What is autism — clinically both psychologically and neurobiologically, and practically? Season 1 finale unpacks the DSM, ableism, and the identity shift that changes everything.
Show Notes
Episode Details
Season (Thread): 1
Episode number: 6
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: 00:30:50
Audience and tone: Educational, conversational, supportive; stigma-free exploration of neurodivergence, diagnosis, and self-understanding using personal experience as a case study
Summary: What is autism — really? In the Season 1 finale of Following the Threads, Natasha Stavros, Ph.D. and Sarah Liebman, MFT break down autism spectrum disorder from three angles: the DSM-5 clinical criteria, the current state of neurobiological research, and what disability actually looks and feels like in daily adult life. They unpack why the diagnostic framework still skews toward children and boys, why the science remains correlative rather than mechanistic, and how ableism — both external and internalized — shapes the identity of every late-diagnosed autistic adult. The episode closes with a reframe: the shift from “I have autism and something is wrong with me” to “I am autistic, and the world wasn’t built for my rainbow” is the moment unmasking, self-compassion, and real change become possible. Inspired by the forthcoming memoir After the Masquerade.
Key takeaways about what is autism
The DSM wasn’t built for you. The clinical criteria for autism were designed around children — specifically boys — which is why so many adults, especially women, go undiagnosed for decades. Understanding that the diagnostic framework is incomplete, not that you are, is the first step.
Ableism isn’t just external — it lives inside you. The shame, the “I don’t try hard enough,” the sense that your struggles are a moral failing: that’s internalized ableism, not the truth. Unmasking means learning to separate your neurodivergent traits from the meanings a neurotypical world attached to them.
Your brain isn’t broken — it’s a different rainbow. Autism doesn’t mean deviation from normal; it means your brain function follows a different but persistent pattern. The disability isn’t the pattern itself — it’s what happens when the energy required to comply with a world built for the average rainbow exceeds your capacity.
Resources and References
For more information on this topic, check out Clarifying Autism in the DSM-5: A guide for adults by Embrace Autism.
While research has found correlation between ASD and neurobiological (brain and genetic) factors, a recent review Frontiers in Psychology shows that these studies do not sufficiently characterize the full clinical and behavioral heterogeneity. Part of that is data sufficiency and sample size across gradients of variation, and part of that could be ableism. A recent perspective piece in Frontiers in Psychiatry argues that autism science has a history of false leads in part because of unexamined ableist ideologies that undergird researcher framings and interpretations of evidence
The Unmasking Autism Diary: Memoir Excerpt on Autism Beyond the DSM - Identity, Science, and the Spectrum
My therapist asked me if I knew what autism is. Here is what I said.
But first, you must know who I am so that you can understand my perspective.
I am not a psychologist, a psychotherapist, nor a neuroscientist. I did get a PhD in quantitative forest ecology as the first person to quantify extreme fire events under climate change. I have a bachelors in mathematics, which had the oh so very big graduating class of about 30 people at an R1 university with over 30,000 students. Later, I did a post-doc at NASA Jet Propulsion Laboratory, California Institute of Technology.
Over the last six years I have written a book on science, innovation, leadership, and systematically changing broken systems. [Side bar: subscribers get updates on the book launch and substack paid subscribers get an early autographed, hardback copy of the book].
My understanding of autism comes from lived experience or from reading other people’s research and educational content as a researcher and scientist myself. I do have deep knowledge of science, measurement, mathematics, and systems.
In science there are a few things that we can measure – time, length, mass, electric current, thermodynamic temperature, amount, luminous intensity, and electromagnetic energy.
In remote sensing, my background of research, we measure either the electromagnetic energy of particles, or the collective vibration of atoms. Most of my work focused on measuring energy radiated and emitted across the electromagnetic spectrum. The electromagnetic spectrum spans radio waves to gamma waves. My area of focus extended just beyond visible light into the shortwave, mid, and longwave infrared. For simplicity, let’s use only the visible part of the spectrum – this is a rainbow.
Imagine that everything you look at has a rainbow associated with it. That rainbow represents the unique characteristics of it – for example, the rainbow of a pine tree represents its water content, health, bark to leaf ratio, etc.
Now, if we took all the pine trees and averaged their rainbows together, we would expect that whenever we saw a rainbow that looked like that, it could very likely be a pine tree.
But what happens when a pine tree has to live in harsh conditions on the side of a cliff, and it is in nutrient poor soil with harsh winds? Its roots may be more present and it may have a skewed nutrient representation – both affecting that pine tree’s rainbow.
Autism is like this. If we were to imagine that everyone’s brain function was a rainbow, it is not a leap to imagine how we build our society and our systems with the average rainbow in mind. But, someone who is autistic has a rainbow that doesn’t quite look like average. Technically, everyone’s rainbow differs from average, but it’s the amount of variation in your unique rainbow that determines how much energy it takes to comply with average assumptions. When the needed energy to comply exceeds your capacity, that’s when you become “disabled” and require more support to comply.
Does everyone have a unique rainbow that differs from the average? Yes.
Does everyone need support to function within the unimodal assumption of normalcy? No.
What autism, ADHD, and AuDHD tell us is that there are persistent patterns in those rainbows of brain function, enough so – that brain function is not a unimodal distribution.
Brain function is a multi-modal distribution, and we can map those patterns of difference in brain function to human behavior, and that’s what we see when we look at what autism is in the diagnostic statistical manual (DSM) for mental health.
By classifying neurodivergent people as disabled, we inherently prioritize one way of living and penalize people for deviating from the average rainbow. This perpetuates ableism and supremacy – the idea that average brain function is a supreme way of being. When in reality, unique rainbows can harness immense creativity and exceptional ability.
AI-generated Show Transcript
Disclaimer
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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Introduction: Why Defining Autism Matters for Late-Diagnosed Adults
**Natasha Stavros** `[00:01:25]`
Welcome to Following the Threads. I’m Natasha Stavros.
**Sarah Liebman** `[00:01:29]`
And I’m Sarah Liebman.
**Natasha Stavros** `[00:01:30]`
Today’s episode is about what autism is — and I am so excited to talk about this. I have to admit that I, like many, had lived my whole life othering autistic people. I was never mean, nor did I think of myself as more than — at least not consciously — but I certainly did not consider myself any different than neurotypical people. And I didn’t realize it at the time, but I was actually perpetuating ableism because I could mask. Or at least I could, until I couldn’t. I think a lot of this stems not just from my own ignorance, but from a general societal ignorance. It wasn’t like I didn’t know these things because I willfully refused to learn them — it was a byproduct of a society that doesn’t talk about it. And if no one’s talking about it, how could I have known what I didn’t know? So today I’m really excited that we’re talking about what autism actually is.
**Sarah Liebman** `[00:02:43]`
Yeah, we’re both really excited about it — and I have to admit, this was a hard episode to pull together. There was a lot of reading, a lot of research that went into this one. What I want to do is strip away the layers of stigma and judgment so that we can really understand autism from a clinical, neurobiological, and practical perspective. Often the resources defining autism in any one of those areas are quite fragmented — some echo the DSM but miss the practical, while others are all practical and light on the clinical, which is what we see from a lot of social media educators on the topic. So it’s really great to pull them all together here today.
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What Is Autism Clinically? The DSM-5 Criteria Explained
**Natasha Stavros** `[00:03:49]`
Let’s start with the clinical. The DSM — Diagnostic and Statistical Manual of Mental Disorders — is what’s currently used to assess autism. The DSM-5 has seven criteria that fall into two buckets: social communication challenges and behavioral differences. On top of that, three additional conditions must be met: evidence that these traits were present early in development, that the traits meaningfully affect daily function, and that the differences are not better explained by intellectual disability or global developmental delay. That clinically sums up the definition of autism.
**Sarah Liebman** `[00:05:08]`
And it’s worth unpacking that clinically, because when you were starting to think about getting an autism assessment, you asked me to send you the diagnostic criteria — and we were both like, how is this connected to what people are actually experiencing? The DSM criteria are still very much based on the diagnosing-children model, and it’s kind of alienating to a lot of adults who look at it. On one hand, it’s very stressful to be asked to produce a bunch of information about childhood. On the other, it puts such a focus on that historical through line that the descriptions don’t really seem to match what it’s like to function in a world that is not school. So much of the diagnostic criteria relies on teachers as reporters — it’s all based on school norms. The DSM is a living document, published in 2013 with work that took place three to five years before that, and it’ll be interesting to see whether future versions are more inclusive of lifelong autism, not just the infantile autism model it was historically built on.
Why the DSM Misses So Many Adults — Especially Women
**Natasha Stavros** `[00:07:19]`
And there’s also been a lot of connections made, especially on social media, between neurobiology and autism. One of the things we found in researching this episode is that while research has found correlations between autism spectrum disorder and neurobiological factors — brain structure and genetics — a recent review in *Frontiers in Psychology* shows that these studies do not sufficiently characterize the full clinical and behavioral heterogeneity of the population. As a researcher who worked for NASA, the way I would describe this scientifically is a data sufficiency problem: we don’t have enough data across all the gradients of variation to actually draw firm conclusions.
**Sarah Liebman** `[00:08:46]`
Right — we know it’s heritable, but that doesn’t actually map to a clean mechanistic story of this led to that. And heterogeneity here means multiple, varied presentations: you start with data about boys, then ask what if you’re a girl, what if you’re transgender, what if you’re an immigrant — and suddenly you have all these different gradients, and we don’t have enough data across them to say mechanistically where this comes from. So the science is in a very correlative place right now.
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The Neurobiology of Autism: What the Research Does — and Doesn’t — Tell Us
**Natasha Stavros** `[00:08:13]`
We also found an interesting perspective piece in *Frontiers in Psychiatry* that argues autism science has a history of false leads — in part because of unexamined ableist ideologies that underlie researcher framings and interpretations of evidence. So it’s both a data sufficiency problem and an ideological one. Which brings us to ableism — and why it matters so much for understanding what autism actually is.
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Understanding Ableism: External and Internalized
**Sarah Liebman** `[00:10:09]`
So ableism is the idea that there is a norm agreed upon by all of us — an objective reality that we are all innately striving to reach. That creates the soup in which questions about disability can even be asked. If you think about someone with a mobility disability, it’s easy to see ableism: no curb cuts, narrow bathroom doors, no room for a wheelchair. People understand ableism pretty easily when there’s an external, visible difference of ability. But when it comes to autism, ADHD, and AuDHD, these are conditions that are problematic to the notion of a norm — and so the entire study of autism and neurodiversity has been built on a deficit-based framework. That’s external ableism. And that same idea — that there’s a norm we’re all striving to meet — feeds directly into internalized ableism.
If you were to make a paper doll of yourself and label each part, there are probably parts of you that are relatively cohesive — and then other parts that are chopped to bits, full of ink, or aren’t even there anymore. Those are the parts that have not conformed to an unconscious ableist world. An example from my childhood: I could read well and comprehend well, but I could not produce writing. On the one hand I had one ability higher than my peers, and on another I had one much lower. And the ableist move — which still happens today — is to use the strength to attack why the deficit is happening. So inside of me, my internalized ableism said: I don’t try hard enough, I don’t care, I have a mental block. As you’re unmasking, internalized ableism comes up constantly in all the shoulds, the shame, the sense that your struggles are a personal or moral failing.
**Natasha Stavros** `[00:13:39]`
And you’re disconnected from the world in a way where you don’t see the connection between your own struggles and external ableism. That’s a huge part of what unmasking actually is.
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What Is Autism Practically? Disability, Identity, and Autistic Burnout
**Sarah Liebman** `[00:13:50]`
So from a practical standpoint — everyone has variation from whatever this idealized norm is. But what makes something a disorder, rather than just a difference? If we take the idea that there is a spectrum of human experience and ability, when the way one does something is at odds with the outside world but also with the inside of themselves — the level of distress that causes moves something from being difficult to being a disorder. The ableism in that framework is real, and it has a long history of being misapplied. But when you have identified a specific domain — say, social communication — where your difference keeps resulting in the same difficulty and the same loss, and you keep hitting the same wall no matter how differently you run at it — that’s when exceeding your own capacity moves something from difference into: I’ve got to figure out how to do this differently.
**Natasha Stavros** `[00:16:57]`
And I’ll give an example of that. I have been in multiple friendships that have ended all the exact same way — and I’m like: how? I really tried to do it differently this time. Long-term maintenance of friendships is really hard for me. It’s not that I haven’t had long-term friends. It’s that I continuously hit the same wall, even though I run at it a different way every single time. I’m actually outside of my capacity, and no way I change it is really enough.
Autism Identity: From “I Have Autism” to “I Am Autistic”
**Sarah Liebman** `[00:17:52]`
And there’s another element to the practical question of what autism is — and that’s identity. There’s a natural tension in how identity forms in an ableist world when you grow up in an ableist family, in a world and society that supports and reinforces ableism. Your identity forms around a kind of moral failing — you’re a bad person, something is wrong with you. And then comes the identity shift toward: no, I’m autistic, and the environment is not supportive of me.
Going back to your friendships example — you said in an earlier episode that you would always focus on your own behavior and how you could change it, which kept you from seeing the actual unkindness happening. Because your ableist bias toward yourself was: here is this thing that is really wrong with me and shameful, and I need to keep trying to get better at being a friend. Which was actually harmful to you. Prior to your autism diagnosis, the only things you had available to you were ableist ideas about yourself. And when you keep missing — when you keep having the same breakdown — you don’t have the information to understand why, and you can’t build a cohesive, safe, and vital identity around something you don’t yet understand.
**Natasha Stavros** `[00:21:34]`
And one thing you said so well to me is that when you are able to disentangle neurodivergent characteristics from the shame-based meanings attached to them — meanings rooted in ableism — you can shift from an identity grounded in conformity or lack thereof, from “I have autism and it’s attacking me and I need to get it off of me,” to a more neurodivergent-affirming identity: I am autistic. And that shift is when you unlock the ability to develop self-understanding and self-compassion, to modify your environments, renegotiate your relationships, seek workplace accommodations, and address the social structures that have been contributing to your distress.
**Sarah Liebman** `[00:22:25]`
And working with a psychotherapist can really help in that — and I can attest to that. Most people who are diagnosed as neurodivergent are not mad about it in the end. There’s grief, yes. But your identity becomes richer and deeper, and a whole lot less full of two-by-fours you’re hitting yourself with.
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Closing: Season 1 Finale and What’s Coming Next
**Natasha Stavros** `[00:22:57]`
So for today, we talked about what autism is clinically — as it’s defined through social communication and behavioral differences. We talked about its connection with neurobiology, i.e. the brain and genetics. And we talked about what autism is from a practical perspective: disability, ableism, and identity. Today wraps up Season 1, Thread 1 — an introduction to the when, how, what, and why of getting an adult autism diagnosis. We will be taking a two-week break as we transition to the next seasons, which follow the different threads of navigating a late diagnosis of autism, ADHD, and AuDHD. Future episodes will chronologically jump between seasons as we follow the threads through the early stages of learning to unmask and embrace an adult autism diagnosis. Don’t miss our next episodes — subscribe now. These next seasons invite some of your favorite educational content creators, pedagogical influencers, and academics in adult neurodivergence onto the show to follow these threads. Please like, share, or comment. We look forward to getting to know you.
**Sarah Liebman** `[00:24:34]`
All right. See you next time.
**Natasha Stavros**
*This episode of Following the Threads is inspired by The Unmasking Diary — snippets from the forthcoming memoir* After the Masquerade *by Natasha Stavros, Ph.D.*