For years, autism was primarily recognized through a narrow lens—one that often missed those who didn’t fit the stereotypical male presentation. If you’ve spent much of your life feeling different but never quite knowing why, if you’ve learned to blend in so well that even professionals overlooked your struggles, if you find the sensory world overwhelming, or if you find yourself exhausted from holding it together socially, you’re not alone. Many teens and adults, especially women and those with high-masking autism and ADHD, go undiagnosed for years.

Let’s explore what autism really looks like beneath the surface, how masking plays a role, and why being neurodivergent is about differences—not deficits.

Social Communication Differences: More Than Just ‘Being Shy’

Autism is often associated with difficulty in social interactions, but for high-maskers, these differences can be subtle and easily overlooked.

• What people assume: Autism means a lack of empathy, avoiding eye contact, and an inability to hold conversations.

• What it actually includes: Social interactions can feel exhausting and require intense mental effort. You might script conversations, mimic others’ behaviors, or feel unsure about when to speak or how to interpret others’ emotions.

• For high-maskers: Many autistic teens and adults, especially those socialized as girls, develop sophisticated ways of camouflaging—making eye contact even when it’s uncomfortable, following learned scripts for social situations, and being highly attuned to others’ emotions. This can lead to chronic exhaustion and burnout.

• Neurodiversity-affirming perspective: Rather than being a lack of social skills, autistic communication is simply different. You may excel in deep, focused conversations, prefer one-on-one interactions, and communicate best in ways that feel natural to you.

Nonverbal Communication: The Hidden Effort of Fitting In

Eye contact, facial expressions, and tone of voice all play a role in social interaction, but for autistic individuals, these may not come naturally.

• What people assume: Autistic people have a blank expression and don’t use body language.

• What it actually includes: You may have difficulty coordinating verbal and nonverbal communication, struggle with tone or volume control, or find eye contact to be physically uncomfortable.

• For high-maskers: You might force yourself to maintain eye contact, even though it feels unnatural, find places on someone's face near the eyes to look so it appears you are making eye contact, or consciously adjust your facial expressions to appear engaged. Internally, though, these efforts can be draining.

• Neurodiversity-affirming perspective: Your brain processes nonverbal cues differently, and that’s okay. Expressing yourself in a way that feels authentic is just as valid as following conventional social norms.

Friendships and Relationships: The Push-and-Pull of Social Connection

Autistic people do have friends and want social connection—but it often looks different from the neurotypical "norm."

• What people assume: Autistic people don’t want or need friends.

• What it actually includes: You may struggle with understanding social hierarchies, making new friends, maintaining friendships, or balancing social expectations.

• For high-maskers: You might appear socially successful on the surface but feel lost when it comes to deeper social dynamics, such as dating and intimacy. You might find friendships easy in structured settings but struggle with unspoken rules in casual interactions.

• Neurodiversity-affirming perspective: Autistic socialization isn’t less-than—it’s just different. You may thrive in friendships built around shared interests, deep conversations, and mutual understanding rather than small talk and social obligations.

Routines, Repetitive Behaviors, and Special Interests: The Comfort of Predictability

Autistic individuals often engage in repetitive behaviors and routines—not out of rigidity, but as a way to self-regulate.

• What people assume: Autism means flapping hands, echolalia, or obsessing over specific objects.

• What it actually includes: A strong need for routine, perfectionism, black-and-white thinking, or hyper-focus on specific interests.

• For high-maskers: Repetitive behaviors might be subtler—pacing, picking at skin, repeating phrases in your head, or rereading the same book over and over. Your special interests might seem socially acceptable, like a deep dive into psychology, animals, or music, but they hold intense focus and emotional significance.

• Neurodiversity-affirming perspective: These behaviors aren’t “wrong” or “abnormal.” They provide comfort, help you process the world, and are an essential part of who you are. They can also make you an expert in your areas of interest!

Sensory Sensitivities: It’s Not Just ‘Being Picky’

Sensory differences are a core aspect of autism, though they can manifest in vastly different ways.

• What people assume: Autistic people hate loud noises and textures or have an unusual fascination with lights and movement.

• What it actually includes: Sensory sensitivities can be both over- and under-responsive. You might have a high pain tolerance, avoid certain fabrics, feel overwhelmed in bright environments, or struggle with hygiene because of sensory discomfort.

• For high-maskers: Many autistic people internalize their sensory distress, leading to anxiety, fatigue, or burnout. For example, you might tolerate itchy clothing in public but need to change as soon as you’re home.

• Neurodiversity-affirming perspective: Sensory needs aren’t a flaw. Understanding your sensory profile can help you create a lifestyle that supports your well-being rather than forcing yourself to endure discomfort.

Masking and Burnout: The Cost of Blending In

One of the biggest challenges for high-masking autistic individuals is the long-term impact of constantly suppressing natural behaviors.

• What people assume: If you don’t “look autistic,” you must not struggle.

• What it actually includes: Many autistic teens and adults push themselves to meet neurotypical expectations—only to experience burnout, anxiety, or depression as a result.

• For high-maskers: You might have excelled in school, seemed socially competent, or held down a job, yet still feel like you’re struggling behind the scenes. Many late-diagnosed autistic adults realize they’ve spent years masking, leading to exhaustion and a loss of self-identity.

• Neurodiversity-affirming perspective: You don’t have to mask to be worthy of support. Your needs and challenges are valid, even if they aren’t always visible to others.

Why Diagnosis Matters

If any of this resonates with you, seeking a diagnosis or self-identifying as autistic can be a powerful step toward self-understanding and self-acceptance. A diagnosis isn’t about labeling yourself—it’s about gaining the language to describe your experiences and the tools to support your needs.

If you’ve spent your life wondering why things feel harder for you than for others, you’re not broken—you might just be neurodivergent in a world made for neurotypical people. And that’s a beautiful, valid, but challenging way to exist in the world.

Safe Haven Psychology Center is here to support neurodivergent teens and adults in embracing their true selves. If you’re exploring the possibility of autism or ADHD, our neurodiversity-affirming approach to psychological testing can help you gain clarity, self-compassion, and strategies for thriving in a world that wasn’t built for you. Reach out today to start your journey.

Telehealth or in-person interviews:

• We start with an intake interview. This helps me make a plan for testing. After I write up that plan, which will include an estimate of the total cost, I will provide that plan to you in writing. 

• Clinical interview, often involving others, which might include parents, partners, or roommates to gather information about family and developmental history.

Standardized, reliable, and valid tests:

• Tests are selected based on the unique circumstance of each person, including their age, demographics, and presenting issues. There are free tests online which can be a helpful starting point, but not necessarily offer the robust and accurate information as those listed below. If you are interested in taking some screening questionnaires on your own, you can visit https://embrace-autism.com/autism-tests/ for more information. Screening questionnaires do not replace a professional assessment. 

• Tests may include the ADOS-2, DIVA-5, MIGDAS-2, selected items from the ADI-R, SCQ, SRS-2, CARS-2, BRIEF-2 (or BRIEF-2A), NEPSY-2, DKEFS, PAI, and/or MMPI-3, and others necessary to bring clarity to the questions we are seeking to answer together. If you don't know what these are, don't worry. That's my job!

Feedback:

• Once testing is done, we will sit down together and go over the results, focusing on answering your questions.

• Feedback includes specific recommendations and resources for you to help improve your life.

Report: 

• Following the feedback session, you will be provide with a written report that reviews in detail the results. This allows you to take more time to digest what can be a lot of information as well as provide the results to others that might be important, such as your medical provider, school, or supports. 

A clear diagnosis can transform how you understand your experiences and patterns, offering a fresh and compassionate perspective.

A diagnosis can provide:

• A foundation for self-acceptance as you come to terms with who you truly are.

• Answers to long-standing questions about yourself, bringing clarity and resolution.

• Insight into your strengths and how to harness them to grow and thrive.

• Access to supportive resources, including connections with others who share similar experiences.

• A direct path to effective treatment options, tailored to your unique needs. 

• A sense of relief as you begin to understand your emotions and inner world more deeply.

• A roadmap to tackle challenges, guiding you toward meaningful progress and empowerment.

This process isn’t just about identifying a diagnosis—it’s about uncovering a deeper understanding of yourself and creating a life that aligns with who you are.

Despite the many benefits of obtaining a diagnosis, there are challenges that can make the process more complex for both clients and clinicians. These include:

• Masking: Learning to act in ways that align with societal expectations rather than expressing your authentic self, which can make core traits of Autism or ADHD harder to detect.

• Exceptional skills in certain areas: Talents or strengths that may cause others to overlook differences or challenges. You may have found ways to adapt to your struggles and overcome many of them in your own creative ways. That doesn't mean there wasn't a cost. 

• Limitations of online screening tests: While these tools can suggest whether further evaluation is needed, they can be misleading and are not a substitute for a comprehensive assessment by a qualified psychologist.

• The absence of a biological test: There are no blood tests or genetic markers that can definitively identify autism or ADHD, making diagnosis reliant on behavioral and developmental evaluations. There are also no brain scans that can do this, despite what some claim. 

• Co-occurring conditions: Challenges like anxiety, giftedness, OCD, executive functioning deficits, or depression can draw focus, leading clinicians to miss underlying autism or ADHD. Often these conditions co-occur and the question needs to be asked, "Is it both?" versus "Which one is it?"

• Gender bias: Autism and ADHD are more frequently recognized in men and boys, which can result in women, girls, and non-binary persons being underdiagnosed or misdiagnosed. These conditions can present differently in women and research is only barely starting to catch up to this. For example, symptoms might be internalized and better hid in women. 

These obstacles underscore the importance of working with experienced professionals who can look beyond surface-level impressions and uncover the full picture of an individual’s experiences.

Many of the tests used are standardized using in-person administration. Tele-assessment methods are considered an adaptation of the standardized administration and, as such, the remote administration will be taken into consideration when reporting and interpreting the results. Testing may require some sessions be in person depending on the person's presenting concerns.

Like with therapy services, we want to be up front about costs so you can make an informed choice. 

Intake Interview:

• The intake interview is $350. After this, your psychologist will provide you with a testing plan and estimate specific to you. 

Total Costs:

• The total cost of testing varies based on each person's circumstance. Testing is a short-term and intensive service meant to get you answers, next steps, and clear direction. 

• For those who have had some previous testing and do not have a complicated history or symptoms, costs can start around $2500. For those with multiple diagnoses to consider and no previous testing, the cost can range from $4500-$7000.

• Insurance companies may provide some reimbursement of costs. Check with your insurance carrier for their out-of-network benefits. 

Understanding the Cost:

Psychological testing may seem expensive, but it’s important to understand what goes into the process. It’s not just about sitting in a room answering questions; it’s a detailed and specialized service that requires significant expertise and resources. Here's why it costs what it does:

1. Comprehensive Evaluation Process:

   • Psychological testing is more than a single session. Evaluations can take 10 to 20+ hours of professional work. It involves multiple stages, including an initial interview, test administration, scoring, interpreting results, providing feedback, and creating a detailed report. These steps ensure an accurate understanding of your strengths and challenges.

2. Specialized Expertise:

   • Licensed psychologists undergo years of training to develop the skills necessary to interpret complex psychological data. They also need to stay updated with the latest research and tools, which often requires ongoing education. Dr. Rachael Berg-Martinez has led testing programs in multiple settings, trained others in testing, and underwent specialized training in the assessment of ADHD and Autism, specifically for high-masking individuals.

3. High-Quality Tools:

   • The tests used are standardized and evidence-based, often requiring expensive licensing fees. These tools are scientifically validated to provide reliable and accurate results. And like any service, there are overhead costs, such as office space, staff support, and administrative expenses, all of which contribute to the overall price.

4. Customized Approach:

   • No two evaluations are the same. The psychologist tailors the process to the individual's needs, ensuring the recommendations are meaningful and actionable.

5. Value of the Results:

   • The insights gained from testing can lead to life-changing interventions, accommodations, and therapies. It's an investment in understanding and improving one’s quality of life.