Ep 1: Late Autism Diagnosis in Adults – Signs You’ve Been Misdiagnosed

Introduction

**Natasha Stavros (00:00:05):**
After the masquerade, the masks come off, the tea is poured, and here we can tell the truth. Using the Unmasking Diary to explore the everyday process of neurodivergent autistic unmasking, author Natasha Stavros, PhD, speaks with licensed marriage and family therapist Sarah Liebman, diagnosed ADHD with special interests in all things neurodiverse. Join us in this episode of Following the Threads as we explore social, psychological, and spiritual frameworks that empower resilience through change.

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Disclaimer

**Natasha Stavros (00:00:48):**
As a reminder, this podcast is for educational, informational, and entertainment purposes only and does not constitute counseling, psychotherapy, or mental health services. Listening to this podcast or communicating with the host and guests does not form a therapist-client relationship. The information here is not a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your own mental health professional with any questions you may have regarding a mental health condition.

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When Do You Know It’s Time for an Adult Autism Assessment?

**Natasha Stavros (00:01:25):**
So it’s our first ever podcast and I’m so excited about this. Where I wanted to start with today’s episode is really this question: when do you know when to get an assessment? I just got diagnosed autistic on February 19th. I started the process on January 26th — it took a little over three weeks. But before I even took the assessment, you and I were walking every day with our dogs, and you kept mentioning, “That’s a very autistic thing.” And then I started to keep a list of all things that were potentially autistic, and that’s when I started to go, huh, maybe I am autistic and decided to get diagnosed. Before we go more conceptual though — you’ve also been diagnosed neurodiverse. What was your experience with getting a diagnosis later in life?

**Sarah Liebman (00:02:51):**
Well, there are two parts to that. I never sought the diagnosis — I was seeing a psychiatrist for severe postpartum depression. By the time my kids were four I was still just grinding, and it was not great. We addressed the depression first, and then he gave me Wellbutrin, but that only helped so much. Honestly, I was afraid of stimulants because I subscribed to the cultural trope that ADHD is a moral failing of will. Then came the day I was sitting there going, this is better and this is better, but I still can’t do anything. I’m always just big ideas that die before I get close to them. He asked what I was like as a kid, and I said I mostly looked out the window, had flashes of brilliance, and everyone thought I was really weird. He said, “That sounds like ADHD.” And I was like — *oh.* Because I just thought I was a person who didn’t love people enough to follow through. I always thought I was lazy but smart, the willful child of older parents.

When it came that day, it felt like those old train station flip boards — things just started clicking, clicking, clicking. Part of that clicking was seeing all the ways I had made choice after choice based on, “I can’t do that, I don’t want to let anybody down,” making my life smaller and smaller. It’s been about ten years, and it’s probably the best thing that’s ever happened to me in terms of my own identity and my ability to figure out why I can’t do something — or how to do it. When you got your diagnosis, I thought: that’s the day when the next part of your life really started. That’s what it feels like when something just comes into focus.

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The Paradox of the “Bad Person” Narrative

**Natasha Stavros (00:06:39):**
You mentioned believing the story — that you didn’t care enough about people, that you just weren’t good enough. And you really believed that narrative. For me, I really believed I was a bully, that I’m not a team player, that I have malicious intent and I’m just a really bad person. I think one of the things we talked about was that breaking point — when you decide something has got to be different, when you decide there has to be a different story.

**Sarah Liebman (00:07:27):**
It’s that the story just *breaks* under the pressure of something real. Like the lotus that spends all its time under the water gathering nutrients and strength, and then it battles its way up. When truth arrives, the groundedness that comes from it is so different. For both of us, carrying the burden of trying to figure out why we were so bad — when actually we didn’t feel the things people assigned to us — the gaslighting you have to engage in to make that narrative work is its own trauma. And I think we both care so deeply that that’s the thing: if anything, that’s the paradox.

**Natasha Stavros (00:08:38):**
Part of that trauma is just feeling misunderstood. Being misunderstood and feeling like I’m showing up and doing these things, trying really hard, and apart from asking every time — “Is there something I need to do differently?” — I don’t know how else to be. Stupid, lazy, mean, malevolent, selfish — all these labels get assigned to you and the traumatic response builds. Every time something happens and you feel that misunderstanding, it comes back stronger, until a breaking point as an adult where you go: this cannot be my story.

**Sarah Liebman (00:09:32):**
Or you never get to that point because nobody sees you clearly enough to say, “I’m not sure that’s your story.” I was already a licensed psychotherapist. I’d had a long-term therapy experience with someone who helped me tremendously. And to her credit, ADHD wasn’t well understood in relation to generalized anxiety disorder then — she never diagnosed me with major depressive disorder, which was really valuable. If that psychiatrist hadn’t had the ability to keep looking for something that could help me feel good, to live in my own skin — I might never have gotten there.

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Why Getting a Full Diagnosis Matters

**Natasha Stavros (00:10:31):**
Okay, so you get that breaking point. Why does having a diagnosis actually matter?

**Sarah Liebman (00:10:39):**
It’s an outward expression of an inward truth. When we get partial diagnoses, we get some relief, but it’s like a lock on a safe where you get a click, and another click — still not opening. Why is it not catching? But once the whole thing catches, the story finally makes sense. The longer I am a human and work with humans: when a diagnosis comes into focus — the *whole* diagnosis, not just a partial piece — the person experiences freedom. And the neurodivergent diagnoses are especially important for women diagnosed autistic or AuDHD, because someone like you — accomplished in the scientific world, all the external markers of success — and yet there’s something you can’t get your hands around. You don’t even know what it is. The trauma just builds and the reactions get faster. So yes, diagnosis is controversial, it becomes political. But as neurodivergent diagnoses get the attention they need, we see fewer of the side diagnoses — the depression, the generalized anxiety — that often mask what’s really happening.

**Natasha Stavros (00:13:48):**
Speaking from my own experience: getting this diagnosis, it was like, oh my God, every single interaction my entire life makes sense. Every time a social situation escalated to a point where, when I tell people, they say, “That’s unreal” — and I say yeah, it is unreal, but it keeps happening. So I really believed I was the problem, the common thread. Getting the diagnosis was empowering because it meant I could claim the story that was being written, and it meant I could seek help in the advocacy journey.

**Sarah Liebman (00:14:38):**
It was restorative too. Watching your face as you tell that story — it restored you to wholeness. It restored you to what you actually feel, which is: “I don’t understand how I end up such a bad person with such good intentions. Why does trying to solve problems turn into bigger problems?” It restored something that had been ruptured.

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The Cycle of Shame and the Question of Why Get Diagnosed

**Natasha Stavros (00:15:12):**
It creates a complete story for yourself — the story that you are fundamentally wrong, you were born wrong, there is nothing you can do that is right. You feel depressed, hopeless. And the more frequent these moments happen, the faster you jump to that place.

**Sarah Liebman (00:15:45):**
It’s like proving the null hypothesis — until you have a better scientific question, you only have the one that’s there: am I bad or am I good? The data gets biased because you go in with “I think I’m going to try to be good this time,” do the thing you didn’t do last time, and you just can’t win.

**Natasha Stavros (00:16:27):**
And that’s that point — because I’ve had people ask: well, why get the diagnosis? In the current political climate, this is not something you want to identify with if you don’t have to. It’s a hard life, you’re constantly fighting, constantly advocating. Nobody’s choosing to have to advocate every day. And then there’s the stigma. In my particular flavor of autism, my special interest is learning — so I was very good at learning how to mask and looking on the outside like a very successful person. Youngest female scientist at NASA, PhD, high-powered positions. Of course I’m successful. And yet at the same time, I felt lonely every day — even with the most amazing partner who leans in and supports me. Work interactions were weird, friendships were hard to maintain. Loneliness isn’t seen as a factor of success, so no one could see that undiagnosed autism was actually creating that loneliness. Now I have a network — you and I talk regularly, I have a group of people who are also diagnosed autistic.

**Sarah Liebman (00:19:19):**
We didn’t really see you as the problem. You can’t put a monetary value on it, but when someone believes — like I believe, Linda believes, we believe ourselves — that your heart is true, the question becomes: how could someone whose heart is so true be as bad as they’ve been taught to believe? And it doesn’t mean you don’t carry it with you, because that’s what having a neurodivergent diagnosis is. You do carry it into each situation, but the way it sits is very different.

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Key Signs: When Should You Seek an Adult Autism Assessment?

**Natasha Stavros (00:20:19):**
So bringing it back to the core question: when is the moment that you know you need an assessment? It’s when you cannot believe the story you’ve been told your whole life. We’ve talked about that moment when you need community, when you’re lonely. Are there any other indicators?

**Sarah Liebman (00:21:06):**
Truly bad people never wonder if they’re bad. So one of the indicators is if you’re carrying around a very paradoxical story about your goodness and your badness. The other thing is: self-diagnosis is valid, especially in the realm of autism where the quality of assessments varies so widely. The ADOS — the most common diagnostic tool — was based primarily on diagnosing boys. It’s not even super valid for girls, for adult men, or for teenage boys who may have gone down in hyperactivity or become very good in school due to a special interest. One of the confusing things when looking for an autism or ADHD diagnosis is that not everyone does a sensory profile, because it has gone in and out of the diagnostic criteria — but we now know that everyone on the spectrum has heightened sensory difficulties. The most important thing is: if you have a story that you can’t live with because you didn’t feel bad or mean or selfish — you felt lost and confused — and the story doesn’t match, that’s a good sign. Do some research yourself. You know your story the best.

**Natasha Stavros (00:22:59):**
The resource I’ve been using is prosperhealth.io — they specialize in adult autism and ADHD diagnosis, and they’re current in their research and methods with support services including assessment, psychotherapy, and community.

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Memoir Excerpt: After the Masquerade: From Misdiagnosis to Clarity — When Adults Should Consider an Autism Assessment

**Natasha Stavros (00:26:03):**
In 39 years, I never once identified as different. I was conditioned to comply. I identified as outside, and something was different for me than for others — but never once did I think that I was different. Instead, I believed that I was a problem.

The therapists — probably at least a dozen — I had seen for nearly 20 years diagnosed me with depression, anxiety, symptoms of agoraphobia, insomnia, obsessive-compulsive tendencies, and complex post-traumatic stress disorder. I believed it was those traumas that made me different. It had never occurred to me that maybe the reason those traumas happened in the first place was because my brain didn’t process things the same way as others — that I am autistic.

Never did anyone question my understanding of social reciprocity, nonverbal communication, or the expectations of maintaining relationships. Instead, I was malignant, manipulative, abrasive, direct, rude, outspoken, and arrogant. Never did it occur to me that my hyperorganization or compulsive behaviors were really just coping skills to soothe the anxiety stemming from hyperstimulation and sensitivity to sensory input. Not once did anyone question that my insatiable appetite to learn was a special interest in how the brain collects and processes information into knowledge and wisdom.

With success and accolades came waning mental health — a spiral into loneliness and despair. No one could stand to be around me day in and day out until my husband. No boyfriend lasted more than a year. Most friendships were short and sweet, or so distant they didn’t take a daily toll. Friends that lasted weren’t without turbulence. Well, that’s not even really being honest — turbulence would imply some rocky bits, when in fact most of my friendships nosedived.

In 2020, I left a job that had me questioning my value on a quarterly basis for a job that fed that same insecurity while devouring my social capital. Not long after, that job also questioned my judgment navigating social dynamics. This became the sole metric by which my work was judged — how well my colleagues liked and trusted me. It didn’t matter that my work was thorough, that my productivity surpassed my peers, or that I solved complex problems with solutions that took others months to realize was the right path forward. My peers thought I was inconsistent, my emotions dysregulated, and my social behavior strange.

Tirelessly, I questioned what could have gone wrong. I applied for another job. I thought: I’ll do it differently this time. Three months in, there was an incident, and I knew. In my core, the fear erupted through my being. I broke down. I convinced myself I could pretend it was fine and that eventually it would normalize. It didn’t. That’s when my friend mentioned that I might be autistic. That’s when I knew I needed an assessment.

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Credits

Thanks for joining us today on this episode of Following the Threads. I’m Natasha Stavros, co-host and executive producer, here with Sarah Liebman, co-host; Linda Highfield, director; and Noah Smith, audio engineer and composer.