Too Pretty to Be Autistic

It’s the erasure of neurodivergent people that causes harm, not diagnoses

Content warning: this essay discusses suicide

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“You meet the diagnostic criteria for autism,” the psychiatrist said, peering over his glasses like he’d spotted a typo. “But you’re too pretty to be autistic.”

My face flushed maroon. I scanned his expression, waiting for a smirk, a wink, any sign this was a terrible joke. He never explained, and I was too overwhelmed to ask for clarity, so I left his office humiliated and confused.

The laugh came later, when I relayed this story to my Primary Care Provider, a middle-aged woman whose warm face froze before she threw her head back and cackled. This initially felt validating until I realized she was surprised by the suggestion I was autistic, not by the psychiatrist’s misogynistic delivery.

“You’re not autistic,” she said after recovering. “You have ADHD, and it’s not possible to have both.” She wasn’t laughing with me, she was laughing at me. It was 2010 so she was correct, technically. It would be a few more years before the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), would acknowledge that autism and ADHD can coexist. Research reinforces that these two diagnoses in fact often co-occur: in one study, 28% of autistic people also met the diagnostic criteria for ADHD.

The idea of daring to believe there might be an explanation as to why I’d felt like an alien my entire life was so humiliating that I was careful not to identify too closely with the diagnosis. I kept it at, this might be a reason for why my directness was often misperceived.

I scrambled to understand my brain and get to the root of things for another decade, as a growing list of medical providers scratched their heads. I wanted an explanation for why I would lose the ability to speak and would strike my own head repetitively when overwhelmed with emotion I could not make sense of, why I could read chapter books at age 2 but never learned to tie my shoes–or why I experienced crippling social anxiety while appearing confident and extroverted. They wouldn't, or most likely couldn't associate these traits with autism, despite being textbook experiences–especially for women and those assigned female at birth.

🦓

“Why do you need a label? Because there is comfort in knowing you are a normal zebra, not a strange horse. You can’t find community with other zebras if you don’t know where you belong. It is impossible for a zebra to be happy or healthy spending its life feeling like a failed horse."

- Unknown

I loved to learn but often got in trouble at school – interrupting, asking questions out of turn, making inappropriate jokes, rigidly regulating rules that seemed like life-and-death, while violating other social norms that everyone understood but me. I struggled to turn in assignments, distracted, but tested in the 99th percentile, so my differences year after year were attributed to matters of effort.

My teachers wrote that my “commitment,” “care,” and “dedication” were the root cause, a 6th grade report card saying “there’s really no reason such a bright and talented student should be getting anything other than all A’s…”

This is such a common experience for neurodivergent folks that there’s a term for it: “twice exceptional” or “2e,” describing those who have both exceptional abilities and disabilities. Research shows these children are often either missed entirely or only identified for their strengths or their struggles, but rarely both. We’re the kids being asked to do things we can’t, and we’re often as confused as the adults around us as to why we are the way we are, often resulting in internalizing shame and self hate.

Imagine a child who uses a wheelchair— what if every time they come up to stairs, they’re teased for being stuck, asked what’s wrong with them, while the adults they love and trust urge them to simply try harder to ascend the stairs? The kid needed a ramp.

In the box with my report cards and school records, I also found a depression survey I’d filled out in a sterile medical office the summer before my senior year of High School, indicating that I felt disappointed in myself and had thoughts of ending my life, although I did not believe I’d carry them out.

By then, I’d already been conditioned to question my perception. My feelings were wrong. I was wrong. Instead of experiencing emotions, I learned to intellectualize them and stay moving. If school and side hustles, later remodels and children kept me busy enough, I’d never have to face my grief.

And work? Work was a great place to hide from grief. While I felt like I came without the preinstalled social software everyone else got, I could master business. From my early career in startups through to much of my time at Facebook, I thrived with structure, clear expectations, measurable outcomes, and values on the wall reinforced in board rooms. Clear marching orders toward complex problems. It was the AuDHD dream (AuDHD is a portmanteau of autism and ADHD).

Peer and manager reviews described me as a leader who saw and elevated people, not just projects; someone who brought rigorous clarity, strategic vision, and relentless drive to the work. I treated global CMOs and garage developers with the same level of respect and forthrightness, creating deep trust and long-lasting partnerships. These traits didn’t come in spite of my neurodivergence—they came because of it.

While my manager feedback and ratings were overwhelmingly positive, I did occasionally receive feedback that I could get rigid and intense—jumping in to save projects, over-clarifying, or holding reins too tightly. At the time, I didn’t understand these were expressions of my hyper focus, need for predictability, and hyper vigilance. If I hadn’t been dismissed because of how I looked, I might’ve gained skills to lead with less over-functioning, and I would have been able to better understand and validate those colleagues’ experiences of me.

When workplace expectations were obscured, when goal posts moved, when I witnessed leaders alternate ignoring and justifying an abandonment of values–my neurodivergence magnified the damage; my entire construct of my workplace and the ways I’d contributed to its success broke, taking my sense of self with it.

I began to lose my ability to mask and perform neurotypicality. My gripping white knuckles became more translucent until hands weren’t on the wheel anymore. I was depressed, anxious, and descending into a systemic shutdown that almost cost my life.

Trying to take care of myself, I booked bucket list trips to “recharge,” only to find myself suicidal overseas instead. I had no idea what was wrong or how to make it better, and most of my interactions with health professionals made things more confusing.

Soon, I couldn’t get out of bed. I experienced regression in my cognitive, emotional, and executive functioning capabilities, and found it hard to tolerate an overwhelming feeling that felt like being expected to sprint on a treadmill in a pitch black room while sleep deprived. Like the bottom of bottomless grief.

Photo by Kinga Howard on Unsplash

After a year of Dialectical Behavioral Therapy (“DBT”), including the Prolonged Exposure Therapy for PTSD (“DBT-PE”), my PTSD was in remission and yet I still couldn’t manage to complete tasks as simple as checking my mail or paying my bills.

I kept thinking back to my autism diagnosis, and sought out updated literature from diverse authors. I downloaded Devon Price’s “Unmasking Autism” and was shocked by how much my experiences made sense as an autistic person: childhood rejection to my overwhelm-meltdowns, burning out in an environment that punished women for doing their jobs, and even becoming so desperate to die.

Donna Henderson, Sarah Wayland, and Jamell White’s book, Is This Autism? A Guide for Clinicians and Everyone else, which is full of experiences shared directly from autistic people, and Dr. Michelle Livock and Monique Mitchelson’s podcast “The Neurodivergent Woman,” further validated my experiences and helped me accept my altered capacity. Through The Neurodivergent Woman podcast, I discovered Dr. Megan Anna Neff's research on autistic burnout recovery.

I learned that healing comes through embracing autistic identity rather than fighting it, finding spaces where autistic traits are valued rather than pathologized, and developing genuine self-acceptance instead of constantly striving for neurotypical presentation.

I’ve seen the same TikToks as you, shaming people for using neurodivergence as an excuse, and I was convinced many would reject the idea I was autistic. I was terrified of continuing to be a joke, just like I’d been in those doctor’s offices.

I was scared to ask my psychologist for a referral for a neuropsychiatric evaluation; I wanted to confirm my years-ago autism diagnosis and deepen my understanding of what I’d been experiencing. I asked and she didn’t laugh at me; it was everything.

She validated me and sent me to an expert to whom I sent school records, my mom’s memories, medical history, mental health history, photos of different chapters of my life, and a Notion database of experiences or traits I’d been unable to explain. Her testing process was safe and her practice was informed by modern research. She didn’t laugh at me either, except when she told me that without even looking at the database, the fact that I made one was diagnostically relevant; I felt so seen, and we laughed together.

Confirming my diagnosis resolved a long series of open loops and non-computes in my mental hierarchy that had distressed me for decades. Instead of being confused and convinced I was defective, I could start learning to navigate my differences with a sense of agency, a more informed support system, and the skills to feel my feelings. I grieve the life I had to leave behind, and I also get to look forward to finally living.

I found DBT because it was created to help suicidal people, and for me it also offered a framework to navigate my sense of “missing software.” DBT helps me recognize when I am performing emotional wellness for others comfort and to make choices based on what’s best for my needs and values, even if it’s not best for everyone else.

Left: Photograph by Collin Quinn Rice; Right: Harmony

“Refusing to perform neurotypicality is a revolutionary act of disability justice. It’s also a radical act of self-love.”

- Devon Price, Unmasking Autism

The mug, a gift from my DBT Psychologist after my initial course of treatment

Check out Self Care for Autistic People by Dr. Megan Anna Neff and Dr. Neff’s workbooks on masking, burnout recovery, and so much more on her website, Neurodivergent Insights.

Working with my occupational therapist to apply Dr. Neff's frameworks has given me practical tools to navigate life in recovery with more self-compassion and sustainable coping strategies. She emphasizes establishing necessary accommodations rather than pushing for "recovery" to pre-burnout functioning, which is likely neurologically unsustainable if possible at all.

The trend to discredit neurodivergent people and their diagnoses fits with a history that erases neurodivergence to maintain power and control. Why? Systems that value and reward conformity are threatened by divergent thinkers.

Despite greater awareness, several myths about autism persist in the public sphere and media. One is the idea that autism has become a “trendy” diagnosis or is over diagnosed. It’s true that reported autism rates have risen dramatically – but experts attribute the estimated 800% increase in diagnoses not to a sudden epidemic, but to new diagnostic criteria, direct access to accurate information, and reduced stigma leading more people to seek evaluations​. In other words, we are finally counting people who were always there. In fact, many clinicians argue autism is still under diagnosed in certain groups (like females, adults, and ethnic minorities), even as overall numbers climb. The misconception that “everyone has autism these days” or that normal behavior is being pathologized can undermine legitimate diagnoses.

Another pervasive misconception is the gender stereotype that autism is a “male condition” – leading to beliefs that girls “can’t be autistic” or that it’s exceedingly rare. This myth was rooted in a lack of research and has been refuted by current evidence.

Finally, one of the most damaging myths is the false link between vaccines and autism. This idea began with a now-debunked study in the 1990s that was disproven by extensive research by the CDC, WHO, and others who have found no association whatsoever between childhood vaccines and autism.

Photo by Diana Polekhina on Unsplash

The history of how society has treated neurodivergence follows a pattern of elimination, suppression, and disinformation:

• First came strategic elimination of neurodivergence in the form of institutionalization, sterilization, and murder. ​In NeuroTribes: The Legacy of Autism and the Future of Neurodiversity, Steve Silberman examines the historical context of eugenics and its impact on autistic individuals. He discusses how eugenicist ideologies, which sought to "improve" the human race by eliminating perceived undesirable traits, led to the forced sterilization and euthanasia of disabled individuals, including autistic people, particularly during the Nazi regime.

• Then came medical suppression, achieved in part through under-educating healthcare professionals, a lack of funding for research, and pathologizing neurological differences as disorders to be corrected rather than variations to be accommodated. Diagnostic criteria were narrowly defined and gate-kept by a flawed, biased medical model.

• Now we're in the era of mockery and disinformation, where diagnoses are dismissed as trends or over diagnoses, and where RFK Jr. reinforces the vaccine myth and proposes sending neurodivergent people to “wellness farms.”

Neurodivergence isn't new, it's a natural human variation that has existed throughout history. Access to information doesn’t cause diagnoses, in the same way that the sudden spike in incidence of left-handedness wasn’t due to more left-handed people, but reflected their unwillingness to pretend to be right-handed after learning they weren’t actually deviants.

When left-handers began using their left hands, it only threatened the ideologies demonizing them, but recognizing the scale and scope of the neurodivergent experience would require education, healthcare, and employment systems to change.

Erasing and invalidating neurodivergent people and their diagnoses was never about health or truth, it is about preserving the status quo; about keeping power and money where it is.

We’ve always been here, erasure has always been the strategy, and diagnoses aren’t death sentences–they’re footholds.

Autistic people often have poor outcomes over the life course, including in health, education, employment, and community inclusion. Many professionals working with Autistic adults in research, clinical, and educational settings devote their careers to trying to improve such outcomes. However, we maintain that real progress cannot happen without a fundamental mindshift. The status quo for professionals is to view autism as an illness. Instead, the neurodiversity movement encourages us to value and embrace autism as an aspect of human diversity and asks us to view Autistic people as a marginalized group that experiences significant disparities.

-Mindshift in Autism: A Call to Professionals in Research, Clinical and Educational Settings (2023)

When we tell people they’re too pretty, too successful, too capable to be neurodivergent, we’re perpetuating institutional gaslighting and harmful stereotypes that deny people access to understanding themselves and receiving the support they need. We are taking beautifully complex, layered, and multifaceted humans and flattening them into two dimensions.

As Dr. Alana McVey and fellow researchers note in Mindshift in Autism: A Call to Professionals in Research, Clinical and Educational Settings (2023): "The way society currently treats autism does not adequately respond to the diversity of autistic people and the plurality of ways in which the experience of being autistic manifests itself in different lives."

“I am different, not less.”​

-Temple Grandin, Autism Advocate

Parenting children who feel deeply and think differently without understanding them is catastrophic to families. Advice from most parenting books did not apply to my kids, and I had no other framework aside from my own experience.

With better understanding and resources, I can model and offer them compassion and validation, as well as tools and skills to navigate environments not designed for them. If you’re contemplating whether or not to tell your neurodivergent child about their diagnosis, YES! Emphatically, completely, from the depths of my deeply feeling heart, yes!

Intergenerational healing is the ultimate revenge against a system that tried to convince us we didn't fit.

A couple of weeks ago, while tucking a Minecraft comforter around my kid’s rapidly growing feet, I looked up and asked if they felt different since their diagnosis. “Of course,” they said, sitting up a little, “instead of wondering why I’m such a broken horse all the time, now I know that I’m a perfectly normal zebra.”

Photos with my kids by my friend and talented photographer Julie Harmsen