16 articles
They appear successful, even exceptional. But beneath the performance is a ledger of exhaustion. For many late-diagnosed neurodivergent adults, "high functioning" meant high-cost masking, and the bill eventually comes due.
They test in the top 2% for intelligence yet cannot write a coherent paragraph. They grasp quantum physics but cannot organize a backpack. This is twice-exceptionality, where giftedness meets disability, and it is the most commonly missed profile in clinical practice.
We have framed autistic social difficulty as a deficit in understanding others. But the research reveals something unsettling: neurotypical people are equally poor at understanding autistic minds. The failure is mutual, yet only one side bears the diagnosis.
They do not skim; they plunge. A single subject consumes them entirely, while the world recedes. This is not mere focus—it is monotropism, the cognitive pattern that defines how atypical minds process depth at the expense of breadth, and why they struggle to surface.
They feel before they think. A reprimand lands like a physical blow; minor disappointment triggers lasting grief. This is not mood disorder. It is the emotional overexcitability of atypical minds, and we miss it because we look at behavior instead of neurology.
She reads at twelve, relates at six, reasons at twenty. He grasps calculus at ten, cannot tie his shoes without rage. The asynchronous child does not develop; they develop in fragments, and the world demands a wholeness they cannot yet give.
They read philosophy at eight but cannot tie their shoes. They design complex systems yet live in daily chaos. Their cognitive profiles refuse the bell curve's smooth slope, creating suffering born not from inability, but from unevenness.
For decades, they held the facade together. High-performing professionals, seemingly competent parents, the ones who "figured it out"—until they arrive in my practice burned out, confused, wondering why success feels like drowning. The bill for passing as neurotypical has finally come due.
They test in the 99th percentile for verbal reasoning and the 15th for processing speed. Schools see laziness; clinicians see only the ADHD or only the giftedness. The twice-exceptional profile is missed because we refuse to hold both truths at once.
They built elaborate systems to function: color-coded calendars, rigid routines, adrenaline-fueled deadlines. For years, it worked. Then parenthood arrived, or a promotion, or simply midlife exhaustion, and the architecture of compensation collapsed. This is the hidden story of adult ADHD.
They grasp complex concepts instantly yet fail at basic organization. They test in the gifted range while struggling with reading or attention. Twice-exceptional minds carry both extraordinary capacity and significant disability, and the interaction between them creates a profile that standard assessments often miss entirely.
They feel fabric as pain, think in spirals that exhaust, cry at beauty others miss. Dabrowski's overexcitabilities describe minds processing the world with volume turned up. The clinical task is not to dampen the signal, but to build lives that hold the intensity.
They performed normalcy convincingly; doctors saw anxiety, borderline personality, eating disorders. Beneath the mask was autism, unrecognized because it didn't look like the textbook written for boys. This is the hidden epidemic of late-diagnosed autistic women.
They were diagnosed with anxiety, mood disorders, personality pathology. But beneath the emotional volatility was ADHD, missed because the DSM ignores what clinicians see daily: ADHD is fundamentally a disorder of emotional self-regulation.
They read philosophy at ten and cannot handle a sleepover at eleven. Their cognitive capacity outpaces their emotional regulation by years, creating a specific suffering that standard developmental models fail to capture. This is dyssynchrony, and it explains much of the pain my clients carry.
We have been asking the wrong question about autism for decades. Not: what is wrong with autistic social cognition? But: what happens when two different cognitive styles attempt communication, and both struggle equally to bridge the gap?