How to Tell Your Psychiatrist That You Might be Autistic

Talking to healthcare professionals about your own conclusions can be a minefield. They too often assume that their patients are drug-seekers or are misunderstanding their own experiences.

This is how I talked to my psychiatrist about my suspicions!

So you think you might be Autistic, and you’re ready to take it to the next step– telling a professional. 

This step is so terrifying that many people never take it at all. Prior to this point you might have shared your suspicions of Autism with your partner, friends, or family members– but this is telling someone with the authority to tell you “no.” Depending on the personality of the provider you see, this interaction could be an informative chat or a face-off.

If you've done some research on your psychiatrist, or if you happen to get lucky, your interaction may be the former. Just a discussion that leads to an agreement to conduct an assessment to find out.

However, in the worst case scenario your psychiatrist may not be as informed as you are about Autism. Or, they may even be very misinformed. I had friends who told me their psychiatrist outright declined to perform an assessment on them because they “had friends” so thereby they “couldn’t be Autistic.” 

Now, I'm not saying that everyone who reads this definitely 100% is Autistic. Or even that everyone who pursues an assessment is either. It's a delicate balance to talk to a diagnosing professional. You must be willing to contradict the professional and stand up for your own experiences and beliefs. However, you must also be willing to step back and accept a sensible "no." More people are being diagnosed each and every day, however there's a possibility that what you believe are Autistic symptoms may be something else entirely.

With this delicate balance of staying firm but also being accepting of reasonable contradictions, let's discuss the step-by-step process to bring up your thoughts to your diagnosing professional.

A note: in some states, psychiatric nurse practitioners can diagnose, prescribe medications, and conduct psychiatric testing. For that reason I use the term “diagnosing professional” instead of psychiatrist throughout this article.

Table of Contents

1. Finding the right professional to talk to

2. How I brought it up

3. How to unmask in front of a psychiatrist

4. Tell them your WORST, not your best

5. How to advocate for an assessment

6. Bring hard data

7. Bring supporters

8. Make them document their refusal

9. Final thoughts

Finding the right professional to talk to

Your first step is either finding a diagnosing professional, or coming up with a strategy to approach the one you already have.

If you are finding a diagnosing professional-- consider looking specifically for professionals specialized in Autism. This can be as much of a mixed bag as other professionals, however at least you're less likely to receive the dreaded "but you have a partner, how could you be Autistic?" Consider looking specifically for someone who specializes in Autistic adults, though depending on your location this may be impossible. Specifically try to find someone who calls themselves "Neurodiversity-affirming"-- this is a good sign!

If you are working with a professional you already have, this is both good and bad. While you may have an established rapport with your psychiatrist/psychiatric nurse/doctor/whatever, and you may be on good terms with them, not all of us are. Or, it’s possible that you may not get the open, accepting response and availability to conduct an assessment that you’re hoping for. 

So what's the best way forward?

The answer is that it's different for everyone. More professionals are growing aware of the unique problem of being an undiagnosed Autistic adults, but simultaneously more are resistant to the idea that Autism is a real disability, period.

For that reason, I chose to work with a psychiatrist who specializes in Autism instead of my regular psychiatrist. 

While even my chosen professional– the specialist– was dubious about my potential Autism diagnosis due to my high functioning (displaying that they didn’t understand that much about masking/coping skills versus reality), it was much easier to have that conversation than with my regular psychiatrist. She approached it as unthinkable, because I wasn’t a Special Ed student– a really antiquated way of thought. 

This is why I recommend seeing a professional who specializes in Autism particularly, if you can.

With this new professional, I started bluntly. From the first message, I clarified that I was experiencing Autistic symptoms and had been all my life, and I was seeking answers or an assessment for my own peace of mind. (Many professionals are asked to perform diagnoses for applications to SSDI, or disability income in the US. My psychiatrist made sure to clarify that I did not qualify for SSDI, even though I never asked. Clarifying from the beginning that you're not seeking SSDI, if you aren't, may be helpful.)

Here's a template message you can send to a psychiatrist on PsychologyToday or other listing websites:

"Hi <name>, are you taking new patients? I saw that you specialize in Autism, and I think I may be undiagnosed with Autism as an adult. I would love to conduct an assessment to find out. You can reach me at <number> and <email>. Thank you!"

Or, you can simply ask if they're taking new patients and then explain what you're seeking after they contact you. Oftentimes, professionals are VERY busy and may not even take this first step with you.

If you're working with a professional you have already worked with, consider calling them or texting them and leaving a similar message. Such as:

"Hi <name>, I have been thinking lately about my family history. My <parent, grandparent, uncle, relation> has Autism, and I think it's possible I may be undiagnosed with Autism as an adult. I would love to conduct an assessment to find out. Can you do that, or should I ask somewhere else? Thank you!"

You can be as direct or indirect as you want to be. Different tactics will work on different people. The key factor is to be kind, even if you have to be firm.

How to unmask in front of a psychiatrist

Next up, once you’ve chosen which professional you’re going to be speaking to, you need to prepare. Both mentally and, ideally, physically (we’ll get to that soon.)

You’re going to need to unmask as best as you’re able. 

Allow yourself to engage in your Autistic traits, the ones you hide away from most other people. Your ability to rant about a specific topic for hours. Your aversion to eye contact. Your desire to wear the same exact clothes every single day. Your professional will be examining you in every dimension, so you need to be true to yourself and behave in the way you do in the comfort of your own home, with no one else around. Or, as many of us who mask/blend in well with neurotypicals might say, when you’re at your “worst” socially. 

It’s extremely dificult to unmask, but it’s very necessary. They will be judging you based on every dimension of your sociality and the transparency of your Autism. Hell, purposefully overwhelm and overstimulate yourself if you want. They will be judging you on how you show up, and it's important to recognize that many of us adults have lived long enough to develop survival skills. Strip those away, and your Autism will be more clearly seen.

Tell them your WORST, not your best

A professional is examining you for the presence of Autistic traits. In their mind, generally, an Autistic person is struggling to cope with life. Even if the reality is that Autistic people frequently find and make coping methods for themselves, a professional’s mind is geared towards finding dysfunction. 

So be prepared to answer questions, every question, with “at your worst” appended. 

“Do you struggle with eye contact… at your worst?”

“Do you have food aversion… at your worst?”

“How often do you have shutdowns or meltdowns… at your worst?”

Avoid entirely explaining the systems you use to cope, because this WILL confuse them into thinking you might be allistic. It might make them think you’re a fully-functioning neurotypical if you answer “No” to struggling with eye contact, because most of the time, you don't. Instead, imagine yourself at your most broken down and overstimulated. That is the person they want to talk to. 

Don’t make the mistake of accidentally convincing them into thinking you’re allistic. 

How to advocate for an assessment

If you’re having trouble getting them to agree to do an assessment in the first place, you have two routes:

1. Gather more evidence, try to convince them again

2. Realize that you’re not getting anywhere with this provider and you may need to see a more open, accommodating one. There's no shame in searching for someone who's more open to possibility.

If you use the first method: 

I recommend being very firm that this is what you want, and you’re paying them for their services. Even if the assessment comes back clear, they will have earned hundreds or thousands more dollars for their time spent on the testing.

If you want to, you can work on providing them more solid evidence of your suspicions of yourself being Autistic. Skip to the next section for advice on that.

If they’re still very resistant, consider seeing another professional. What if they perform the testing inaccurately because of their resistance to the thought of adults being diagnosed with Autism? What if they have prejudice about Autism in particular? Consider this before continuing to pressure a resistant professional. 

In that case, if they’re VERY resistant to even doing an assessment due to their own beliefs about Autism, it may be better just to see another psychiatrist

But how do you convince someone who's on the fence?

Bring hard data

A method commonly used by chronic illness patients is this: 

Record your symptoms in great detail. 

Why?

1. It’s much more convincing that someone is serious if they’ve tracked their symptoms for X weeks, months, years. 

2. It demonstrates knowledge of the condition, which can work against you, but with Autism there is essentally no risk of you being a drugseeker. Just a SSDI-seeker.

3. It shows that you’re not imagining symptoms, if anything they feel very concrete to you. 

Now this isn’t one-size-fits-all, and some methods of tracking may be more effective than others. Here are some apps I've found helpful:

• Thruday has been recommended to me before. It's specifically for Neurodivergent individuals, and offers mood tracking primarily.

• Daylio is a fantastic mood tracker app

However, these aren't comprehensive for the broader experiences of Autism.

Instead of, or in addition to these, I recommend making a simple spreadsheet, or printout, of tracking your symptoms. Here is a simple sheet I made that you can copy if you'd like! I only filled in 7 days with checkboxes, but feel free to modify the sheet as needed after copying it! The point is to make it fit YOUR needs.

Some good things to track could be:

• Number of meltdowns in a day/week/month

• Number of shutdowns in a day/week/month

• Number of times you felt sensory overstimulation in a day/week/month

• How could you describe that overstimulation?

• What caused it?

• etc.

In this way you’ll have more informed knowledge about what to tell the psychiatrist about when you visit them. 

But as with all tools, your mileage may vary. This isn’t a foolproof method unfortunately. They may just set aside your careful tracking and refuse to consider it. The best method is to find a neurodiversity-affirming therapist or psychiatrist, who won’t question your own understanding of yourself in the first place, but instead help explore it with you. 

Bring supporters

Next, if you’re still trying to convince a given diagnosing professional, consider bringing people with you to your appointment. In particular, and with preference descending in this order: parents, other family members, partners, friends.

Parents: your diagnosing professional may require you to give paperwork to a parent anyway, asking them specific questions about their experiences of raising you as a child. Cut out the middleman and bring your parent directly to the appointment. 

Other family members: They may also be familiar with your childhood experiences and Autistic symptoms. 

Partners: They know you very well, so they will be especially able to speak to your symptoms. If your partner is male it will be doubly effective, as there is a bias in the medical community to take men more seriously. 

Friends: A professional might see this as you recruiting backup, and less so as using an informative resource. But if you clarify that you’ve known eachother for many years, it may still be effective, and the friend can argue for you on your behalf if you’re uncomfortable with doing so.

You may find yourself having to use this method more often if you’re female, as there is a misconception in the medical community that most Autistic people are male.

These are my thoughts on bringing someone to an appointment: there is no guaranteed accuracy. Overall, I recommend being prepared to speak for yourself, but also you can (and perhaps should) talk over your plan for the appointment with your confidant beforehand– so they know how much they should speak up, if at all.

Make them document their refusal

Finally, if all else fails, make sure and demand the diagnosing professional document their refusal to accommodate you. Watch them while they take said notes. This can be the fire that makes them realize you're serious, and that they may be held to their decision later down the line. This is a final trick that may convince them to conduct an assessment, though begrudgingly.

Final thoughts

Telling a diagnosing professional that you think you might be Autistic is difficult. It takes bravery, dedication, tolerance with frustration, and more. It may take a little time to come to the task, but I recommend the above techniques to prepare yourself for it!