Ep 26: Understanding Neurodivergence (AuDHD, Autism & ADHD) - More Than Diagnosis

🎙️ 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 Disorder
• Damian Milton's Double Empathy Problem
• The neurodiversity-affirming paradigm
• Social and relational models of disability

We are different, not defective.

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Transcript

SPEAKER_00 0:00

Potty potty potty potty potty potty, potty, potty, potty, potty, potty, potty pod podcast, potty, potty, potty, potty, potty, potty, potty, potty, potty, potty, potty, potty pod podcast. We love an audio stim and self-acceptance. It's the Audi HD Psych Podcast. Hello friends, welcome back to the Audi HD Psych Podcast. I'm Aaron Howard, Clinical Psychologist, and we are different, not defective. How can I be autistic without a diagnosis of autism spectrum disorder? Well, I'm so glad you asked, and today that's exactly what we're going to talk about. Recently, on one of my Instagram posts where I make the comment I can be autistic without autism spectrum disorder, in the same way that I can have legs without being broken, another advocate challenged that. And I wanted to make an episode that actually describes what I mean there and how I demonstrate that. So I guess to start with, we need to set some definitions, and that's what today will look like. I'll set some definitions. I'll talk about the diagnosis of autism spectrum disorder, and then I'll talk about how the characteristics that underpin the diagnosis can exist without difficulties. So, in terms of definitions, let's start with neurodiversity. We talk about the neurodiversity of famine paradigm. What is neurodiversity? Often we confuse neurodiverse with neurodivergent. Neurodiversity is like biodiversity. Just as there are lots of different types of biology, uh lots of different types of animals and plants in the world. Neurodiversity is there are lots of different types of brains or brain styles or cognitive styles, of which autism is one, of which ADHD is one, learning differences, and there are a whole series of other conditions that can fall under that umbrella. When we break the word down, we're talking about neurodiversity, neuro, brain, diversity, differences. So what's the difference between neurodiversity and neurodivergence or neurodivergent? If neurodiversity is the spectrum of differences of brains, then neurodivergent is a brain that is different. So neurobrain diverge difference or forked pathway. So neurodivergent is just a brain that functions differently from the typical community. In that case, then, what is autism versus autism spectrum disorder? And I will just grab my notes here to remind myself to stay on track. So, autism and autistic are words that have been used in clinical contexts, in diagnostic contexts, but actually refer to the underpinning characteristics. In the same way that I can be academic without having academic difficulties. I can be autistic without having autism-related difficulties. Autism really refers to a cluster of cognitive characteristics. Think about rigidity, the repetitive patterns of behavior. So what we see of an autistic person might be somebody who does the same thing over and over again, might be somebody who stims a lot, taps their feet because it's a nice, predictable, repetitive pattern of behavior, underpinned by cognitive characteristics. So autism is the characteristics. Autistic is the identity label that we use. I am an autistic ADHDer or an Auder. So autistic is an identity label. Not to be confused with the diagnostic label autism spectrum disorder. Autism spectrum disorder we diagnose in the presence of autism-related difficulties. So difficulties that are related to my autistic characteristics. And just as a knife, for example, really, really helpful in the kitchen when I'm making a sandwich, not that helpful in the garden when I'm trying to dig a hole to plant a tree. And our characteristics of autism or ADHD or our learning differences are the same. In the settings to which in which they come to attention, they can be noticed as strengths or weaknesses. But in other settings where they're not the characteristics that are in use, they're completely valence neutral. And it's discussed, sometimes those things that we consider weaknesses or deficits can actually be strengths in other environments. And that's a conversation about the social and the social relational models of disability and of impairment. I want to make a note that there is a the same person who appeared to be advocating on my social media post made a comment that autism is not a social construct or the diagnosis is not a social construct. And I want to challenge that idea. Because normally when we talk about social constructs these days, we're talking about identity as a social construct, gender as a social construct, for example. And if you could hear that, I think that was my practice manager popping in behind me. Hello, Sandy. And so when we talk about uh diagnosis in the context of social uh social constructs or the challenge that it's not, um diagnosis is absolutely a socially constructed thing. Usually it's something that we construct based on I make a clinical observation as a clinician, and then I think, oh, this looks like a new condition that might that might warrant supports. Then we do some research, and the research bears out that that condition exists and it's it's noteworthy enough or it impacts enough people for us to be able to construct a diagnostic framework around it. And then where the research converges and the clinical perspectives converge, that is how we have a diagnosis. It is a socially agreed upon idea that necessarily involves the input of clinicians and then usually researchers afterwards. And when we talk about a social construct, we're talking about any idea that two or more people agree on. Two or more people create a social setting, and a construct is we socially construct that by agreement. So diagnosis is absolutely a social construct. Now, moving on to autism spectrum disorder, and I'll I'll just define this because I think it's really important before we uh move into how autism and the diagnosis are separate. Autism spectrum disorder is essentially characterized by two clusters of characteristics. One is social, emotional, and communicative difficulties, and there are three diagnostic criteria, and we must meet all of those. The other is the restricted and repetitive patterns, uh, restricted and repetitive patterns of thought, behavior, use of objects, and our sensory differences, which arguably can be uh conceptualized under the repetitive or restricted patterns. That's a conversation that I could have separately at length. So we make the diagnosis not just because the cluster of characteristics are there. We make the diagnosis and we can only make the diagnosis if there are difficulties arising out of the characteristics. So, for example, if I am stimming and my stim is a self-harming STEM behavior, that is difficulties that require clinical attention. That would be a characteristic that warrants diagnosis. If I'm unable to engage in social settings because of my social expectations the way I exist, that is difficulties arising. However, if those difficulties are specific to certain settings and not characteristic of all settings, then the difficulties are not based in our characteristics. They're based in the interaction between our characteristics and the environment that we're in. And Milton's double empathy problem really speaks to this. We talk about historically the social and communicative deficits in autism. However, we also see through uh Milton's ideas how if we put a bunch of autistic people or ADHDers together or Audi HDs together, there is no social or communication difficulty. However, if we put a single neurodivergent person in a large group of uh neurotypical people, that's where the social difficulties arise or the communication difficulties arise. So that tells us that it's not so much a language problem as it is a dialect problem. If I'm with people who speak the same dialect as me or communicate in the same way as me, then there's no difficulty. But if I'm in a group that have different social and communicative expectations, then I have difficulty. The reverse is also true. If you take a neurotypical person and put them in a group of autistic people or neurodivergent people, they will be the person who has difficulty communicating in the acceptable way. So the disorder is specific to uh when there are difficulties that arise or are related to my characteristics, but it also means that the characteristics can exist in the absence of difficulty. So that's essentially autism spectrum disorder. We diagnose it if you know I don't follow the same social rules as my classmates, so I come to my teacher's attention. Um I don't make eye contact, is the most common uh example of one of the differences in uh my communicative intent versus what my body is doing. Um, flat affect, those of us who have resting bitch face or my resting vapid face, or people whose face doesn't change all that much when they become extremely emotional from when they're not emotional at all. These are the differences that we're looking at there, and they're not inherently disordered. With the restricted and repetitive, it's the the stereotypes of, you know, I actually like to, when I have time, line all my clothes up together, pants together in on hangers, shirts together on hangers, separated t-shirts from button-downs, separated short sleeve from long sleeve. Uh, and if I have time, I like then like to color code them in that as well. That is restricted and repetitive patterns of behavior. I like the things that are together to be together. Our sensory differences are really interesting because we everybody has slight variation in their sensory experience and their capacity to gate that sensory experience to block things out. Um but the higher our stress is, the less able we are to block those things out. And this is true across humans, I would argue, but certainly true in our environment. And the advocate who commented on my post actually made that point. And I 100% agree with it. The more stresses I have in my life, the more I'm going to lean back into my autistic characteristics and needing to know what's coming up so that I don't have to think about it at the time. Uh, you know, that autistic rigidity is often about saving cognitive bandwidth. If I live in a world as we all do, um where, sorry, we neurodivergents do, where the world expects my cognitive functioning to be at a certain level on certain characteristics, and I have a different level of those. If my level is lower, then I'm going to be using other parts of my cognitive function to manage that or compensate for that. It's part of the implicit masking that we do. Why does that matter? Because if I'm doing that, my stress is inherently higher than everybody else's, alongside the social masking that we do, alongside managing our sensory differences that we do. So I have less capacity to deal with the unexpected. This is my clinical observation and my personal experience, by the way. I want to differentiate that from the research and the academic literature. But I have less cognitive bandwidth to deal with the unexpected because I'm already tying everything I have up, managing trying to be typical in a typical world with an atypical brain. So in that case, we can see how, and you know, I have many friends who, if we go to a new restaurant, they'll know where to park, where the toilets are, where the kitchen is, what the reviews are like for how long we're going to be waiting there. And that manages that cognitive bandwidth that we're tying up more often than not in a typical world. So those characteristics aren't inherently disordered. You know, if I have lots of spare time to look up the things and be really comfortable with what's going on at the new restaurant, then there's no deficit, there's no disorder there. But also that predictability that saves my mental effort, my mental bandwidth, that is really, really a helpful characteristic in the military. I know my novelty seeking, my ADHD-based novelty seeking, was something that made me love a lot about my time in the Navy. Uh, there were new people coming into the ships and establishments I was in regularly, so I got social novelty. Um, often we were going interesting places, or I was going away somewhere else doing courses. That was really novel. But within that environment, I also knew exactly what the rules were. I knew that, you know, on our ships, everything has to be put away so that if the ship's rocking and rolling, it doesn't become a trip hazard or block up pumps if we're flooding, doing damage control, things like that. I knew the rules, and that gave me a sense of safety because I didn't have to ask myself when I went from one ship to another, what are the expectations here? So my cognitive rigidity alongside my novelty seeking were both really helpful characteristics in the Navy for me. At the same time, my novelty seeking was really unhelpful. Did I go out far too often because I would make an impulsive decision to go to dinner and then go to a bar after I'd gone to dinner? Absolutely, I did. Very unhelpful expression of the same characteristic of impossibility, impulsivity and novelt novelty seeking. And when I'm working with actual humans, that rigidity, that needing to understand what's coming up, is arguably helpful and unhelpful. What it does is it means that I spend a lot of time understanding how people might react in a particular situation so I can be prepared for it. Which, on and I don't love the word expert, but in an expertise kind of way, it means that I have a lot of information to draw on. The downside is in my life, it means that I'm spending a lot of time developing that knowledge. I'm very lucky that my work is my interest. So it's enjoyable uh work in my downtime, but that's not everybody's experience. But I think it really demonstrates how the same underpinning characteristics can be both helpful and harmful, and they don't actually come with an inherent balance. So, what are some of the arguments against the idea that I've just proposed, or I didn't propose it, that I've just put forward? Um often it's and this uh advocate made these comments, is it's my language, not theirs, that it's invalidating the support needs of other people. No, no, it is absolutely not. Because just because I can have a characteristic that doesn't have an inherent valence that can cause difficulties in some settings and doesn't in others, doesn't say that there are not difficulties related. Uh, we absolutely do have difficulties related in one way or another. Sometimes we have environments or characteristics that compensate for those difficulties, so they're not seen from the outside, and that's often where we see language like subclinical used. Um, however, we need to also consider, and I I implied this earlier, we need to also consider that my characteristics and the difficulties or strengths related to them will be amplified by what else is going on in my life. If I'm really well rested and if my diet and exercise have been really good for the last couple of months and I'm physically healthy, my cognitive functioning will be generally doing its work in a much easier way. However, if I got two hours sleep last night and I've just had an argument with maybe another psychologist, uh, maybe I missed breakfast this morning, my attention's going to be distracted to my stomach, my emotions will be all over the place, and they will color my cognitive processes, they'll color what I'm thinking about. If I'm angry with somebody, I'll think about all the terrible things that they did. But if I'm not, I'll probably be thinking, oh, I wonder what I can do today to make everyone feel happy in the office. Can I bring some cake in or something like that? So my actual day-to-day expression of my characteristics as strengths or difficulties is heavily influenced by everything else in my life, by my physical health, by my social environment, by my professional stresses and my life stresses. And so to imply that a neurodiversity-affirming perspective is one, denying that there are difficulties is false. And two, doesn't account for the interaction of my characteristics with my other life difficulties is also false. And in clinical psychology, as I've touched on in a previous episode, that's our formulation process. I know that if I don't sleep well, my I'm going to be less attentive, my concentration's going to be poorer, and I'm going to be more emotionally reactive to things. But their core characteristics of ADHD. Well rested, even without taking the medication that I take for my ADHD, my concentration is much better. I'm better at using my behavioral strategies to keep my attention on task, and I'm less emotionally impulsive and reactive to the world around me. So I guess in closing, it's really important to note that autism and the characteristics that underpin autism, and the characteristics that underpin ADHD, are not the same as the difficulties that we must identify in diagnosing the related problems that we call autism spectrum disorder and ADHD or learning disorder, which I think is really just learning differences. It's important to understand the language. Neurodiversity is not the same as neurodivergent, is not the same as diagnosis. And it's really important to understand within ourselves as neurodivergent people that every single one of our characteristics will act as a barrier, will be unhelpful in some settings, and will either be not relevant or helpful in other settings. And how the rest of my life is traveling, how physically healthy I am, how socially included I feel, how competent I feel in my work, these will all interact with our core characteristics to yield our strengths or difficulties. And I look forward to monologuing at you again another time soon. Run rabbit, run rabbit, run, run, run.