Episode 122 (Season 4): Claiming Your Neurodivergent Identity: Discovery and What Comes Next
Sep 04, 2025
Show Notes
Learning you’re Autistic or ADHD—whether through diagnosis, self-identification, or discovery—can spark relief, uncertainty, and a cascade of new questions. Navigating not only the process of finding out, but also what happens next, is a profound and often emotional journey for many neurodivergent adults.
In this episode, Patrick Casale and Dr. Megan Anna Neff, two AuDHD mental health professionals, discuss the fundamentals of neurodivergent identity discovery, exploring how people come to understand themselves as Autistic, ADHD, or both. They provide an honest look at diagnosis versus self-identification, address language preferences, discuss personal pathways to discovery (including stories about parenting neurodivergent kids), and examine the practical, emotional, and systemic barriers to formal assessment. The conversation covers common starter-pack questions, the importance of community support during this process, accommodations, and the real-world pros and cons of disclosure in educational and workplace settings.
Top 3 reasons to listen to the entire episode:
- Gain clarity on the different routes to neurodivergent self-understanding—whether through formal diagnosis or self-identification—and the language that feels most affirming and inclusive for our community.
- Understand the real barriers (waitlists, cost, systemic hurdles, stigma) involved in seeking a diagnosis, and get valuable advice if you’re considering assessment for yourself or a loved one.
- Learn practical guidance for navigating disclosure, accommodations, and imposter syndrome, with candid stories and encouragement from both hosts’ personal and professional experiences.
If you’re exploring your neurodivergent identity or supporting someone who is, this episode offers validating insight, real-world advice, and affirmation that every journey is unique.
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Transcript
PATRICK CASALE: Hey, everyone. You are listening to the Divergent Conversations podcast. We are two neurodivergent mental health professionals in a neurotypical world. I'm Patrick Casale.
MEGAN NEFF: And I'm Dr. Neff.
PATRICK CASALE: And during these episodes, we do talk about sensitive subjects, mental health. And there are some conversations that can certainly feel a bit overwhelming. So, we do just want to use that disclosure and disclaimer before jumping in. And thanks for listening.
MEGAN NEFF: Welcome back, y'all, to Divergent Conversations. We are starting another new series, season. We don't know what we're calling these things, series, season.
PATRICK CASALE: Whatever.
MEGAN NEFF: Not collection. We've cut out collections.
PATRICK CASALE: Not collection, cross that out.
MEGAN NEFF: Yes. But I'm excited about this one. It's kind of we're going back to the fundamentals of… for people who are just entering this conversation and talking about kind of the arc of some of the experiences from coming to learn that we're autistic or ADHD, perhaps being diagnosed, and then some of the emotional experiences that often show up for people after that. And then, the kind of what comes after that, or the, I think, we're calling it, like, the autistic or ADHD starter pack questions that often come up. So, that's what we're diving into now.
PATRICK CASALE: Yeah, so I know we are going to tackle both diagnosis, discovery, identification in between the first two episodes of this series. And it is interesting for us to circle back to this. You know, I think we've had some episodes where we've touched on a lot of this, but new thoughts, new ideas. You made such a great set of content around the arc of discovery. And I think so many people are interested in that, because a lot of people are just finding themselves in these spaces more and more, and a lot of the same questions keep coming up as well.
MEGAN NEFF: Oh, maybe we should add that at the end of the series. Yeah, I created a like identity development arc of some of the common identity themes and these phases that a lot of us go through as we're integrating a new identity, specifically, a neurodivergent one. So, yeah, we could definitely touch on that on this series as well.
Yeah, yeah. So, I think we're starting with diagnosis, because that's often where people enter the conversation. Diagnosis, or discovery, or self-identification. There's lots of different language used because some people pursue a diagnosis, that's how they come to know is a therapist literally saying, "Have you ever considered autism?" I think that was your experience.
PATRICK CASALE: Mm-hmm (affirmative.)
MEGAN NEFF: And then, for some of us, it's self-identification. And so, the coming to know, like there's not one linear path here, by any means. There's a lot of different ways people enter this conversation.
PATRICK CASALE: What's the terminology that you most prefer these days? I assume it's discovery.
MEGAN NEFF: I use a lot interchangeably. I use self-identification a lot because it feels the most inclusive and non-pathologizing.
PATRICK CASALE: Sure.
MEGAN NEFF: Yeah, I think I use discovery, but yeah, I think self-identification is the phrase I most commonly use instead of self-diagnosis.
PATRICK CASALE: Sure, yeah, that makes sense. And I think as you are moving into this space, and this headspace of newly identifying, self-discovering language is something that can trip people up oftentimes. And we just want to give you the space right now to just acknowledge that everyone's in different parts of their journeys, and that language is probably going to shift, change, and evolve, as it always does in all spaces. But that's important as well.
MEGAN NEFF: Yeah, absolutely. I think that was my intimidation. Entering the space was there was a lot of rules around language. And I'm someone who likes to know the rules, and understand them, and follow them. And then, when I missstepped a couple times, feeling really bad, and like, "Oh, I'm not a good autistic person because I broke the rule."
So, I really am glad you said that, it's helpful to, I think, normalize that there's a learning curve here, and especially, if you're new to the community, you're going to step in it. And then, for those of us who have been in the community a while, how do we be gentle with people when they're learning, so that we actually are supporting their learning and growth. And not shutting them down?
PATRICK CASALE: Absolutely. And I think you do a really wonderful job of inviting people into that space energetically. So, that's really an important piece.
So, for those of you listening, I think you've shared this a couple of times, but your journey here was a little bit different. I think you mentioned you discovered that you were autistic after a child of yours was also figuring this out simultaneously.
MEGAN NEFF: Yeah. And for both of us, it was actually all exploratory, in the sense of that child had already been diagnosed with ADHD. And we, together, started having a conversation about whether autism was in the mix, together started researching it. They really related to it, but I think it was another nine months before we could get them in for an assessment. So, that's what kicked it off for me, was like, getting curious about it because of them.
Literally within a week of learning about it with them, I was then self-identified myself, because I was like… Yeah, and that was that unique experience I have, of like, I had my IQ test, I had these personality assessments. And I could look at it, and I was like, "Oh my gosh." Like, it's there. Like, it's always been there. I just didn't know what to look for.
PATRICK CASALE: And you were testing and research psychologist for a long time.
MEGAN NEFF: Yeah, I mean, I feel like research psychologist makes me sound more robust than I am. I did peer-reviewed research. I did assessments. But yeah, so like, I was doing assessments for autism and ADHD, and then just did it on myself. And then, I did go get a formal assessment, but yeah.
PATRICK CASALE: I think that's such a unique experience to be able to, like, re-examine all of that information after… And it sounds like a really beautifully connecting, and collaborative experience between you and your child, too, throughout, like, that time in your lives.
And for a lot of you, you know, you might be listening, and that may have been your pathway to discovery, was through parenting an autistic or ADHD child. And then, starting to kind of re-examine yourself and getting more curious about it. A lot of you may have entered into this journey because someone else close to you might have recommended that you do like myself. A lot of you may have done it via, I would just say entrance way, not like… This always gets messy, of just seeing a few relatable clips on social media and saying that sounds a hell of a lot like me, but…
MEGAN NEFF: And then, there's also people who are actually diagnosed in childhood or young adult, but they're still starting to see social media, and it's like clicking with them. And they were diagnosed, but no one ever really unpacked what that meant for them, especially with ADHD, where it's like, "Well, I was diagnosed in childhood, but they just told me it was about attention, and they gave me medicine. And now I'm listening to people talk about it from lived experience, and I'm realizing, 'Oh, all of these other parts of my life make more sense from this lens of ADHD.'"
So, it's almost like it's not a new discovery, but it's almost a new discovery in the sense of realizing how integral it is to identity, if that makes sense.
PATRICK CASALE: It makes so much sense. And I'm so glad you made that point, because I think if you were diagnosed early in childhood, and let's say, 15, 20 years ago, your experience is probably very different than those of us who are in our 30s, 40s, 50s, hearing some of this stuff now on social media, or listening to podcasts, reading books and being like, "Oh yeah, that was my whole life in a nutshell. But I didn't really have the language for it, or didn't really understand more than just simplistically, like…" Not simplistically, that's the wrong word, just simply put like, "Here's this label that I got from a doctor and I was like, 'Oh, okay.'"
MEGAN NEFF: Yeah, I would say, especially with ADHD, that happens a lot, where maybe they were diagnosed in childhood, but no one ever taught how it connects to emotional regulation, or rejection sensitivity, or how we're motivated. And so, even though they were diagnosed, they might still fall into those character-based labels for a lot of those things, because they don't realize it's connected to their ADHD until they connect with ADHD culture, and education, and lived experience.
PATRICK CASALE: 100%, yeah. I think that is a really, really great point. So, no matter how you got here, just acknowledging that you are here in this moment, and maybe becoming more and more curious about identity, and some of the areas that you do struggle, and some of the areas you need more support in, and maybe unpacking who you're going to talk to about this.
And I think one part that you mentioned, you know, you said it took about nine months for your kiddo to get in for an assessment. That's something to talk about, right? As a barrier, is oftentimes, I mean, nine months could be considered short in some spaces.
MEGAN NEFF: Yeah. I mean, I was thrilled to get it within nine months. Like, I was expecting it might be longer. And so, like, that was a pretty accessible route, I would say. Yeah, a lot of people either assessments stay inaccessible to them, or the wait lists are so long.
I would say here in the States, I don't know if you'd agree with this, but here in the States, I think it's different. Like, I've heard in the UK, the wait list can be really long for ADHD. But in the States, my experience is it's actually a lot easier to get an ADHD diagnosis than an autism one. Like, it was a pretty straightforward process for me, just through connecting with my primary care doctor, getting a referral within the system. Like, I almost hate to say this, but it was, like, shockingly easy, and maybe that's just because I'm someone who used to do full assessments, or because I always had autism in mind, but the ADHD diagnosis was a lot more streamlined.
PATRICK CASALE: Yeah, I would agree. I often see in a lot of these, like, therapy clinical referral Facebook groups that so many people offer ADHD assessment and evaluation, and a lot of whom, in my opinion, are not that affirming, but they are certainly doing them. And it's been a part of their practice for a long time.
And it feels like people who are doing autism assessment, especially in an affirming way, can be harder to find in a lot of spaces, especially if you are looking for an autistic assessor, if you are looking for someone who is neurodivergent themselves, if they are allistic or not autistic, like, it can certainly become a more cumbersome experience and journey. And can be filled with frustration, too.
MEGAN NEFF: Yeah, yeah. And then, for adults, like, insurance often won't cover it, so there's often also financial barriers as well, whereas, I think partly for ADHD, because again, in the States, a lot of PCPs, so primary care doctors will prescribe ADHD medication if someone within the system has diagnosed it. So, I just feel like there's a workflow there.
And again, when I used to work in primary care, I was doing a lot of ADHD assessments, because it's like someone brings this up in a primary care visit, you refer to behavioral health, you know, you do a few sessions to assess. And then, you go back to, typically, the PCP, unless there's complex other factors, then it might be a psychiatrist, then it goes back to the PCP for a prescription.
So, it's part of the workflow, whereas I think most people, if you bring up autism to your primary care doctor, there's not that workflow in place, partly because we don't medicate autism, right? We have medication for ADHD. So, it's a different experience.
I also feel different about the ADHD diagnosis than I do the autism one of, like people often ask, you know, "Should I get an assessment if I can't find an affirming provider?" I might take these words back at some point, but for ADHD, I feel like it's less important. I feel like it's more about can someone's, like… Because there's often a very specific… If someone's interested in medication or a medication trial, there's often a very specific outcome you're hoping to get with that diagnosis.
And so, sometimes it is about just getting someone who will, yes, see this and confirm it or not… That's not the right word. I don't want to say, like, check the box, because an assessment shouldn't be a check-the-box experience, but…
PATRICK CASALE: But you and I know that it isn't certain instances. Like, I see that.
MEGAN NEFF: Yeah. And assessments should not be check the box, but it is often kind of created that way.
PATRICK CASALE: Yeah.
MEGAN NEFF: And I think for ADHD, it is less important that you find, like, the perfect assessor to walk you through this, because, like my process was very much, fill out this, have your spouse fill this out, answer a few questions. Like, I kind of had some odd feelings about how easy it was to get a ADHD diagnosis. Like, I was like, I feel like, should we be ruling out other conditions that this could look like? Like, it was an interesting experience of like, wow, that was really easy to get.
PATRICK CASALE: I think that's a really good reminder that for you and I, who have, you know, higher education in mental health, and have worked in systems of mental health, and medical care, and kind of understand the behind the scenes of it, that we are in the minority of people in this country, like who are doing that work.
So, a lot of people, like, to them, it may feel easy, it may not, it may feel simplistic, it may not. But in reality, it's like, for us, we're looking at the process sometimes, like, should this be more complicated? Like, this be more almost intensive, and certainly more collaborative, and have more depth to it? And in reality, because we live in a healthcare system that is for-profit in the United States, it is oftentimes, like, how do people get paid?
MEGAN NEFF: Yeah. And also, I would say a healthcare system that's incredibly strained. And so, it's I've got one session to diagnose this, and so, there's also that factor of just how strange providers are.
So, there is this interesting, and maybe that's part of, you know, there's this idea out there that ADHD is over diagnosed. And that's where it gets tricky, because I think with ADHD, it is both over- and underdiagnosed, but it is just this interesting experience. And I know that not everyone's experiences this. This was my personal experience, was that the ADHD diagnosis almost felt too easy to get, and the autism diagnosis can feel so, so complex and hard to get. So, there is this interesting kind of duality there, I guess.
PATRICK CASALE: Yeah, using my favorite words. I agree, 100%. I think, like, you know, I did some, like, online assessments that the psychologist had, including… And then, some questionnaires and assessments that I had to take home for ADHD. But really, I only met with that person like twice. And it was very short-lived. And it did not feel hard.
And that referral came from like a therapist specializing in ADHD. So, that therapist referred me to this person. It was already like, I guess, implied that I was ADHD, so it did not seem like it was that complex to the process, at least. I do think the autism assessment process for myself felt a lot more laborious. Like, there was a lot more energy that went into it. I think there was also a lot more mental energy that I experienced, like putting into the process. And a lot of it was my own, like, doubting the process, doubting my experiences. I really struggled to get collateral information from family members, especially parents who might have had a very different perspective of how my childhood was. It was not an easy process for me.
MEGAN NEFF: That would be an interesting thing to look at. So, with a lot of assessments, especially for ADHD and autism, it's common, kind of, best standard is to get both self-report and other report. I would be curious if… And I did see this, because the one for autism that I used was the SRS, which the language is really ableist, but kind of, it's highly like respected as in regards to how assessments goes. And it wouldn't be uncommon for someone's self-report, and then, perhaps their partner or family member, for there to be a big gap between self-report and other because of masking. But I wonder if that happens less with ADHD?
Like, when I looked at my spouse's report, it was actually really validating, but I think his scores were maybe higher than mine, because he sees my struggles more than I do sometimes. And I'm curious if there's less of a gap between self and other report on ADHD measures than there are on the autism ones. Not that ADHDers can't mask. We certainly can. But I think someone, especially someone who lives with us, tends to see those struggles a bit more clearly.
PATRICK CASALE: Oh, for sure, that's such a great point. And just, you know, this whole process is interesting to me, in general. And I am glad that, in my opinion, we're seeing more accessibility to assessment, or at least to some sort of process of screening, because I know a lot of adults who are searching for autism diagnoses, maybe they don't want to go down the formal, formal, formal route of like, seeing a neuropsych and doing a formal assessment, and doing all the pieces for it, and getting it in your medical record. And they just want to know, like, yes or no. I just want to know for my own validation purposes.
So, we're seeing a lot of mental health therapists coming into the space too, who are doing probably less intensive and less formal assessment, but still coming to the same conclusion.
MEGAN NEFF: Or they're doing like the same robustness in the screeners being used, but they're not doing a formal diagnosis and a formal report, because, especially, in the last… So, we're recording this in August 2025, especially in the last six, eight months. Like, our context has shifted. And so, I think, like, the conversation in our community used to be around the struggles to be able to access diagnosis. Now, I feel like it's like be cautious of a diagnosis, understandably.
And so, I think especially now, we're seeing a lot more of these, like self-identity assessments, where it's informal, there's no medical diagnosis put on a chart, there's no report. And I'm so glad that more people are offering that, because you're absolutely right. Like, for a lot of people, what they're looking for is understanding around their identity, because especially, if you're autistic, it's really hard to start integrating this identity until you know with certainty. And we often need someone else outside of us to be able to really kind of start to settle into this.
Although, actually, that said, I had a really interesting call in my community where we were talking about kind of the impostor syndrome around identity. And I asked on the call, because someone who was sharing this it's because they hadn't been diagnosed. And I said, "For those of us who have been diagnosed, how many of us still struggle with impostor syndrome?" And all of us raised our hands.
So, there's also sometimes, I think, this kind of myth out there that once I'm officially diagnosed, it'll cure any impostor syndrome I have around this identity. And that's actually not always the experience is that many of us still, like, continue to have questions as we integrate it.
PATRICK CASALE: I think about it every single damn day.
MEGAN NEFF: I don't anymore. I think I have enough evidence now that I don't question the autism. I'm like, "Yep."
PATRICK CASALE: Yeah. I mean, okay, let me reframe that. That's not accurate. I question, this is a different conversation, I question in self-doubt mode of like, do I know enough about my own autistic identity to write the book that I'm writing? That's really where my mind goes, not that I question that I'm autistic anymore. I don't question that anymore.
I did question that throughout the assessment process. I questioned it when I got the results of the assessment process. I did not like my assessor, so that did not help me with buy-in. I think if you have more rapport built, I would be interested to know how that lands for people when they receive the information. Like, I just didn't like him. So, when I got it, I was, like, I want to curse now, but, you know, I'm going to do better. And I just put it to the side, you know, like I didn't put much stock into that at first. It took like a week or two for me to finally, like, really unpack that and start exploring it.
So, I'd be interested to hear from some of you about, like, if you had good rapport with the assessor, did you not only experience a better assessment process? Did you trust the end result? And did the impostor syndrome diminish after? I would be very curious about that.
MEGAN NEFF: Yeah, I would too. I would too. And also, like, for you, it wasn't of your own initiative. It's someone else had brought it up. And so, the combination of you weren't pursuing this information and given with someone that you didn't have a lot of rapport, I imagine there was, yeah, some like, knee-jerk reaction to reject this, and to not want to accept it.
PATRICK CASALE: Yep, and it was just, you know, we've talked about our diagnosis journeys on this podcast before. I think it's like episodes three and four maybe, and throughout, obviously, 100 plus episodes. But like, I just remember who I told immediately, and the very, very, very different reactions. And I know we both talk about, like, self-disclosure, doing so when you feel really confident, like you've mentioned before, really, like, fortified in it, sometimes able to defend it. And I just got such different reactions immediately. And that also did not help with the impostor syndrome and self-doubt around this, like, experience.
MEGAN NEFF: Yeah, yeah. Oh, I'm sure. I'm sure. Should we shift a little bit to, like, giving people some kind of advice if they are pursuing an assessment, diagnosis?
PATRICK CASALE: Yeah.
MEGAN NEFF: And yeah, we're in the States. Some of this, I think, can extend beyond the States, but I realize our listeners are very global.
I think the place I would start, no matter where you are in the world, I'd start with, like, what is your goal of pursuing an assessment or a diagnosis? We've talked on previous episodes of the potential pros and cons, especially of an autism.
So, again, for ADHD, I feel like it's clear. Like, actually, I'm a little embarrassed to admit this, but I didn't get my ADHD diagnosis. I was very procrastinating in getting it because I didn't necessarily want to try a medication. And again, I did all the assessments on myself, but so I actually didn't have a lot of motivation to actually go get it until I was like, I really would like to try a medication trial.
So, for ADHD, that one feels really clear. It's like, if you're interested in a medication trial, you need ADHD diagnosis. And I think there can be other reasons for identity, but I feel like that one, there's just such a clear objective that a lot of people have around that.
PATRICK CASALE: Sure.
MEGAN NEFF: I also think it can be clear to, like, if there's a lot in the mix, like, potentially, if there's big mood dips, then, you know, teasing it out between bipolar or ADHD, if there's complex trauma. Like, I always think it's good, it's possible to get a really robust assessment, so we know what we're looking at, because a lot of us have other things. We've got sidekicks that come along with the autism and ADHD.
PATRICK CASALE: We sure do.
MEGAN NEFF: Yeah, for autism, it's tricky. And I tend to see two things that, typically, for adults, is often about the identity piece. And also, it kind of can give people the confidence to advocate for themselves if they have an official, like someone else has agreed with this.
PATRICK CASALE: Right.
MEGAN NEFF: And then, the other one I see is accommodations where people are wanting to access accommodations, and so that's why they're pursuing it. Are there other things that you see of like, what motivates people to pursue assessment?
PATRICK CASALE: No, I think it feels like pretty cut and dry with that. I mean, sometimes you are pursuing ADHD to try to pursue accommodation requests as well, if you're really struggling [CROSSTALK 00:27:28]-
MEGAN NEFF: Oh, yeah, yeah.
PATRICK CASALE: …again, things like that. But I do think the medication piece is the primary end goal, especially, if it's going to help support you, just overall, get through your day significantly easier, makes a hell of a lot of sense. And I know there's a lot of shame for people around medication, of like, I've got to rely on medication so that I can get through my day, or so that it's easier, or it's a crutch, or… There's so much shame around the medication combo.
MEGAN NEFF: There really is, which is so, like, that's one of the myths I like to bust is when you look at the research around, kind of, what medication can also help protect from around, like, co-occurring conditions, it's really sad how much stigma medication has when we know, like, how life saving it can be and life altering. Yeah, yeah.
PATRICK CASALE: Yeah, yeah. It's 2025, and yeah, there's still a lot of stigma. And, I mean, this could create a whole nother episode. We probably should do one at one, at some point in time. But I know there's people who are like, and there's real concern for those of you who are listening, who are like, I do want to pursue an ADHD diagnosis. I do want to do it for medication reasons, and I also have a history of addiction. And then, the addictive component with taking a stimulant. But there are non-stimulant options as well. And, you know, that's a very complex conversation, but nevertheless, I think that plays a role in some of this as well. And I think that, yeah, you covered all of the reasons I can think of for pursuing.
MEGAN NEFF: One thought I just had, I'm so glad you brought up accommodations for ADHD, because yes, of course. And when people are struggling to get the autism diagnosis, whether it's for their child or for themselves, you can often get a lot of the accommodations that would also help your autism under ADHD. And I think it's helpful for folks to know that is that there's a lot of accommodations that you can ask for under that ADHD diagnosis that will also, like, support the autism, even if you're not able to access that assessment.
PATRICK CASALE: Right, yep. So, yeah, I would say that's kind of the final, like, end point for the why. Yeah, go ahead.
MEGAN NEFF: Well, I was just going to say, with the accommodation pieces, this is where assessments do start getting really tricky in that, so, like, the assessment I described, that I did through my medical system that was enough to get me, like, a medication trial. I'm not sure I could go back and say, "Hey, can you…" Actually, maybe they would. Maybe they would be able to write a letter of accommodation. For the kinds of assessments I was doing in the medical system I used to work in, the way it worked is it's almost like it was a diagnosis that the system would honor. But that didn't necessarily mean that you could take that and submit it to a school like a university for school place accommodations. This is where assessments can get so tricky around, especially, because different universities might have different requirements. So, like some universities might require a full neuropsych assessment to get the accommodations.
And this is something I'm starting to see kind of as a murmur in the community, as we're seeing more and more clinicians offer assessments. And I'm pivoting a little to talk about autism more.
First of all, this is so good because it's filling a need. But one thing that's happening is… And most conversations I'm having around this are with other psychologists, and part of what they're seeing are kind of more master level clinicians. And I'm not saying this to say that there's like master level bad doctor good, because I know master level clinicians who are offering, like, very robust assessments. But what some psychologists are seeing, or master level assess assessors.
And I think they're probably coming from a good intention of trying to fill the gap, but what they're mostly doing is like, maybe they're just doing assessments based on screeners, not actual assessments. Or they're living in a state where, you know, some states allow for master level clinicians to diagnose autism, some don't. And so, people are paying a couple of $1,000 for an assessment, but then that assessment isn't giving them the accommodations they need. So, what I'm hearing from some psychologists is they're now doing a second assessment to get that person the proper assessment, to get accommodations, and now that person has paid 5, 6, $7,000.
So, for those who are clinicians, I think, it's really important in our informed consent process to be like, here is what this assessment will give you, here's maybe what it will give you, here's what it might not give you.
And even when I was doing assessments as a psychologist, I was doing this because I wasn't doing neuropsych aspects. So, even I was saying, like, you know, many universities will honor this because there'll be a full report. However, some require neuropsych.
So, I just think that's important to be aware of, and why it's so important to know what is my motivation here? Because I feel so sad if people are spending all that time, and $2,000, and their goal is accommodations, and they can't get it because of the diagnosis or the assessment that they got.
PATRICK CASALE: 100%, yep. Hugely important point. And that's why, yeah, it gets really tricky. And it's like every state in our country is so different. Hell, like you said, every university is probably going to have very different processes and things that they do and don't accept. I can imagine some universities are like, "Get me a letter from your therapist that says that you're ADHD." And that's fine. And some that are like, "I need the full neuropsych assessment."
MEGAN NEFF: Neuropsych, yeah, yeah.
PATRICK CASALE: So, you got to ask the questions, unfortunately. And sometimes we don't know what to ask. And I think that becomes somewhat intimidating. So, we end up living in a world where we are doing everything that we possibly can to survive in these mechanisms, because it's either easier than asking for the help or the guidance, or we just don't know what to ask in general. And that really sucks, too.
MEGAN NEFF: Yeah, yeah. I mean, it's such an overwhelming process to navigate, and then, throw in all of these complexities that I just listed out. Like, part of me wants to, like, eat my words, because I'm like, "That's so overwhelming." But I'm also like, "Oh, I actually want people to know this, because I think it's good to know." Yeah, I think-
PATRICK CASALE: You need to know it. I really do.
MEGAN NEFF: Yeah, yeah. The other thing that kind of throws people off is how there can be, like, so like, with autism, there can be school-based assessments, and then medical assessments. And like, if your child gets diagnosed through the school system, that's actually not the same thing as a medical diagnosis, and vice versa. Like at least in the States, the school will do their own assessment. And so, the process, yeah, it's so complex.
So, Luke and I talk about this. He's got a doctorate in education. I have a doctorate in psychology. And like, our heads spin with this process. And like, we know the systems. So, it's just, it is unfortunate what a complex system it is.
PATRICK CASALE: Very much so.
MEGAN NEFF: So, self-identification makes a lot of sense.
PATRICK CASALE: It really does. I mean, you know, there are so many barriers, right? Not just wait times, and cost, and insurance versus private pay. There's racial barriers, there's systemic barriers. There's barriers in terms of, like, how women, and trans, and gender expansive people are assessed. I mean, there's so much. And it makes sense why self-identification takes up a large portion of the pie, because it's a hell of a lot more accessible in all of the ways.
MEGAN NEFF: Yeah, yeah, yeah. Ooh, somehow this episode became about accommodations, which isn't where I thought it was going. But the other accommodations thing is, the itchy thought is that, I think, people often don't realize that you can also get accommodations under mental health conditions. So, like, if there's an anxiety disorder. And so, it's also possible that you can get, like, the workplace accommodations that you might need, under a different diagnosis that you might already have.
And so, yeah, I just hope people don't feel like I can't start asking for the accommodations that would support me until I have this diagnosis, because there's a lot of other routes to getting accommodations at school and at work.
PATRICK CASALE: Yep, yep. That's a really good point. That's a really good point. And you know, I just want to also name that, although in this country and in a lot of countries there are components to our society that are supposed to protect people when they ask for accommodations and support. And sometimes also disclosure, and disclosing any sort of diagnosis can lead to backlash, not just from employer, but from employee or from… There are shadow sides to it as well.
MEGAN NEFF: Yeah, so there's a study that came out recently where it was only 30% of autistic people chose to self-disclose at the workplace and to pursue, like, formal accommodations.
And that just makes so much sense for me, because even if a place is sane, like, you know, we're inclusive, and we're disability friendly, and we're neurodivergent friendly, there can still be backlash. Like, people can still get pushed out of jobs or looked over for that promotion.
So, self-disclosure at the workplace, I think, is such a… I mean, speaking about complexity, that's such a complex one of, it kind of feels damned if you do, damned if you don't, because if you don't disclose, maybe your colleagues or your employers are like, "Well, that employee is lazy or they don't care." Because they're struggling with, like, executive functioning, or organization, or they're rude because they're talking directly.
So, people will have narratives about you, and it's like, is that worse than the narrative of, "Oh, they're ADHD or they're autistic." And it's hard to know until you do disclose, which is… That's partly why I'm a big fan of starting with partial self-disclosures to kind of test the water-
PATRICK CASALE: For sure.
MEGAN NEFF: …of like, how are people going to respond? And then, will a full self-disclosure be safe here? But, yeah, that's a tricky one.
PATRICK CASALE: Yeah, I agree. It actually makes me feel really special. That made me feel really special. It makes Resilient Mind Counseling, the group practice that I own, feel really special, because we have, like, so many autistic ADHDers working there, and tons of threads that are related to special interests, and identification, and just talking about all things neurodivergence. And it just makes me feel really connected, and also acknowledge that that's not the norm in a lot of spaces. So, it makes me feel really special. It makes me feel really proud, is the word I was looking for.
MEGAN NEFF: I don't know, I kind of love that you said-
PATRICK CASALE: Yeah.
MEGAN NEFF: "It makes me feel really special."
PATRICK CASALE: [INDISCERNIBLE 00:38:47] part of this episode will end with the word vanity.
One more, you know, we're not going to go into this right now, because we've talked about this in prior episodes. But if you haven't listened to all of them, or you missed it, you know that in this country, in this current iteration of this country, disclosure and identification, and especially formal diagnosis, can certainly be an intensified risk right now.
So, I think, it's important, like Megan Anna said, to really think about with intentionality what is my reason for pursuing? And to acknowledge that there are lots of pros, unbelievable amounts. And there are also cons. There are also risks that come along with that as well.
MEGAN NEFF: Yeah, yeah, yeah. And I would say, just because I feel like I didn't hit on it enough, I would say another pro of getting, like, a really robust assessment is to really be able to know what's going on. Because I really can't reiterate enough, so many of us do also have OCD, bipolar, depression. And we do want to know what's going on.
PATRICK CASALE: True.
MEGAN NEFF: Or even like, let's say it is social anxiety and not autism, like, I also think that's really good to know, because like, there's treatment for social anxiety. So, also, like, I'm realizing we're talking at it from the angle of, I think mostly people who are self-identified and who are looking for assessments that confirm that identity. But there are also people for whom I'm relating to these experiences. I'm relating to some of these experiences, but I don't really know what it is. That is a huge pro for an assessment of someone who can walk you through it, again, especially if you trust the person truly understands masked autism, and to actually understand what your context actually is.
So, that would ideally be the experience of anyone getting an assessment. It's just, like, clarity of what we're looking at. I realize that can be hard to find, but I just feel like I need to mention that as a pro, because-
PATRICK CASALE: That's a huge pro.
MEGAN NEFF: Yeah, it's a huge pro. We need to know our context of-
PATRICK CASALE: Absolutely.
MEGAN NEFF: ...what really is this.
PATRICK CASALE: Absolutely. And you know, oftentimes, a lot of us who are at least identifying or discovering later on in our lives, into adulthood, have probably gotten some assessments where autism wasn't even considered, right? And then, we end up here. So, it's kind of this weird, like experience of, "Oh yeah, I had an assessment, and I was like OCD, and someone said OCPD, or major depression, or bipolar 2." Or whatever that comes along with complex PTSD. Nobody ever mentioned the words autism until three years, four years ago for me. Like, and I did assessment after assessment after assessment.
So, this is why having someone who really understands and asking those questions when you reach out to a provider, if you are able to, to just say, like, can you tell me, you know, how do you ensure that you're rolling things out? How do we ensure that this is really comprehensive? If that is what you are looking for and what you need.
So, just be really clear in communication, if you can, via email, text, phone, call, etc. And I know that can be really hard in that power dynamic that occurs when we're reaching out for support.
MEGAN NEFF: Yeah, yeah, yeah. I think the other thing that is easy to fall into in our space is when we have had that experience that you just outlined. And then, we do get the autism or the ADHD diagnosis, is to look back and think, "Oh, all those other diagnoses were misdiagnoses."
And it's true that some of them might have been a misdiagnosis. By misdiagnosis, I mean a wrong diagnosis was given. It's also possible that an accurate diagnosis was given, and the autism was missed.
And I get a little bit nervous when I see like, "Oh, I was falsely diagnosed with all these things." I think bipolar is the one I see a lot. But we also know that bipolar is a lot more common among autistic and ADHD folks.
So, I think I also kind of want to gently encourage people to not be too quick to discount past diagnoses. Yes, the autism was missed, but it doesn't necessarily mean that diagnosis was wrong, and that could be a really important piece of someone's context in getting the support they need, is to not just kind of throw that out.
PATRICK CASALE: I mean, hell, if you all listened to our OCD episode, you know how prevalent OCD is, too, and also treatable, and also something that a lot of us struggle with. So, we just don't want to, like, exactly-
MEGAN NEFF: And yeah, if we're, like, "That's the autism, so I'm going to integrate it." Like, no honey. You don't have to do that. Like…
PATRICK CASALE: Right. Yes, exactly that. So, I just want to say to all of you who are tuning in, like after our amazing, in my opinion, Burnout series that we just had, which we got so much good feedback for with all of our metaphors, and creative processes, and jokes, I don't think this series is going to feel that way. I think it's going to be [CROSSTALK 00:44:19]-
MEGAN NEFF: It's a little bit heavier.
PATRICK CASALE: Heavier, introspective, vulnerable, hopefully still helpful. Go back [CROSSTALK 00:44:27]-
MEGAN NEFF: That's like a tagline.
PATRICK CASALE: …burnout city. One of my therapist's today text me and was like, "Sensory hell burnout city really does feel like an Applebee's." And I was like, "Yeah, exactly." So, sorry, Applebee's. All right.
MEGAN NEFF: Do we have like, anti-sponsorships on this podcast.
PATRICK CASALE: Oh, God, yes. If somehow the chain restaurant of Applebee's reached out and was like, "I want to be a part of this." I would turn down every single dollar that I could unless we got, like, lifetime, endless sizzling Steak Fajita platters, I don't know, something horrible that they serve.
MEGAN NEFF: Applications open now for anti-sponsorships.
PATRICK CASALE: An anti-sponsorship thing would be pretty cool. That should also go into the list, all the lists. Okay, I'm going to wrap us up, y'all. I appreciate you following us along that journey. Excited for this upcoming series. A lot of good stuff on here. We are batch recording. So, if you see us having a lot of similar conversations in the same day, you know, that might be why. And we also did this in a way where we jumped around from end to beginning to middle. So, just a fascinating process for our brains.
Episodes are out on Fridays. Make sure you check out our sponsor, the Jane app for healthcare, especially if you're a mental health or medical provider. We really do support and like them, because of how supportive they are of the mental health and medical communities based out of Canada. They have a discount code of DCPOD for two free months when you sign up. And we will see you next week.
