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Dr Emily Compton-Smith | Clinical Psychologist | ADHD & Autism

@drcomptonsmith

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5 years of specialising in autism and ADHD… here’s a few reflections I’ve made during autism assessments 🧡

A lot of the autistic people I assess don’t “look autistic” in the way people expect. They make eye contact. They can chat.
They’re warm, empathic, often very successful on paper. And they’re also completely and utterly exhausted.

For most people I see it’s not so much about the label. It’s because they’ve spent their lives feeling like they don’t fit in, that life doesn’t seem so hard for others.

So many have already done years of therapy for anxiety or depression, yet the burnout and self-monitoring never really shifted… because the underlying neurodivergence was not yet identified.

And the process of unmasking - as empowering and freeing as it can be - can also be confusing, exposing and unsettling to navigate 🧡

And I think it’s important to acknowledge that I know this process isn’t right for everyone. The diagnostic process itself isn’t without its issues, and it’s rooted in the medical model with issues with power and bias. However, I have had the privilege of working with some incredible humans who have found the process validating, affirming and rewarding and feel very grateful to be able to navigate part of their journey with them 🧡

#neurodivergent #audhd #actuallyautistic #autisticwomen #autismassessment by @drcomptonsmith

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9 months ago

Conversations I find myself having over and over again 🥲

A lot of harm happens not because of people’s neurodivergence, but because it’s misunderstood. Or minimised. Or praised in ways that actually reward people for hiding how much effort things take.

Labels like “high functioning”, assumptions about late diagnosis, ideas about overdiagnosis of adhd and autism, burnout being brushed off as depression… none of these exist in a vacuum. They shape who gets noticed, who gets support, and who keeps pushing until they can’t anymore.

We absolutely need to change the narratives around neurodivergence 🧡

#adhd #autism #audhd #adhdwomen #adhdassessment A post talking about common misconceptions and challenging widely held beliefs around adhd and autism by @drcomptonsmith

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There’s a whole generation of adults who grew up believing they were broken… that they were fundamentally flawed 💔

In that often quiet (but sometimes loud) grinding way where life just always felt harder for you than it seemed to for everyone else. In a way that was difficult to explain.

Most people I work with didn’t grow up thinking “maybe I’m autistic” or “maybe I have ADHD”. They grew up thinking they were anxious, lazy, too sensitive or simply not trying hard enough.

And because they could still show up, get things done, and meet expectations, nobody really questioned that story. They were coping in public and falling apart in private, but no one really saw or understood that bit.

Over time, you stop asking why life feels so hard and start assuming it’s just you. You try to fix yourself instead of questioning the systems, environments and expectations that never really fit you in the first place.

And in my experience, for a lot of neurodivergent adults, that’s where the burnout and exhaustion comes from. Because they’ve spent years forcing themselves to live in a way that costs far more than anyone realises.

And that’s how so many people end up believing they are the problem… when really, the problem was a world that never made space for how their brain actually works 🧡 by @drcomptonsmith

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9 months ago

Highly sensitive, neurodivergent, or both? 🧡

The lists overlap SO much that comparing them doesn’t get you very far, which is why I find it more useful to look at the everyday moments. The supermarket, a free afternoon, the day after seeing friends, plans changing at the last minute.

Lots of autistic and ADHD people are highly sensitive too, so it was never really an either/or. But sensitivity on its own doesn’t explain everything, and when it’s the only explanation anyone offers, the rest can get missed for years.

None of these moments mean much on their own either, everyone has the odd afternoon where nothing gets done. What’s worth paying attention to is when it’s most of the time, and how much it’s costing you.

Which of these moments felt most like you? 🧡

#neurodivergent #autism #adhd #audhd #actuallyautistic by @drcomptonsmith

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2 days ago

Quite possibly one of the most reported memories of school in my assessments = “teachers said I could try harder” / “teachers said I needed to apply myself more”. Or comments that their ability wasn’t reflected in the work they produced.

Every single one of my school reports said I talked too much and needed to pay more attention (you can imagine how much I looked forward to parents’ evening 🤪)

I did well enough in the end, because I could pull it out of the bag at the last minute, but there was a LOT of stress and a lot of tears before every exam, and nobody really looked twice because the grades were there.

Obviously not every neurodivergent person had an awful time at school, and plenty of people had a teacher who really got them and made a huge difference. For the most part, my experience at school was positive. But school is a big part of the history I go through with people in assessments, and it’s so rarely just about the grades. A lot of the people I see were never the ones getting told off. What they talk about is the constant worry that they might be, and that someone would eventually realise they weren’t as capable as everyone thought.

When people think about trauma they often picture one big awful event. For a lot of neurodivergent people it was years of being told to try harder, or worrying about getting something wrong, in a building that was never set up for how their brain works, and that tends to stay with people well into adulthood.

What did your school reports say? 🧡

#adhd #autism #audhd #neurodivergent actuallyautistic by @drcomptonsmith

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The way someone interacts with me in an assessment is never going to be the reason I rule out autism 🧡

Because the idea that you’ll “see it in the room” if someone’s autistic is still very much the dominant narrative, even within my own profession. Look for the poor eye contact, the lack of small talk, the limited facial expression, the difficulty with the back and forth of conversation. And for some people those signs are there, sometimes really obviously, sometimes in much subtler ways.

But so many of the people I assess have spent their entire lives working out how they’re meant to come across and then doing it, over and over, until it’s automatic. Asking them to drop that in a room with a stranger, when they’re anxious and scared they won’t be believed, is asking a LOT. Honestly I’d be more surprised if they didn’t mask.

And just to be clear, this isn’t me saying that every assessment that doesn’t end in a diagnosis has got it wrong. Sometimes autism isn’t the best explanation for what someone’s been going through, I’ve concluded that with people myself, and that outcome can be completely valid. What worries me is when autism gets ruled out because of a limited understanding of how it can look or “present”, especially in women and girls, and in people who aren’t identified until adulthood, who’ve usually had so many more years to get good at masking.

#autism #actuallyautistic #autismassessment #neurodivergent #audhd by @drcomptonsmith

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9 days ago

A chatty (or quiet) kid who’s never any bother doesn’t set off anyone’s alarm bells 🧡

So they tend to get missed, and the first time anybody looks properly is often years later, in the middle of another crash. Sometimes even then, people don’t consider neurodivergence as a possible explanation.

This themes are pulled together from the hundreds of assessments I’ve done. Which slide felt most like you? 🧡

#adhd #autism #audhd #neurodivergent #actuallyautistic by @drcomptonsmith

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12 days ago

I came across the term “dynamic disability” a while ago and since then I’ve thought a lot about how it relates to neurodivergence.

It mostly gets used for fluctuating physical conditions like ME or EDS, and the first time I read it I thought, well, that’s most of my assessments.

Because what I hear constantly is people describing themselves as unreliable, or flaky, or inconsistent, and then going on to describe a capacity that moves 🧡

The bit that causes the most trouble is that everybody else sees your best day and holds you to it. You managed it ONCE, so apparently you can manage it whenever. And the days you can’t, get treated as something about you.

Have you come across this term before? I’d be interested to know if it lands for you the way it did for me 🧡

#adhd #autism #audhd #actuallyautistic #neurodivergent by @drcomptonsmith

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15 days ago

I couldn’t tell you how many times someone’s told me something in an assessment with a caveat in front of it. “This is probably irrelevant, but…” (spoiler, it’s usually relevant!)

And so often, if you do share any of these sorts of things with other people, they’ll say something like “oh yeah, I don’t like the supermarket either”.

But it really isn’t the same is it? There’s a difference between not enjoying the food shop and finding a supermarket utterly impossible. Just like there’s a difference between disliking phone calls and feeling totally paralysed when you have to make one.

People share these things with me half embarrassed, like they’re the only person in the world who’s ever felt that way. And they’re almost never the first person to tell me that exact thing!

So if any of these are you, you’re nowhere near the only one 🧡

Let me know if any of these resonate for you? 🧡

#adhd #autism #audhd #neurodivergent #autisticwomen by @drcomptonsmith

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20 days ago

“She’s a delight to teach” 🙃

I hear that phrase constantly in adhd and autism assessments. Usually from women in their 30s, 40s and 50s, recalling their time at school or reading me their old school reports.

Being easy to teach is not the same as coping. Often, it just meant nobody had a reason to look more closely. Nothing in the school system was set up to spot a child who was struggling while meeting expectations.

By the time anyone does look it is usually because something has stopped working. Perimenopause. A new baby. A promotion. A bereavement. Whatever it is, something changes, and the tiny bit of capacity that was holding everything together is no longer available.

Suddenly, the effort becomes impossible to ignore.

Do you recognise yourself in any of these? 🧡

#audhd #neurodivergent #actuallyautistic #latediagnosedadhd #latediagnosedautistic by @drcomptonsmith

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23 days ago

This is quite possibly the sentiment that comes up the most in my adhd and autism assessments. Whether that’s a conversation we have directly in the assessment itself, or something I make sense of afterwards when I’m writing their report.

Coping has so often cost you everything you have.

Managing has often meant getting through the working day with nothing left, going to bed at 1am because the evening was the only part of the day that was yours, and starting the next one already behind. Then doing that for 20 years without anyone noticing, including you.

When someone says that to me I usually ask what managing has actually involved. Sometimes it’s the first time anyone has asked them, and it can be surprisingly difficult to figure out 🧡

#audhd #neurodivergent #actuallyautistic #adhdwomen #autisticwomen by @drcomptonsmith

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a month ago

Maybe this is a bit controversial? But I’m just being honest over here 🤷🏻‍♀️

There’s just no real incentive for people to notice, is there?

Not at school or work. Not in a society that decides your worth based on what you produce and contribute.

As long as you keep performing, everyone else benefits from the version of you where you’re completely “fine”.

Obviously this isn’t always the case. Sometimes people do notice. And sometimes when they don’t it’s because things aren’t all that obvious.

But sometimes people miss the signs because seeing them would require them to change something. Like offering support or lowering their expectations. It’s easier all round to convince themselves you’re fine.

And what really gets me about this is that I’ve sat with countless people who so desperately want other people to GET it. To notice how hard they’re having to try or how much they’re struggling. Like they have to prove their struggles exist because other people don’t seem to see it.

And that’s the part I find hardest. Not the struggling. The having to prove it on top of the struggling 🧡

#adhd #autism #audhd #actuallyautistic #adhdwomen by @drcomptonsmith

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