It’s just about coming up on 2 years since I pulled the plug on pretty much everything therapy related.

And I’m not being flippant when I say I pulled the plug - because that’s pretty much exactly how it happened.

In November of 2024 I stopped writing, stopped posting, deactivated my TikTok & Instagram and deleted my website all on the same day, and very shortly after I completely stopped seeing clients.

For probably the 5th time in my life, I sleep-walked into a burnout that rendered me incapable of anything other than immediately and completely vanishing without a trace.

The somewhat laughable (very much not laughable at the time I tell you) thing about this burnout, which I have unaffectionately named The Great Implosion - is that I’d been acutely aware of my being autistic for several years, I’m a psychotherapist with a substantial amount of autism expertise, and an intensive years-long special interest in late diagnosed autistic women. And yet I was still absolutely blindsided by my sudden inability to function.

In the glorious technicolour of hindsight, I can see that I was running headfirst into disaster for at least 6 months before I imploded. Or if I’m being absolutely honest with myself this was possibly creeping around in the shadows for the greater part of a year. I was over-functioning, over-advocating, over-working, over-writing, over-social media posting and spreading myself thinner than butter on a cracker (or at least how my ARFID daughter spreads hers)

The very short version of the first half of this story is that I burnt out, retreated, slowly recovered, made huge lifestyle changes to offset the fallout & swore to myself I’d never let it happen again.

So you can of course imagine my absolute astonishment when in the past few weeks, whoops, here I am again - rattling around like a forgotten chip in the bottom of your air fryer - charred, shrunken, sizzled and completely inedible.

What.The.Hell.Is.Going.On

Now I could write you an essay about the genesis of autistic burnout, the warning signs, the symptoms, how to catch it before it’s too late, how to heal and support yourself when you’re in it - all that stuff.

I could write that, but instead I’m going to tell you about my experience with it.

I want to tell you about how it crept up in my life and how (if you’re like me) internalised ableism and the social conditioning of simply existing as a woman (worse again if you’re also a mom, and extra bonus worse points if you’re a mom of ND littles) in society can really mess with your ability to see it coming.

Let me step it back a bit.

I’m late diagnosed - 34 when I got my neurotype confirmed.

I’m a mom of a wonderfully autistic young daughter.

I have a husband.

I have a full time job.

I have a mortgage.

I have a car.

I have friends.

I have all the visible markers of a “successful” life. Perfectly normal, right? Nothing to see here folks.

And time and time again I fall for my own bullshit.

I trick myself into thinking that because I tick all of the above boxes that I really am fine, that there actually is nothing to see here.

I talk about MY autism in terms of quirks and preferences and sharing humorous little anecdotes about social awkwardness or silly little miscommunications.

I advocate about everyone else’s autism in terms of support needs and meltdowns and burnouts and comorbidities. I tell anyone who will listen about suicide rates, eating disorders, self harm statistics and how we need to mind our girls’ mental health.

I talked to my clients about softness and self-compassion, about the need to go at their own pace and recognise their own strengths and limitations. About boundaries and regulation. About measuring success or joy or neutrality by their own standards, not the obscene cookie-cutter standards that society thrusts upon people/women/moms.

And somehow I completely forget (every bloody time) that all of this applies to me too.

Around the time of The Great Implosion, my mental health took a nose dive. And the bar was set pretty low to begin with because 2023 was probably the worst mental health experience I’ve ever had. My health anxiety was bubbling at a level that I didn’t know was possible - I must have sat across from the GP 20 times that year, too anxious to function and too anxious to do anything about it.

I was absolutely miserable in the job I was working and spending a huge amount of time in bed. I gained 20kg in a little over 12 months and spent most of my free time googling symptoms of all kinds of rare brain diseases and spiralling myself into madness.

So what did I do to support myself through this awful period? Well, I went back to college to add another level to my psychotherapy qualification of course (obvious choice, I know).

And back at the college where I had done my primary degree, I stomped in and became the Ambassador of Autism (self-appointed). And oh how I excelled externally. My website and social media took off at breakneck speed and so obviously I did too.

I can see in retrospect that as a coping mechanism, there was a complete splitting of my self during this time. There was the horrendously burnt out me who was experiencing daily panic attacks and Health OCD, who broke out in a rash (literally) every time she posted a video or looked at her waiting list.

The one who asked her husband 100x a day if he thought she was mentally ill. And then there was the version of me that I sold to the world - the “acceptable” autistic me. The “I have my shit together” me. The absolute bullshit me.

I realise now that this is was the epitome of my internalised ableism. I genuinely could not see that I was operating stratospherically beyond my capacity because “other autistics do it and they’re grand”. So obviously I must be grand too, just maybe a little bit anxious? It says on paper that I have low support needs so that means I just need to get over myself, okay? I’m fine, this is fine.

Alas, all mad things must come to an end, and in November of 2024 it did. Phew.

By January of 2025 I had completely and utterly renounced all things psychotherapy and slowly began to gather myself back together.

I chalked it down to me just not being cut out to be a therapist and that of course was the root of my issues - absolutely nothing to do with the extended period of over functioning or ignoring my actual needs and definitely nothing to do with the fact that I fundamentally cannot cope with being perceived - and yet had somehow built an entire career by thrusting myself onto the internet and inviting people to perceive me.

(As I write this now I’m beginning to wonder if I’m harbouring some deeply masochistic tendencies. I’m joking. Sort of).

Anyway with the bandage of therapy abandonment covering my gaping self-neglect, I decided that my next big thing would be self care. Oh yes, I was going to be the best self-carer that ever self-cared. And boy did I mind myself in 2025. I changed jobs, and took to nutrition and exercise with gusto, lost a significant amount of weight and was feeling pretty smug about it all. Look at me winning at recovery, I’m the best burnout recoverer ever. I’m so successful at this…there’s a theme here isn’t there?

And the fitter I got, the harder I pushed. More steps, more cardio, more weights, better macros, better micros, more sessions. I’ve given serious consideration this year to either entering a bodybuilding competition or maybe a Hyrox race - two dramatically different disciplines, neither of which I am remotely trained for (nor have I the capacity to handle the stress of).

And at no point in the last 18 months have I scheduled in any kind of rest or recovery beyond the bare minimum. Because I’m grand. Because other people do this too. And then a few weeks ago the physical symptoms started.

You might notice from reading this that the 2024 burnout where I thought I was losing my mind was probably pretty closely linked to overworking my brain.

And so it’s not a big stretch to imagine that this brand new burnout which is all heart palpitations and a&e visits and heart monitors and panic attacks is probably from overworking my body.

I’m writing all this while very anxiously awaiting the results of the heart monitor, and I can see what I’ve been doing with razor sharp clarity now.

I’m autistic, I know this.

My autism is a disability.

I am disabled.

Sometimes (more like all the time) I hide the disabling parts of my autism away so deeply that even I can’t see it. And I mean that genuinely, I cannot see it. At least not until it’s gotten so bad that my brain is imploding or my heart is aggressively misbehaving.

People know that I’m autistic because I tell them all about it, because I’m openly autistic, because I consider myself low masking.

But I need to sit and reflect deeply on the less palatable bits of my autistic self that I’ve been masking even from myself. The bits that need the most support.

The bits that are less manic pixie dream girl and more panicked goblin nightmare woman.

I am a mother to a child with additional needs, I’m a wife, I’m a friend, I’m a homeowner.

I’m a psychotherapist (in hiatus) and a government employee.

I’m a chronic over achiever, a never-quite-good-enough-er, a cannot-ask-for-help-er and the absolute champion of all things self-abandonment.

I’m also disabled, burnt out and autistic and I deserve so much more (or honestly, probably so much less) than what I’ve been demanding from myself for the last number of years.

And if any of this resonates with you, then so do you.

Anyway, how have you been?

I’ve noticed an interesting theme emerging in some of the late diagnosed autistic clients that I work with - parental estrangement – and more specifically estrangement from the mother.

I’d hazard that about 50% of the autistic clients that I’ve worked with don’t speak to their mother and/or father. And it got me curious about the why of this.

I see a lot of online discourse about it too – from late diagnosed eldest daughters usually, who explain that they have been the scapegoat of their family of origin and who as adults (before or after diagnosis), make the choice to disconnect or remove contact with their childhood primary caregiver (usually the mother) for their own wellbeing.

Now in fairness, the online anecdotes could just be my algorithm algorithming - as a no contact eldest daughter myself – but I can’t explain away the 50/50 split of adult children in my practice that don’t speak to their parents quite as easily.

So I went looking for evidence, or at least an explanation that would satisfy my own curiosity.

My original theory is centred on autistic people who did not receive their autism diagnosis until adulthood, and so the parent was unaware of their specific support needs during childhood, and my thoughts went something like this:

·       A lot of late diagnosed Autistics grew up in the 1970s/1980s/1990s and autism was very poorly understood back then – so many parents labelled their undiagnosed kids as “bold” or “lazy” or “useless” or “stupid” and these labels followed the children into adulthood.

·       In the 20^th Century, Ireland had more people per capita institutionalised in psychiatric facilities than any other country in the world – we can’t know for sure but I’d bet my house that the Psychiatric Institutions, Magdalene Laundries & Industrial Schools of Ireland were full of undiagnosed autistic folk.

·       Ireland was a very conservative country until the late 90s/early 00s and the Catholic Church had incredible power – people were expected to conform to the “norm” and those who didn’t would bring “shame on the family”, or even get thrown into an institution - so the unusual kids were quite often severely punished out of fear.

·       Autistic kids are more likely to have (undiagnosed) autistic parents – undiagnosed autistic parents will have more support needs than NT parents (and if they grew up in the Catholic Ireland of the earlier 20^th Century then they may also be pretty traumatised), therefore their capacity to co-regulate, empathise and support their undiagnosed child may be compromised. The undiagnosed parent may find their own sensitivities triggered and they may project their discomfort onto the child (“it’s the child’s fault that I react this way because their behaviour is so bad”). Undiagnosed autistic parents can also have pretty poor mental health, and this can impact the parent/child experience too.

·       Autistic kids by definition are harder work than NT kids – this may create a drain on the caregivers energy resources and may result in inconsistent responses, potentially impacting the child’s attachment style.

·       Autistic kids need more support than NT kids – again this may drain the parent of their resources and the parent may not be able to offer a consistent level of co-regulation and empathic responsiveness

·       Autistic kids are more likely to display challenging behaviour –this may result in parental bitterness or resentment towards the child because if the parent feels that they cannot “control” the behaviour, they may initially blame themselves or project that blame onto the child.

·       Autistic kids are more likely to present with PDA (Pathological Demand Avoidant, often misinterpreted as Oppositional Defiance Disorder) behaviours – historically, a lot of parents would have used authoritarian parenting styles which will put the PDA child straight into fight/flight mode and therefore have the snowball effect of the more the child pushes back, the more the parent doubles down until the child eventually relents, this will be at a great cost to the child’s nervous system.

·       Autistic kids (and NT kids) may present with behaviours that their parent was not allowed to express in their own childhoods, therefore causing the parents threat response to activate – for example, if it was not acceptable for a parent to cry in their own childhood, they may become very distressed when their child cries – and this may be expressed by telling the child to stop crying, sending them out of the room to deal with their emotions alone, or punishing the child for crying – because the parents internal response may be screaming that they must do anything within their power to stop the “unsafe” behaviour (the unsafe behaviour being the crying).

·       Some parents had kids because that’s what they were “supposed to do”. And they may not have been prepared or equipped for the challenges of having an autistic kid, resulting in poor parent/child relationships – Contraception was illegal in Ireland until the 1980s & abortion was illegal until 2019!

·       Some parents are simply narcissists, and narcissists view their children as an extension of themselves – for better or worse. So when the autistic child does not conform, or (usually when the child gets older) refuses to let the narcissistic parent control or overpower them – they may become the family scapegoat, and the receptacle for all of the narcissistic parent’s toxicity.

When considering the broken parent/child relationships of Autistic adult children, I’m really struck by a piece from The Body Keeps the Score by Bessel Van Der Kolk. – Van Der Kolk spoke about mothers who didn’t know how to be attuned to their kids, often as a result of their own traumas. He says “once the mother comes to see the child, not as her partner in an attuned relationship, but as a frustrating, enraging disconnected stranger, the stage is set for subsequent abuse”.  Whilst this piece was not specific to autistic children, it makes a lot of sense to me when thinking about it from a lens of a poorly equipped parent with an undiagnosed autistic child. So, for example - if we have a (traumatised; or rigid; or reluctant; or undiagnosed autistic; or narcissistic) mother who cannot attune to their undiagnosed autistic child, rather than considering that the child may needs a different approach when it comes to connection and relating, the mother may begin to “other” the child. Once the child becomes “othered”, it is far easier for the caregiver to disconnect from feeling any level of empathy or compassion towards them. But am I talking out of my arse here, or is there any evidence to back my theory up?

Sharpley & Bitsika (2023) looked at the differences in mother-rated and self-rated symptoms of depression in autistic girls & found that about 15% of the mothers and daughters gave the same total score ratings, more than 47% under-rated their daughters’ severity of depression scores. The mothers also under-rated the girls’ change in activity and their change in sleeping compared to the girls’ scores.

This surely indicates that some mothers are not correctly attuned to the level of distress that their autistic child is experiencing – and if they are underestimating this distress, then it is not surprising that the autistic child may not feel understood or supported to the level they themselves require which may result in estrangement later in life.

The researchers concluded that and that mothers’ ratings may also be influenced by their own depressive state.

Meirsschauta et al (2011) noted that maladjusted behaviour in Autistic children are a significant source of stress and depressive symptoms for parents of an autistic child (Eisenhower et al., 2005; Estes et al., 2009; Montes & Halterman, 2007). These impairments and the stress involved also have a considerable impact on parent’s interactive behaviour (Hoppes & Harris, 1990; Kasari & Sigman, 1997).

In their 2011 study, they looked at differences in how mothers interact with their autistic children versus their NT children and found that mothers seemed to respond more often to the initiatives of their NT child, yet their Autistic demanded more (help or objects).

This may suggest that the mother may be more able to read and respond to the needs of the NT child, but the autistic child may need more than is offered. So if the “maladjusted behaviour” of the autistic child impacts how a parent interacts with the child, then there is a double whammy of the child’s needs exceeding the parent’s capacity, and the parent’s capacity being further reduced by the child’s needs.

I dug around a bit more:

“Mothers of a child with autism were highly stressed and more likely to report poor or fair mental health than mothers in the general population, even after adjustment for the child's social skills and demographic background. However, mothers of a child with autism were more likely to report a close relationship and better coping with parenting tasks and less likely to report being angry with their child after adjustment for the child's social skills and demographic background.” (Montes & Halterman, 2007).

This piece really interested me, because the mothers studied by Montes & Halterman were mothers of diagnosed children – so what happens if the child has no diagnosis?

Siller et al (2015) looked at the impact of Focused Playtime Intervention (FPI) in a sample of 70 autistic children. The results found that children who were assigned to FPI showed positive increases in their attachment related behaviours. Conversely, the children who were studied that were not assigned to the FPI showed a significant increase in avoidant behaviours. They go on to say “The parent–child relationship provides an important context for children’s early social, emotional, and communicative development. Even seemingly small changes in children’s attachment-related behaviors may impact the parents’ affective attachment to their child, which may have lasting implications for the parents’ ability to support their child throughout the lifespan…in the absence of appropriate parent support, the interactions between children with ASD and their parents may become increasingly strained as children get older”

Again, this study was carried out with diagnosed children, but if we consider the absence of supports for the undiagnosed child in the same vein as the children who were not assigned to the FPI, then strained relationships between parent and adult child really starts to make sense.

A couple more papers told me the following:

“Parents of Autistic children are at risk for high levels of distress. Children's problem behavior was associated with increased parenting stress and psychological distress in mothers” (Estes et al., 2009)

Hang on, what about parent’s problem responses?!

Hoppes & Harris (1990) assessed the maternal perception of child attachment and maternal gratification of mothers with autistic children and found lower perceived attachment and lower gratification…they concluded that there is a significant correlation between perceived attachment and gratification. Results highlighted that “the autistic child's lack of interpersonal responsiveness as a source of parental stress…suggesting that the autistic child's deficit in social responsiveness interferes with the child's capacity for reciprocity in the mother–child relationship, and therefore may reduce the mother's experience of reinforcement from the child”

This is starting to read to me a lot like what Van Der Kolk was saying – essentially, if the child does not respond to the mother in a way that the mother expects, this can alter how the mother views the child and the level of gratification they get from being the child’s mother – therefore increasing the likelihood of the “othering” effect?

So an undiagnosed autistic person reaches adulthood – and maybe they begin to pull away from their parents for any of the reasons laid out above. Maybe they go low contact, or no contact. And eventually, they get an Autism diagnosis. This new information may encourage them to reconnect or re-engage with their parent(s) in the hope that this will encourage healing in the fractured relationship. From what I’ve learned, both personally and professionally – there are a few ways that this tends to go in respect of the Parent-Adult Child relationship.

First up is what is probably the ideal situation – the newly diagnosed autistic says “Hey Mom/Hey Dad, I’ve gotten this key piece of information that has reshaped my entire view of life to this point” and the parent holds space for them to process this new reality, hopefully having the capacity to self-reflect on their own experience/reactions/behaviours and fostering the healing of old childhood wounds for the adult child in the process.

Another way, and the one that I have experienced the most in my practice is that the newly diagnosed autistic reveals their diagnosis and the parent uses this to validate their mistreatment of the adult child during their childhood. (This one is very common with the narcissistic parent.) The parent responds from a victim space “I always knew there was something wrong with you, oh poor me, you were a nightmare to raise, you caused me so much shame, you were so difficult”.

And then you have a cohort of adult children who remain so deeply wounded by their childhood that they choose to not reveal their diagnosis to their parents – instead turning the information inwards and embracing the work of their healing themselves.

For anyone who is curious – my experience fell into the second group with one parent. We will likely never speak again, and that’s okay.

So really to summarise, there appear to be 5 main themes that influence the estrangement of autistic adult children from their parent(s) – and these are:

·       Generational: traumatised parent traumatises child

·       Parental Attitudes: The capacity or lack of capacity to meet the child’s support needs, the projection of negative labels onto the child’s presentation.

·       Cultural: “what will the neighbours think”; perceived risk of institutionalisation

·       Educational: parent is unaware of the child’s needs due to lack of information or and/or the availability of professional support

·       Parental Acceptance: The capacity of the parent to reflect on the adult child’s diagnosis from a supportive place.

And for those of you who are reading this that have made the (extremely painful, I know) decision to remove contact with your parent(s):

It is okay to be estranged if that is what it takes to keep you safe.

It is okay to be estranged if that is what it takes to keep your own children safe.

It is okay to be estranged if that is what protects your peace.

It is okay to be estranged if that is what it takes to help you heal.

It is okay to be estranged even if other people don’t understand why.

Because your needs are important, they are valid and they deserve to be respected and treated with compassion – even if this is not what you were met with in childhood – you are allowed to meet yourself with it now.

My phone was a pinball machine & the glut of input and attention coming from so many directions ping-ponged my already skittish nervous system into hyperspace – but I didn’t really notice it at the time. In fact, I only realised that something was wrong a week later, when I found myself sitting in the car with my husband hysterically howling about how we needed to sell our house immediately and move to a remote part of the West of Ireland because I was suffocating in our mid-terrace and couldn’t take another second of having neighbours.

Dramatic overtures aside - like approximately 50% of autistic folk, I have alexithymia.

Alexithymia is a really common condition in our community, where a person has difficulty in recognising, identifying and expressing feelings and/or emotions. This can be SO frustrating. I often have days where the only way I can describe how I’m feeling is “arrrgh”. However, I won’t be able to tell you why I feel like that, or what the argh means – only that it doesn’t feel good.

Add onto this the processing differences that many autistic people experience, where something might happen and I’ll think to myself “ooh I bet my nervous system won’t like this”, but I probably won’t consciously feel impacted until days later - when I find myself at the back end of a massive panic attack, threatening to sell my house.

In hindsight, I can see that the constant Tiktok notifications were slowly sending me into overload, kind of like drip-feeding mentos into a coke bottle – every time my phone pinged it was adding another layer of pressure and dysregulation to my nervous system - and this built up over the course of a few days until the bottle burst in the passenger seat of my car. (But Karen, why didn’t you just disable notifications? Would that not have helped? – Well maybe, if my need to not be perceived hadn’t kicked in, but I’ll come back to that.)

Reacting like this is perfectly okay – autistic processing times can be very different to neurotypical processing times, and if we try to compare ourselves to what we’ve been taught is the “normal” way to feel and/or express emotions then of course we’re gonna feel abnormal, aren’t we? Not understanding that we have alexithymia or processing differences will also really drive internalised ableism and low self-esteem, leaving us with self-critical messages like: Why am I so weird? Why is everybody else ok with this? What’s wrong with me? Why can’t I just be normal? Is there something wrong with my brain?

When actually, the experience I’ve described above is a really normal autistic response to stuff, so if you can relate then you’re normal too – a normal autistic person.

It’s really such a conflicting thing to want to share knowledge, to advocate, to write and to educate online and in public as an autistic person - because as much as I want to be visible - I have an equal and opposing drive to be completely invisible, to not be perceived whatsoever. The perception thing is another common occurrence in the autistic community – so many of us just don’t want to seen.

Now there’s a few different schools of thought on this – but if you’ve been systematically shunned/shamed/humiliated by society since childhood, then of course you’re not going to want to feel exposed and vulnerable, right? We have long internalised the messages that we’re weird or alien or too much or whatever – and maybe we can tolerate being perceived when we’re not already dealing with nervous system overload (“tolerate” being the key word here) but when we’re overwhelmed then of course it makes sense that we want to hide.  Another aspect of this is masking – masking takes up a huge amount of psychological energy, and the more dysregulated we become, the harder it is to mask because we’re exhausting our bandwidth trying to regulate (even if we’re not consciously aware that we’re dysregulated).

I’ve worked with a lot of people who had never heard of the autistic desire to not be perceived – and this realisation tends to come as a huge sigh of relief. Proof that they weren’t horrendously anti-social, or weird or difficult or sick or all of the other self-blame labels we tend to attach to ourselves. No, they are an exhausted autistic person with a lifetime of social trauma desperately trying to keep themselves safe.

A lot of autistic people also struggle with the idea of being perceived even when they’re alone – as though they are on some kind of hidden camera show and this can be really scary. Some people may begin to think that they are severely mentally ill, but this is not a sign of severe mental illness. It’s most often explained by how intensely a person has had to mask to survive over the years - that unmasking, even when alone feels dangerous to our nervous system. How sad that we have been so traumatised by society that what should be our safe spaces don’t even feel safe. This particular fear is really common in the late diagnosed population, however as we begin to heal our wounded parts – this tends to settle down.

After my meltdown in the car – I knew I was skating dangerously close to burnout. And I knew this, not because I could “feel” it, but from learning the patterns and doing a bit of self-detective work. And this is what I recommend to a lot of people with alexithymia: “what are the patterns, what are the clues”

So for example, for me it looked like “okay, I’ve just howled hysterically for an hour that I need to move house immediately – what could be going on?” Let’s investigate:

·        I need to move immediately – that sounds like I need to escape something

·        I can’t cope with neighbours anymore – that sounds like I’m peopled out and need to be invisible

·        Need to be invisible – don’t want to be perceived, do I feel too perceived?

·        West of Ireland is rural and sprawling and bare – that sounds like I’m feeling strangled and need some breathing space

·        What has been happening in my life recently that could possibly make me feel like that?

Ahhhhh, okay, so it’s my frickin TikTok?! TikTok has made me want to sell my house?! Cue a load of internalised ableism around not being able to post a few videos without falling apart – followed by more compassionate self-talk around dismantling these bullshit learned messages.

Then my inner pattern detective figured that I needed to take some action, because:

·        I’ve just had a meltdown over this – unchecked, this will lead to more meltdowns

·        More meltdowns will drive my anxiety sky high and mess up my executive functioning

·        Messed up executive functioning and high anxiety will send me into burnout

·        Burnout is bloody horrendous and I don’t deserve it, I deserve rest and recovery.

·        So I need to assess what I’m doing and adjust before that happens.

And what I needed to do in this instance was deactivate my socials until I was regulated enough to be perceived again (this took 3 weeks – sometimes it may be shorter or longer and that’s okay! Autism is a dynamic disability after all.)

The take-away here is that even with alexithymia, processing differences and perception issues, we can still find ways to support ourselves. First up is recognising these things for what they are – they are differences – they are not flaws, not weaknesses, not “something that’s wrong with us”, just different ways of experiencing things. We don’t need to fix these things about us – we need to work with them.

Once we have the knowledge about how we experience things, we can begin to look back at previous experiences and connect patterns, behaviours and outcomes – so even if we don’t “feel” a certain thing, we can learn that if this thing happens, it probably means this is responsible, or this will be the outcome.

Sometimes we have to work backwards from the meltdown – cognitively tracking back over what’s been going on in our lives that might have triggered it, and how we can use this information to support ourselves in the future. Autistic meltdowns and shutdowns may always occur – but we want to try to figure out the contributing factors so that we can reduce the frequency and distress, because we deserve regulation. You deserve regulation, you deserve rest, you deserve peace (and so do I!)

·        You’re so self aware

·        You’re so self reflective

·        You really seem to understand your own processes

·        You’re so resistant

·        You’re avoiding your feelings

·        You’re too in your head

·        You’re hyper-intellectualising everything to deflect from your real issues

·        You need to get out more

·        You need to make more friends

·        You need to push through

·        Try harder

Maybe you’ve even had a therapist break up with you because they felt they couldn’t bring you any further, or they’ve wondered aloud why you even feel you need therapy?

One of the pillars of psychotherapy is psychoeducation – where the therapist imparts theoretical knowledge to the client as to “why” people sometimes behave in certain ways – maybe it’s from past trauma, attachment style, developmental wounding, learned behaviour, safety strategies etc. When a client becomes aware of the “why” this can help to facilitate a deeper understanding of themselves and allows the client to foster change in their life.

Another pillar is the therapist’s development of a working hypothesis* for each client – ie having observed the clients presentation and presenting issues, we begin to formulate our own private theory of the client’s “why”, through our own understanding of psychological theory and our professional experience. We consider what we suspect might really be going on for the client and what interventions may potentially be helpful to bring about change. *A therapist should never use this as a way to direct therapy, rather it may serve as a roadmap of what might be going on and what might help.

Generally speaking, this can be really helpful. (As long as we view the ND client from an ND lens).

You see NT folk aren’t as likely as NDs to have felt fundamentally different from everybody else for their entire lives, nor are they as likely to have spent days, weeks or years scouring books, online journals, research papers and other sources of information to try to get to the bottom of exactly “what’s wrong with me?”  So then, when a late diagnosed autistic person lands in the therapy chair, chances are they’ve already got a huge body of self-directed psychological education under their belts – they may even have their own working hypotheses of what their underlying issues are.

However, a lot of late diagnosed autistics are battling with a mountain of internalised-ableism, and possibly still applying NT expectations to themselves. If, as their therapist, we don’t know how to work with autistic brains – then we can really mess our clients up by delivering NT therapy to their ND minds.

As an example, autistic women (diagnosed or undiagnosed) often come to therapy with some of the below issues (this is a tiny example, there are many more common presenting issues, but I don’t want to turn this into a thesis!):

·        Anxiety

·        Depression

·        Anger issues

These might seem like run of the mill, everyday presentations in the therapy space for many of our clients – but let’s take a deeper look:

Anxiety

Around 70-80% of Autistics have comorbid anxiety issues – and this often comes from the sensory overload and overwhelm of trying to live in an NT world without knowing you have an ND mind, or consciously trying to mask your ND mind.

Anxiety can also be caused by continuous masking, suppressing stims, denying sensory needs such as recharge requirements, minding your social battery, environmental sensitivity; and “social anxiety” can occur from previous lived (valid!) experience of social rejection and/or isolation.

If we have no idea of how to work with the client’s neurotype – we may decide to use a CBT style approach that includes exposure therapy. (ah yes, I can see no potential problems arising from forcing an already frazzled ND person into further masking, more sensory overload or overwhelming social situations. CBT homework can be really tough for folks with executive functioning issues too – some ND clients do like CBT overall though.)

However, if we work from an ND affirming perspective – then this is where psychoeducation can come in really handy – things like “yep that’s a pretty normal ND response to overwhelming stimuli; yep I can see why you might not want to push yourself into social situations after your previous experiences; yep here are some self-care tips for minding your social battery; let’s talk about spoon theory; let’s talk about accommodations etc”

Depression

Autistic Burnout can often be misidentified as depression. And a really good way to describe the difference is – depression says “I don’t want to” and burnout says “I can’t”.

Typically with NT depression, we might look at getting the client to engage in the world by doing things – making small incremental steps such as: taking a walk every day, spending time in nature, making your bed every morning, spending time with friends, cooking a nourishing meal; having a bath.

If you have an ND client in burnout, then asking for more can be really destructive, because what the client really needs is less. When a client is in burnout, their sensory sensitivities can be far higher, their executive functioning far lower, and something as seemingly innocuous as “going for a walk”, for example, could create a storm of sensory overwhelm (weather conditions, people, noise, light) and if a client’s executive functioning is really low then there may be too many tasks involved in this “simple” exercise that will prevent it from even happening (get out of bed, find clothes, get dressed, put on shoes, find coat, find keys, leave house).

So then the client can end up feeling much worse “why can’t I even go for a walk? Jesus I’m such a failure”

Autistic burnout requires as much rest as humanly possible, and affirmation that rest is okay. A client in burnout has usually ended up there by pushing themselves too hard for too long, and eventually the body/mind says no more, then everything implodes. Validating a client’s experience and their need for rest is so important. Psychoeducation around executive functioning and sensory accommodations can also support the client to become more accepting of themselves and their autistic needs, which in turn can support their recovery.

Anger Issues

There can be a lot of shame around anger issues for ND clients. And very often, these anger issues are actually autistic meltdowns. The client may describe having “rages”, “outbursts” or “feeling out of control”, perhaps hurting themselves or breaking things when this happens. If we treat this from an NT perspective, we might explore coping mechanisms for controlling anger, or look at ways of releasing anger before it reaches boiling point. But a meltdown isn’t something that can simply be controlled – it is an involuntary response to too much overwhelm. This can be caused by sensory/environmental overstimulation, sudden changes, stressful situations etc, and can build up over a period of time. An autistic person may be holding and holding and holding until there is one final straw and whooosh, we go up like a bonfire.

What might really be helpful here is (again) psychoeducation – “hey, this is what a meltdown is and this isn’t your fault; let’s identify your triggers and help you avoid/accommodate; let’s talk about not pushing yourself too hard, and what that might look like; let’s talk about what might help to keep you regulated etc”

What I’m really saying here is that it doesn’t actually matter what modality a therapist practices – and I say this from my own experience as a practitioner, and the shared experience of the practitioners that took part in my recent research. The most important element for positive ND therapy is the therapist’s understanding of autism and their ability to avoid applying NT assumptions to ND folks.

If you’re an ND person considering therapy - your chosen therapist, at an absolute minimum, should have undertaken some formal autism-specific training (ND-affirming, of course) if you’re going to entrust them with your inner workings.

If you’re a therapist reading this, I hope some of the information above has been helpful and I’d really encourage you (beg you!) to seek out specific training to support your ND clients, if you haven’t already.

Flicking through Moodle, I discovered that Autism and ADHD would be covered this time around (yay!) but that the coverage would be in the Understanding Psychopathology module (sorry, what?)

Psychopathology in broad terms is the study of mental illness. I’ll make this clear - Autism and ADHD are not mental illnesses – they are neurodevelopmental disabilities with which comorbid mental health issues frequently occur (often a side effect of being a Neurodivergent person in a Neurotypical world).

To say I was pissed off about this was a massive understatement, but I figured I’d withhold judgement until we got to that topic and if nothing else, I could use it as an opportunity to educate the college on why including these areas of neurodivergence in the module was ableist, incredibly offensive, and absolutely inaccurate.

The year progressed and we got into the module, and my ruminate-y autistic brain was excited and nervous in equal parts to address this with the tutor. However, we were advised last-minute that time pressures meant we couldn’t cover both ADHD and Autism, so ADHD was briefly covered instead. Autism wasn’t mentioned – not even a sentence.

Now anybody with a brain like mine will know that this type of unfinished business is maddening. Not only the injustice of my neurotype firstly being squeezed into a random place, a bit like an annoying sibling “yes you can go, but bring your little sister with you” but then after all the agonising of how I’d address the inaccuracies with the college – it didn’t even get a mention. It takes a full 4 years of professional training to become a psychotherapist – and how my brain operates, the literal filtration system of how I practice psychotherapy – wasn’t even offered a sentence.

Frustrated, but undeterred – I decided I’d use the end of module assignment to illustrate the autistic brain. The requirement was to complete a piece of creative writing from the viewpoint of a fictional character highlighting the key features and struggles of a condition featured in the DSM5. The objective here was to showcase a solid understanding of the chosen condition.

My piece took the form of a blog-post by a late diagnosed autistic woman who had received a diagnosis 6 months prior (stretching the boundaries of fiction here I know, but the story itself was fictional). In this piece, I really worked on unmasking my character – leaning in to the common autistic communication preferences of info-dumping, sharing statistics, and using quantifiable information to explore meltdowns, shutdowns, sensory issues, social isolation, communication struggles, alexithymia, masking etc - and openly discussing the mental health struggles that come with being late diagnosed. I was so proud of this authentically autistic piece of writing about autism. But oh my god, did I live to regret this.

The feedback from the assignment cut me so deeply. It was as if the grader had gotten deep within my psyche and shamed every part of my being. All of the internalised ableism that I had worked so hard to deconstruct came roaring back at me as I read through their laser-sharp dismantling of my inner self. The grader noted that my fictional character was “nothing more than a cipher (ah yes, because autistics are robots aren’t they?) for seeding in facts and statistics” (hello fact based information sharing) “as opposed to a rounded character exploring the emotional impacts of Autism” (because autistic people are not fully formed characters and have no emotions, obviously). They also noted that my assignment appeared to be a lecture about autism (info-dumping!!) rather than a reflective piece from within it (because reflective pieces can’t be backed up by stats?).

Let’s break this down a little bit more: my autistic essay about autism was written too autistically for the neurotypical grader. Had I written the essay with my neurotypical hat on, my grade would have been higher. Had I masked my character and used flowery neurotypical language instead of the natural direct communication style true to my neurotype, my grade would have been higher.

And I say this with absolute confidence, because the final part of the essay was an exploration of how this client might be “treated” psychotherapeutically – and the mask went back on for this piece. The grader referred to this in their feedback – “the therapeutic intervention section at the end is very strong…I would be confident in the author’s ability to be an effective therapist”. (great, thanks).

The grader completely missed the point of my essay, and inadvertently became the posterchild for every misinterpretation that I had ever been on the receiving end of, every blame and shame that I had ever heard. A real life walking, talking example of “the double empathy problem”.

A quick info-dump on the double empathy problem here (Neurotypicals beware!):

Simply put, Damien Milton posited that when people with very different experiences of the world interact with one another, they will struggle to empathise with each other.

The burden of “communication problems” has tended to be laid in the laps of autistics – we were the problem, we couldn’t communicate or empathise apparently. However, studies have shown that Autistic people tend to communicate just as well with other Autistics as Neurotypicals communicate with other Neurotypicals. The issue is the frame of reference, not the neurotype. It’s not that autistics don’t communicate effectively or hold the capacity for empathy (actually a LOT of autistics experience hyper-empathy, and can be far more empathic than our NT counterparts – but that’s a rant for another day) it’s more that some NTs don’t get us, just as we also don’t get some of them. And there’s nobody at fault here, we just have very different ways of processing the world.

So how can an NT therapist be expected to work effectively, and safely with an ND client when even the training colleges appear to not have the foggiest idea of how we see the world?

Surely these institutes have a duty of care both to trainee therapist and client to ensure maximum competency of their graduates when it comes to working with a sizeable and vulnerable section of our society?

This is particularly relevant when we see now that adult women are the fastest growing cohort of people receiving autism diagnoses – and alongside this, approximately 80% of us will have at least one co-occurring mental health problem. Autistic women have terrifyingly poor mental health outcomes: we are 13x more likely to die by suicide, 3x more likely to self harm and 90% of autistic women have been victims of sexual abuse; up to 35% of anorexics are likely autistic, and up to 36% of autistic people have substance abuse issues.

On top of that – recent research says the true prevalence of autism is 4:3 female to male instead of 4:1 male to female (McCrossin, 2021). So if it really is 4 autistic girls for every 3 autistic boys, instead of the currently accepted 4 autistic boys for 1 autistic girl, then that speaks to a huuuuuge amount of undiagnosed females. And I’d bet my house on a huge cohort of undiagnosed therapists too – undiagnosed women in particular tend to gravitate towards studying psychological theories as a way of figuring out “what’s wrong with me?”. (Anecdotally, my autism radar goes off around a lot of therapists – trainee or otherwise). So it’s ever more likely that you’ll have a neurodivergent client (or 10) sitting in your therapy chair.

I finished my thesis recently, which looked at how therapy can support late diagnosed women and the results were shocking – I’ll write more on this in another post.

But in a nutshell, poorly informed NT therapists are really damaging their ND clients, and mostly through ignorance – no outward malice intended by the therapist – just a complete lack of knowledge on how to work with neurodivergent brains. But how are you supposed to work with neurodivergent people if you’ve never been trained to do so?

At the time of writing this, there is no psychotherapy college in Ireland offering Neurodiversity training in their core programming, and this unequivocally needs to change. We are failing a huge demographic within our society by not including this essential element.

Furthermore, including neurodiversity training in the core programmes may also help undiagnosed trainees to recognise their own neurodivergence – and the results of my research was loud and clear: autistic people want access to autistic therapists. But for now at least, demand is far greater than supply.

My hope is that QQI, IACP and all of the training institutions can begin to see the necessity of training our therapists on Neurodivergence. And not just micro-learning or CPD hours presented by non-autistic people, or expensive additional courses - but full modules created and presented by Neurodivergent practitioners. And finally, I hope to god that Autism and ADHD can at least be removed from the psychopathology module, because my brain is not a mental illness.

She’s really sociable & loves playing with other children but sometimes finds the fluidity of neurotypical play confusing. When my daughter plays, she has an idea of how the game should look in her head - and can really find it tough when things don’t go quite as she expects.

She was outside with some neighbourhood children this evening, a girl her age and 2 older boys (aged 8 approx.) and whilst it was glaringly obvious to me that the older boys didn’t want to play with her, she doggedly tried to sustain their attention.

My rational brain knows that 8 year old boys might be “too cool” to hang out with 5 year old girls, and that this exclusion is perhaps age-appropriate and not personally aimed at my daughter whatsoever. However, my heart ached at her repeated failed attempts to connect with shouts of “hey guys look at this” “guys watch” “guys look”. I compensated for the uncomfortable silences that followed with “I’m watching baby!” “Hey well done!” and “Wow that was amazing!” all the while pleading internally with the boys to just acknowledge her little voice calling. Even as I type this, I have an overwhelming sadness radiating from my solar plexus, threatening to consume me.

On the way home, I explored with my daughter how she felt her playtime had gone & I asked if she had felt left out by the boys. She cocked an eyebrow at me and quizzically exclaimed “No Mammy, they were playing with me!” My stomach squeezed as I listened to her innocently recount her version of events, her spirit not yet bruised by the rejection that haunts so many autistic people.

When we reached our house, I was dizzy, a headache was forming at my temple and my body felt like it was vibrating internally. Heat prickled across my breastbone and into my upper back as I stood in the kitchen, swaying slightly from hip to hip in an attempt to calm the flames of anxiety. My daughter flopped down on her beanbag, happily munching some crisps. And I started to wonder “how much of this is my stuff?”

Projection is a commonly used term in psychotherapy, originating from Freud’s work on defense mechanisms. There are several types of projection, one of which is the act of displacing our own feelings and/or experiences onto another person.

The question for me then is: Am I so deeply wounded by my undiagnosed autistic childhood experiences that I am projecting this onto my daughter? And what can I do about it?

It’s no secret that becoming parents ourselves can bring up a lot of difficult childhood memories, and it’s really common for clients who “completed” therapy years ago to find themselves sitting once again in the therapy chair. Although they might have found great support previously, the emergence of parenthood can also unleash a tsunami of unresolved pain.

Like a lot of late diagnosed autistic folk, my childhood memories are almost non-existent, save for a few flashes of younger versions of me in various locations, and these memory scraps often appear without any context. Yet in the words of Bessel Van Der Kolk - the body keeps the score. And the hyper-reaction of my nervous system to my daughter’s socialising this evening hints that my body is keeping secrets.

My daughter is in her first year of primary school now, with access to an SNA and additional supports as needed - which was unheard of for little girls like her (and me) in the 90s. She still struggles in a lot of different ways though. Her emotional support needs are quite high, although conversely she has been described by professionals as “high functioning” (I despise this shitty ableist term). Due to how her Autism presents, I imagine that her diagnosis would have come many years later - if at all - had it not been for the persistence of myself and her Dad to get her assessed and identified. Although my own childhood memories are scarce, my gut tells me that I was a lot like her. I recognise our similarities within my core being. I intuitively understand her needs because they are also my needs, even if decades of unconscious masking sought to suppress them into oblivion.

That being said - my experiences are not her experiences, and my childhood is not hers. Attunement to our children is so important, is essential to their development really. Keeping them safe from unsafe people and situations is equally important. Yet I was the one who arrived in from playtime completely frazzled - and she was fine.

I know I’m not alone in this - I’ve worked with many other late diagnosed Mothers who share similar feelings, who also project their fears onto their child as a result of their own traumatic experiences. The inner children within us understand the vulnerability of our children on a cellular level, because we were once a vulnerable child too. It can often be too painful to acknowledge our own childhood rejections so we try to “save” our children from pain instead.

The question is - if we’re not careful, might we stifle our children’s growth and/or re-traumatise ourselves in the process? As Carl Jung said “what we resist, persists”.

Incidents like today are an unavoidable part of growing up for my daughter, and I recognise that I cannot shield her from every difficult life experience - so what can I do instead?

• I can offer a safe space for her when things go wrong.

• I can understand her regulation needs and support her with this when things are hard.

• I can recognise my own projections and consciously separate her from them.

• I can differentiate truly unsafe people and situations from the necessary “growing pains” lessons.

• I can honour my wounded inner child, and when she appears I can offer her the soothing that I did not receive in childhood.

• I can ground myself in the present moment - that was then, this is now - yes it feels scary but there is no actual danger here.

• I can remind myself that I am an adult who has the agency and necessary skills to keep myself safe.

• I can acknowledge that my nervous system is over-reactive due to my neurotype and not spout ableist nonsense at myself.

• I can remember that I’m doing my best and offer myself grace.

Subscribe now