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In this episode, I examine the diagnostic paradox of autism masking and camouflaging, specifically focusing on how clinicians can identify autism when a client’s surface behavior appears neurotypical. I discuss the limitations of traditional observational tools like the ADOS-2 and explain how the DSM-5-TR provides a framework for recognizing compensation and historical symptoms. By looking at the cognitive mechanisms behind masking and the significant mental health toll it takes, I offer a perspective that re-conceptualizes autism as a neurobiological reality rather than a purely behavioral one. My goal is to help practitioners understand that the ability to camouflage is not a reason to rule out a diagnosis but is often evidence of the diagnosis itself.

Main Topics

00:01: Introduction to the diagnostic paradox of observable deficits versus effective camouflaging
02:20: Explicit recognition of compensation and the currently or by history clause in the DSM-5-TR
05:50: The cognitive shift from intuitive social cognition to rule-based learning and executive function
08:30: Why the need to camouflage confirms the presence of underlying social cognitive differences
13:50: Neuroimaging and the persistence of brain-based markers despite behavioral changes
18:00: Assessing functional impairment through the lens of exhaustion, burnout, and mental health burden
24:10: Re-conceptualizing autism as a neurobiological profile and the role of clinical consensus
27:30: Practical implications for clinicians and the risks of false negatives in adult evaluations

Cool Things Mentioned

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About Dr. Jeremy Sharp

I’m a licensed psychologist and Clinical Director at the Colorado Center for Assessment & Counseling, a private practice that I founded in 2009 and have grown to over 20 clinicians. I earned my undergraduate degree in Experimental Psychology from the University of South Carolina before getting my Master’s and PhD in Counseling Psychology from Colorado State University. These days, I specialize in psychological and neuropsychological evaluation with kids and adolescents.

As the host of the Testing Psychologist Podcast, I provide private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. I live in Fort Collins, Colorado with my wife (also a therapist) and two young kids.

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570. Autism Mini-Series: Exploring the Camouflaging Paradox