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Send us Fan Mail 🎙️ Episode 34: AuDHD (& Human) Experience — Self-Concept & It's Influence on Autistic, AuDHD & ADHD Experience "Am I actually broken? Or do I just have these lessons that I've learnt that have informed my understanding of myself?" Summary: This week Aaron unpacks self-concept: what it is, how we develop it as neurodivergent people, and how we can deliberately change it to improve our emotional experience. Building on the working model of emotions from the previous episode, he frames self-concept as our integrated understanding of who and what we are, woven together from core beliefs and spanning every domain that matters to us: relationships, learning, work, family, and social life. Aaron explains that every single experience teaches us something about ourselves, and shares personal examples of how failure experiences shaped his own self-concept: failing year twelve twice, mixed performance in the Navy, and believing he was "academically stupid" until nearly 40, when a colleague encouraged him to study psychology. He contrasts this with the success experiences since, which have reshaped his understanding of himself as a learner once he found the right environment and the right anchors for his attention. He then turns to the neurodivergent experience under a deficit-based model, where "normal" is implicitly assumed to be "right" and difference is repeatedly fed back to us as vague, impulsive, too much, or not enough. These implicit lessons create a self-fulfilling loop: expecting social situations to go badly, becoming anxious, performing worse, and reinforcing the belief. Aaron closes with two practical pathways for change: deliberately collecting new success experiences through scaffolded, CBT-style exposure, and finding community, where comparing ourselves against a realistic norm teaches us that we are not wrong, deficient, or broken. He cautions against the "superpower" framing just as much as the deficit framing, landing on a balanced view of ourselves as humans with strengths, weaknesses, and neutral characteristics alike. Key Themes & Takeaways: Self-concept as integrated beliefs – our understanding of who and what we are, across every important life domainEvery experience is a lesson – successes and failures alike continually update our self-concept, which is never set and forgetFailure experiences and anxiety-driven motivation – relying on urgency and deadlines without the right anchors can build a history of perceived failureThe deficit model's implicit lessons – when the construct itself is framed as a deficit, neurodivergent people learn they are "not right" simply by being differentThe self-fulfilling loop – a negative self-concept raises anxiety, reduces performance, and makes mistakes the salient memorySuccess experiences change self-concept – scaffolded challenges teach us "I can cope with this" and build confidenceCommunity as a realistic comparison – being among similar people replaces comparison against "normal" with a fair and appropriate normBalanced, not superpowered – a truthful self-concept includes strengths, weaknesses, and value-neutral characteristicsSelf-concept drives emotion, and emotion is the quality of our livesReferenced Concepts: Self-concept and CBT core beliefsWorking model of emotions (previous episode)Deficit-based and medical models of neurodivergenceImplicit learning and the "normal equals right" heuristicScaffolded exposure and success experiencesCommunity and realistic social comparison (queer theory and minority community)LOAPAC – the League of Autistic Psychologists and Affirming ColleaguesWe are different, not defective. Follow us on Instagram for updates and community discussion. Got a question or story to share? Send us fan mail — we'd love to hear from you. Support the show Keywords: AuDHD podcast, autism and ADHD, neurodivergent psychologist, neurodiversity affirming, Howearth Psychology, queer psychologist, autism diagnosis, ADHD awareness, lived experience, neurodivergent mental health, clinical psychology podcast

Send us Fan Mail 🎙️ Episode 33: AuDHD Experience — Disclosure and Self-Advocacy "Disclose where it serves you, and only where you feel safe doing so. People are not entitled to our information." Summary: Should I tell people I'm neurodivergent, and how do I advocate for what I need? This week Aaron reframes disclosure as something almost everyone gets wrong: it isn't a one-off announcement but a repeated, context-specific process that happens across settings and across a lifetime. Borrowing the queer community's language of "inviting people in," he explains why partial disclosure is the norm, not a failure, and why the decision always comes down to a personal cost-benefit analysis grounded in safety. Aaron walks through what the research tells us. In a UK study of 238 autistic adults, around 55% disclosed to some people, about a third disclosed to everyone, and roughly 10% told no one, with close to half of employees only disclosing after starting a job and outcomes split between positive and negative experiences. He contrasts this with the only experience-sampling study of disclosure as it happens, where about two-thirds of opportunities led to some disclosure and three-quarters of those were experienced positively, and he lingers on one participant's line: "I don't have the spoons to disclose and self-advocate in this context right now." From there, Aaron turns to accommodations. In Australia you don't have to name a diagnosis to a workplace; you can describe your difficulties and ask for reasonable adjustments, and employers have both a legal and a moral obligation to provide them where they don't cause undue hardship. Speaking as both a clinician and a small-practice owner, he explains what an employer needs to know to act, acknowledges that accommodations are often only partially met or not met at all, and closes with a practical self-reflection framework: identify the environment, the differences that matter in it, their impact, the accommodation that would help, and whether seeking it is worth the cost. That list tells you where disclosure actually serves you. Key Themes & Takeaways: Disclosure is a process, not an event – we invite people in repeatedly, to new supervisors, HR, teachers, colleagues and friends, across settings and across our livesPartial disclosure is normal – telling some people and not others isn't doing it badly; it's the most common pattern and reflects safety, not commitmentCost-benefit analysis sits at the centre – weigh the energy and anxiety of disclosing, and the risk of prejudice, against the accommodations and expectation management it could unlockSpoons matter – capacity to disclose and self-advocate fluctuates day to day with everything else going on in your life, and it's okay to say not todayYou don't have to name the diagnosis – in Australian workplaces you can describe difficulties and propose solutions without disclosing a health conditionAccommodations are a structural good – for employers, adjustments aren't an inconvenience but the way to keep goal-aligned people who feel safe, included and respectedIf nothing improved, it isn't you – partially met, unmet, delayed and self-funded accommodations are a documented pattern in the research, not a personal failingThe AuDHD research gap – almost all disclosure research lumps neurodivergent people together; ADHD is thin and AuDHD is near-absent, so prospective PhD students take noteKnow your needs before you disclose – mapping environment, differences, impact, accommodation and worth-it-ness tells you where disclosure is actually in your interestReferenced Concepts: Romualdez et al. (2021), "People Might Understand Me Better": diagnostic disclosure experiences of 238 autistic adults in UK workplacesLove et al. (2023) / Aspect Australia: experience-sampling study of 36 autistic adults across 231 disclosure opportunitiesReasonable adjustments and undue hardship in Australian workplacesLearning plans in school and university settingsSpoon theory and fluctuating cognitive and social energyMasking, stress-related rigidity and sensory differences (including misophonia)LOAPAC (League of Autistic Psychologists and Affirming Colleagues; LOAPAC.org) register of affirming practitionersThis episode is psychoeducation for general information only and isn't individualised therapy. If you need individual support, please find an affirming clinician in your area. We are different, not defective. Follow us on Instagram for updates and community discussion. Got a question or story to share? Send us fan mail — we'd love to hear from you. Support the show Keywords: AuDHD podcast, autism and ADHD, neurodivergent psychologist, neurodiversity affirming, Howearth Psychology, queer psychologist, autism diagnosis, ADHD awareness, lived experience, neurodivergent mental health, clinical psychology podcast

Send us Fan Mail 🎙️ Episode 31: AuDHD Experience — A Working Model of Emotions "Emotions are our integrated experience of our body's response to our understanding of ourselves in our context." Summary: This week Aaron shares a working model for understanding emotions, developed with alexithymia and interoceptive differences in the neurodivergent community in mind. He defines emotion as combining cognitive appraisal (our understanding of self and context) with the body's physiological response, drawing on Darwin's survival-of-the-fittest framework extended to a "survive then thrive" lens. Aaron distinguishes challenge from threat, then walks through the activated spectrum of emotions using a real-world example from his own neighbourhood, St Kilda: fight (anger), flight (fear/anxiety), freeze, and fawn, explaining the physiological and attentional shifts behind each — heart rate, digestion, muscle tension, and narrowing focus. He extends the model into flop (depression, underpinned by hopelessness) and touches on disgust as a slower-threat, memory-enhancing response distinct from the acute threat responses. He then turns to positive and deactivated states — calm, contentment, boredom, and the activated positives of excitement, interest, curiosity, and play — showing how these emerge once safety is established and how they support learning and thriving rather than mere survival. Aaron closes with practical questions listeners can use to identify their own emotions when interoception is limited, such as noticing expectations, direction of movement (towards or away), activation level, and sense of agency. Key Themes & Takeaways: Emotion as appraisal plus body response – emotions reflect both our understanding of self-in-context and our body's activation (or non-activation) in responseChallenge vs threat – the same event can trigger different emotions depending on our perceived resources relative to the demandThe activated spectrum – fight, flight, freeze, and fawn each reflect a different appraisal of available resources to manage a threatFlop and hopelessness – depression's low-arousal presentation is framed as a response to perceived hopelessness about safetyDisgust as a distinct response – slower-threat, memory-enhancing, and less about urgent escapeThriving states – curiosity, interest, and play are framed as extensions available once safety is establishedPractical self-reflection tool – simple questions (expectation, direction, activation, agency) can help identify emotions without relying on interoceptive cuesReferenced Concepts: Alexithymia and interoceptionSchema theory and internal working modelsDarwin's theory of natural selectionFight, flight, freeze, fawn, and flop responsesDisgust and contamination-avoidanceKelly McGonigal's TED talk on stress reappraisalWe are different, not defective. Follow us on Instagram for updates and community discussion. Got a question or story to share? Send us fan mail — we'd love to hear from you. Support the show Keywords: AuDHD podcast, autism and ADHD, neurodivergent psychologist, neurodiversity affirming, Howearth Psychology, queer psychologist, autism diagnosis, ADHD awareness, lived experience, neurodivergent mental health, clinical psychology podcast

Send us Fan Mail 🎙️ Episode 31: Neurodivergent Experience - Male/Female Vs Internalising/Externalising Presentations & Late Diagnosis "When we talk about male and female presentations, we're really talking about internalising and externalising presentations." Summary: In this episode of The AuDHD Psych Podcast, clinical psychologist and AuDHDer Aaron Howearth asks why more boys and men are diagnosed with autism and ADHD than girls and women. He argues that what we call male and female presentations is better described as internalising and externalising. An internalising presentation suppresses the impulse and works hard to fit the social rules, while an externalising presentation acts on it and is visible to everyone in the room. He links that split to how we still raise sons and daughters differently, and to how diagnostic criteria are built from what clinicians and researchers could observe. Because externalising presentations are the observable ones, they are the ones encoded in slow-moving manuals like the DSM and ICD, while quieter internalising presentations are less likely to be noticed or referred on. He then traces the cost of being missed. Internalising presentations more commonly come with anxiety, depression, self-harm and suicidality, difficulties with self-esteem and self-concept, and a greater likelihood of a personality disorder diagnosis. Externalising presentations more often attract conduct diagnoses, defiance and aggression, but they also tend to bring earlier recognition and the relief of seeing yourself reflected in peers with the same label. Without that recognition, "I'm different" quietly becomes "I'm not enough". He closes on late diagnosis: masking eventually meets a threshold it cannot hold, and for many neurodivergent women that arrives at perimenopause, when falling oestrogen affects GABA, serotonin and dopamine and brain fog, inattention and sensory gating become harder to hide. Key Themes & Takeaways Internalising vs Externalising – What we often call male and female presentations may be better described as suppressing the impulse versus acting on it.Culture May Contribute to Teaching Us Our Presentation – "Boys will be boys" permits externalising, while girls are taught to be pro-social, so masking is learned earlier.How Criteria Get Built – Manuals encode what clinicians could observe, so externalising is captured and quieter presentations are missed.Masks, Scripts And Stress – An internal compendium of social rules, with a script for each situation, works but can be a costly constant effort.Patterns of Difficulties Differ – Internalisers more often meet criteria for anxiety, depression and personality disorders; externalisers for conduct and aggression.Self-Concept Is A Deeper Injury – Without a name for what you are, self-understanding drifts from who you actually are.Community Repairs The Picture – Seeing your strengths and struggles in others replaces being a bad person with being a different one.Perimenopause And Late Diagnosis – A real Female-Male difference may be the reduced effects of oestrogen on GABA, serotonin and dopamine, amplifying brain fog, inattention and sensory gating.The Double Mask – People approaching burnout often mask the burnout too, which can push diagnosis even later and burnout deeper.Referenced Concepts Internalising and externalising presentations of autism and ADHDHow diagnostic criteria are constructed in the DSM and ICDPersonality disorder diagnoses in internalising presentationsSelf-concept and identity after late diagnosisPerimenopause, oestrogen, GABA, serotonin and dopamineSensory gating, attention and autistic burnoutSee Eps 10, 20 & 24 for related diagnosis/late diagnosis content. If this episode raises difficult feelings, support is available in Australia: Lifeline 13 11 14, 13YARN 13 92 76, or Beyond Blue 1300 22 4636. We are different, not defective. 🎙️ Follow @AuDHDPsychPodcast on Instagram for content reels from each episode. 📩 Send us your questions via fan mail — links in the episode player. Support the show Keywords: AuDHD podcast, autism and ADHD, neurodivergent psychologist, neurodiversity affirming, Howearth Psychology, queer psychologist, autism diagnosis, ADHD awareness, lived experience, neurodivergent mental health, clinical psychology podcast

Send us Fan Mail 🎙️ Episode 30: AuDHD Experience - Autistic Burnout & Recovery "Downtime is a necessity, not a nice to have." Summary: In this episode of The AuDHD Psych Podcast, clinical psychologist and AuDHDer Aaron Howearth takes on two questions: what is autistic or neurodivergent burnout, and what can we actually do to protect ourselves from it? He begins by being clear about where the evidence sits. Autistic burnout has been described within community since around 2008 but only reached academic publication in 2020, when Raymaker and colleagues offered a description, followed by Higgins and colleagues the year after. There is no specific research on ADHD burnout — that literature is about occupational burnout in ADHDers — and no research at all on combined AuDHD burnout, so this episode draws on the autistic burnout literature and says so plainly. Aaron works through the characteristics the two descriptions broadly agree on: debilitating exhaustion that leaves people drained and depleted, a loss of existing skills that increases disability, and, in Higgins' description, withdrawal. He makes the skill loss concrete — heightened sensory sensitivity, more emotional difficulty, reduced cognition, memory, speech and executive function, and increased difficulty with the activities of daily living like showering, cooking, cleaning and getting to work. He also complicates the three-month timeframe commonly quoted from Raymaker and colleagues, noting that the lived experience research mostly doesn't specify a duration at all: for some people it is days, for others months or years, and some don't fully recover. Drawing on a recent systematic review synthesising the lived experience literature, Aaron maps the consequences across three domains: adverse health and wellbeing impacts, our place within the community, and our capacity to stay hopeful about the future and about ourselves. That includes longer-lasting disability and continued fatigue, difficulty expressing our intelligence and feeling like we come across as silly, the sense of having lost part of ourselves, anxiety, depression, increased meltdowns, self-injury and somatic distress; reduced capacity to engage in education and work, with homelessness, inpatient admission and lost independence reported by some participants; and lowered self-esteem, self-criticism, hopelessness and increased suicidality — where, for some people, the wish is not to die but to escape the feeling of being burnt out. Aaron then turns to what feeds burnout and what protects against it. He handles camouflaging carefully: much of the lived experience research points to masking as a contributor while some follow-up research hasn't shown a significant influence, and his own argument is that what matters is our relationship with masking and whether the benefits genuinely outweigh the costs. He names ignorance, stigma, disbelief and unaccommodating environments as exhausting in their own right, before closing on the protective themes from the review — the power of knowledge, the power of taking care of our own needs for rest, solitude and sensory relief, and the power of others. He finishes by inviting listeners to choose one thing over the coming week that lowers the cost of their days, while noting that sometimes the thing to do is nothing at all. Key Themes & Takeaways  • Three Very Different Evidence Bases — Autistic burnout has descriptive academic research from 2020 onwards, the ADHD literature is really occupational burnout in ADHDers, and combined AuDHD burnout has no research at all.  • Exhaustion, Skill Loss & Withdrawal — The agreed characteristics are debilitating exhaustion and a loss of existing skills that increases disability, with withdrawal included in Higgins' description.  • Skill Loss Is Concrete, Not Abstract — It shows up as heightened sensory sensitivity, more emotional difficulty, reduced cognition, memory, speech and executive function, and difficulty with basic activities of daily living.  • No Fixed Timeframe — The frequently quoted three months is not a rule; the lived experience research describes days, weeks, months or years, and incomplete recovery for some people.  • Burnout Reaches Across Life — Impacts span physical and mental health, education and employment, housing and independence, and our hope about the future and about ourselves.  • Masking Is Associated, Not Proven Causal — Lived experience research points to camouflaging as a contributor while some follow-up research does not; what likely matters is our relationship with masking and whether it earns more than it costs.  • Ignorance & Stigma Are Exhausting — Sensory-harsh environments, unmet accommodations, being told we're overreacting, and disbelief in our autism or our distress all carry their own cost across healthcare, education, employment and family.  • Self-Knowledge Is Protective — Being unaware means our support needs stay hidden and self-concept difficulties are more likely; understanding our own patterns makes life more manageable and replaces "I'm broken" with "I'm doing things differently."  • Rest, Solitude & Sensory Relief — Pacing, permission to leave early, managed expectations in both directions, working from home, deliberate solitude and protected low-demand time are necessities rather than luxuries.  • The Power of Others — Being trusted, accepted and seen, in accommodating environments that account for a disability they can't see, is both preventative and restorative; community is where we stop feeling broken. References: Ali, D., Bougoure, M., Cooper, B., Quinton, A. M. G., Tan, D., Brett, J., Mandy, W., Maybery, M., Magiati, I., & Happé, F. (2025). Burnout as experienced by autistic people: A systematic review. Clinical Psychology Review, 122, 102669. https://doi.org/10.1016/j.cpr.2025.102669  Clarey, M. M., Abel, S., Ireland, M. J., & Brownlow, C. (2026). Autistic burnout on Reddit: A Sisyphean struggle with daily tasks. Journal of Autism and Developmental Disorders, 56(7), 2790–2802. https://doi.org/10.1007/s10803-025-06765-4  Higgins, J. M., Arnold, S. R. C., Weise, J., Pellicano, E., & Trollor, J. N. (2021). Defining autistic burnout through experts by lived experience: Suggested data-based model and consensus method. Autism, 25(8), 2356–2369. https://doi.org/10.1177/13623613211019858 Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., & Nicolaidis, C. (2020). "Having all of your internal resources exhausted beyond measure and being left with no clean-up crew": Defining autistic burnout. Autism in Adulthood, 2(2), 132–143. https://doi.org/10.1089/aut.2019.0079 Support the show Keywords: AuDHD podcast, autism and ADHD, neurodivergent psychologist, neurodiversity affirming, Howearth Psychology, queer psychologist, autism diagnosis, ADHD awareness, lived experience, neurodivergent mental health, clinical psychology podcast

Send us Fan Mail 🎙️ Episode 29 — Work, Burnout & Ableism: Why So Many of Us Aren't Employed Episode Summary If we are different and not defective, why are so many of us unemployed, underemployed, or exhausted at work? In this episode, Aaron Howearth (Clinical Psychologist) works through the employment gap for neurodivergent people — and makes the case that it is structural, not a matter of effort or willingness. We start with the numbers. Around three in ten autistic adults are employed in UK research, roughly half in Australia, and in the Netherlands the most common employment trajectory across thousands of autistic people was long-term unemployment. ADHD sits differently in the data, with productivity loss, injury, and time off carrying much of the cost. What ties it together is a person-environment mismatch — and the uncomfortable finding that most interventions still try to change the person rather than the workplace, even though environmental change is what actually shifts employment outcomes. From there we get into burnout as a mechanism. We work through what autistic burnout actually is — chronic exhaustion, skills loss, reduced tolerance for sensory and cognitive demands, nonlinear and often long-term — how it must be differentiated from depression, anxiety, trauma responses and personality differences without excluding them, and why the withdrawal looks different (recovery, not amotivation). We are careful with masking: it is associated with burnout and likely a leading mechanism, but the causal evidence isn't there yet. We also name the thin ground honestly — ADHD burnout is a clinical and community idea without a defining study, and AuDHD burnout has almost no academic literature at all. Then we turn upstream to ableism: the assumption that able-bodied and typical means right, normal, and appropriate, and that anything else is deficient. That shows up bluntly (employers who say they would not hire an autistic person under any circumstances) and subtly (be quiet, slow down, be more cheerful) — and both feed masking, stress, and burnout. We extend the double empathy problem to triple empathy in professional settings, where the mismatch is with colleagues and managers too, not just clients. Finally, we get practical: what accommodations actually cost, why everyone already uses accommodations, what to ask for, and how to plan recovery before you run out of spoons. In This Episode (Chapters) (00:00) Different, not defective — so why aren't so many of us employed?(01:00) The employment gap is real and structural: UK, Australia, US, Netherlands(03:30) ADHD and work: productivity loss, injury, and time off(04:30) Barriers are structural, not effort-related(05:30) Why interventions change the person instead of the environment(07:00) Autistic burnout: Raymaker, Higgins, and what it actually looks like(09:00) Differentiating burnout from depression, anxiety and trauma responses(10:30) Why late diagnosis changes the presentation(11:30) Masking and burnout: associated, not proven causal(13:30) Recovery withdrawal vs depressive withdrawal(15:00) ADHD burnout: a clinical idea without a defining study(16:00) AuDHD burnout: almost no evidence base at all(17:00) Who is most at risk: gender, and co-occurring conditions(18:00) What ableism is, and why it drives everything upstream(20:00) Over half of employers say they wouldn't hire an autistic person(21:30) The subtle version: "be quiet", "slow down", "be more cheerful"(24:00) Minority stress, cumulative feedback, and why our masking is safety-related(26:00) Double empathy at work — and the triple empathy problem for professionals(28:30) "Why should you get accommodations?" — the stairs and the lift(30:00) What accommodations actually cost: mostly free, average around USD $300(31:30) Practical accommodations: headphones, quiet spaces, breaks, stimming, routine(33:30) Supported work models and work-person fit(35:30) Disclosure: entirely your call, and how to open the conversation(37:30) What employers can do to make disclosure less frightening(38:30) Planning recovery before you run out of spoons — closing reflection Key Takeaways The employment gap is structural, not motivational. Roughly three in ten autistic adults are employed in UK research, about half in Australia, and long-term unemployment was the most common trajectory in a large Netherlands study. Nobody is sitting at home deciding they can't be bothered.ADHD shows up differently in the data — around 21 to 22 extra days of lost productive work a year, plus higher rates of injury and time off — rather than as outright exclusion.Most employment interventions try to change the person. The research points the other way: changing the work environment substantially increases neurodivergent employment.Autistic burnout is chronic exhaustion, skills loss, and reduced tolerance for sensory, social and cognitive demands, arising from unsupported person-environment mismatch. It is debilitating, nonlinear, and often long-term with spikes.It must be differentiated from depression, anxiety, trauma responses and personality differences — but the presence of those does not exclude autism, ADHD or AuDHD. Burnout withdrawal is recovery-seeking; depressive withdrawal is amotivation and hopelessness.Masking is associated with burnout and is likely a leading mechanism, but the causal evidence is not there yet. It's said plainly in the episode: the relationship is real, the causal claim isn't earned.ADHD burnout is an idea in clinical, community and advocacy circles without a defining study, and AuDHD burnout has almost no academic literature. That gap is named rather than papered over.Ableism is the upstream driver: the assumption that typical ability is right and normal, and difference is deficient. Over half of employers in one study said they would not employ an autistic person under any circumstances.The subtle version does the quiet damage — "be quiet", "slow down", be more expressive, be more cheerful — accumulating as minority stress, which drives masking, which drives burnout.Double empathy extends into the workplace as triple empathy: research on young GPs found communication difficulty with colleagues and managers, not only with clients.Everyone already uses accommodations. Stairs, lifts and escalators are accommodations for capacities humans don't have. We are just further from the middle of the human road, so we need a few more.Accommodations are cheap — most are free, averaging around USD $300 — and quiet spaces, headphones, redistributed breaks, permitted stimming, clear routines and flexible or online work all support engagement.Neurodiversity-affirming does not mean nobody has support needs. Some of us need considerably more support than others, and that has to stay visible.Disclosure is entirely personal and case by case. Where it feels safe, framing it as a shared problem to solve makes it a win for both sides — and employers can make those conversations normal so disclosure stops being frightening.Plan recovery before you need it. Build restoration into the day, week or month rather than waiting until the spoons are gone. A Note on the Evidence Today's discussion draws on a mix of peer-reviewed research (strongest for autistic employment outcomes, autistic burnout, and accommodations), thinner and largely non-definitive material on ADHD burnout, and clinical and lived-experience observation where the literature does not yet reach — particularly for AuDHD burnout, where academic evidence is close to absent. Where a claim is associational rather than causal, or clinical rather than trial-based, that's named clearly in the episode. Disclaimer This episode is general educational and advocacy information only. It is not individualised or tailored therapy, assessment, advice, or employment or legal guidance. If you need support, please speak with your GP or a registered practitioner in your area. Thanks for listening, and remember — we are different, not defective. Support the show Keywords: AuDHD podcast, autism and ADHD, neurodivergent psychologist, neurodiversity affirming, Howearth Psychology, queer psychologist, autism diagnosis, ADHD awareness, lived experience, neurodivergent mental health, clinical psychology podcast

Send us Fan Mail  🎙️ Ep 28 — Relationships: Friendship, Loneliness & Intimacy Across Neurotypes "It's not meeting my needs. It's not meeting your needs. It's meeting our needs in the best balance for us" ⚠️ Content note: this episode includes brief discussion of trauma, including sexual trauma. If we're different and not defective, why do so many of us find relationships hard? In this episode, Aaron Howearth (Clinical Psychologist) sits with that question and works through friendship, loneliness, and intimacy across neurotypes — not as evidence of a deficit inside us, but as something that lives in the space between us and the people we're trying to connect with. We start with what the research bears out: on average, autistic people report being lonelier and having fewer, lower-quality friendships — though this varies enormously from person to person, and many of us genuinely prefer smaller, higher-quality networks. From there we get into the double empathy problem: the idea that communication difficulties aren't a one-sided skills deficit, but a two-way mismatch, like speaking the same language in a slightly different dialect. When neurotype-matched pairs communicate, that difficulty largely disappears — which tells us it's a language barrier, not a broken person. We look at why community is protective, why masking costs us, and why the evidence is stronger for autism than ADHD, with only grey-literature hints that double empathy extends to ADHD too. We then turn to intimacy across neurotypes — comparable desire for connection, but real barriers around sensory sensitivity, communication style, and a statistically higher likelihood of trauma. Finally, we bring in Gottman's work on partner responsiveness (turning towards vs turning away) and a warm-hug framing of attachment styles, landing on the most practical lever of all: understanding how you and your partner work, and meeting needs in the balance that's right for your context. In This Episode (Chapters) (00:00) Different, not defective — so why are relationships hard?(00:45) Friendship and loneliness: what the research bears out(02:00) Fewer but higher-quality friends — and why that's often a preference(02:45) A spectrum of understanding, not a skills deficit(03:30) Same language, different dialect: where nuance gets lost(04:15) The thin evidence base for ADHD and friendship(05:00) Masking costs us; community is protective(06:00) The double empathy problem, and how it was tested(08:00) Why it's a language barrier, not a broken person(09:00) Does double empathy extend to ADHD? A pragmatic argument(10:30) Intimacy across neurotypes: comparable desire, real barriers(11:30) Sensory sensitivity, communication, and trauma (content note)(13:00) It's not always "because I'm autistic" — stress and history matter(14:00) Gottman, turning towards vs turning away, and bids for connection(17:00) Partner responsiveness: the strongest lever we can pull(18:30) Attachment as a big warm hug: secure, avoidant, anxious, disorganised(21:00) ADHD, conflict, and satisfaction — statistical, not deterministic(23:00) The push-pull cycle of anxious and avoidant partners(25:00) Higher risk of interpersonal stress and how it shapes attachment(26:30) What we can do: naming our style, our needs, and our part(28:00) Boundaries as meeting our needs in balance — closing reflection Key Takeaways The difficulty usually isn't in us — it lives in the interaction. Relational difficulty is a mismatch between communication styles, not an inherent deficit.On average, autistic people report more loneliness and fewer, lower-quality friendships — but this varies widely, and many of us genuinely prefer small, high-quality networks. Loneliness drops with better friends, not necessarily more of them.The double empathy problem reframes "social deficits" as social differences: neurotype-matched pairs communicate without significant impairment; the difficulty arises when different neurotypes meet. It's a contested idea, but a simple, elegant one.Masking costs us — it raises stress. Being around community is protective because our communication styles align more closely, so we feel heard, understood, and connected.The evidence base is strongest for autism; ADHD friendship research is thin, mostly in children and college students. Double empathy probably extends to ADHD (a pragmatic, clinical argument), via verbal impulsivity rather than filtering.Intimacy: desire for connection is comparable to the general community, but barriers around sensory sensitivity, communication, and a higher likelihood of trauma can get in the way — often it's stress or history amplifying the dynamic, not the neurotype itself.Partner responsiveness is the single strongest determinant of healthy neurodivergent relationships. Turning towards small bids for connection — even a "mm-hmm, yes dear" — builds trust; consistently turning away erodes it.Attachment is about trusting that our needs will be met. Secure, avoidant, anxious, and disorganised (anxious-avoidant) styles play out in a push-pull cycle — and our higher risk of interpersonal stress and trauma can push us toward insecure attachment.The practical work: ask what my attachment and relational style are, what I expect, what I might be doing that makes my partner pull away — and the reverse. Then have the conversation. Boundaries aren't about my needs or your needs; they're about meeting our needs in the best balance for our context. A Note on the Evidence Today's discussion draws on a mix of peer-reviewed research (strongest for autism, and for the double empathy work), grey literature (particularly for any extension to ADHD), and lived-experience and clinical observation. Where the ADHD-and-friendship evidence is thin, or where the argument is pragmatic rather than trial-based, that's named clearly in the episode. Disclaimer This episode is general educational and advocacy information only. It is not individualised or tailored therapy, assessment, or advice. Aaron does not provide relationship counselling. If you need support, please speak with your GP or a registered practitioner in your area. Thanks for listening, and remember — we are different, not defective.  Support the show Keywords: AuDHD podcast, autism and ADHD, neurodivergent psychologist, neurodiversity affirming, Howearth Psychology, queer psychologist, autism diagnosis, ADHD awareness, lived experience, neurodivergent mental health, clinical psychology podcast

Send us Fan Mail 🎙️ Ep 27: AuDHD Experience - Therapy Adaptations for Neurodivergent Folk (AuDHD, ADHD & Autism)  — What's the Point? "Barriers aren't a 'you' problem — they're an 'us' problem to manage together." Hi friends. If neurodivergent people are already showing up to therapy, why do affirming adaptations even matter? In this solo episode I work through that question from my own clinical experience and lived experience as an AuDHD psychologist. We map the barriers that keep neurodivergent people out of the therapy room — physical, psychological, emotional, sensory, and cognitive — and then walk back through the same five to look at small, practical, often low-cost changes that make care genuinely accessible. From externalising working memory and body doubling, to trauma-informed safety, non-fluorescent lighting, situational mutism, and a cushion instead of new chairs, this one is for neurodivergent listeners deciding what to ask for, and for clinicians wanting to do better. A note on the evidence: I'm speaking mostly from clinical and lived experience here, not a deep RCT base. Where I mention that neurodivergent people "endorse" adapted approaches as helpful, that's about acceptability and client-rated helpfulness — how much people value these adaptations — not proven treatment efficacy or effect sizes. The main study behind that point is Paynter, Sommer & Cook (2025), who asked autistic adults to rate the helpfulness of specific therapy adaptations. The passage on perimenopause and sensory gating is an emerging, still-contested area, not settled science — hold it lightly. Takeaways: • There's no single "neurodivergent barrier" — physical, psychological, emotional, sensory, and cognitive access all matter, and they stack. • Affirming therapy is trauma-informed by default; many of us carry complex stress and iatrogenic harm from past care. • Speech is never a choice — situational mutism is overwhelm, not defiance. • Meltdowns are overwhelm, and what looks like social anxiety or agoraphobia is often sensory-cognitive overload. • Most adaptations are cheap: in-session alarms, chunking information, body doubling, dimmable lights, a cushion, starting on time. • Clients: you're allowed to ask for a reasonable accommodation. Clinicians: mostly, just ask. If this was useful, please share it with a clinician who needs to hear it — that's the single best way to get affirming care to more people. 📚 Reference: Paynter, J., Sommer, K., & Cook, A. (2025). How can we make therapy better for autistic adults? Autistic adults' ratings of helpfulness of adaptations to therapy. Autism. https://journals.sagepub.com/doi/10.1177/13623613251313569 Educational content only — this is not therapy or personalised clinical advice. We are different, not defective. Keywords: neurodivergent therapy, AuDHD, autism, ADHD, affirming practice, therapy adaptations, accessibility, situational mutism, sensory overwhelm, trauma-informed care, clinical psychology Support the show Keywords: AuDHD podcast, autism and ADHD, neurodivergent psychologist, neurodiversity affirming, Howearth Psychology, queer psychologist, autism diagnosis, ADHD awareness, lived experience, neurodivergent mental health, clinical psychology podcast

Send us Fan Mail   🎙️ Episode 26: Understanding Neurodivergence - More Than Diagnosis "I can be autistic without autism spectrum disorder, in the same way that I can have legs without being broken." Summary: In this episode of The AuDHD Psych Podcast, clinical psychologist and AuDHDer Aaron Howearth takes on a question sparked by a challenge on social media: can you identify as autistic without holding a formal diagnosis of Autism Spectrum Disorder? The answer is yes — and in this episode, Aaron unpacks exactly why, drawing on clinical definitions, diagnostic criteria, the neurodiversity-affirming paradigm, and his own lived experience as an autistic ADHDer and former Navy serviceperson. Aaron begins by untangling three terms that are often conflated: neurodiversity, neurodivergent, and diagnosis. He explains that neurodiversity — like biodiversity — simply refers to the natural range of cognitive styles that exist across humans, while neurodivergent describes a brain that functions differently from the neurotypical majority. Autism, he argues, is a cluster of cognitive characteristics — not a disorder by default. Autism Spectrum Disorder, on the other hand, is the diagnostic label that applies only when those characteristics cause functional difficulties in the person's life. Drawing on Damian Milton's Double Empathy Problem, Aaron explores how social and communicative differences in autism are not inherent deficits, but mismatches between communication styles — a dialect problem, not a language problem. He walks through how the same characteristic (say, cognitive rigidity or impulsivity) can function as both a strength and a barrier depending on the environment, using vivid examples from his own clinical work and time in the Navy. Aaron also addresses the claim that autism diagnosis is "not a social construct," offering a clinical and philosophical unpacking of what a social construct actually is — and why diagnosis, by its very nature, fits that definition. He closes by emphasising that a neurodiversity-affirming perspective does not deny difficulty; it contextualises it. A person's expression of their characteristics as strengths or challenges will always interact with physical health, social inclusion, life stress, and environment. Key Themes & Takeaways Neurodiversity vs Neurodivergent vs Diagnosis — Why these three terms are distinct, and why conflating them creates confusion about identity, language, and clinical need.Autism vs Autism Spectrum Disorder — Autism refers to a profile of cognitive characteristics; ASD is diagnosed only when those characteristics cause functional difficulties.Diagnosis as Social Construct — A clinical and philosophical explanation of why all diagnostic frameworks, including ASD, are socially constructed — and why that doesn't undermine their validity or usefulness.The Double Empathy Problem — Milton's framework explaining that autistic communication difficulties emerge from mismatch, not from inherent deficit; neurotypical people experience the same difficulty in autistic-majority environments.Valence-Neutral Characteristics — Every autistic or ADHD characteristic is contextually neutral: the same trait can be adaptive in one environment and a barrier in another.Cognitive Bandwidth & Masking — How the implicit effort of operating in a neurotypical world consumes cognitive resources, raising baseline stress and reducing capacity for flexibility.Formulation Thinking — Why a neurodiversity-affirming lens requires us to account for the interaction between characteristics and everything else in a person's life: sleep, health, social safety, and stress.Referenced Concepts DSM-5 diagnostic criteria for Autism Spectrum DisorderDamian Milton's Double Empathy ProblemThe neurodiversity-affirming paradigmSocial and relational models of disabilityWe are different, not defective. 🌐 Follow @AuDHDPsychPodcast on Instagram for content reels from each episode. 📩 Send us your questions via fan mail — links in the episode player.  Support the show Keywords: AuDHD podcast, autism and ADHD, neurodivergent psychologist, neurodiversity affirming, Howearth Psychology, queer psychologist, autism diagnosis, ADHD awareness, lived experience, neurodivergent mental health, clinical psychology podcast

Send us Fan Mail  🎙️ Episode 25: AuDHD Experience - Neurodiversity-Affirming Practice "Neurodiversity-affirming practice" is now on almost every clinician's website here in Australia and around the world — but what does it actually mean, and what should it look like in the room? In this episode, Aaron Howearth (Clinical Psychologist) unpacks affirming practice not as a marketing label, but as a genuine reorientation of how we understand, formulate, and work alongside neurodivergent people. We start with the conceptual foundations: relocating difficulty away from the individual and into the mismatch between a person and an environment that demands they be someone they're not. From there we walk through the domains where affirming practice actually shows up — formulation, language, collaborative goal-setting, therapeutic-style fit, and environmental adaptation — using the five Ps formulation and plenty of lived-experience examples along the way. We then name clearly what affirming practice is not: relabelling old deficit-focused work, abandoning clinical reasoning, avoiding difficulty, or imposing an affirming frame on someone who hasn't asked for it. Finally, we offer six practical markers you can use to tell whether the care you're giving or receiving is genuinely affirming — and an honest note on where the evidence base currently sits. As always, this is general educational information, not individualised therapy or advice. In This Episode (Chapters) (00:00) Welcome and why affirming practice matters(01:30) What the research tells us — and where the evidence base is thin(03:00) Affirming practice as a reorientation, not a new treatment model(04:30) Relocating disability: the environmental mismatch(06:00) What we're actually trying to do in therapy (and what we're not)(08:00) The domains of affirming practice: formulation, language, goals, adaptation(09:30) Identity-first vs person-first language(10:30) The five Ps formulation, worked through as a personal example(15:00) Building treatment plans that align with the client's goals(18:00) Why suppressing natural ways of being costs us — masking, burnout, safety(20:30) Adapting the therapy itself: the person–therapy fit and homework(24:00) What is NOT neurodiversity-affirming practice(28:00) Six markers of affirming care(34:00) Outcomes: quality of life, not typicality(36:00) A closing reflection and an honest note on the evidence Key Takeaways Affirming practice changes the work, not just the words. It's a reorientation of perspective, not a rebrand of deficit-focused therapy.Difficulty is relocated into the mismatch between a person and an environment that expects them to be different — not into the person themselves.The goal of therapy is a life that has value to the client and meets their goals, not normalising someone for what society expects.It is collaborative and consent-based: language, goals, and adaptations are co-designed, never imposed.It does not abandon clinical reasoning, the evidence base, or honesty — it holds those alongside genuine respect for the person.Homework that isn't getting done is a design problem to be barrier-managed, not a motivation failure.Six markers of affirming care: formulation names the environment; goals are client-led; goals don't ask for unhelpful masking; adaptations are individualised; language preference is asked, not assumed; outcomes are measured by quality of life. A Note on the Evidence Much of what's discussed today draws on lived-experience research and correlational data rather than randomised controlled trials. We don't yet have affirming interventions rated as evidence-based across systematic reviews — but the parallels with affirming practice in trans and queer communities, alongside strong lived-experience data, point clearly in this direction. Disclaimer This episode is general educational information only. It is not individualised or tailored therapy, assessment, or support. If you need support, please seek out an affirming clinician in your area. Thanks for listening, and remember — we are different, not defective.  Support the show Keywords: AuDHD podcast, autism and ADHD, neurodivergent psychologist, neurodiversity affirming, Howearth Psychology, queer psychologist, autism diagnosis, ADHD awareness, lived experience, neurodivergent mental health, clinical psychology podcast

Send us Fan Mail 🎙️ Episode 24: AuDHD Experience - Late Diagnosis and Identity Reconstruction "After a lifetime of feeling wrong, broken, like a weirdo, along comes late diagnosis — but that's the doorway, not the destination." In this episode of AuDHD Psych, Aaron explores late diagnosis and identity reconstruction for autistic, ADHD and AuDHD people — why so many of us are found so late, and how we rebuild a sense of self afterwards. Drawing on the research and his own experience, he unpacks why late diagnosis is the norm rather than a personal failing, how internalising presentations and masking keep us under the radar, and why our diagnostic criteria, built around externalising behaviour, miss so many of us for decades. He looks at the double feeling of diagnosis — relief and grief arriving together — and at diagnosis as something that confirms who we already were rather than changing us. He also handles the borderline personality disorder pathway carefully, as a frequent misdiagnosis and conceptual overlap rather than a relabelling, while naming the stigma that does real harm. Takeaways: Late diagnosis is the norm, not the exception — being missed for years is what the research predicts, not evidence that you were ever fine. You weren't missed because you're not neurodivergent; you were missed because you didn't present the way the criteria expected.Our diagnostic criteria were built around externalising presentations in academic and clinical settings, creating an observation bias — so people who internalise, the author included, fly under the radar until the science catches up with the lived experience.Masking hides our characteristics, and higher masking predicts later diagnosis — the more we mask, the less we show up against the criteria. That same effort drains the cognitive and emotional energy we need for daily life, pushing us toward burnout, overwhelm, anxiety and, for some, depression and self-harm risk.Masking carries a heavier cost where we're raised to be "socially acceptable," which is part of why we talk about masculine and feminine presentations when we really mean externalising and internalising ones.Many neurodivergent people — particularly those raised as girls — receive a borderline personality disorder diagnosis before autism, ADHD or AuDHD. The two can genuinely coexist, but it is often a missed or mistaken identification, and the unfair stigma attached to BPD others people even further and makes things worse.Late diagnosis is frequently cathartic and a relief, and at the same time brings grief for what could have been and anger at having been called lazy, chaotic, "too much" or "not enough." Holding relief and grief together is not contradictory — it's the normal shape of finding out late.Diagnosis or self-identification doesn't change us; it gives us a framework to understand ourselves through that isn't only deficit-based. Compared against a neurodivergent frame, the "typical" person would look deficient too — it's difference, not defect.Identity reconstruction is gradual, not instant — we reconfigure our sense of self over time, find ourselves reflected in community, and integrate our emotional history, coming to see our characteristics as a source of strengths as well as struggles.Reflect on a characteristic you associate with deficit — say impulsivity — and look for where it has actually served you: a leap that brought adventure, curiosity that fed creativity or research, pattern recognition that made you brilliant with systems. A balanced, true view of yourself is the foundation for rebuilding who you are.Support the show Keywords: AuDHD podcast, autism and ADHD, neurodivergent psychologist, neurodiversity affirming, Howearth Psychology, queer psychologist, autism diagnosis, ADHD awareness, lived experience, neurodivergent mental health, clinical psychology podcast

Send us Fan Mail 🎙 Episode 23: AuDHD Experience - Joy, Strengths and Quality of Life "Strengths-based framings sit alongside, not instead of, our support needs — so keep both ideas in mind." In this episode of AuDHD Psych, Aaron explores joy, strengths, and quality of life for AuDHDers — moving past both the deficit-and-disorder framing and the neurodivergent-superpower narrative to find the partial truth in each. Drawing on recent research, he unpacks the strengths autistic and ADHD people endorse (pattern recognition, hyperfocus, humour, creativity), how flow, hyperfocus, and monotropism overlap, and why our strengths are linked to well-being when we name and use them. He also looks at what genuinely lifts quality of life — affirming relationships, good environmental fit, support, and community — while warning against environments that extract our strengths without supporting our needs. Takeaways: Neither the deficit-and-disorder framing nor the superpower narrative is the full truth — strengths-based framings sit alongside, not instead of, our support needs.Research backs the strengths neurodivergent people describe: autistic strengths like pattern recognition, detail orientation, systematising, deep expertise, and a justice orientation; ADHD strengths like hyperfocus, humour, and creativity, endorsed well above the typical community.Strengths are linked to well-being — first by knowing and naming them, then by using them in your life. ADHD creativity and divergent thinking are also linked to real-world achievement and even deliberate mind-wandering.Flow, hyperfocus, and monotropism share much of the same terrain — feeling good in the doing and getting to unmask — but it's a dose-response curve: restorative up to a point, then a driver of burnout.Monotropism appears to be transdiagnostic, scoring above the general population in both autistic people and ADHDers, and underpins special interests as a well-being variable.Autistic adults score lower across all four WHO well-being domains, with autistic women carrying a disproportionate burden — but employment, support, and relationships are concrete, observable improvers.Quality over quantity: a few reciprocal, accepting, affirming relationships support well-being far more than many social contacts. A positive autistic identity, mediated by external acceptance and community, also lifts quality of life.Much of the "disorder" we diagnose reflects a mismatch between person and environment, not an inherent flaw — Milton's double empathy problem reframes communication "deficits" as differences that dissolve in affirming spaces.Beware extraction: environments that benefit from your strengths without supporting your difficulties are a structural problem requiring a structural fix — environmental, cognitive, sensory, and social accommodations.Reflect on three of your own neurodivergent strengths and where you apply them, and seek out environments and community where you can unmask and feel safe — joy and well-being are real, and joy is a variable of well-being.Keywords: AuDHD, neurodivergent strengths, joy, quality of life, monotropism, hyperfocus, flow, well-being, special interests, double empathy problem, environmental fit, burnout, affirming community, different not defective Support the show Keywords: AuDHD podcast, autism and ADHD, neurodivergent psychologist, neurodiversity affirming, Howearth Psychology, queer psychologist, autism diagnosis, ADHD awareness, lived experience, neurodivergent mental health, clinical psychology podcast

Send us Fan Mail ⚠️ Content note: This episode discusses suicide and suicidal thoughts directly and at length. It is general education, not personal advice. If this feels like a lot, please pause and reach out to a support service (Australian helplines listed at the end). Episode 22: AuDHD Experience – Suicidality & Protective Factors In this episode of the AuDHD Psych Podcast, clinical psychologist Aaron Howearth explores why suicidality risk is higher in neurodivergent communities — and why that risk is not inherent to being autistic, ADHD, or AuDHD. Drawing on clinical work, lived experience, and recent research, Aaron is clear that elevated risk is an outcome of the interaction between neurodivergent people and environments that don't accommodate them. The through-line of the whole conversation: we are different, not defective, and it's not your fault. Aaron unpacks the mechanisms behind heightened risk — constant masking leading to defeat and entrapment, thwarted belonging and a sense of burdensomeness, isolation and minority stress, and unmet support needs. He then turns to crisis care and affirming support, with a direct message to clinicians about flat affect, sensory-hostile environments, and the difference between autism, ADHD, AuDHD and trauma. The episode closes on hope: the protective factors and practical safety-planning scripts that can genuinely reduce risk. Key Themes & Takeaways Risk Is Real, Not Inherent – Suicidality is elevated in neurodivergent communities, but it reflects environmental mismatch and accumulated stress, not a flaw in the person.Masking → Defeat → Entrapment – Constant camouflaging is exhausting and, when reinforced over time, can drive feelings of defeat and entrapment.Belonging & Burdensomeness – Thwarted belonging and a sense of being "a burden" can heighten risk, especially alongside complex trauma histories.Isolation & Minority Stress – Social exclusion, sensory load, and the extra stresses of being a disempowered group compound over time.Crisis Care Can Fail Us – Flat affect being misread and sensory-hostile crisis settings can drive disengagement from support.Affirming Care Matters – Sensory and communication accommodations, and directly asking about risk, help people feel safe enough to engage.Protective Factors – Positive childhood experiences, community and belonging, unmasking, and sensory fit all reduce risk.Safety Planning Works – Make a safety plan while you're well, with someone you trust — it's yours, and it can change over time. Includes scripts for clients and clinicians.If you need support:   · Suicide Call Back Service 1300 659 467  · 13YARN (for Aboriginal & Torres Strait Islander people) 13 92 76.  · QLife (LGBTIQ+ peer support) 1800 184 527.  · Lifeline 13 11 14  · Beyond Blue 1300 22 4636 Support the show Keywords: AuDHD podcast, autism and ADHD, neurodivergent psychologist, neurodiversity affirming, Howearth Psychology, queer psychologist, autism diagnosis, ADHD awareness, lived experience, neurodivergent mental health, clinical psychology podcast

Send us Fan Mail Episode 21 – Trauma, PTSD & Systems Harm What if you're not "too much," "too complex," or "treatment resistant"? What if the very systems designed to help neurodivergent people are inadvertently causing harm instead? In this episode, Aaron explores the deep intersection between neurodivergence and trauma — and why so many AuDHDers, autistic folks, and ADHDers find themselves stuck in cycles of misdiagnosis, invalidation, and burnout. What we cover The difference between big T trauma (PTSD) and complex trauma (cPTSD), and why complex trauma is so prevalent in neurodivergent communitiesWhy neurodivergent people are statistically more exposed to trauma, bullying, social exclusion, and adverse childhood experiences (ACEs)How diagnostic overshadowing leads clinicians to mislabel trauma responses as personality disorders — or dismiss them entirelyThe structural harms baked into school systems, healthcare, and historical practices like ABAHow masking, allostatic load, and burnout compound trauma and erode identityWhy service avoidance is often a reasonable response to repeated invalidationThe link between systems harm, hopelessness, and elevated suicidality in our communitiesPractical scripts for advocating with GPs, psychologists, and other clinicians when you feel unheard Key takeaway The "complexity" so often attributed to neurodivergent clients usually isn't about us — it's about a mismatch between our characteristics, our histories, and systems built for someone else. Understanding trauma and neurodivergence together makes the "complex" much less complex. Content warning This episode discusses trauma, complex trauma, interpersonal violence, school bullying, healthcare harm, and suicidality at a conceptual level. Please pause and reach out to a support service if needed: Lifeline: 13 11 14Beyond Blue: 1300 22 463613YARN: 13 92 76QLife: 1800 184 527Emergency: 000 Referenced research Stickley (2022) – ACEs and neurodivergenceBerg (2024) – Adverse childhood experiences in autistic adolescentsAdams (2025) – Parents on CAMHS: "accumulating harm and waiting for crisis"You are not too much. You are not defective. You are different — and you are worthwhile. 🎧 Subscribe, share with someone who needs to hear it, and join the conversation on Instagram @audhdpsychpodcast Support the show Keywords: AuDHD podcast, autism and ADHD, neurodivergent psychologist, neurodiversity affirming, Howearth Psychology, queer psychologist, autism diagnosis, ADHD awareness, lived experience, neurodivergent mental health, clinical psychology podcast

Send us Fan Mail Episode 20: AuDHD Explained — Misdiagnosis, BPD & Mental Health in Late-Diagnosed Adults In this episode of the AuDHD Psych Podcast, clinical psychologist Aaron Howearth and co-host Dan unpack why mental health diagnosis is so complex for AuDHDers, and why so many of us collect a stack of labels — depression, generalised anxiety, borderline personality disorder, bipolar, treatment-resistant depression — before Autism and ADHD are ever properly considered. Drawing on clinical work, lived experience, and the qualitative research literature, Aaron explains how diagnostic overshadowing happens, why internalising presentations are most at risk of misdiagnosis, and what genuinely neurodiversity-affirming assessment looks like in practice. Aaron and Dan work through the mechanics of overshadowing — how a clinician's existing diagnostic lens quietly re-explains every new symptom and closes the door on alternative formulations — and the elevated mental health risks that ride alongside AuDHD, including anxiety, depression, self-harm and suicidality. They examine why biological females and internalising males are disproportionately mislabelled with borderline personality disorder when emotional impulsivity, rejection sensitivity and rigid thought patterns are actually expressions of an undiagnosed AuDHD profile. They then move into the practical: how to script questions for your clinician without it landing as an attack, why differential diagnosis and formulation are the antidote to overshadowing, and how late diagnosis reframes self-concept from "bad person, not trying hard enough" to environment-fit. Throughout, the conversation returns to the affirming reframe — difficulties arise from the mismatch between who you are and what the environment expects, not from a defective self. Key Themes & Takeaways Co-occurrence Is the Rule, Not the Exception – Around 40% of autistic people have a co-occurring mental health condition, ADHDers are similarly elevated, and AuDHDers sit at higher risk again for anxiety, depression, self-harm and suicidality.Diagnostic Overshadowing Defined – Once a clinician holds one diagnostic lens, new symptoms get re-explained through it, and alternative formulations stop being considered.The Observation Fallacy – Clinicians can only diagnose what they know to look for; if AuDHD isn't on the radar, the symptoms get mapped to whatever lens is familiar.BPD as the Classic Misdiagnosis – Emotional impulsivity, rejection sensitivity, identity disturbance and rigid thought can all be AuDHD expressions, particularly in biological females and internalisers whose presentations don't match the externalising male stereotype that built the diagnostic criteria.1 in 5 Autistic Adults Report Overshadowing – Lived experience and self-report research show roughly 20% of autistic adults have experienced misdiagnosis or missed diagnosis tied to overshadowing.Treatment-Resistant Doesn't Mean Broken – When treatment plans target the wrong formulation, "not responding" is a systems failure, not a character flaw or proof of imposter syndrome.Differential Diagnosis & Formulation – Good assessment ticks the diagnostic boxes and excludes confounds, situating symptoms inside developmental history, sensory profile, trauma, family history and cognitive profile.Neurodiversity-Affirming Assessment – Goes beyond awareness to actively consider AuDHD interactions, masking effects, and the cognitive and sensory differences that shape presentation and treatment.Scripting for Appointments – Lines like "I'm wondering how you came to that conclusion — do you have a formulation that led to the treatment plan?" make hard conversations doable without landing as an attack on the clinician.Self-Knowledge Is a Clinical Safety Issue – Understanding your own formulation isn't an optional extra; it protects against decades of misfitting diagnoses and treatments built on the wrong foundation.Late Diagnosis Reframes Self-Concept – Understanding your characteristics through an AuDHD lens replaces years of "bad person, not trying hard enough" narratives with environment-fit explanations and self-forgiveness.Hard Mode Is Context-Specific – AuDHDers may live life on hard mode for admin and rigid-rule contexts while playing easy mode for problem-solving and pattern recognition; diagnosis is a context map, not a verdict.Different, Not Defective – Change the environment and the expectations, and the same characteristics that look like disorder in one setting become strengths in another.Scripts to use with your clinicians: Re-Assessment Request: "I have been carrying these diagnoses for a long time and the treatments have not led to the changes I had hoped for. I would like to ask whether autism, ADHD or AuDHD has ever been formally considered as part of the formulation, and what a neurodiversity-informed assessment might look like."  Formulation Question: "Can we look at this together as a formulation rather than only as a diagnosis? I would like to understand how my sensory experience, my history of masking and burnout, my executive functioning, and my life context are being weighed in the picture you are forming."  Diagnostic Overshadowing Prompt: "I am concerned that some of what I am experiencing is being explained primarily by my existing diagnosis. Can we slow down and consider whether there is something else, including potentially a neurodevelopmental factor, that needs to be assessed in its own right?"  Support the show Keywords: AuDHD podcast, autism and ADHD, neurodivergent psychologist, neurodiversity affirming, Howearth Psychology, queer psychologist, autism diagnosis, ADHD awareness, lived experience, neurodivergent mental health, clinical psychology podcast