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6 Obscure Signs Of Autism That Psychiatrists Secretly Look For | Dr Amber Sadiq

What if the things you've criticised yourself for your entire life... weren't flaws at all? What if struggling to make simple decisions, feeling overwhelmed by change, or caring so deeply about fairness weren't personality quirks, but signs your brain has been working differently all along? Today I'm joined by Dr Amber Sadiq, Consultant Clinical Psychologist and Clinical Director at Eleos Clinic. She has assessed hundreds of autistic adults and has helped countless people finally understand why they've always felt different. Chapters: 00:00 Trailer 01:54 Why Every Decision Feels So Overwhelming 06:24 Why Autistic People Need Predictability 09:04 Why Injustice Feels Physically Painful 19:19 When You Can't Start... But Can't Stop Either 23:17 The Secret to Switching Between Tasks 25:43 The Autism Trait Everyone Calls Laziness 27:33 The Shutdown Nobody Sees 32:57 Tiimo Advert 34:17 The Hidden Reason Some People Can Mask for Decades 36:08 Why So Many People Don't Realise They're Autistic 41:14 How Masking Slowly Erases Your Identity 43:13 The Most Emotional Part of an Autism Assessment 45:15 The Moment People Realise They've Been Masking Their Entire Life 50:56 The One Sentence That Makes Psychiatrists Think "Autism" 54:15 The Autism Assessment Reactions I'll Never Forget 57:22 Washing Machine of Woes (Audience Questions) 01:03:02 A Letter to My Younger Self Download Dr. Sadiq’s free guide, Could This Be Me?, which explains why so many autistic adults were missed for decades, and what clarity could look like for you 👉 https://www.eleosclinic.com/wondering Find Dr Sadiq on Instagram 👉 https://www.instagram.com/eleos_clinic/ Get 30% off an annual Tiimo subscription 👉 https://www.tiimoapp.com/offers/adhdchatter Buy Alex's book entitled 'Now It All Makes Sense' 👉 https://www.amazon.co.uk/Now-All-Makes-Sense-Diagnosis/dp/1399817817 Order Alex’s book about Rejection Sensitive Dysphoria 👉 https://linktr.ee/adhdchatter?utm_source=linktree_profile_share&ltsid=9ffd8709-06df-444c-9936-c136fbd14d6e Producer: Timon Woodward  Recorded by: Hamlin Studios Trailer editor: Ryan Faber DISCLAIMER: The content in the podcast and on this webpage is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

Alex PartridgehostDr. Amber Sadiqguest
Aug 3, 20261h 4mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 1:54

    Trailer

    1. AP

      Autistic people, they like watching the same film over and over again, listening to the same song. Does that predictability give them comfort?

    2. AS

      There are sensory differences, being hypo or hyperreactive to sensory aspects. That's why a decision that feels so small, like picking socks out of a whole sock drawer-

    3. AP

      Yeah

    4. AS

      ... can feel extremely difficult.

    5. AP

      If they don't have that awareness, can that person just believe that they are too sensitive?

    6. AS

      Autism or not, you often believe what you're told. You are too sensitive, too much, too mouthy, too defensive. People start to believe those external voices, and they internalize that.

    7. AP

      What's the autistic person scared of? Is it perfectionism, or is it something deeper?

    8. AS

      There's so many aspects to this. So one is-

    9. AP

      Can I have just a second of your time? If this podcast has helped you understand your brain or made you feel less alone, can you do me one favor? Can you hit the subscribe button? And I'll repay the favor by continuing to book the best and most exclusive conversations on this topic. Please enjoy the episode, and always remember you're not broken, just different, and you have always been enough. [upbeat music] Dr Amber, most people probably think, like, they know what autism looks like or at least the signs of it: difficulty making eye contact, sensory sensitivities, wanting routine. But you as a consultant psychiatrist, you've seen thousands of neurodivergent individuals.

    10. AS

      Mm.

    11. AP

      So today we're gonna explore the six signs that a psychiatrist will look for in an assessment that might not be the obvious ones. But before you begin, you said something fascinating off camera to me, and that's that there's one sentence that people say during an assessment that makes you as a psychiatrist think this person has autism. But we're gonna come back to that a little bit later because I truly believe that that is gonna shock people.

  2. 1:54 – 6:24

    Why Every Decision Feels So Overwhelming

    1. AP

      So today let's start with the first sign, and that's when every decision feels enormous. One thing someone with autism said to me was that they can spend 20 minutes deciding on what pair of socks to wear in the morning, for example, and that-

    2. AS

      Mm

    3. AP

      ... it's not because they don't care. It's because that to them every single decision feels immensely important. That kind of thing, is that something you hear often in autism assessments?

    4. AS

      Autistic individuals often describe the decision-making process as being really difficult at times, uh, often more than not, and it's because, like you said, Alex, that every decision has multiple variables, multiple inputs, and so many outcomes as well. And for people that are autistic, they care so deeply. They process deeply. They're looking at, you know, that, that question or that dilemma or that decision as, as being a very important one. And therefore, because they process deeply, it can also take them longer to process. So whereas somebody who isn't autistic might be able to make that decision very, very quickly, someone who's autistic will take longer, and they might find that process really laborious, really tricky because they're looking at all the different possible questions around, let's say, picking something from a menu. That can be one of the most common things that I see in my clinic. It's people that say, "You know what? When I go into a restaurant, first of all, I have to deal with the noise, the sensory input. I have to deal with the people. So I don't know what's going to happen next." People that are autistic, they prefer predictability and therefore maybe going to a restaurant where you know what to expect, what the menu's going to look like. Maybe you've whittled down to a few options-

    5. AP

      Yes

    6. AS

      ... feels a lot easier-

    7. AP

      Mm

    8. AS

      ... than having a whole menu where you're having to weigh up the pros and cons and what it might taste like, and is this going to be as good as the last macaroni cheese that I had?

    9. AP

      [laughs]

    10. AS

      And that can be, you know, very, very difficult and very cognitively demanding. What I mean by that is that it uses up a lot of energy. So if you can imagine in an average day, an autistic person has to make so many decisions. They're kind of having to, you know, make, make an opinion on not just what they're going to eat, but are they going to leave the house, um, you know, managing their day-to-day structure as well, that that actually involves a lot of energy in the first place but also then that addition, an additional part of transitions and moving from one thing to another. So often, you know, what I see in clinical practice as a psychiatrist is that decision-making can feel very, very painful, and it looks different from what we might see with other neurodivergent conditions as well.

    11. AP

      So interesting, Dr Amber. So if we focus in on the decision paralysis for a moment and the lovely example-

    12. AS

      Mm

    13. AP

      ... you said, go to a new restaurant and-

    14. AS

      Mm

    15. AP

      ... oh my gosh, I have to choose what to eat.

    16. AS

      Mm.

    17. AP

      I mean, that's terrifying.

    18. AS

      Mm.

    19. AP

      What's the autistic person scared of? Is it perfectionism, or is it something deeper?

    20. AS

      There's so many aspects to this. So one is not, not knowing what to expect because the autistic brain likes to know what's going to happen next. And if they've never ate in that restaurant before, they don't quite know what that dish is going to be like, how it's going to look, how it's going to be presented. The smell as well can be an additional factor. And then if you're thinking about, um, making the wrong decision as well because often autistic people are kind of weighing up the pros and cons, and they're kind of... Every decision feels like a new, a new dilemma, a new problem, and that's often what's described to me in the clinic. And that's why it feels so hard, and that's why, you know, I always use the analogy of, of being in a, in a restaurant and how you can then put adaptations in place to make it a bit easier-

    21. AP

      Mm

    22. AS

      ... for them.

    23. AP

      So is it that autistic people, they get huge comfort from knowing the outcome, i.e., they like predictability, they like watching the same film over and over again, or they like listening to the same song over and over again because they know how it starts, they know how it makes them feel, they know how it ends? Does that

  3. 6:24 – 9:04

    Why Autistic People Need Predictability

    1. AP

      predictability give them comfort?

    2. AS

      It's really important for autistic people. Of course, I want to add just now, Alex, that one autistic person has a very different experience from another autistic person.

    3. AP

      Sure.

    4. AS

      But generally, you know, there are things like sensory differences, which we know can impact, so either being, um, hypo or hyperreactive to sensory aspects in your environment, and really appreciating and having a preference for that consistency, and knowing what's going to happen next, and being prepared for that. And that's why, you know, in my opinion, actually, a decision that feels so small, like picking socks out of a whole sock drawer-

    5. AP

      Yes. [laughs]

    6. AS

      ... or picking something that you're going to eat when you're out in a restaurant with your loved ones, can feel extremely difficult.

    7. AP

      Hmm. What happens when an autistic person is forced to make a decision? Like, they're, they're put under pressure. Is that overlapping between sort of shutdown and overwhelm?

    8. AS

      So, so there are overlaps.

    9. AP

      Yeah.

    10. AS

      There are overlaps between, you know, how autistic people make decisions-

    11. AP

      Hmm

    12. AS

      ... and what that experience is like for them. And also, autistic people generally need space-

    13. AP

      Hmm

    14. AS

      ... and time to make decisions. They need time to process, because if we think about what autism is, it's a difference in processing information and processing the world around you. So if you're somebody that just needs that little bit more time, and maybe some scaffolding around that decision-making, then if you put an additional stress, or if you ask that person another question on top of that, that just ma- that just can be so difficult for that person to manage because, A, it's unpredictable. They've not expected it. It's kind of come from nowhere. B, they've possibly not prepared for it as well, so it's kind of something that's kind of, again, you know, come out of the blue. It's moving from one problem to then moving to another problem, and we know that for many autistic people, that they struggle with transitions. So moving from one thing to another thing can feel really, really difficult.

    15. AP

      Hmm.

    16. AS

      So actually, yes, when we talk about shutdowns and meltdowns, there is an overlap, because that, if someone who's autistic is faced with multiple things to have to make decisions about, that can impact on their energy and their cognition.

    17. AP

      There was another sign, Amber, that felt like somebody had had a camera hidden in my flat and was spying

  4. 9:04 – 19:19

    Why Injustice Feels Physically Painful

    1. AP

      on me. Um, and that's the, when unfairness feels impossible to ignore.

    2. AS

      Hmm.

    3. AP

      When you feel like you should just be able to let something go, but you can't.

    4. AS

      Hmm. Hmm.

    5. AP

      And I think an example that happened to me recently, I was in a coffee shop and queuing up to get my coffee, and someone just walked in, walked to the front of the queue, ordered their coffee, and the person behind the counter served them, and they walked out and, and, and off they went. And no one said anything. Well, I, I didn't say anything, but it was-

    6. AS

      [laughs]

    7. AP

      ... it really stuck with me-

    8. AS

      Hmm

    9. AP

      ... all day. Like, how could that person-

    10. AS

      Hmm

    11. AP

      ... not stick to the rules? Like, why did no one say... I didn't say anything.

    12. AS

      Hmm.

    13. AP

      But that justice sensitivity-

    14. AS

      Hmm

    15. AP

      ... is that something that you see come up in assessments?

    16. AS

      Something that I ask about in all of my assessments when I'm looking at neurodivergence, and in particular autism, is that strong moral compass, that strong sense of justice. So it's really interesting what you describe, Alex, because that feeling of, "That didn't feel right," you know, "How did that happen?" You know, it's, it kind of jars you, doesn't it? It kind of, that experience, it just doesn't feel ethical. And if you've got a preference for rules, which many autistic people have, which I think is, is wonderful in many ways, but you're also somebody who has to make sense of a situation. And if a situation has kind of gone in a way that you think is really unfair for yourself, for somebody else, for somebody in your workplace, then you might be more likely to call that out. And that is something that many of my autistic human beings that I see, and, and families describe. They say, "Look, I've really felt this injustice, and I can't let go of it. You know, it's just, like, sitting there, and I just... It's, it's just, I keep mulling over it." Because I think there's a sense of, unless you can find an explanation for it, unless you can kind of make it right, or unless you can get that other viewpoint of why did that happen, how did that happen, often many autistic people describe themselves as being very good problem solvers. So if you're not able to solve that problem, and if someone has violated the rules, then you can really see how that could almost become an area of focus for somebody who's autistic.

    17. AP

      Could... Following on from that, could that cause problems in the workplace? If, if an autistic person who has massive justice sensitivity, and perhaps they witness somebody get a promotion, for example, and in the autistic person's mind, they can tell that-

    18. AS

      Hmm

    19. AP

      ... the reason that person got the promotion is because they might be just more chummy with the boss, not because they are necessarily there through merit. And therefore, if that justice sensitivity is so overwhelming and it bubbles up, could it cause problems where the autistic person feels like they have to say something, even though if that saying something is gonna put them in a-

    20. AS

      Hmm

    21. AP

      ... position that could cause the rest of the office to think that they're-

    22. AS

      Hmm

    23. AP

      ... awkward or being difficult?

    24. AS

      Again, there's different ways that people, autistic people, will respond to that situation. Some people will suppress what they notice and what they feel, and that kind of, that radar for noticing injustice or that something doesn't feel right, or this doesn't feel fair. You know, they may suppress it, and they might mask, and they might just say, "Look, um..." They might really feel it inside, if that makes sense. Other people, autistic people, may call it out, and I would hope that somebody in that situation has a supportive line manager or somebody that can explain why. Because often, you know, we will make some interpretations, or we'll find, you know, in that kind of, that person got a promotion and I didn't, and this is why, and these are all the reasons why, often making that autistic person feel less than or worthless, which often then fits into maybe negative experiences that they've had in the past as well. It really fits into that low self-confidence, that low self-esteem. Why that person? Why not me? I'm really hoping that in that situation, that person has, you know, someone supportive that they can go to and say very candidly, "How did this happen?" And that they can get an explanation for it as well. Because often what I find with my autistic clients is that when they have an explanation for something and it makes sense, it can really help them through. And then if they've got some practical things that they can do to help improve their situation, and if they feel heard and witnessed for what they experience internally and cognitively, then that can really help.

    25. AP

      So, so interesting. If the person is feeling intense justice sensitivity, and they have that overwhelming bubbling up of-

    26. AS

      Mm-hmm

    27. AP

      ... of, of a emotional response when they witness something that they perceive as unfair-

    28. AS

      Mm

    29. AP

      ... if they don't have that awareness of autism and justice sensitivity, can that person just believe that they are too sensitive?

    30. AS

      You often believe what you're told. So if you're told, as a human being, autism or not, that you are too sensitive, that you're too much, that you're too mouthy, that you're too defensive, that you always have a strong opinion about things, then I truly believe that people start to believe those external voices, and they internalize that as well. And they might think, especially if they get further feedback from others, that they are too sensitive, and then that then fits into that negative construct that they might have about themselves.

  5. 19:19 – 23:17

    When You Can't Start... But Can't Stop Either

    1. AP

      almost having, like, an inability to start sometimes, but also having an inability to stop. And I hear some people with autism say they just can't start a task, and other times I hear the same person saying, "I can't stop something."

    2. AS

      Mm.

    3. AP

      How can both be true at the same time?

    4. AS

      It's incredible, isn't it? Kind of-

    5. AP

      Yes. [laughs]

    6. AS

      It's, it's almost like a bit of a contradiction-

    7. AP

      Mm

    8. AS

      ... when you think about it. So if we think about kind of the, the starting of a, of a task, you know, we've talked about kind of that inertia that can happen or that sense of it's, it's too complicated to make a decision to start a task. The environment needs to feel right. Um, you know, there can be too much visual clutter. Um, there can be a lot of sen- sensory stimuli. Where to start first? You know, do you start with this bit of the problem? Do you start with that bit of the problem, that bit of the task? It can feel really overwhelming to the nervous system. And then what we find is that when some people, some autistic people start a task, then it's almost like they can't, they can't finish it, right?

    9. AP

      Yes.

    10. AS

      So they, they continue and, and to the point where someone has to tell them, or they have to recognize in themselves that they've not eaten, they've not been to the toilet, they've not drank water, and, and that can be really challenging. So I would say that kind of with the starting a task, that can be linked to transition. That can be linked to, um, starting something that perhaps, perhaps they're not interested in. If you think about, you know, autism like ADHD, it's linked to having an interest-based brain, so you're more likely to be able to do something that feels manageable, that's enjoyable, that fits in with your life purpose.

    11. AP

      So, and funny, really. Is it... Does this explain why some people, they might drive somewhere-

    12. AS

      Mm-hmm

    13. AP

      ... and then they have to sit in the car for, say, 20 minutes before they can walk into the place that they're going? 'Cause this is something that I struggle with. I, I-

    14. AS

      Interesting. Mm

    15. AP

      ... I can start a particular task-

    16. AS

      Mm

    17. AP

      ... which might be get in the car, get ready-

    18. AS

      Mm

    19. AP

      ... and go.

    20. AS

      Mm.

    21. AP

      But then I almost have to have this, like, 20-minute, 25-minute transitional period where I'm just sat in the car, and I don't know if that's related to this inertia or I, I'm still in the mindset of finishing this task. Am I preparing my mask for starting the new task? Because that's gonna be involving meeting new people.

    22. AS

      Yeah.

    23. AP

      Like, is that experience common?

    24. AS

      Yeah, yeah.

    25. AP

      Like, just having to have this transitional period-

    26. AS

      Yes

    27. AP

      ... where you might just stop yourself from going into another environment?

    28. AS

      Mm. I think it's really helpful that, that you've got that insight and, and really valuable that you're recognizing the important of, importance of that time in between tasks. I think often the challenge is when people don't build that in to their schedules. They're moving from one thing to another thing-

    29. AP

      Mm

    30. AS

      ... to another thing, and actually, that transitioning becomes way too much because it leads to anxiety, and it leads to that sense of unpredictability and nervous system, system dysregulation. So actually, that sense of kind of like needing time in the car, just kind of quiet time, [laughs] you know, I think many people will be able to, to relate to that as well. It's almost time for your nervous system to catch up on itself, to allow you to prepare for the next stage, to get your mind and your body into the right space. And I suppose what I would be really interested in is during that transition phase, what else could people do to help them regulate themselves? I think actually it's really important that autistic people recognize the importance of having extra transitions and building in some self-regulation time. I think that can be really valuable.

  6. 23:17 – 25:43

    The Secret to Switching Between Tasks

    1. AS

      Yeah, yeah.

    2. AP

      But that's so interesting. So in, in the breaks that we create for ourselves-

    3. AS

      Mm

    4. AP

      ... what could an autistic person do to make the best use of that time?

    5. AS

      Be- being intentional about-

    6. AP

      Mm

    7. AS

      ... making sure, you know, have they drank? [laughs]

    8. AP

      Yeah.

    9. AS

      Have they drank water?

    10. AP

      Sure.

    11. AS

      Uh, have they had something to eat? Have they peed? Have they been to the toilet?

    12. AP

      Yeah.

    13. AS

      You know, just making sure that their basic bodily functions have been attended to because many autistic people, when they get into that flow, or they... We call it monotropism, where you're kind of so into a task, and you can't finish it. You know, it's that leading to that kind of can't stop scenario that often because autistic people can struggle with noticing their bodily cues, so sometimes they don't know when they're hungry. They don't know when they're thirsty. They can get so caught up in something, that kind of hyperfixation, that- They don't have their needs met, and that makes it even more likely that they can become more dysregulated. So just kind of like having your basic needs met. Using breathwork, so kind of taking a pause, taking, you know, inhalation, exhalation. Stimming, you know, thinking about kind of using that opportunity to unmask as well, because often people are performing so much in today's world-

    14. AP

      Hmm

    15. AS

      ... that they don't have opportunities to unmask and just to be and just to, like, listen to their favorite song on the radio or, um, you know, watch something that they enjoy, you know, because they kind of lose sense of who they are in day-to-day life. And I think just things like that can be really valuable. Obviously, each person is going to be very different in how they want to use that time, but I think it's so valuable to build in that time and almost, like, block it in your diary as well. So if you notice that you're moving from one task to another, and on that particular day, there's a heavy cognitive load, and you're going to be making lots of decisions about things, it's giving yourself some grace and some respite in all of that, and also recognizing that perhaps in the days following, that you might need to do a bit less as well.

    16. AP

      I think au- aut- autistic people struggle with what this behavior looks like from the perspective of other people.

    17. AS

      Mm-hmm.

    18. AP

      Like, if you picture the scene, I'm sat in the car for 25 minutes.

    19. AS

      Mm.

    20. AP

      I'm doing the exercises you suggested.

    21. AS

      Mm.

    22. AP

      Or I'm at home and I'm lying on the sofa for 15 minutes between my Zoom meetings.

  7. 25:43 – 27:33

    The Autism Trait Everyone Calls Laziness

    1. AS

      Mm-hmm.

    2. AP

      Like, why do you think these transitional periods can look like laziness?

    3. AS

      Because they're not the dominant narrative about... You know, for most people who are not neurodivergent, moving from one task to another isn't as challenging. It doesn't come with the same level of anxiety. It doesn't come with the same level of decision-making. You don't have to manage the sensory stimuli. You're not having to think about all the different combinations and algorithms, and you know, that ChatGPT in your head. You know, you're not kind of going through every single possibility. Actually, you can use, as somebody who's not autistic, you can use prior learned knowledge to be able to help you make a decision, which is a different way of processing a problem. But for someone that's autistic, because you are a deeper processor, actually, it feels... It can be more exhausting, actually, for them to be able to-

    4. AP

      Hmm

    5. AS

      ... to live a life where they're having to make these decisions. And so for the person on the outside, they'll be looking at, um, Johnny or Amelia, just making up these names, you know. They'll be looking at those people thinking, "Actually, why are, why, why are they just lying, why are they just lying down? Like, what, what's going on? They should be doing more. Like-

    6. AP

      Yes

    7. AS

      ... come on, work harder. Come on, let's go, let's go for a run." But actually, what I would say for somebody who's autistic and for their loved ones is actually allow somebody to build in that restorative practice. Ensure that it's almost like it's, it's a habit. It's a non-negotiable. It's something that they build into their week, into their daily practice, because that's what's going to help them in the longer run as well.

    8. AP

      I wanna move on to the sign of autism that I think probably causes the most damage-

    9. AS

      Mm-hmm

    10. AP

      ... if it's not

  8. 27:33 – 32:57

    The Shutdown Nobody Sees

    1. AP

      spoken about, and that's the shutdown that nobody notices. I think we mentioned-

    2. AS

      Mm

    3. AP

      ... briefly earlier-

    4. AS

      Mm

    5. AP

      ... uh, meltdowns, but I think nobody talks about shutdowns quite so much.

    6. AS

      Mm.

    7. AP

      What is the difference between a meltdown and a shutdown?

    8. AS

      Meltdowns and shutdowns, in, in my experience, often come from a similar root cause. They come from a sense of being overwhelmed. They come from an experience of your resources not quite meeting the demands that are being placed on you or the activities that you're having to engage with. Also managing sensory stimuli, which can be extremely difficult. Managing social interactions, some which are predicted and some which, which are not. And a meltdown is more of like, if you think about someone whose meltdown, having a meltdown, it's more of a dysregulation on the outside. So, you know, somebody who becomes very upset, who becomes very distressed. Um, you know, there, there might... It's, it's, it's, it seems like it's more of a problem, but actually, I see people who go inwards, so they experience the same level of anxiety and nervous system dysregulation. But actually, the way that they respond to that can look quite different.

    9. AP

      Hmm.

    10. AS

      Where, again, the autistic experience is so varied.

    11. AP

      Sure.

    12. AS

      So you've got autistic people that are non-verbal. You've got autistic people that are verbal. Often, in the clients who I see who are verbal, the majority of them, they describe losing their ability to speak. They just, they don't know where this comes from, and I always ask about it. They lose their ability to engage in everyday activities. This could be things that they can actually do really well on a normal day, but they just can't do it anymore. You know? Even getting out of bed can be really challenging. Uh, or they might almost kind of appear fine, but they're not processing in the way that they normally do. And in my opinion, and from my experience, that's coming from a real sense of overwhelm and a real sense of protection. Actually, it's, at that point, it's like an acute episode that that person goes into in order to help them cope with a situation.

    13. AP

      So interesting. You said you could go non-verbal if-

    14. AS

      Mm

    15. AP

      ... if you aren't otherwise non-verbal.

    16. AS

      Mm.

    17. AP

      And I think-

    18. AS

      Mm

    19. AP

      ... I think of my own story a little bit here.

    20. AS

      Mm-hmm.

    21. AP

      I mean, I, if I have an, a conversation with one person, I, I enjoy that.

    22. AS

      Mm.

    23. AP

      I'm able to monitor their reactions.

    24. AS

      Mm.

    25. AP

      I'm able to listen to them. I'm able to have a good conversation, I think. If there's more than one person It's a significant struggle. If it's three or more people, for example, if I'm in a restaurant with a group of people that I don't know very well, I go non-verbal to the point-

    26. AS

      Mm

    27. AP

      ... because I'm... It's too much to pay attention to.

    28. AS

      Mm.

    29. AP

      It's too many different people to observe their patterns and understand what everyone-

    30. AS

      Yes

  9. 32:57 – 34:17

    Tiimo Advert

    1. AS

      screaming.

    2. AP

      So sorry to interrupt your hyperfocus, but I promise it's worth it. Our sponsor is Tiimo, the best organizational tool for neurodivergent people. Tiimo wasn't named iPhone App of the Year in 2025 by Apple for no reason. It's the ultimate planning partner, gently helping you turn the chaos in your head into a day that actually feels doable, a day you might even look forward to. Tiimo is designed by neurodivergent brains for neurodivergent brains, and you can tell. It supports the stuff ADHD brains can find hardest: managing time, planning what needs doing, prioritizing tasks, staying focused, and actually finishing the thing. And the great news is Tiimo is now back on Android. The app on Android is still being built up to match the iOS experience, with even more features in the works. So if you're an Android user and you've been waiting to try it, you can now use Tiimo's core features too, including your daily plan, multiple to-do lists, and AI prioritization to help you figure out what to focus on first. Tiimo offers a visual way to plan your day without relying on willpower, memory, or a million sticky notes, helping you break down your daily agenda into something clear, calm, and actually possible. Give it a go, and use the link in my bio for 30% off. Just a note, though, the code only works in the web browser, not in the smartphone app. Back to the episode.

  10. 34:17 – 36:08

    The Hidden Reason Some People Can Mask for Decades

    1. AP

      This is interesting. If I'm with a group of people, I f- I find that I can't even mask, because I don't know who to copy. If I'm on a dinner table with three or more people, I'm thinking, "Who do I mirror? Whose mannerisms-

    2. AS

      Mm

    3. AP

      ... am I copying? What persona am I putting on to..." 'Cause there's too many people to please, so I don't know what to do, and I just completely shut down and do nothing. Is that experience common, do you think?

    4. AS

      It is in terms of the autistic experience of mimicking and adapting to their environment. So if you're somebody who masks a lot and hides your autistic features, then if you're in a room with more than one person, and you're not sure if they're neurodivergent or not, right? Because neurodivergent people often can bounce off each other.

    5. AP

      Yes.

    6. AS

      And it's okay to not look each other in the eye, and it's okay to sit in silence together, and it's okay to be what other people might say is awkward together.

    7. AP

      Yes.

    8. AS

      That would be absolutely fine. But if you're in a group where you don't know what to expect, and again, there's that unpredictability, and if you've got more than one person, that just adds in even more variables, then I can completely see how that would then lead to a feeling of overwhelm-

    9. AP

      Mm

    10. AS

      ... and shutdown. But it could also lead to a meltdown as well, or it could also lead to behaviors to then manage that situation, such as drinking too much, for example.

    11. AP

      Yes, done that. [laughs]

    12. AS

      Or-

    13. AP

      Yeah. Gosh. Mm

    14. AS

      ... or using substances, or having a smoke, you know. So I think there, there, there could be different ways that you might respond to a challenging situation like that.

    15. AP

      And that leads us actually nicely on to what I think is the, the saddest consequence of, of living with undiagnosed autism, and that's losing yourself, and I think this one sentence breaks my heart:

  11. 36:08 – 41:14

    Why So Many People Don't Realise They're Autistic

    1. AP

      "I don't know who I really am anymore." How common is that after a late autism diagnosis?

    2. AS

      I, I hear that so often, and I also hear the, "I never, ever knew who I really was." Right? So that, that comes up in the clinic space. So much. And if you think about, you know, 20 years ago, we never had this language. We never had this understanding. It's fabulous that we're now talking about this here today, Alex. But, you know, in, in the kind of the, the older times, like when I was growing up, for example, when we didn't talk about autism or ADHD, there were lots of people who were learning to hide bits of themselves, parts of themselves that they actually felt ashamed of. They were observing, quietly observing, and watching social situations, reading guides of how to interact with others, suppressing things like their stims, so like their hand flapping or their fidgeting or, you know, things that brought them comfort. And through that suppression, they actually... Now when they come in as later diagnosed adults, you know, recounting their story, they recognize that there were parts of them that they never really acknowledged, and that can be really difficult, especially when people look at old photographs of themselves, and they see a child that looks outwardly happy and smiling and conforming and, and listening to people and following the rules because, you know, isn't that what you're meant to do? You're meant to follow the rules.

    3. AP

      Ooh, yes.

    4. AS

      And then you recognize that you've kind of not nurtured those bits of yourself which were actually equally as important, and there can be, you know, a real sense of grief. There can be a real sense of, what would life have been like if I had known this earlier? You know, how would I feel about myself? And also, when you think about the kind of consequences of being autistic and, and having a later diagnosis, often it can link to additional mental health conditions such as depression, anxiety, obsessive compulsive disorder, self-harm, suicidal thoughts, sadly, in some cases, completed suicide as well, substance misuse. And therefore, you just wonder if life could have been different for that human being if they'd known sooner. Rather than having to mask and hide those beautiful bits of themselves, although it can be hard to be autistic at times, actually, part of the work that we do once someone receive, receives a diagnosis is to help them relearn who they are, what their strengths are, what they actually believe, how they want to live their life, that they don't have to do things just because people tell them to do those things. They don't have to socialize in big gatherings. They don't have to, you know, follow rules that don't fit the way that they want to live their future life as well. So when somebody gets a later diagnosis, and they've gone through that process of recognizing that they've been masking, they recognize that they've been scripting and rehearsing and preparing and suppressing and hiding and camouflaging and all those different kind of aspects of off masking. Actually, then it can be really liberating for them to learn a different way of being.

    5. AP

      That's a heartbreaking image. You mentioned perhaps looking back and seeing a picture of yourself when you were younger-

    6. AS

      Mm-hmm

    7. AP

      ... and not recognizing the person in the image. I mean, that, that really hit me.

    8. AS

      Mm.

    9. AP

      I think, I imagine, you know th- those sort of, those flick books you get?

    10. AS

      Yeah.

    11. AP

      It's like 100 pages, and you flick through them, and often it's like an animation, and the pages are moving so fast it, it changes. You, you can imagine almost just flicking through, like, 100 different pictures of an individual over the years, and perhaps the first picture is them looking really happy and smiling-

    12. AS

      Mm

    13. AP

      ... and, and content and not anxious. And then as you flick through the pages, the, the image slowly transitions into somebody, and the smile fades. They, they, their posture changes. They look a bit more insecure. It's devastating. I, I think when I was younger, I, I used to go into school. I used to go to the library in the morning and look at the stock market, read, read the newspaper.

    14. AS

      [laughs]

    15. AP

      And then someone one day said I was weird for doing that. And I remember peeping out of the window in the library and looking down to the playground and seeing all of the other kids playing football.

    16. AS

      Mm.

    17. AP

      And they were playing with these football cards.

    18. AS

      Mm. Mm.

    19. AP

      And um, um, when I got home that day, my, I asked my mom if we could go to the shop and buy some football cards.

    20. AS

      Wow.

    21. AP

      And I stayed up all night researching all of the players.

    22. AS

      Mm. Mm.

    23. AP

      Walked into school the next morning with these cards in my hand, football cards, walked up to this group, and in my head, I was saying to myself, "Do not talk about the stock market. Do not talk about the stock market. Do not talk..."

    24. AS

      [laughs]

    25. AP

      And I mentioned something about football, and it got a smile, and, and from that moment on, I was like, "Okay. Wow, I can be accepted by hiding

  12. 41:14 – 43:13

    How Masking Slowly Erases Your Identity

    1. AP

      who I am."

    2. AS

      Yes.

    3. AP

      How long does it take for masking to slowly rob someone of their identity?

    4. AS

      I think that's a really difficult question to answer, and I, I won't have, like, a clear-cut, um, response for you. But ultimately, it's, it's from when you're a child, really, because you're surrounded by these dominant narratives of what a child should look like, and then you hit puberty, and there's all these big expectations of, you know, children starting secondary school and having to then fit into what can be quite a challenging environment, and that's why we see rates of autism increase during that period because the capacity and demand can become quite... You know, there's a friction there. And then when people move into university or further education or further careers, and relationships really, you know, if you're always pretending to be someone else and not yourself, then in a way you're not really being true to who you are. But perhaps society hasn't given you an opportunity to do that either. And often there can be lots of regrets and, and mixed feelings, you know, when people do realize, gosh, I've been masking all my life. Like, who am I, you know? And where do I even start with this? And I suppose that sense of Meaning making with somebody who you trust, somebody that can help you guide yourself through that process of learning to accept yourself for all those differences that you have. That being different is absolutely fine. It's not less than. And maybe bringing in some of those aspects that you've previously suppressed into your future life so that you can live what I would call a richer life as well.

    5. AP

      I mean, it's such an emotional realization, isn't it? That you have perhaps been playing a character your whole life-

    6. AS

      Yeah

    7. AP

      ... for

  13. 43:13 – 45:15

    The Most Emotional Part of an Autism Assessment

    1. AP

      decades.

    2. AS

      Yeah.

    3. AP

      Like, when the topic of masking comes up-

    4. AS

      Mm

    5. AP

      ... is that the most emotional part of an assessment?

    6. AS

      It's really hard because people, when they realize that they're doing it, and often, you know, when I work across families, it's ... 'Cause I work with systems, right? So that's kind of my, my kind of interest in working with neurodivergent human beings, it's working with the family system as well. So if you've got, like, a young adult, um, who's going through the process of recognizing that they're masking, and then the adult next to them is also realizing that they've been masking all their lives, that, that can be very, very powerful indeed. And I think it's really important to have these conversations so that people learn what masking is. They also learn about the fact that when you're masking so much and you lose that sense of self, what you can then do to manage that as well. And it is, it's, it's a very ... It's, it's very hard, and I suppose that's why I feel really passionately about early identification and actually recognizing autism, ADHD needs.

    7. AP

      Mm.

    8. AS

      You know, people's needs really early on so that it reduces that need or having to mask as well. That the system around that human being can allow that person to be, to look at the stock market in the morning, and, you know, read newspapers, or go to the library and spend time just decompressing and regulating themselves. You know, to, to have different options and different choices at their disposal so that that person feels that they've got the agency to be a bit more of who they are.

    9. AP

      Mm. We're nearly at the moment where you're gonna reveal that one sentence that people say in assessments that make you think this person might have autism. But first, like,

  14. 45:15 – 50:56

    The Moment People Realise They've Been Masking Their Entire Life

    1. AP

      what usually happens when somebody finally realizes that they've been masking for decades? Is there a common reaction that you see time and time again?

    2. AS

      Often it can feel like grief. You know, it can really feel like that, that child that they once were, um, that there's been lost years, there's been lost time. That they've perhaps made decisions, made mistakes, you know, made decisions for themselves that could have been different, could have had a different outcome, and there can be lots of regrets as well. But at the same time, what, what I'm seeing more and more is relief. That sense of, "Ah, okay, this now makes sense," you know? And just thinking about, um, the work that you've been doing around ADHD, that sense of sense making, meaning making, can be hugely valuable. It's not just about a diagnosis at the end of the day. It's about being able to understand your story, and your strengths, your vulnerabilities, the challenges that you've had, and being, being able to connect the dots a lot more easily.

    3. AP

      What are the biggest regrets?

    4. AS

      Regrets of not knowing. You know, if you think about people that are autistic, often they want to know. [laughs] They want to know. They predict things. Uh, they are pattern spotters, you know? And they're very good at it as well, you know, tend to be very, very good at it, and they tend to pick up on things before other people do. And that sense of them not knowing, and, and often the way that I talk to my clients and within my clinic as well, is that, you know, you don't know what you don't know, right? So back in the day, we didn't have this language. We weren't talking about autism and ADHD in the same way. We didn't have the same level of lived experience research, which I'm really pleased to say is increasing. But we recognizing that ... We recognize that we need more autistic voices as part of the research that we're doing. We want to know what's happening internally for people, not just what they're showing on the outside, what's happening on the inside. And now that we have the language, now we can actually honor that language, and honor that expertise, and find a way of helping people to make sense of who they are.

    5. AP

      Can people genuinely rediscover who they are?

    6. AS

      When people realize that they're not what society's told them, so they're not weird, they're not strange, they're not just awkward. You know, not just all these things. They're too intense or, you know, highly emotional. Then that can, that can make a huge difference. I have worked with, with people, and in particular, uh, a client many years ago, who had actually lost their voice and their ability to articulate their viewpoint, their ... A verbal, this was a verbal autistic young adult, and it took a lot of trust and a lot of relationship building to help them see all the different parts of them and to make sense of why they had ended up in that position. And in their situation, it was around social exclusion, being bullied. Also, some cultural differences as well, which made it even more difficult, because in that particular culture, they were expected to engage in lots of social-

    7. AP

      Mm

    8. AS

      ... activities, and dress up in a certain way, and, and actually, that lifestyle wasn't something that they necessarily connected with, and they found it really difficult, and those demands became Very, very heavy for them, and they developed other mental health difficulties, an eating disorder, and depression. And when we worked through their profile and worked through their neurotype and made sense of those autistic aspects to their presentation, it just made so much more sense. And it's really lovely because I received a gift which said, "Thank you so much for helping me find my voice." And it was such a privilege to be part of that journey. And I see that in older adults as well. You know, I see that in people who are diagnosed in their 30s, their 40s, their 50s as well, that when people lose that sense of who they are, but then they start to rebuild themselves and they start to develop that sense of-

    9. AP

      Mm

    10. AS

      ... agency-

    11. AP

      Yes

    12. AS

      ... and autonomy.

    13. AP

      Mm.

    14. AS

      Like, they, they get a sense of, "Actually, you know what? I want to do things my way." And what I've often said to clients, to, to my human beings more recently, is that, "You're going to walk a path that no one has trodden before. This is going to be your path, and along the way, there's going to be lots of challenges, and there's going to be difficulties, and there's going to be decisions that you make that you may wish that you hadn't made. But actually, there's going to be lots of strengths and courage," and it's to help people see that positive self-identity as well, that they can be more than one thing. And it's very hard for autistic people to see that sometimes because either you're this or you're that.

    15. AP

      [laughs]

    16. AS

      But actually helping them to see that they're more than what they even believe themselves.

    17. AP

      Such a powerful story, and I think it really shines a light on the importance of the work that you're doing, and I think it can be life-changing and, in many instances, life-saving when you get that awareness and you get that understanding of, of how you-

    18. AS

      Mm

    19. AP

      ... operate in the world.

  15. 50:56 – 54:15

    The One Sentence That Makes Psychiatrists Think "Autism"

    1. AP

      At the beginning of this conversation, I mentioned there was one sentence that if you hear it in a autism assessment, you really do begin to think this person has autism. Let's finally talk about that. What is that sentence?

    2. AS

      "I've always felt different ever since I've been a child, and I've never understood why. Why does everyone have a script as to how to cope with everyday things, but everything is so much of an effort for me?" Now, that's a very, very long sentence.

    3. AP

      [laughs]

    4. AS

      Sentence, and it's very kind of... There's a lot of nuance with that. But that sense of feeling different, that's something that comes up again and again and again. And when I hear that, I really do, my ears do prick up, and it's not because I jump to the conclusion of that person must be autistic, but I suppose it does make me really curious, and it does make me wonder, what is it about this person's lived experience that has made them feel different? What have they experienced? You know, why... Not that they can't do things because actually often a lot of the, the human beings that I work with can do amazing things. They're doing phenomenal things, right? They've got this, um, huge capacity to change the world, actually. I truly believe that. But actually, there's certain things that they can't do as well, which other people might take for granted.

    5. AP

      Mm.

    6. AS

      You know? So it could be things like, um, getting ready in the morning and, uh, having breakfast [laughs] and leaving the house. You know, that's just way too many decisions. It's too many things to manage. Um, but then there can also be that sense of I need to get somewhere on time, and if that doesn't happen, that can feel very overwhelming as well. And that sense of being different often goes all the way back to childhood. So when I see somebody who's in their 30s and 40s in my team, and we go back to, when did you first notice that something felt different? They often will go back to, to their childhood. They'll go back to when they were five, six, seven, or eight, and feeling different from their peers, feeling very self-conscious, feeling socially anxious, struggling to know how they could start a conversation, really struggling in groups, maybe preferring their own space and their own time, but not being able-- not being given the permission to do that so much in a school setting. And, and that was really hard, and then kind of hearing those negative messages, which then emphasize even more that they're different. So kind of, "You're weird, you're awkward, you're intense," you know, all those things. Hearing that and then adapting themselves to mask and camouflage. And so for me, it's that sense of curiosity and, and also thinking about the un- other intersectional aspects that could be coming up for that person. So things like, you know, gender and race and culture.

    7. AP

      Mm. And after a lifetime of feeling different-

    8. AS

      Mm

    9. AP

      ... and, and you hearing that sentence, and then you perhaps do diagnose them with autism,

  16. 54:15 – 57:22

    The Autism Assessment Reactions I'll Never Forget

    1. AP

      what are some general reactions that you see? Behaviors? What do they do? What do they say?

    2. AS

      "Now I feel seen." You know, lots of people that I work with, they've, they've been on this long road of self-discovery. They've-- Some of them have self-identified as being autistic. They've done lots of reading. They've, um... [lips smack] There can also be a sense of, for some, imposter syndrome because we can't deny that there's still a lot of stigma about autism, which is something that I believe we need to really fight against. And so people will come in, and they'll, they'll go through this process and, and the way that we Assess is using a multidisciplinary framework, so we'll have different clinicians working with that person to kind of help make sense of their story. And often, by the time they get to the end, because we've done that kind of support alongside, there is a sense of, "Ah, this all makes sense now. I get this. I get my story." And it's weaving in those other neurodevelopmental traits that might exist alongside.

    3. AP

      Mm-hmm.

    4. AS

      Right? So it might be that they had a diagnosis of ADHD 10 years ago, and they didn't recognize that autistic bit, or they might be dyslexic, or they might have had an eating disorder, and then recognizing that autism was there all along, and it's part of their story, can be hugely enlightening and often leads to a real path of self-discovery, where then they start to... They want to know everything about that, and they want to research that. And I'm really pleased to support people along that journey as well and to work through those emotions that might come up that can be very mixed. Uh, because we expect that, don't we? We expect that there'll be maybe some disappointment, some regret. There can be anger as well, that, "No one else noticed this, that I was struggling-

    5. AP

      Yes

    6. AS

      ... all my life."

    7. AP

      Mm-hmm.

    8. AS

      "And my parents didn't even pick up on it." But again, the way that I often, you know, talk to, to people now is that, you know, our parents didn't have this language. Our parents didn't have an understanding of autism and ADHD and neurodivergence. Even we're catching up, right?

    9. AP

      Yes.

    10. AS

      So even we're now having these conversations and recognizing the overlaps-

    11. AP

      Mm-hmm

    12. AS

      ... between, you know, not just looking at things in silos, looking at dimensions, looking at context, looking at, you know, an autistic person in this context can be very different in this context, and, and really recognizing the role of dysregulation, emotions, language, sensory differences. And so I feel like we're actually at such an exciting point, where we can really help guide people in a much more positive way.

    13. AP

      So interesting, and I feel like you're gonna be helping a lot of people feel more understood, just i- in this conversation alone. I want to move on to the most emotionally unpredictable part of

  17. 57:22 – 1:03:02

    Washing Machine of Woes (Audience Questions)

    1. AP

      the show-

    2. AS

      Okay. [laughs]

    3. AP

      ... which is the Washing Machine of Woes.

    4. AS

      Okay.

    5. AP

      Which is essentially audience questions.

    6. AS

      Ooh, okay.

    7. AP

      We've got three tumbling around in there.

    8. AS

      Mm-hmm.

    9. AP

      Um, and it also double u- doubles up as a public service announcement for people to empty their washing machine, because I always forget-

    10. AS

      Lovely

    11. AP

      ... my load in the machine. Um-

    12. AS

      I can relate to that-

    13. AP

      Do you?

    14. AS

      ... Alex.

    15. AP

      Do you do, do you do that as well?

    16. AS

      I do. I often then have to re-run it-

    17. AP

      Ah, yes. [laughs]

    18. AS

      ... again.

    19. AP

      Yeah, yeah, 'cause the smell of damp. Yes. You're making me feel less alone already. [laughs] The first question, the first load: If you could magically remove just one part of autism for every autistic person in the world, but they would keep all the strengths, which symptom are you taking away?

    20. AS

      I would not change anything about autism. I do not believe that that's the problem. Instead, what I'd want to ensure is that we identify autistic needs earlier. We identify neurodivergent needs earlier. So rather than having the 45-year-old in the room with me recognizing that they might be autistic, I'd love to get to a place where we have a 10-year-old or a 15-year-old recognizing that they're autistic and recognizing what they can put in place to help support them so that they don't end up in fight or flight, and they don't end up living a life that goes on to develop mental health issues. That's what I would want to stop.

    21. AP

      Mm-hmm.

    22. AS

      And then alongside that, thinking about the system and really educating the system. Because I feel that if we were to change something about autism, then we lose a lot of the strengths, because being autistic comes with... It's a profile, right? It's a dimensional profile that comes with strengths, it comes with differences, it comes with vulnerabilities. But actually, what I really would love is for the system to see that, to have the language, to have the understanding, so that we create a much more inclusive world for everyone.

    23. AP

      Yes. A lovely answer. The Washing Machine of Woes never disappoints.

    24. AS

      [laughs]

    25. AP

      Fantastic. The second load out of the machine: What's one sentence a patient has said during an autism assessment that you've never forgotten?

    26. AS

      It definitely comes back to, and I've said this already, "But now it all makes sense."

    27. AP

      Mm-hmm.

    28. AS

      And it is coming back to, I know, Alex, you know, this is, this is actually, you know, something that you've, that you talk about a lot with regards to, to ADHD. But that, "Now it all makes sense," that huge sense of relief, that huge sense of actually now... Especially for autistic people who like to connect the dots, and actually being able to connect the dots and have the language to be able to put into words and to feel witnessed and to feel validated and to feel seen, and to feel seen for all the different parts of who they are, that none of this is wrong, that none of this is weird, it's just different, is something that comes up again and again. And it often comes up in the families that I work with, where one member of the family is assessed, so a young adult is assessed for autism, and then the adult sitting next to them is listening on and thinking, "Wow, this all makes sense."

    29. AP

      Mm-hmm.

    30. AS

      But they're not talking about their child. They're actually talking about themselves.

  18. 1:03:02 – 1:04:13

    A Letter to My Younger Self

    1. AS

      Hey, little one. I know you think you're broken. You spend every day wondering why everything seems so much easier for everyone else. You try harder, mask better, smile bigger, and still feel different. One day, you'll discover it called autism, not because you changed, but because someone finally found the words for what you've been carrying your whole life. You'll grieve the years you spent blaming yourself, but you'll also meet yourself for the very first time. You were never too much, never not enough. You didn't need fixing. You just needed understanding. Love, your future self.

    2. AP

      Wow. I mean, what a lovely tone to finish on. And as, as I said before, I think a lot of these letters, it really is a letter to the younger selves of many of the viewers and listeners as well, and I'm sure many of your patients.

    3. AS

      Yeah, definitely. It's beautiful.

    4. AP

      Dr. Amber, on behalf of everyone grappling to understand their brains, their brilliant brains, thank you so much.

    5. AS

      Thank you for having me. [outro music]

Episode duration: 1:04:14

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