David and Isabelle go into greater depth about neuropsychological assessments--both back in the day and now-for kids, and for adults--and Isabelle's AHA moment about self-disclosing her AuDHD self. From the odd history of the intersection of Autism Spectrum Disorder (ASD) and ADHD (did you know you couldn't be diagnosed with both for a long long time?) to realizing how literally she takes the world and how much it helps to finally have a turn signal on the car that is her, David and Isabelle dive deep into unmasking and the mistrust we have for the world when we are so misunderstood.

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Isabelle likes having her new neuropsychological results because someone who is not her got to tell her that she has autism, and David has a different experience. His story was like three different hours of testing done at school, and it spit out that he was Oppositional Defiant, and then only in college did it notice he had differences in spelling and then ADHD. His experience is watching clients have their kids be flagged by a pediatrician or teacher to be tested and then they want to retest themselves. But David is so scared he’d go in now and learn…he doesn’t have ADHD? And that Isabelle actually understands this, because there was a big gap (of several months) between the interview and the tests. Isabelle goes into further details around how she took her test in a little cubicle. And how for kids, it looks more like play, it involves an IQ test and way more details about processing speed, working memory, visual spatial reasoning, reading, symbols, numbers, etc. to help with understanding learning differences and accommodations. So Isabelle had to sit in a cubicle and stare at a computer and click on a mouse for fifteen minutes and it was awful. When he was a kid, David was pulled from class, he had no idea how long it was going to take, there was a person sitting there who was reading from a book and asking him questions. For kids, a level of buy-in becomes very important, it’s hard to get data when you’re a willing participant. For David, his first neuropsych showed how unwilling he was to participate, because it was something he was forced to do because there was “something wrong” and they were looking for what was wrong. This is not don’t like this anymore. It’s important to talk to someone who has been assessed to see how they liked their assessment. You can get a second opinion. There are people who specialize in different areas of neuropsychological testing. And someone who is great at diagnosing ADHD may not be great at diagnosing autism or vice versa. And up until 7 years ago or so, it was impossible to have both autism and ADHD be a primary diagnosis; which connected to insurance company lobbying when the DSM was being updated, ensuring that the rates of certain conditions wouldn’t skyrocket because that would impact insurance coverage and ability to cover/deny and all kinds of political and social isms. The history of diagnoses and what makes the cutoffs incorporates layers of ableism, racism, sexism, homophobia…all kinds of oppression. David names how important it was an opening when you could have a combined AuDHD diagnosis because it started to mean that these diagnoses of deficiency, and all the stereotypes around all autistics being nonspeakers or having high support needs, started to get busted and it became more encompassing, maybe even of strengths? It’s possible for us to be complex beings, being perceived as having ADHD or autism in another context. We are the keepers of the stigma, it was the ‘last thing we wanted to be.’ The other day, Isabelle’s kid went to the doctor, and she always felt the doctor was annoyed with her for being so literal and asking so many detail-oriented questions. Her kid answered the doctor’s question of “does your throat hurt?” By checking in and saying “No.” And she had a lightbulb flash and realized he was taking the doctor literally. So she tells her kid “You and me, we both take things really literally and answer questions extremely honestly. I think the doctor means when she asks if your throat hurts, she means across the last week or so and not necessarily all the time or right now.” And he answers, “YES!” And she saw the doctor warm up to her kid and to her and she felt the difference, and maybe it was the vulnerability or the disclosure. For David's friend, there was a significant amount of distrust in the world, there was a pattern of miscommunication and people asking you things that they don’t mean, when they learned they were autistic, their last instinct was to tell someone. But when they came back from the dentist, they talked about how much the light was bothering them, they gave me some glasses and made it so much better. David can't make us all believe we are safe, we can feel cared for when we tell people what we need and they respond. Statistically, some of the time, your need won't be missed and until recently, Isabelle didn't know she really needed, she would’ve said words like “anxious” and “please give me more time"