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Adult Autism and Masking: Why Diagnosis Matters and How to Recognize What’s Beneath the Surface

Dr. Michael Lenz interviews clinical psychologist Donna Henderson, co-author with Sarah Wayland and Jamel White of “Is This Autism? A Guide for Clinicians and Everyone Else” and a companion diagnostic guide, about why autism in adults is often missed, especially in people who camouflage. Henderson describes realizing autism in a client with many prior diagnoses and how the field’s training focused on stereotyped, observable behaviors rather than internal experience. They discuss how diagnosis can support self-understanding, self-advocacy, and self-compassion; the difference between social motivation and social energy; why autism in girls often becomes evident around middle school; and how neurocrash, burnout, sensory overload, and misinterpretations of affect can lead to dismissal in healthcare. Henderson argues for clinician education, careful interviewing over test scores, broader access to diagnosis, and considering autism before personality disorder labels.

00:00 Late Autism Discovery
00:27 Meet The Expert
02:40 From Training To Insight
06:42 Why Diagnosis Matters
11:17 Beyond Observable Traits
16:07 Social Energy Vs Interest
20:11 Girls And Middle School Shift
24:43 State Of Autism Today
30:18 Clinicians Need Training
37:45 Misdiagnosed As Personality
39:37 Hoarding And Pink Flags
41:57 Strengths And Sensory Overload
44:39 Strengths Need Context
45:37 Medical Care and Misread Signals
47:35 Pain Expression and Masking
50:35 Social Mislabels and Directness
53:07 Neurocrash vs Burnout
57:42 Reframing Kids and Parenting
01:02:19 Cross Neurotype Communic

Click here for the YouTube channel

International Conference on ADHD in November 2025 where Dr. Lenz will be one of the speakers.

Joy Lenz

Fibromyalgia 101. A list of fibromyalgia podcast episodes that are great if you are new and don't know where to start.

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When I started this podcast and YouTube Channel—and the book that came before it—I had my patients in mind. Office visits are short, but understanding complex, often misunderstood conditions like fibromyalgia takes time. That’s why I created this space: to offer education, validation, and hope. If you’ve been told fibromyalgia “isn’t real” or that it’s “all in your head,” know this—I see you. I believe you. This podcast aims to affirm your experience and explain the science behind it. Whether you live with fibromyalgia, care for someone who does, or are a healthcare professional looking to better support patients, you’ll find trusted, evidence-based insights here, drawn from my 29+ years as an MD.

Please remember to talk with your doctor about your symptoms and care. This content doesn’t replace per...

Text Dr. Lenz any feedback or questions

Walk and Talk in Austin: Activity, Weather, and Fibromyalgia Insights

Dr. Michael Lenz records a walk along the Lady Bird Lake trail in Austin, Texas, including views of downtown and the Congress Avenue “bat bridge,” explaining how bats congregate there in summer but are gone by mid-November. He reflects on staying active with chronic pain and fibromyalgia, noting many patients were previously very active and may grieve lost abilities, and recommends starting low and gradually increasing movement. He discusses how weather affects symptoms, with many doing better in warm summers and worse in dark winters, while others struggle more in heat due to dysautonomia, temperature regulation issues, POTS, or autism; he shares a patient who felt significantly better while hiking in Central America. He notes nature and activities like kayaking can reduce perceived pain and closes with channel and podcast information and his medical background.

00:00 Walk and Talk Intro
00:33 Austin Bat Bridge
01:55 Staying Active With Fibromyalgia
04:47 Weather and Symptom Flares
07:24 Music or Silence on Walks
10:09 Colorado River and Lady Bird Lake
11:59 Nature Therapy and Kayaking
12:48 Downtown Views and Trail Life
13:57 Wrap Up and About Dr Lenz

Support the show

When I started this podcast and YouTube Channel—and the book that came before it—I had my patients in mind. Office visits are short, but understanding complex, often misunderstood conditions like fibromyalgia takes time. That’s why I created this space: to offer education, validation, and hope. If you’ve been told fibromyalgia “isn’t real” or that it’s “all in your head,” know this—I see you. I believe you. This podcast aims to affirm your experience and explain the science behind it. Whether you live with fibromyalgia, care for someone who does, or are a healthcare professional looking to better support patients, you’ll find trusted, evidence-based insights here, drawn from my 29+ years as an MD.

Please remember to talk with your doctor about your symptoms and care. This content doesn’t replace per...

Text Dr. Lenz any feedback or questions

Cohort Study Links ADHD to Earlier and More Severe Perimenopausal Symptoms

The episode reviews a population-based cohort study using the Icelandic SAGA cohort (women aged 35–55; n=5,392) examining perimenopausal symptom severity in women with versus without self-reported ADHD (9.9%). Using the Menopause Rating Scale (MRS), Adult ADHD Self-Report Scale v1.1, and PHQ-15, researchers found higher overall perimenopausal symptom burden in women with ADHD (mean MRS 18 vs 13) across psychological, somatic, and urogenital domains, and higher prevalence of severe symptoms (overall PR 1.8; somatic PR 2.2; psychological PR 1.63; urogenital PR 1.57) plus severe general symptoms (PR 1.94). Symptoms peaked earlier in ADHD (ages 35–39 vs 45–49), suggesting onset up to 10 years earlier. Adjustments for sociodemographics, smoking, binge drinking, and PTSD (more common in ADHD) did not remove associations. Limitations include cross-sectional measures, self-reported ADHD, symptom overlap, and lack of treatment data; the script calls for tailored guidelines for perimenopausal women with ADHD.

00:00 ADHD Meets Perimenopause
00:23 Study Purpose And Rationale
01:16 Cohort And Measurement Tools
02:33 Menopause Rating Scale Breakdown
03:17 Overall Symptom Burden Results
04:11 Severe Symptoms And Ratios
05:26 Earlier Onset By Age
06:23 Confounders And PTSD Analysis
07:38 Clinical Takeaways And Guidance
08:39 Limitations And Future Research
10:00 Wrap Up And Call To Action

Support the show

When I started this podcast and YouTube Channel—and the book that came before it—I had my patients in mind. Office visits are short, but understanding complex, often misunderstood conditions like fibromyalgia takes time. That’s why I created this space: to offer education, validation, and hope. If you’ve been told fibromyalgia “isn’t real” or that it’s “all in your head,” know this—I see you. I believe you. This podcast aims to affirm your experience and explain the science behind it. Whether you live with fibromyalgia, care for someone who does, or are a healthcare professional looking to better support patients, you’ll find trusted, evidence-based insights here, drawn from my 29+ years as an MD.

Please remember to talk with your doctor about your symptoms and care. This content doesn’t replace per...