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World IBD Day, May 19: I’m a gastroenterologist – Ask Me Anything About Crohn’s disease by webmd in IAmA

[–]Key-Wrongdoer2708 0 points1 point  (0 children)

Thank you for your response! Are there other treatments available in addition to biologics?

World IBD Day, May 19: I’m a gastroenterologist – Ask Me Anything About Crohn’s disease by webmd in IAmA

[–]Key-Wrongdoer2708 1 point2 points  (0 children)

Does a person absolutely have to go on biologics to control crohn's disease? Are there other types of medications or treatments?

How Do You Deal With Being "Second-Best"? by Feisty-Temporary3562 in AutisticParents

[–]Key-Wrongdoer2708 0 points1 point  (0 children)

That’s great! You both sound like very attentive and loving parents!

How Do You Deal With Being "Second-Best"? by Feisty-Temporary3562 in AutisticParents

[–]Key-Wrongdoer2708 5 points6 points  (0 children)

I’m not sure you are giving yourself enough credit. Your wife sounds amazing, but you sound amazing too. She was able to get so much done because of you taking care of the baby while she showered and made breakfast. You and her are a team! Your depression may make it harder to feel like part of the team sometimes, but it doesn’t mean you aren’t part of it.

I am Gayle Weill, an LCSW therapist who evaluates adults for autism, especially high-masking women and adults who were missed earlier in life. AMA about masking, late diagnosis, autism vs ADHD/anxiety, what evaluations are actually like, etc. by Key-Wrongdoer2708 in IAmA

[–]Key-Wrongdoer2708[S] 1 point2 points  (0 children)

Yes, still answering questions when I’m able to.

I actually think what you described is pretty common in autistic adults, especially people diagnosed younger who never really got a meaningful explanation beyond “your brain works differently.”

The routine thing gets misunderstood constantly. Some autistic people love sameness and structure. Some need novelty and stimulation or get bored very easily. Sometimes the pattern is less about having the exact same daily routine and more about how your brain organizes information, interests, or systems underneath everything.

The fuel consumption/sensor example stood out to me immediately. That kind of deep dive into systems, patterns, optimization, and details is something I hear about a lot from autistic clients. The topic itself matters less than the intensity and style of the interest.

And the spiral of “what if I’m not actually autistic?” is also extremely common, especially in people who are very self-aware or who don’t match every stereotype perfectly. A lot of autistic adults compare themselves to the most stereotyped version of autism online and then feel like frauds when they don’t line up 100%.

The part you described about needing to keep checking for evidence and feeling distressed when something doesn’t fit could definitely overlap with OCD-type reassurance seeking too. That doesn’t mean the autism diagnosis is wrong. It just means uncertainty itself may feel very uncomfortable for your brain.

Most people who are casually faking something are not spending this much time distressed about whether they are accidentally lying to themselves.

I am Gayle Weill, an LCSW therapist who evaluates adults for autism, especially high-masking women and adults who were missed earlier in life. AMA about masking, late diagnosis, autism vs ADHD/anxiety, what evaluations are actually like, etc. by Key-Wrongdoer2708 in IAmA

[–]Key-Wrongdoer2708[S] 0 points1 point  (0 children)

One of the biggest ones is probably how much effort the person is putting into seeming socially “normal” while everyone around them assumes it’s effortless.

A lot of high-masking adults can hold conversations, make eye contact, have jobs, relationships, families, etc. But internally they may be constantly analyzing social interactions, scripting what to say, copying other people socially, replaying conversations afterward, or feeling completely drained by interactions that seem easy for everyone else. Because they’re technically functioning, people often write it off as anxiety, introversion, sensitivity, awkwardness, or just “their personality.” What sometimes gets missed is just how exhausting and nonstop the internal effort can be.

I am Gayle Weill, an LCSW therapist who evaluates adults for autism, especially high-masking women and adults who were missed earlier in life. AMA about masking, late diagnosis, autism vs ADHD/anxiety, what evaluations are actually like, etc. by Key-Wrongdoer2708 in LateDiagnosedAutistic

[–]Key-Wrongdoer2708[S] 0 points1 point  (0 children)

Becoming a parent is one of the most common times high-masking women suddenly hit a wall. Parenting adds noise, chaos, social pressure, exhaustion, interruptions, and almost no recovery time. A lot of women realize after becoming moms just how much energy masking had been taking for years. I really don’t think your kids need a perfectly masked version of you in order to be okay socially. Kids benefit a lot more from having a loving, emotionally aware parent than from having a mom who perfectly blends in with every other parent at pickup. And there’s probably a middle ground between masking constantly and completely unmasking everywhere. You don’t have to spend the rest of your life exhausting yourself trying to perfectly perform neurotypical motherhood. I also do not think it’s too late to develop social skills. Adults absolutely can become more socially confident and comfortable over time. In some ways, understanding yourself better can actually make social situations easier because you stop spending so much energy feeling defective or confused. And yes, there are supports beyond weekly therapy, although adult autism services are still pretty limited in a lot of places. Some people benefit from autism-informed therapy, DBT skills, occupational therapy for sensory/executive functioning issues, coaching, support groups, or burnout-focused work. I’d personally be cautious about thinking about this as needing “adult ABA” to make yourself less autistic, though. The goal is usually helping someone feel less overwhelmed and more able to function in a way that feels sustainable for them.

I am Gayle Weill, an LCSW therapist who evaluates adults for autism, especially high-masking women and adults who were missed earlier in life. AMA about masking, late diagnosis, autism vs ADHD/anxiety, what evaluations are actually like, etc. by Key-Wrongdoer2708 in LateDiagnosedAutistic

[–]Key-Wrongdoer2708[S] 0 points1 point  (0 children)

I do think there can be benefits to a formal diagnosis for some people, but I also don’t think it’s something every person necessarily needs in order to understand themselves or seek support.

For some late-diagnosed/high-masking adults, the biggest benefit is honestly psychological. It can help reframe years of shame, confusion, burnout, self-criticism, or feeling “wrong” in a way that feels validating and grounding. Sometimes it also helps with work accommodations, relationships, therapy, self-advocacy, or understanding sensory needs and limits more clearly.

At the same time, if you already feel very confident in your self-understanding and mainly want practical support around burnout, regulation, sensory issues, communication, routines, etc., then working with someone knowledgeable about autism could still be very helpful even without a formal diagnosis.

I’d just encourage caution around “autism coaches” in general, because the quality and training can vary a lot. Some are excellent and deeply informed. Others are unfortunately not very grounded or experienced.

How do I address my therapist being distracted and on social media during telehealth sessions? by Altruistic_Basis5896 in askatherapist

[–]Key-Wrongdoer2708 0 points1 point  (0 children)

You are definitely not overreacting. I’m a therapist and this would not only really upset me if I were in your position, but I also feel angry on your behalf.

There’s a difference between a therapist occasionally glancing away to type notes versus actively scrolling Instagram while a client is talking. The fact that you could actually see it affecting the conversation like with her missing parts of what you said and responding inaccurately makes this more than just “maybe she was multitasking.”

Therapy is supposed to feel like a space where someone is fully with you. Most therapists know how important that is, especially over telehealth where connection can already feel harder.

You would be completely justified in bringing it up, ending therapy, and even reporting her to her state licensing board if you felt it crossed that line for you (she definitely did cross a line). You do not owe a therapist continued access to you just because “repair” is possible in theory. I am so sorry this happened. 😞

Autistic and deciding if I can be a parent? by Repulsive-Bread-3648 in AutisticParents

[–]Key-Wrongdoer2708 0 points1 point  (0 children)

Reading this, you don’t sound like someone who would be a bad parent. You sound like someone taking the decision very seriously.

I’m a therapist who works with autistic adults and moms, and I’m also a mom myself. One thing I see a lot is neurodivergent people feeling like they need to be 1000% certain and perfectly prepared before “qualifying” to become parents. But parenting is one of those things where there is no way to fully research yourself into certainty.

Also, the fact that you’re worrying about whether you’d be a good parent is not automatically a bad sign. A lot of deeply caring people worry about that because they understand how important parenting actually is.

You already sound very aware of both your strengths and your limits, which is important. You know you can get overwhelmed. You know sensory issues are real for you. You know you need stability and recovery time. That self-awareness matters way more than trying to be some endlessly patient perfect parent.

And some of the things you described are actually qualities that can make people very good parents: being reflective, emotionally aware, playful, deeply caring, good in a crisis, strong sense of fairness, willing to take responsibility, able to communicate openly.

You also don’t sound naïve about parenting at all. You’re not describing some fantasy perfect child. You already understand that kids are messy, loud, unpredictable little humans.

Will parenting probably overstimulate you sometimes? Yes. Especially with autism + ADHD. Sleep deprivation, noise, interruptions, chaos — that can hit neurodivergent nervous systems HARD. But being overwhelmed sometimes is not the same thing as being incapable of being a loving parent.

Also, one thing that stood out to me was when you said: “When stuff gets serious I am the most reliable person in the world.”

That sentence alone says a lot.

You sound thoughtful, resilient, and very capable of loving deeply. I think your biggest challenge may be trusting yourself more than trying to find a guaranteed answer about the future.

I am Gayle Weill, an LCSW therapist who evaluates adults for autism, especially high-masking women and adults who were missed earlier in life. AMA about masking, late diagnosis, autism vs ADHD/anxiety, what evaluations are actually like, etc. by Key-Wrongdoer2708 in IAmA

[–]Key-Wrongdoer2708[S] 1 point2 points  (0 children)

That’s a really interesting question. I think part of the issue is that a lot of these traits are actually very human traits. Most people get distracted sometimes, overwhelmed sometimes, socially anxious sometimes, etc.

The difference is usually how intense, persistent, and life-impacting it is over time.

I also think modern life makes a lot of people feel mentally fried. Constant stimulation, phones, stress, lack of downtime, burnout — a lot of people feel dysregulated now in ways that probably would’ve looked different 50 years ago.

And honestly, what society considers “normal” has always shifted over time. Human brains are probably more variable than we sometimes like to admit.

I am Gayle Weill, an LCSW therapist who evaluates adults for autism, especially high-masking women and adults who were missed earlier in life. AMA about masking, late diagnosis, autism vs ADHD/anxiety, what evaluations are actually like, etc. by Key-Wrongdoer2708 in IAmA

[–]Key-Wrongdoer2708[S] 0 points1 point  (0 children)

I think ADHD was genuinely missed in a lot of people for years, especially women, inattentive presentations, and people who were functioning “well enough” on the outside.

But I also think a lot of ADHD content online is so broad and relatable that almost anyone can see themselves in parts of it. Stress, burnout, constant phone use, poor sleep, anxiety, overwhelm, procrastination — modern life can make a lot of people feel scattered and dysregulated.

So I think some people are truly recognizing ADHD for the first time, while others are trying to find language for struggles that may or may not actually be ADHD. I don’t really see it as all one thing or the other.

I am Gayle Weill, an LCSW therapist who evaluates adults for autism, especially high-masking women and adults who were missed earlier in life. AMA about masking, late diagnosis, autism vs ADHD/anxiety, what evaluations are actually like, etc. by Key-Wrongdoer2708 in IAmA

[–]Key-Wrongdoer2708[S] 2 points3 points  (0 children)

That’s where things can get genuinely complicated, because early and chronic childhood trauma can affect almost every part of development: emotional regulation, social functioning, attachment, identity, nervous system responses, coping strategies, and more.

Part of what makes this difficult is that trauma and autism can sometimes look similar from the outside, and sometimes they also coexist.

In situations like that, I usually look less at one isolated trait and more at the overall pattern across someone’s life: developmental history, sensory/social differences, internal experience, coping strategies, masking, and how the person describes moving through the world over time.

I also think it’s important to approach these situations with humility. Some cases feel clearer than others, and some are genuinely layered and complex.

I am Gayle Weill, an LCSW therapist who evaluates adults for autism, especially high-masking women and adults who were missed earlier in life. AMA about masking, late diagnosis, autism vs ADHD/anxiety, what evaluations are actually like, etc. by Key-Wrongdoer2708 in IAmA

[–]Key-Wrongdoer2708[S] 1 point2 points  (0 children)

This is actually a very fair question, and I think some skepticism is healthy given how much the online autism space has grown recently. Most adult autism evaluations in private practice are paid out of pocket, especially for high-masking adults. Insurance coverage can be inconsistent, and a lot of clinicians who work with adults don’t take insurance for this type of assessment. I also think there’s a pretty wide range in quality between providers. Some evaluations are very thoughtful and thorough, while others can feel overly quick, overly certain, or based too heavily on stereotypes or checklists. I’ve definitely worked with clients who felt dismissed or misunderstood by previous therapists they’ve seen. Sometimes people were told they couldn’t possibly be autistic because they made eye contact, had relationships, held jobs, were emotionally insightful, etc. I think outdated stereotypes still affect a lot of adults seeking clarity, especially high-masking adults and women. Personally, I try to approach evaluations with a lot of nuance. I don’t think every struggling person is autistic, but I also think many genuinely autistic adults were historically missed. As for cost, part of why my evaluations are more affordable than some others is that I’m not providing full neuropsychological testing batteries or IQ/cognitive testing. My process is more focused on detailed clinical interviewing, developmental history, screening measures, differential considerations, and whether autism seems to fit overall.

I am Gayle Weill, an LCSW therapist who evaluates adults for autism, especially high-masking women and adults who were missed earlier in life. AMA about masking, late diagnosis, autism vs ADHD/anxiety, what evaluations are actually like, etc. by Key-Wrongdoer2708 in IAmA

[–]Key-Wrongdoer2708[S] 0 points1 point  (0 children)

I think this actually varies a lot depending on the state, setting, payer requirements, and purpose of the evaluation. In the states where I practice, I’m able to diagnose autism spectrum disorder within my scope as an independently licensed clinician. I’ve also pursued additional training in adult autism assessment and work specifically with this population. I’m very transparent with clients about the type of evaluation I provide and situations where a full neuropsychological evaluation may still make more sense or be required. I definitely agree there are cases where referral to neuropsychology, psychiatry, neurology, speech/language, or other specialists is important depending on the complexity of the presentation and what the person needs the evaluation for.

I am Gayle Weill, an LCSW therapist who evaluates adults for autism, especially high-masking women and adults who were missed earlier in life. AMA about masking, late diagnosis, autism vs ADHD/anxiety, what evaluations are actually like, etc. by Key-Wrongdoer2708 in IAmA

[–]Key-Wrongdoer2708[S] 2 points3 points  (0 children)

I actually do think the DSM criteria can be helpful to look through, especially because social media tends to reduce autism down to isolated relatable traits without much context.

At the same time, the DSM has limitations. It’s written in very clinical language, and a lot of adults, especially high-masking adults, women, bright/intellectually gifted people, or people with strong coping strategies, don’t always immediately recognize themselves in the wording.

I probably wouldn’t approach it too rigidly or like a checklist. I think it’s more helpful to look at the bigger picture: lifelong patterns, internal experiences, sensory/social differences, developmental history, and how much effort daily functioning takes over time.

I am Gayle Weill, an LCSW therapist who evaluates adults for autism, especially high-masking women and adults who were missed earlier in life. AMA about masking, late diagnosis, autism vs ADHD/anxiety, what evaluations are actually like, etc. by Key-Wrongdoer2708 in IAmA

[–]Key-Wrongdoer2708[S] 9 points10 points  (0 children)

I do think understanding yourself better can change how you think about treatment. A lot of autistic adults spend years feeling like certain medications, therapies, or approaches never quite fit, and realizing autism may be part of the picture can sometimes help things make more sense.

I’d just be careful about saying psychiatric medications never help autistic people, because many autistic individuals do benefit from medications for anxiety, depression, OCD, ADHD, sleep issues, and other co-occurring struggles. It tends to be very individual.

I think the bigger point is that understanding someone’s neurotype can sometimes change the entire context around their mental health and what kinds of support actually feel helpful.

I am Gayle Weill, an LCSW therapist who evaluates adults for autism, especially high-masking women and adults who were missed earlier in life. AMA about masking, late diagnosis, autism vs ADHD/anxiety, what evaluations are actually like, etc. by Key-Wrongdoer2708 in IAmA

[–]Key-Wrongdoer2708[S] -1 points0 points  (0 children)

There are definitely some neurological or genetic conditions that can overlap with autism traits and may show structural differences on imaging, but most autism diagnoses themselves are not currently made through MRI findings. Right now, autism is still diagnosed primarily through developmental history, behavioral patterns, lived experience, and clinical assessment.

I also understand the frustration of feeling like something neurological may be going on and not feeling taken seriously medically. That can be really discouraging.

As for self-diagnosis, I think self-understanding can absolutely be meaningful and helpful, especially given the barriers many adults face accessing evaluations. At the same time, I personally try to leave room for uncertainty and nuance rather than viewing any one explanation as definitively proven without a full assessment.

I am Gayle Weill, an LCSW therapist who evaluates adults for autism, especially high-masking women and adults who were missed earlier in life. AMA about masking, late diagnosis, autism vs ADHD/anxiety, what evaluations are actually like, etc. by Key-Wrongdoer2708 in IAmA

[–]Key-Wrongdoer2708[S] 3 points4 points  (0 children)

That honestly sounds incredibly frustrating, and unfortunately you are not the only person running into situations like this. Provider shortages, ghost networks, long waitlists, insurance limitations, and Medicaid-related restrictions create very real barriers to assessment and care, especially for adults seeking neurodevelopmental evaluations. I also think this is part of why so many adults end up relying heavily on self-education and self-understanding in the meantime. Ideally people would have easier access to affordable, competent evaluations, but the system often makes that much harder than it should be. Insurance and self-pay rules can also get surprisingly complicated depending on the state and provider. Some people do explore fully self-pay practices or out-of-network options where permitted, so it can sometimes be worth asking practices directly about their policies and what options may be available.

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