High Masking Autism: The Most Misunderstood Psychiatric Diagnosis

Autism spectrum disorder is the diagnosis Jonathan Murphy, PMHNP-BC, sees the most confusion around — from patients and clinicians both. People get evaluated, spend a lot of money, and come back without much.

This is what he actually looks for, and what high masking autism looks like from the chair.

If you're a late diagnosed adult, or you've wondered whether you're autistic and the evaluation didn't give you an answer, this one is for you.

This episode covers:

▸ Why a diagnosis only has to be documented when you need to access something outside the appointment
▸ Autism as one of the rare psychiatric diagnoses where people feel better just by knowing
▸ High masking autism vs. autism spectrum disorder, and why it's about observable signs rather than function
▸ Monotonous tone and speech patterns as an early cue, and why it isn't required for diagnosis
▸ Sensory sensitivity and difficulty processing multiple inputs at baseline
▸ Concrete logical thought sitting on top of and taking precedence over other senses
▸ Why typical neurodevelopment includes a felt social sense that doesn't require thinking
▸ Concrete communication, taking people at face value, and vulnerability to manipulation
▸ The mismatch between deeply felt emotion and limited external expression
▸ Developmental Reinforcement Theory and the eight survival modes
▸ The Strategist as the most common mode on the spectrum, and how it leads to shutdown
▸ The Operator, avoidant cohesion at the periphery, and the path toward OCPD
▸ The General, agitation as protection, and why you can't tell you're dysregulated when you're stuck in your head
▸ Regulate before you navigate
▸ Staying in the job, the marriage, the boiling water, and where meltdowns come from
▸ Why attachment is different from autism, and why autism explains the attachment pattern
▸ Autism and bipolar, and what that co-occurrence usually reflects
▸ What a narcissistic parent does to someone on the spectrum
▸ Social skills training, and checking the environment before assuming the problem is the person
▸ Reading the room calmly versus feeling activated and mistaking it for reading the room

On the "fashionable diagnosis" argument: most high masking adults on the spectrum don't identify with internet groupthink at all. Separate what happens online from what happens in real life.

Jonathan Murphy is a board-certified psychiatric mental health nurse practitioner specializing in adult ADHD and autism. Licensed in MA, NH, OR, and WA. 20,000+ clinical hours.

For educational purposes only. Not medical advice. Consult your own provider for clinical decisions. If you are in crisis, call or text 988.

📕 The Process: An Adult's Guide to ADHD Medication — https://www.amazon.com/dp/B0H2Z6PM4T
📗 Cheat Codes — https://www.amazon.com/dp/B0FMJLQKBW

Find the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog, including the Developmental Reinforcement Theory and Survival Modality series: https://www.youtube.com/@focuspathsystems