Not all autism evaluators are equal. Learn what a current adult assessment looks like, how to vet your evaluator, and build support when your circle doesn't get it.
Show Notes
Episode Details
Season: 1
Episode number: 5
Release date: 2026-05-21
Hosts:
Natasha Stavros, PhD — author of The Unmasking Diary and Burning Inside Out (coming to a bookstore near you in December 2026)
Sarah Liebman — licensed marriage and family therapist, ADHD-diagnosed, special interests all things neurodiverse
Audio Engineer and Composer: Noah Smith
Director: Linda Highfield
Duration: 00:26:10
Audience and tone: Educational, conversational, supportive; stigma-free exploration of neurodivergence, diagnosis, and self-understanding using personal experience as a case study
Summary: What actually happens during an adult autism evaluation — and how do you know if you can trust the person doing it? In this episode of Following the Threads, Natasha Stavros (Ph.D., autistic) and Sarah Liebman (MFT, ADHD) walk through the real experience of getting an autism assessment as an adult. They trace the evolution of the DSM from 1952 to today, explaining why the diagnostic criteria have historically missed women and late-diagnosed adults. They break down what to expect in the room, how to evaluate your evaluator for cultural competency, current research awareness, and neurodivergent-affirming practice, as well as what kind of resources and support you should expect to have in place. The episode closes with Natasha’s personal account of the moment she received her diagnosis, and a frank conversation about why your nearest support circle may not be your best one. Inspired by the forthcoming memoir After the Masquerade.
Key takeaways getting an adult autism, ADHD, or AuDHD assessment
The Diagnostic Statistical Manual (DSM) of mental health is in its fifth version! It’s changed a lot over the years as we learn more about the variation in representation based on the breadth of experiences. It is still very much written in a way that centers a young boy’s experience. Girls have different social expectations that shape the experience that someone has and how they adjust their behavior to survive.
Evaluate your evaluator – how do you know if you should trust this evaluator with something so deeply personal as sharing what you have tried so hard to keep hidden? You want to do what you can to find out if your evaluator is taking a nuanced and current on the research approach, or if they are applying a cookie cutter approach without thought put into the difference in diagnosing children, and adults, and how gender and race plays a role.
Ring theory was developed by Susie Silk and Barry Goldman and it describes a social framework for navigating crisis through organizing support in concentric circles that prioritizes support for those closest to the situation. Often cartoons depict this theory with the individual at the center, and then spouse, family, friends, community, etc. The problem with that is that sometimes when getting an assessment, you might be the first person in your network to do it. It might be that your next circle of “closeness” from whom you would normally seek support, doesn’t feel safe.
We have built our lives in a world that begins to know you one way for better or worse, and how they have interacted with you shapes the narrative they hold of themselves. When you confront that, there is likely to be some confusion or the worst rejection.
But it’s so important to remember that as much as you may still feel you have to learn about your own autistic experience. We are often sharing these things with people who only have you know a pop culture, understanding or who themselves may feel kind of uncovered by you.
Resources and References
Clarifying Autism in the DSM-5: A guide for adults by Embrace Autism.
University of Oregon: The Autism History Project describes the evolution of the
Free open-access academic review of Sex and gender impacts on the behavioral presentation and recognition of autism
From The Autism Center, hosted on Sheppard Pratt Insights: The Autism Spectrum Gender Gap
If you are looking for an adult autism assessment Prosper Health is a US provider and is current in their research and methods with support services including assessment, psychotherapy, educational seminars, and an online community.
The Unmasking Autism Diary: Memoir Excerpt on Adult Autism Assessment
It’s been a month of evaluation – multiple online intake forms – both multiple choice and long answer, as well as many phone calls and nagging conversations with my husband and father to fill in their portions of the assessment – also online forms both multiple choice and long answer.
Then, there were the two 1.5 hour assessments with a psychologist. It was funny sitting there with the psychologist. I am very familiar and comfortable with research and researchers, but for the first time, I was the object of study.
When I had read the Diagnostic and Statistical Manual (DSM) of Mental Disorders, I was truly perplexed as to whether or not I was autistic. The DSM criteria are strangely specific and obtuse. By my rudimentary interpretation of the literal translation of the DSM criteria into assessing my world, I was surely not autistic.
The psychologist performed her evaluation, sticking to the DSM criteria but asking clarifying questions to my answers. I never really knew if I was answering correctly for any one of the, what felt like, hundreds of questions I was asked.
Then, today, she read me my evaluation. Autistic.
The tears flooded my eyes. It was like coming up for air amidst the tire and terror of treading water, barely keeping my head above water and surviving in this world amidst severe depression and anxiety. Every cell in my body expanded with oxygen and I felt relief embrace my body.
She started by explaining the organizational structure of the DSM and then reading evidence to support her evaluation of me within each criteria. As she read, she referenced common representations as they varied by identity in age and gender, but how when you account for that variation in lived experience, the patterns still hold.
Society has normalized a depiction of autism spectrum disorder through movies and television that prioritizes one way of experiencing the differences in brain function that autism describes and the way that the world responds to those experiences. For example, as a woman, I have been conditioned to comply with and placate the people around me with niceties and humility. While leadership coaches and influencers advise speaking with confidence and removing unnecessary apologies and use of the word “just” to belittle my presumption for authority, I have found that this is not well received by people. Often I receive feedback that I should be “softer” or that I am “overly confident” or “arrogant.”
This means that masking was taught to me as a means of likability and thus survivorship much earlier than it would have been if I was a boy. Similarly, as an adult I have learned what is accepted and I aim for it every minute of every day, judging myself and living the judgment of others when I fail. As a child, I was far less concerned with how others or myself perceived me. I just existed.
It was through the psychologist’s study of these variations that she was able to interpret my responses in the context of the intent behind each criteria. She described each criteria and what it meant. Then she cited evidence from my, my husband, and my father’s testimony that supported how I qualified as meeting the criteria.
As she read my evaluation, for the first time – I truly felt seen, not judged.
This text is a snippet from my next book: After the Masquerade. For early access to the book and other resources, upgrade to a paid subscription via substack at natashastavros.substack.com.
AI-generated Show Transcript
Introduction: The Adult Autism Assessment Journey
**Natasha Stavros** `[00:01:26]`
Welcome to Following the Threads. I’m Natasha Stavros.
**Sarah Liebman** `[00:01:30]`
And I’m Sarah Liebman.
**Natasha Stavros** `[00:01:32]`
Today’s episode is about getting a late diagnosis of autism or ADHD as an adult. We’ve been on a journey from the pre-contemplative state — “maybe I’m neurodivergent” — through preparing to get an evaluation. Today we talk about what actually happens when you get an autism assessment.
It’s important to remember that each person’s experience will be different. We represent a sample size of two middle-class white women in the middle of the United States, with some time on the coasts and in big cities. Place what you hear in that context — there is going to be a lot of variation. What we want to do is step away from hyperfocusing on that specific experience and look more generally at what we were looking for at each step. With that in mind, we did still think it was important to talk about what the current evaluation process looks like when it is tracking the latest scientific understanding — because the evaluation itself has been an evolving process. And that’s why it’s so great to be here with Sarah, who has been a clinical psychotherapist working with hundreds of people through their personal journeys over the last 20 years.
**Sarah Liebman** `[00:02:55]`
Wow, hundreds. That’s pretty impressive. Probably.
—
The Evolving Science of Autism Diagnosis: A Brief History of the DSM
*Understanding the DSM’s history matters because it reveals why so many adults — especially women — were missed for so long.*
**Natasha Stavros** `[00:03:03]`
When you go get a clinical evaluation, they use the Diagnostic Statistical Manual — the DSM-5 for mental health. That’s the important part: it’s the fifth version.
**Sarah Liebman** `[00:03:25]`
The fifth version. The first was published in 1952. Given that the context of mental disorder at that time was split between “psychotic” and “neurotic,” they labeled almost everything schizophrenia — specifically something called “Schizophrenia praecox,” meaning schizophrenia of childhood. The concept then was to get all the unconscious material conscious: the neurotic worries about things that are real; the psychotic worries about things that aren’t real. Those are not good descriptions of how we understand things now, but that was the baseline. And that wasn’t purely 1952 thinking — it was an evolution in itself.
DSM-2 came in 1968 and still categorized it under childhood schizophrenia, but introduced the words “autistic, atypical, and withdrawn behavior.” An autistic defense was understood as a withdrawing defense in classic psychoanalytic terms. Then in 1980 — woohoo — it got named “Infantile Autism” and was finally separated from childhood schizophrenia. DSM-III introduced actual diagnostic criteria: present before 30 months of age, gross distortions or deficits in language development, and peculiar sometimes rigid attachments to objects.
I graduated college in 1995 while people were still using the DSM-3R from 1987, which described autism as “Autistic Disorder” characterized by a pervasive lack of responsiveness to other people — a very narrow lens compared to what we’ve since learned.
**Natasha Stavros** `[00:06:14]`
Okay, so — the year I was born.
**Sarah Liebman** `[00:06:15]`
Yeah, the year you were born. I’m not a lot older than Natasha, but… In 1994, DSM-IV introduced four subcategories of autism. The most recognizable is Asperger’s Syndrome — colloquially, people who met autistic criteria but had language. Then in 2013, the most recent version, all four subcategories were swept under Autism Spectrum Disorder. The good thing about that is it is more bounded, but it still allows for internal variation. Importantly: autism can present with or without intellectual disability, with or without language impairment, and with severity levels ranging from requiring support to requiring very substantial support. That is still what stands today.
**Natasha Stavros** `[00:08:01]`
Right. We’re going to link to a really excellent explainer from Embrace Autism on the DSM-5 and current criteria in the show notes. When you go for an evaluation, this is what they will use. There are seven criteria: three fall under social communication challenges, and four under behavioral challenges. When we say challenges, we’re talking about areas where you might need support to navigate the current system the way it’s designed.
Why the Developmental Requirement Makes Adult Autism Diagnosis So Difficult
**Sarah Liebman** `[00:09:24]`
I want to throw in a word that I think is really important and it’s on the explainer: developmental. Part of the criteria that have to be met is that traits must have been present since childhood. That is the part that causes so much trouble getting an adult autism diagnosis.
—
What to Expect During an Adult Autism Evaluation
**Natasha Stavros** `[00:08:45]`
For me, I sat down and they asked me hundreds of questions over a three-hour period. I’m quite concise when I try to answer things — laser focused on the question, not a lot of detours. But if you took more detours, it could be much longer, depending on the type of person you are.
**Sarah Liebman** `[00:09:08]`
But that’s also diagnostic. Because you’re being evaluated both by what the questions and answers are, and by how the experience of the testing unfolds between you and the evaluator.
—
How to Evaluate Your Evaluator: Finding the Right Autism Assessor as an Adult
*One of the most important — and underappreciated — steps in the autism assessment process is vetting the professional who will assess you.*
**Natasha Stavros** `[00:09:52]`
There are resources out there, but depending on where you’re listening from, you may be somewhere in the rural backcountry. An important part of getting your evaluation is, in a way, evaluating your evaluator. You have to trust them with something so deeply personal as what you’ve tried so hard to keep hidden from the rest of the world. So how do you decide that somebody is worth having the evaluation with? They’re going to use the DSM — knowing there’s variation in how it’s applied. How do you decide that this person is the one who is going to hold your hand through all of it?
**Sarah Liebman** `[00:10:46]`
And you have to do it kind of quickly — it’s not like a therapeutic relationship where you spend a lot of time feeling it out, building trust and rapport, and then maybe you bring up this thing. So what are some of the ways to evaluate your evaluator?
**Natasha Stavros** `[00:11:14]`
The evaluation can be very nuanced. When someone says “I’m going to do your assessment,” you want to know: are they going to take a nuanced approach based on the latest research? Are they aware of what the latest research even is? You could ask them directly: “What’s the last research article you read on this topic?”
**Sarah Liebman** `[00:11:51]`
Some of us probably couldn’t answer that. But most of us go to a web page first, right? How well does their web page communicate what they bring to the work? Does it convey that they’re engaged in adult autism diagnoses? Do they have a special interest — for example, girls who were high-achieving? How well are they describing what brings them to the work and the consciousness they bring to it? Of course, there may be wonderful evaluators with terrible web pages — but we can only work with what we can work with.
**Natasha Stavros** `[00:12:41]`
Right. And you can ask directly if you prefer verbal communication. Another thing to look for is how much thought they’ve put into the differences in diagnosing children versus adults, and people of different genders or races.
**Sarah Liebman** `[00:13:08]`
Yes — and cultural experiences, immigrant experiences. How far someone is from their family’s immigrant experience also matters. It’s pretty clear it’s a bad idea if someone says “I don’t see culture, I don’t see race.” The cutting edge of this work is more inclusion, more prism — not winnowing down to exclude. It’s not a diagnosis of exclusion.
**Natasha Stavros** `[00:13:47]`
So: they’ll use the DSM, you’ll identify someone you can trust who is up to date in the research and holistic in how they think about who you are as a person.
**Sarah Liebman** `[00:14:05]`
And vibing. Let’s be clear — vibing is important. Because if you look at everything on paper and then you meet them and you just get no feel for them, ignore what you saw on paper. That’s a vulnerability we’ve talked about in past episodes — not trusting one’s own internal radar.
—
Building Your Support System Before and After an Autism Diagnosis
*Many people underestimate how emotionally significant receiving an autism diagnosis as an adult can be — and how important it is to plan for support in advance.*
**Natasha Stavros** `[00:14:38]`
That brings us to the third point we really wanted to hit: at some point they’re going to sit you down and read you their findings. We talked about having support — and knowing what that support is going to be before you sit down in that chair.
A really popular model is ring theory. The cartoons you see of this have you as an individual at the center of the crisis, with concentric circles going out — your spouse or children in the next ring, then your family, friends, community, and so on. But this traditional support model for crisis doesn’t really work for an identity crisis, where the people in your nearest support circle may not actually be receptive. They may not be where you are in their own journey. Often, autism is genetic — your family members may not be very supportive. And if they’re touting off national-level resources, or resources that perhaps haven’t been demonstrated to be inclusive or neuroaffirming, that might also be a sign to approach that evaluation with some caution.
**Sarah Liebman** `[00:17:01]`
Well, I’d say people are allowed to not be great at everything. You have the evaluation — it feels valid, it really resonates, you’re like: yes, that’s why I put myself through this experience. And then, Prosper Health has a model where you’re paired with both an evaluator and a psychotherapist so that you can have that continuous support.
I like to reference what happens when one person in a family system decides they’re no longer going to drink. Say they go through AA, do their amends, read the amends letters — and the person they read it to is blank-faced, or says “you’re not an alcoholic, you’re just a klutz.” You can’t actually expect everyone in your family to be as ready as you are for a big change.
**Natasha Stavros** `[00:18:33]`
And if you’re an alcoholic, what does that mean about me? — that addresses a ton of fear for them.
**Sarah Liebman** `[00:18:38]`
And if you’re autistic, what does that mean about me? They may not necessarily be the most supportive person for you because they might be a little too close. We’ll touch more deeply on ableism in future episodes — but we’ve all masked ourselves into safety, and ableism is part of that. So identifying: who is going to be my emergency contact? Who is the person who gets this? Especially if you’re not living in an area where you feel there’s a lot of safety and acceptance for being different — Discord, gaming groups, all the different ways the internet makes life better for some of us.
—
A Personal Note: What Receiving an Autism Diagnosis Really Feels Like
**Natasha Stavros** `[00:19:31]`
I just want to end with a little story about that last point — thinking about your support and what the place where you go for an evaluation can provide is really important. I didn’t really think much about it. Fortunately, I have Sarah as a friend I see every single day and can text. But when they read my evaluation, it was like a dam broke. I just cried. And then all of the arteries in my nose got inflamed — I had a histamine reaction and actually had to take four Benadryl and go take a nap. You have no idea what kind of support you’re going to need, because this can be really life-shattering.
So with that — don’t miss our next episode on what autism is. Please like, share, or comment. We look forward to getting to know you.
**Sarah Liebman** `[00:20:34]`
All right, see you next time.