Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered podcast. I'm Dr Neha Pathak, WebMD's chief physician editor for health and lifestyle medicine. If you've been on social media at any point in the last few years, I'm sure you've heard the term neurodivergent. More and more often, this term is being used in conversation with friends, at school, and at work.

Maybe you or someone you love has seen some content describing symptoms of ADHD, autism, or sensory sensitivity and thought, "Hey, that maybe sounds like me." With so much information online, it can be hard to know what these terms actually mean and how to approach the topic with curiosity rather than fear or self-judgment.

In this episode, we're taking a step-by-step approach to neurodivergence to understand differences in how people process information, experience the world, communicate, and navigate everyday environments. We'll discuss why social media may be a meaningful starting point for people who have felt overlooked or misunderstood, particularly within the traditional healthcare system, and why it should be a doorway to learning and not the final word on diagnosis.

You'll also hear practical guidance for talking with loved ones, advocating for your needs at school or work, and replacing shame-based labels with a more compassionate understanding of yourself or the people you care about. But first, let me introduce my guest, Dr Megan Anna Neff.

Dr Neff is a clinical psychologist, researcher, writer, and educator, and the driving force behind Neurodivergent Insights. She's the author of "Self-Care for Autistic People" and co-host of Divergent Conversations podcast. Welcome to the WebMD Health Discovered podcast.

Megan Anna Neff, PsyD: Thank you so much for having me. It's an honor to be here.

Pathak: Well, I am really looking forward to this very important conversation. But before we jump in, I'd love to ask about your own personal health discovery or aha moment as it relates to the work that you're currently doing.

Neff: Absolutely. So it was a pretty poignant aha moment for me. It was the discovery that I was autistic, and then a couple years later, the discovery that I was also ADHD. And I think part of what made it so poignant was I discovered this right as I was wrapping up my doctorate in clinical psychology, right as I was about to be licensed.

And so it was this moment of, how is it that I'm a, a clinical psychologist and none of this was covered in my training? I'm so shocked to discover this about myself. And so that's really what lit a fire in me, 'cause I, I started thinking back to all of the clients that I had missed and to all of the, especially the adults that I just knew were in mental health treatment seeking care and where this huge part of them was being missed.

And so that's what created a career pivot for me, and it's why I do the work I do.

Pathak: Thanks so much for sharing that really personal anecdote. I think that that is really helpful for us all to connect with the topic and realize that we sometimes have these conversations around words and we don't necessarily even know what some of these words mean and what that means in the lived reality for the people that we're interacting with.

So let's start there and take a step back. So we often are hearing the word neurodivergent. And I think people have a lot of questions around whether that's a diagnosis. Is it a social term? What do we mean when we say that we're talking about the topic of neurodivergence today?

Neff: First of all, I, I love that you're starting with this question, 'cause you're absolutely right. It is creating a lot of confusion and it's not a medical term, and it's very intentionally not a medical term. So if someone's not diagnosed as neurodivergent, you might be diagnosed with ADHD or autism or dyslexia, and a person might choose to identify as neurodivergent.

But it's, it's not a medical term. It's a sociopolitical term or an identity term, we could also say. So it really came out of the autistic rights movement and the disability rights movement. The term was coined back in the early 2000s by an autistic activist, uh, Kassiane Asasumasu. And at the time that she coined it, she—autistic folks, we tend to be very, uh, literal with our words, so we notice when words don't make sense.

And at the time, people were talking about, you can be autistic or you can be neurotypical, but that creates a sort of false binary 'cause there's a lot of people who aren't autistic but also aren't neurotypical. So folks who are, for example, ADHD or dyslexic or have epilepsy, they are neurodivergent in that they diverge from what we might call neuronormativity, but they're not autistic.

So we needed a word to capture those experiences. So yeah, really it, it's kinda capturing that social experience, that sociopolitical experience of your relationship to neuronormativity. I realize that's probably a new word for a lot of folks. I think maybe a lot of listeners might be used to the concept of, like, heteronormativity, the idea that there's, spaces and cultural norms that ass—assume a certain way of having a gender or expressing a gender or assume that partnerships are between different sex folks.

So neuronormativity operates similarly, where there's a lot of cultural norms or expectations or the way systems are built that expect a person to process information a certain way. That includes sensory information or cognitive information or even how we communicate socially. So the more a person diverges from neuronormativity, they tend to experience more friction in their lives.

They tend to experience more disability in the sense that it's harder to navigate those traditional work or school spaces. So really it's, capturing that relationship to neuronormativity. And it can also be an identity.

So that's what that term means.

Pathak: That's really helpful for setting the landscape of what we mean or the breadth of what we're talking about. So can you tell us a little bit more about some of the conditions that fall under this umbrella?

Are we mostly talking about ADHD, autism? You mentioned dyslexia here as well. So talk to us about what's under that umbrella.

Neff: Yeah. So that umbrella is actually quite broad and, and there is some debate here and there's some complexity here. ADHD and autism, I sometimes joke we hog the mic, but it is so much bigger than ADHD and autism. So yes, epilepsy, dyslexia, synesthesia. The medical term analogy we might use is like neurodevelopmental conditions, so things that are innate and that things that people are born with as part of our wiring.

I think that's what people most commonly are referring to when they talk about neurodivergence. But neurodivergence can also be acquired. So, for example, someone might experience a traumatic brain injury and then their brain is processing information so differently to where they would also be neurodivergent, or complex trauma or even PTSD.

We know the way that would change the brain would also significantly change the processing of information. Where I think it gets a little complex, in the disability and the social justice space, the umbrella also includes things like depression, anxiety, OCD, personality disorders.

I think that I... As a clinician, I think that gets a little tricky 'cause a person is certainly said to be experiencing a neurodivergent experience when they meet diagnostic criteria for PTSD or an—anxiety. I do worry a little bit that that might encourage people to over-identify with their mental health conditions.

And I know for me personally, I—the way I respond to my ADHD and my autism is pretty different than how I think about my depression or my anxiety. Those are things I'm wanting to treat and target for treatment and have less of, whereas my ADHD and autism, I'm not treating those. I'm not trying to get rid of them.

I'm supporting them. I'm accommodating them. So yes, it's a broad umbrella. Some people would include everything that's in the DSM in it and it's a complex conversation.

Pathak: So then I want to move into where a lot of young people are first learning about these terms, potentially starting to identify some of their characteristics as falling under the umbrella of things like ADHD or autism, whether that's through TikTok or Instagram.

So I'd love to understand from you, what do you think social media is getting right about neurodivergence?

Neff: Yeah. So, so I feel a little bit embarrassed to admit this, but even for me as a clinical psychologist, it was, it was actually social media that opened the door for me. One of my children was also diagnosed with ADHD when she was young, and e- every couple years, my spouse and I would say, "I, I feel like there's more."

And so we'd open the door on autism, and I'd go back and read the diagnostic criteria, or I'd find some clinical article online, and then I'd find some stereotype of why it didn't fit her. Like, she's too empathetic or, well, she goes up to people and enjoys talking with folks. And something happened one night where it, it brought back these curiosities again, and this time, instead of going back to the medical literature, I, I went to social media and I found a creator who knew what she was talking about and who was talking about autism and girls, and my whole world opened up.

And I, I just... It felt like my, 10 years of parenting this child all of a sudden makes sense. Felt like her life made sense. Now I went off social media to go look at the peer-reviewed research, and to do that. But, but that was the doorway to understanding autism in girls.

And I think that's what social media is getting right, is that for so long, ADHD and autism has been described from the observers, from the people who are observing the person with it. If you look at the diagnostic manual, it's, like behavioral check marks, like are you distractible? Do you climb the furniture? Can you make eye contact? But people haven't stopped to ask, what is eye contact like for you? How do you make eye contact? What's the inside experience? And that's what people started doing on social media, sharing that internal experience.

And also part of what's happening is we get such a diversity of perspectives. A lot of the research early on really focused on a pretty narrow demographic and presentation, mostly kind of affluent white cis boys. And so all of a sudden now we have voices from Black people who are autistic and brown people who are autistic and, and girls and women and trans people. So it gives us this kaleidoscope of different experiences of the lived experience of being autistic or ADHD, which has opened up a whole new conversation.

Pathak: I'm also curious about, to your point, how there are so many diverse ways of experiencing and living with some of these conditions, and that you're sort of discovering that in these online communities.

So how do these condition-specific communities, specifically online, how do they help someone who might, in their journey to diagnosis or wherever they may be, may be sort of feeling stigmatized or misunderstood?

Neff: Yeah, absolutely. So we see this, I think, within many marginalized communities, that when you have an identity that's stigmatized, there's a lot of stress that comes with that. There's a lot of discrimination. There's a lot of chronic invalidation that comes with that. So in the context of disability, we'd call this ableism, kind of the prejudice or stigma around around disability.

And, and then many of us ourselves will begin to internalize it. So I think one of the things... to give an example of what that might look like, internalized ableism with ADHD might look like, those beliefs of I'm, I'm lazy, and if I just tried harder then I'd be a better human.

So I think part of what's happening when we start to have community and we come together, that's where a lot of validation begins to happen. That's where we can start to melt some of the shame that we've been carrying. We can feel less isolated. I think a lot of folks have the experience of feeling so alone.

I often talk about how I just always struggled to get into the same rhythm of people conversationally, and so I felt isolated for a lot of my life. And then finding community, it's much easier to get into the same rhythm, the same conversational flow with other neurodivergent folks, specifically other autistic and ADHD people.

It can create a lot of belonging. It can support that integration of a more positive identity. And it can help us to start to catch our ableism and to start to work through that. So I think there's a lot of ways that community can be really supportive for folks when they're coming to understand this about themselves.

Pathak: So I'd like to then shift us a little bit to more nuance around this. So there are certainly some benefits to the online communities and hearing about these experiences. Why do you think so many people are turning to self-diagnosis when they recognize themselves in ADHD or autism content online?

Neff: Self-identification is imperfect And it's an imperfect response to an imperfect medical system. And so we, we need to have these conversations in relation to one another. So I think there's a few reasons this is happening. For one, we're, in a really unique cultural moment. We're in a moment where there's a, a whole generation of specifically autistic and ADHD adults who were missed and that's for a variety of reasons.

One, the diagnostic criteria itself has changed, especially for autism, where they've, broadened the criteria. So for example, I grew up in the 80s and 90s, and as a child, I, I probably wouldn't have met the criteria being used back then. If I was a child now, I would. So there's that practical piece of-- that's contributed to it, but also there's just so much that we have learned in the last 10 years that we didn't know.

So for example, we know that girls, girls were missed at much higher rates. We know that Black and brown children were missed at much higher rates and were more likely to receive diagnoses like oppositional defiance disorder or conduct disorder before things like ADHD w- would be considered. So there's some gender and racial bias that is part of the history and, thankfully when we look at the children being identified right now and diagnosed, that gap has closed quite a bit.

However, that leaves everyone who's, older than 10, 12, 18 who's been missed. And adult providers, for the most part, aren't trained to look for adult ADHD and autism. There's this kind of belief that, well, these are developmental conditions, so they would've been caught in childhood. So adults aren't necessarily-- or providers treating adults aren't necessarily trained for this, and so often it's not even on their radar to consider is autism or ADHD part of what's bringing this person in?

Which is unfortunate because we tend to have high mental health needs, so we tend to be in people's offices quite often. So that's part of like clinically why we've missed people, why people are going to self-identification. But on top of that, there's just a lot of-- a lot of people can't access it. And so in the sense that most folks, especially for an autism adult diagnosis, you typically have to go outside of your insurance.

So it's can this person pay $3,000 or $4,000 for an assessment? The wait lists are long, often a year or longer. And then even if you are waiting for a year, even if you're able to pay that much, does this provider really understand the nuanced presentations of autism or ADHD? So a lot of people are turning to self-identification because the medical system hasn't yet caught up to the current research.

Pathak: And what are some of the risks of trying to-- or not even trying to, but of diagnosing yourself based on social media content? Sometimes, social media content we know it has to be very brief and it cannot cover what you pointed out is a nuanced conversation. So what are some of the risks that you are concerned about?

Neff: Absolutely. So, so the risk there, and, and yeah, there's this concept from psychology, the Barnum effect, where if we're given something vague and general, we'll tend to add in personal descriptions and, and personalize it to us. It's part of why horoscopes can feel so accurate when we read them.

So I think there's absolutely a risk. If you see a TikTok, especially if it's someone who, like, you admire their attributes, and if they're talking about social struggles, that's pretty vague. And so someone maybe who has a social anxiety disorder might relate to that and then fill in the gaps.

So, in that case, that would be the risk of that is that social anxiety is something that we have good treatment for. And so if someone identifies with something and it's, "This is an identity, I'm gonna start accommodating this," well, that's the opposite of what you wanna be doing if you have anxiety.

We don't wanna accommodate the anxiety. That makes it grow. And so that would be a case where that person would not be getting the treatment that would support them. Or, an- another one might be bipolar. Bipolar and ADHD are really tricky to pull apart, so if someone identified as ADHD because they were maybe bipolar, especially if they were bipolar II, bipolar can create a lot of suffering and distress when it's not treated.

So if it stops the person's curiosity because they've misattributed things they're experiencing to being ADHD or autistic and then they're integrating that identity and accommodating these things that are actually mental health symptoms that can be treated, that would be the risk.

Pathak: Yeah. I love how you framed that, and it strikes me as a primary care doctor, I found when folks come in with, I'm gonna, I'm putting this in quotes, a "social media diagnosis" or something that they're sort of exploring because of social media, sometimes we are finding that that's really helpful.

So it's almost like in my mind, I'm thinking about this as hypothesis-generating content. You're seeing people experiencing something that now needs to be further evaluated.

And so I'm curious, as a clinician yourself, how would you think about that in terms of people coming in as sort of a doorway now to investigate something that you may not have before, rather than coming and saying, "I have this particular diagnosis"?

Neff: You sound like a dream physician, because I think that is, is the response I would hope providers would have of like, "Wow," like, "You're curious about yourself and we're generating hypotheses, and yeah, let's look at it together."

I feel like that is, is such a great way to approach this. I think especially because it is so complex. For example, when a person's bipolar, they are more likely to also have ADHD and vice versa. So we're often looking at, in these cases, someone who's often both with a neurodevelopmental condition like ADHD or autistic and having mental health conditions.

So I think coming in without a fixed mindset, but with curiosity of like, "I'm having these experiences," and being open to what the clinical picture is, I feel like that's so important because often it is more complex than just ADHD or just autism. So yeah, I feel like curiosity is, one of the most, I think, important, characteristics for humanity, I would hope that both clinicians and people coming in would be able to have some curiosity about what they're experiencing and why they're experiencing it.

Pathak: And then what does an actual, and it absolutely varies and it differs by what path we're going down or what condition we're talking about, but then what's the next step in a proper evaluation when you have deemed it necessary to come to a healthcare professional for the evaluation?

Neff: Yeah, and that-- there's a lot of different professionals that do diagnoses, so it'll depend on what a professional. You know, some can be as short as an hour, especially for ADHD. Some are multiple days. I think the thing you want to look for, especially as an adult, is someone who's doing a really solid clinical interview.

And so that's where they're talking you through your life. Because these are neurodevelopmental, we would expect some indication of this being present in childhood. And so that clinical interview becomes really important. And ideally, like a green flag for a, a positive assessment is that the clinician's asking about your internal experience.

So again, not can you make small talk, but how do you make small talk? Are you scripting it ahead, for hours and hours and practicing it ahead of time? So not do you have sensory aversions, but like, tell me about your, your food and your experience of clothing. A lot of people say, "No, I don't have sensory sensitivities," but it's 'cause they cut off their tags and they wear the same socks and they wear the same clothes.

So you want an interviewer, ideally they're asking about your internal experience. And then there tends to be a handful of screeners or assessments. Those are typically self-report things that the person fills out. Maybe sometimes a partner or family member or parent would also fill out some paperwork as part of that.

Pathak: That's really helpful. And then how do you recommend people, as they're sort of exploring and getting curious about pursuing this pathway and getting more information, talk to their loved ones, their parents, I'm just sort of curious about that communication with people who, love you, who care for you, who really want to see what's best for you, but may not have the correct words or may say things that are actually hurtful when they're not meaning it to be.

Neff: Yeah. So, one topic I, teach about a lot is self-advocacy and there tends to be a lot of self-advocacy we need to do when we're neurodivergent, especially, ADHD or autistic, and with that comes a lot of education. Sometimes we have the energy for that, sometimes we don't.

If it's someone who's really, like you're gonna interact with that person a lot in your life, like a parent or a teacher, I think that's when it's worth using that energy and that emotional bandwidth to do some of that education of like, actually this language is more affirming or I experience this language as more affirming.

I think when it comes to advocating, one thing I like to do is to really drill down to what is the need I have here, and then to pair the self-disclosure with that need. And so, for example, disclosure doesn't always have to be a full self-disclosure. If you're not comfortable disclosing you're autistic, like, for example, if you're at a noisy restaurant and it's too loud to hear the person, can you say...

But maybe you're just getting to know them, like, "I have sensory sensitivities. Would it be okay if we move over to this table? I'll be able to hear you better." That would be a partial self-disclosure, and you're pairing it to the need.

So being able to identify what's the need I have here. Maybe I need my teacher to understand this thing about me.

And then what's the ask? You don't always have to self-disclose, but people respond a little bit better to vulnerability, so it tends to go a little bit better if we're able to self-disclose a little bit about why that accommodation would help us. So that, that's a starting point for some of that self-advocacy.

Pathak: I'd love to cede the last few minutes to you to help us end with the big picture and action items. So how should someone be thinking about taking the next steps if they've discovered some of these behavior patterns being similar to theirs, neurodivergence is something that they want to learn more about, whether it's from social media or other places? What's the best next steps for them to take?

Neff: Yeah. I think the best next step is to follow your curiosity. A lot of neurodivergent folks, especially ADHD and autistic, are interest-led in what engages us. And it can be an overwhelming process when you start to open this door. So I would say let your curiosity lead and your interest lead, and that it's okay to go slow.

That sometimes, especially when we're later in life, if we are learning this about ourselves, it can actually feel a little... It can feel more destabilizing before it feels stabilizing. So I think finding a few voices in the space that where you feel like you can learn from them, or when you are listening to them, you feel more grounded and it's where it's helpful.

Finding those voices, being gentle with yourself in the process and going slow. And then if you can, finding community, because community is often where we start to make sense and we start to be able to drop some of that shame and have more self-compassion for ourselves.

Pathak: Thank you again for your time and the conversation. Really appreciate it.

Neff: Thank you so much for making space for this conversation. I, I really appreciate it.

Pathak: I'd like to share my three key takeaways from this discussion. First, neurodivergent is not a diagnosis. It can be an identity, and it's a social term.

It can include people with conditions like ADHD, autism, dyslexia, or even acquired differences in brain functioning.

Second, social media can help with self-understanding, but it should not be the final word. Hearing lived experiences online can help people recognize patterns that may have been missed in the traditional healthcare system, especially among adults, girls and women, and people from historically underserved communities.

But as with every health topic and condition we discuss on this podcast, short-form content cannot replace a thoughtful evaluation, particularly because anxiety, depression, trauma, OCD, bipolar disorder, and neurodevelopmental conditions can overlap in important ways. And each of these conditions has a different management strategy for optimal results.

And finally, it's important to lead with curiosity and self-compassion and find ways to seek or offer practical support. If you're exploring neurodivergence, noticing the patterns in your life or someone that you love, learn from trustworthy sources and talk with a healthcare professional.

If you're supporting someone else, listen to their experience, avoid assumptions, and ask what would help. This may mean a quieter environment, clearer instructions, extra time, or other reasonable accommodations. And a label doesn't have to be a limit. It can become a useful framework for understanding needs and building on strengths.

To find out more information about Dr Neff and her work, make sure to check out our show notes. Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform. If you'd like to send me an email about topics you're interested in or questions for future guests, please send me a note at [email protected].

This is Dr Neha Pathak for the WebMD Health Discovered Podcast.