on diagnosis
The Difference Between Clinical and Just Being Hard
A woman at my daughter's school told me last spring: "I'm pretty sure I'm neurodivergent." She explained getting overwhelmed in Costco. Parent-teacher night was exhausting for her. This got me thinking about clinical vs. difficulty. Costco is a lot; parent-teacher night is exhausting. I did not say what I was thinking. Those facts do not add up to a diagnosis. They don't even describe what is happening to her.
This is a conversation I have wanted for a while. Not the language police version, correcting strangers. Not telling them which words to use. The other one. Where we are honest about a real difference. There's a difference between clinical deficit and ordinary human difficulty. The words used now cannot tell them apart.
Some history explains why these words can't do their job. They cannot do what people are asking.
"Neurodiversity" appeared in 1998 print. It was in an article by journalist Harvey Blume in The Atlantic. It was also in Judy Singer's honors thesis. Both drew on conversations from autistic adults. These online communities existed in the mid-1990s. "Neurodivergent" was coined around 2000. Activist Kassiane Asasumasu created the term. None of these people sought to make a diagnosis. They were doing something else. They built a social and political identity. This was for those told something was wrong.
Asasumasu said the term should be broad. There was no threshold for it. The point was inclusion and dignity. It was not a clinical test. "High functioning autism" was never in the DSM. Asperger's disorder was in the DSM until 2013. It was absorbed into Autism Spectrum Disorder. Severity levels and specifiers were added then. "High functioning" persisted informally in culture. It meant "has language and an average IQ." This tells you almost nothing about how someone is actually doing.
Before dinner parties, two key words aren't clinical. They were never meant to be. These terms are cultural. A community built them for cultural work. That work was real and valuable. Trouble started when others used them. People used them as if clinicians could measure them.
Here is the line I want to draw, because this is where the blog I am writing rests.
A clinical deficit is a stable, pervasive impairment in a specific area of functioning. It shows up across settings, not just under stress. It is present even when the conditions are good. It started early enough that it shaped how the person developed. And it limits what the person can actually do, not just what feels unpleasant.
Difficulty is something else. Difficulty is effort. It costs something to do hard things. Or things harder for you. But you can do it. It gets better with rest or practice. It does not derail your life. Difficulty is real. Difficulty is exhausting. Difficulty deserves compassion. Difficulty is not a diagnosis.
Most of what people are describing when they say they are “a little neurodivergent” lives in the difficulty category. Costco is sensorily overwhelming. Open offices are awful. Small talk is tiring. Phone calls are draining. Routines are soothing. None of these are pathological. Most of them are just being a person in a world that was not particularly designed for human nervous systems. Calling that neurodivergence is reaching for a word that was built for something more specific.
Let me show you what I mean with three people.
The first is a man in his early forties who came in convinced he was autistic. He had read several articles. He had taken three online quizzes. He had a sister whose son is autistic, and he saw himself in her descriptions. In the evaluation, his history was clear. He had always been an introvert. He found groups draining and meetings exhausting. He preferred deep conversations to small talk. He had two close friends he had known for twenty years and a long marriage.
However, he advanced socially at work. This required reading rooms and managing conflict. He presented to clients. None of that was easy for him. All of it cost him. But he could do it. He had always been able to do it. In safe settings, he was funny, warm, and fluent. He had a temperament. His job was a poor fit for it.
He did not have a social communication deficit. He left without a diagnosis. He had a real plan. It structured his week to prevent depletion. He later told me something. It was the first time his exhaustion was taken seriously. Nobody told him it meant something was wrong.
The second is a teenager who has been told by friends and TikTok that he is on the spectrum. He freezes when called on in class. He avoids eye contact with people his age. He replays conversations for hours afterward and is convinced he embarrassed himself. He has stopped going to lunch. His mother brought him in worried about autism.
His social skill was clearly intact. He was easy company with his brother and grandfather. Also with his two best friends. The examiner saw it once he warmed up. He made jokes and read the room. He picked up on sarcasm, all of it. Remove the fear of judgment. The skill came back. That is not autism. That is social anxiety disorder. It is among the more treatable DSM things.
He started cognitive behavioral therapy. It included exposure work. Within four months, he was back at the lunch table. If he'd stayed with "I'm just neurodivergent," he might have spent five more years. He would adapt to a problem he didn't have. Instead, he treated one he did.
The third is a woman in her late thirties. She came in for an ADHD evaluation, but as the history unfolded, the picture was more complicated. She had always felt one step behind socially. She scripted conversations in her head before they happened. She found ordinary social interaction so depleting that she needed two days alone after a wedding. She had spent her life copying other women, watching what they did and doing it back.
She was bright and polished. She was a high performer at work. Nobody had ever flagged her. Her sensory sensitivities were significant and lifelong. Her interests were always narrow and intense. Her social difficulty wasn't fear driven. It was there even when calm. She was surrounded by people she loved. The evaluation came back as Autism Spectrum Disorder. This presentation is routinely missed in girls and women. They mask well.
She cried in the feedback session. Not because she was sad. For the first time in thirty-eight years, she had an explanation. It was accurate for her own life. That is a deficit. The difference between her and the first man is not degree. They are not on the same spectrum. It is entirely different.
Now, see what happens. We use the same word for all three. The man with introversion has a unique experience. The woman with autism also has one. They do not need the same support. The teenager with social anxiety misses real treatment. Treatment that works fast. When language flattens, calibration breaks. People with highest need disappear. They fade into the "oh same" chorus. People needing fit treatment never find it. They already decided they understand themselves. Clinicians, teachers, partners, and employers lose ability. They cannot respond differently to various things. Everything is described in the same vocabulary.
This is the cultural drift we should be honest about. The neurodiversity movement did something good. It pushed back on an idea. Not every difference is a defect to cure. It gave autistic and ADHD adults permission. They stopped apologizing for how they are built. That work mattered, and still matters. But in the last decade, language slipped its tether. It became a way to say, "I find some things hard." This is true for every human. There is a difference between something that is hard to do and something that is clinically interfering with your life. When a word means everyone, it means nothing. The people it described lose their naming word.
I don't think people use these terms loosely. They use them because unnamed difficulty feels like personal failing. Any name at all brings relief. That instinct is correct. The relief is real. The problem is wrong names close doors. They close doors on the right names. If you have social anxiety, calling it neurodivergence won't help. It won't get you to effective treatment. If you have autism missed for forty years, don't say "everyone feels that way." This stops evaluation. An evaluation would finally explain you. If you have a temperament and a bad job fit, redesign your week. Don't seek diagnosis to validate exhaustion.
A version of this conversation exists. The takeaway is "stop saying neurodivergent." That is not my version. My words should do their intended work. If you mean "I find the modern world hard," say that. You will get sympathy from almost everyone. Almost everyone agrees. If you wonder if something specific is happening, say that. Something lifelong and genuinely limiting. That is a different sentence. It deserves a different response. It needs careful evaluation. A trained person will tell deficit from difficulty.
Both sentences are honorable. They are just not the same sentence. And the gap between them is where most of the help lives.
#CenterForBalancedLivingDE #CFBL #PsychologicalEvaluation #MOTarea #MiddletownDE