots of autistic therapists, psychologists, social workers, and so on, who do see clients for therapy all week. But anyways, seeing some some normal issue amount for me was quite draining, was very draining and quite challenging for me, despite me loving the activity of being a therapist. For quite a while, it was my favorite thing to do. And it's just so stimulating and interesting. And you get to try to help people in a very clear and direct way and connecting and learning more about human nature.

And it was just a beautiful, fascinating way to spend time. So it was for a while, it did really feel like a lot to let go of, which was particularly difficult when I didn't quite know what I wanted to do. Fortunately, I'm lucky enough to have this very cool credential, which would allow me to do a lot of quite different activities professionally, like therapy, but also clinical supervision, research, insurance, policy, assessment, for example. And I have done quite a few of those things in the past. From a practical standpoint, assessment seemed like a nice way

to still help people in a clinical sense, but not have all of my work hours be directly like client facing like time spent with people. Beyond that, in that time when I was away from work, I thought a lot about shifting my specialization towards working with the autistic community in particular. Even if I was going to quote, just do therapy, I would want to do that mostly with neuro divergent people. So that was very clear to me that I wanted to contribute directly to that community. It felt very important, very meaningful to me. And then

from a more practical lens, doing the work of assessments rather than therapy was probably, it seemed like it was going to be a better fit for me for my social battery and these kinds of things. So I started doing that. And it was fascinating and interesting. And of course, taking on a new practice area is a substantial professional commitment and required lots of training and education and supervision and all these different things. But I was feeling very motivated and did all of that work for years. I think I have the obvious advantage as well, being

autistic myself, I think that deeply appeals to many potential clients, but also from that networking point of view, I think people tend to find that quite interesting and compelling. But early on in that assessment work I was doing, I never directly said that I was autistic in a public way. I told many friends and family. And when I was communicating directly with clients, I would let them know I was autistic, but publicly in writing, I would say that I'm neurodivergent, which is true, but it was sort of intentionally vague because it was still fairly new

to me. And I was still wrestling a bit with that stigma. And to some degree, it's known that at times the most stigma can come from other healthcare professionals. So if I were to tell colleagues that I was autistic, the repercussions could be more significant than telling people in my personal life. And also those healthcare professionals could be quite a bit more likely to not believe me or be dismissive or to be critical. And to some degree start to question my competency, right? It's like, if, well, hey, if autism is this condition, this disorder of

social and emotional problems, then how could you possibly be a therapist? I don't believe that. I think that that's ridiculous. And we have tons of evidence to the contrary, but these were not questions I was ready to face with people. It made me uncomfortable. And I thought, you know what? For now, I just won't say that I'm autistic publicly. Over time though, I would periodically see these discussions. And at times I got into these discussions with people who were talking about how they wish that they felt they were in a stable and secure position professionally

to be public about being autistic and for a variety of reasons, they didn't feel like they could be. And I heard from a number of people who were being very thoughtful, suggesting that there's a lot of autistic people out there who do still experience a lot of that stigma and aren't really in a position professionally or socially to advocate that effectively for themselves, or perhaps not effectively at all, depending on what's going on for them. And so if there are these autistic people who do have quite a few privileges in life, but then they also

choose to not disclose that they're autistic, that could be quite frustrating. And personally, I think it's each person's decision, whether or not they're public, about being autistic or sharing about any aspect of their identity or personal experiences, it's up to you. But I found this argument very compelling personally. And I thought, you know what, I have been extremely fortunate in my life in a lot of ways. And I do benefit from a lot of different privileges. And more than many, many autistic people, I am in a position to be more of an advocate. And I

think that the more people who are public about being autistic, the better, because that gives just one more example of what autism can, quote, look like in another person, particularly these high masking presentations. And I suppose I feel particular empathy for healthcare workers who are autistic. Like I said, there can be a lot of stigma from other healthcare workers against that. So the more healthcare workers who are publicly autistic, the better it becomes for everybody. So I was teetering in this position of kind of saying I was autistic publicly and specializing deeply in the work,

but not quite ready to say it yet. This was probably like a year and a half into my assessment journey. I just really do think that advocating when we can and in the ways we can is an important thing to do. And it was becoming increasingly obvious to me that I was in a position to do that, but I wasn't taking the action. And that just wasn't sitting well with me. So I gave it a lot of thought. And ultimately what helped me tip over into directly stating that I was autistic publicly was communicating with

a professor who I was getting to know, Heather Brown. She's a professor at the University of Alberta, I think in the educational psychology department. And she's a really wonderful person and is public about being autistic. And so her and I connected, we had a wonderful conversation. During part of that though, I had asked her about what's it like to be so publicly autistic in a role like yours. She told me that people ask her that constantly. People reach out being like, "Hey, I'm the head of engineering at this company," or "I'm a professor at this

university and I'm autistic, but I haven't told anyone at work." So people ask her for advice on this all the time, which I find on the one hand, I find interesting, but on the other hand, I find extremely understandable because that was part of why her and I were connecting anyways. And so she gave me a very positive feedback about her experience with this. And I sat with that for a couple of days, but that was really the catalyst for switching it over. So it's funny hearing myself tell this story now because years later, because

it makes it seem like this was such a big, scary thing to do, just to tell people, "Hey, I'm autistic." And it's like, what does that either say about my personal anxiety and/or the perception of autism within our society currently? And I do think that that's really stratified by generation, like younger people today who I speak to through my work and so on. There seems to be way more awareness about things like autism and neurodivergence generally, not just knowledge about it, but awareness and in some cases, a complete lack of stigma of any regard. It

just makes me feel a little bit like a dinosaur that I had to wrestle with this for so long. But of course, I was merely a product of my time. And I suppose it represents also some of that internalized ableism, which can just be so sneaky and so pervasive within a person and in this case, within myself. Telling the people closest to me was one thing, telling my friends and family and so on, even telling my clients who I was directly connected with, I got more and more comfortable with that. By the time I had

changed the written statement about this on my website in different places like that, to say directly that I was autistic, I'm sure I had told hundreds of people. So I had a lot of experience disclosing at that point. To be very clear, I don't think there's anything wrong with being autistic. I don't think that being autistic is something to be ashamed of at all. I do think that unfortunately, it's probably worth being quite thoughtful or careful about who we disclose to that we're autistic, depending on the circumstances of our life at that time. To a

large degree, everything I just explained can be understood through this idea of being who I needed when I was younger. I've always found that to be a beautiful sentiment. And I don't know exactly where it comes from, but I've always understood it to some degree from a trauma lens, as in if you experienced some kind of trauma growing up, one of the avenues to healing is exactly that. Try to become the person you needed when you were younger. It would have been so wonderful if some healthy person had entered your life when you were younger

and been supportive towards you. What would you have wished that person would have been like? What would they have acted like? What would they have done and said to you? And so on. So becoming that person now both for yourself and also for others, I think can just be such a powerful thing to do. And that's why that sentiment was already in my mind. And that's why during my time off of work from the concussion and so on, that's why I shifted my specialization onto autistic adults. And that's also why I built and continue to

optimize the assessment service that I currently offer. I was building the service or support that I wish had existed when I needed one. Back to that idea of I was trying to be who I needed when I was younger. And that's what I'm still doing. That's why I'm making this podcast. That's why I'm writing the book. I'm in the middle of writing a book explaining high masking autistic presentations to healthcare professionals because I currently explain that to healthcare professionals sort of one person at a time. And that's great. But if I can spread that information

faster or to more people that will have a larger effect, I don't care at all about the other pieces that come along with that kind of behavior of writing a book or whatever. I just think about the effect of helping people because I was in that position for so long. And instead of getting the support that I needed, I didn't get it. And unfortunately, a lot of people in that situation have their experiences dismissed or criticized by healthcare professionals who don't know enough about autism. So again, healthcare professionals are learning a lot more about autistic

experience, which is great. But anything I can do to catalyze that process, I am working towards doing. So hopefully that gives you somewhat of a sense about who I am. And within reason, I tried to share both my experience with finding out that I was autistic and what it was like for me to process that experience over time, as well as some more general comments about how that experience might go for other people as well. I know everyone's unique, but at this point, I've diagnosed hundreds of autistic adults and done lengthy interviews with them and

all the testing and also fairly substantial sessions after when I'm sharing the diagnosis and talking to them about what they're thinking and feeling, hearing that and answering their questions and these kinds of things, sharing about what's in the report. And then depending on what the client chooses, at times I do follow-up calls months later as well. So I think more than most people, I get to really have these direct and lengthy discussions with people as they're going through this process of wondering if they're autistic, then finding out that they're autistic, and then the processing that

happens in the days and months following that, which is a unique and fascinating experience for me to have and one that continues to help shape how I understand autism and my experience of being autistic about how much it matters or doesn't matter to me and how I make sense of it and how it fits within my identity. So that's it for today's episode. I really wanted to just introduce the podcast itself, introduce the idea of high-masking autism, discuss some of my story and what it was like for me to find out I was autistic as

an adult, and then blending that together with some of the common kinds of experiences people have when they're finding out they're autistic later in life. And I'll probably talk more about that in depth in a later episode. And then finishing up talking about this idea of stigma and advocacy and really trying to highlight that idea of being who I needed when I was younger, which was just such a central aspect of my journey towards healing and coming to know myself better and finding a way to contribute to my communities that I find to be very

meaningful and very motivating. So that's it for today's episode. As a reminder, this podcast is for education and entertainment. It's not clinical advice. At times I do AMA episodes, so if you have any general questions about the autistic experience or things of that nature, feel free to submit them. There's a form on my website, ndsych.com/podcast, and I may answer your questions in an upcoming episode, though of course that can't replace professional advice. Anyway, I appreciate you listening, and whether you're autistic or not, I hope you're feeling happy and healthy these days.