You Don't Really Mean That

I ask a follow-up question in a meeting, and I can feel the temperature change. I skip the small talk and go straight to the problem, and that reads as cold. I look at the table instead of at your eyes, because that is how I listen, and that reads as rude. None of it is meant as anything. It is just how I exist in a room. The room does not read it that way.

We are told, constantly, to be ourselves. The posters say it. The onboarding decks say it. Then we are ourselves, and we find out the invitation had terms.

I am autistic and I have ADHD. The community shortens the combination to AuDHD. I also live with generalized anxiety disorder and severe depression, and the bill for all of it has come due in social anxiety, burnout, and irritable bowel syndrome. I had my dream job, and I was pushed out of it because the accommodations I needed never came. I have written about that job in an eight-part series, and I am not going to retell it here. This essay is the bridge between that series and everything around it, because the job was not the beginning of the story, and it is not just my story.

The claim is narrow. We are telling you what we need. The failure is treating those needs as wishes. That gap is not one person’s misfortune. It shows up in employment data, in the cost of staying well, in who gets believed by a doctor, and in suicide data. The fixes are mostly cheap, and they start with listening.

The Sleepover

When I was a kid, spending the night at a friend’s house was the expected thing to do. Everybody did it. Everybody seemed to want to.

I hated it. I struggled to sleep anywhere that was not my own bed. I needed far more time alone than other kids seemed to, and time with other people, even people I liked, drained me in a way I could not explain. A sleepover was a full day of that with no exit, followed by a night of not sleeping, followed by breakfast with someone else’s family.

My parents were usually the ones who volunteered me. They did what they thought was right. Nobody in that house knew what autism was yet, and a kid who did not want to go to a sleepover looked like a kid who needed a little push. I do not hold it against them.

What stayed with me was what happened when I said I did not want to go. People laughed it off. You don’t really mean that.

I did mean it. I meant it every time. That was the first version of a sentence I would hear for the rest of my life, in different words, from different people. It feels isolating in a specific way: knowing you are different from everyone around you, finally saying so out loud, and being told that what you just said is not true.

Information Is Fun to Me

Middle school and high school were harder. I had a hard time connecting with people my own age.

I was super into professional wrestling. I wrote wrestling fan fiction on my laptop, for fun, the way other kids played video games. I went canvassing across the internet for any piece of independent wrestling media I could find, every obscure promotion, every grainy upload. (I told the origin story in How I Got Into Wrestling; this is what that same hunger cost me at school.) Autistic people often have interests that run this deep. Mine was wrestling, and it still is. Information is fun to me. That was not fun to anyone else.

When I let people into that world, I mostly found ridicule. After enough of that, you stop letting people in. You do not decide to. You just notice one day that you have stopped mentioning the thing you care about most.

I did not go to Homecoming. I did not go to Prom. I do not regret either decision. Some kids are just different, and a gym full of loud music was never going to be my night. Not every difference is a wound. The harm was never in being different. It was in not being believed about it.

I do have one regret. I regret not being more myself, even knowing what it would have cost. I wish I could go back and do theater. I wish I had flown my nerd flag even higher instead of trying to fit into the boxes other people had already drawn for me.

The irony took me years to see. I spent my whole adolescence performing, just not on a stage. I was acting in life, and I was doing it to survive.

The Names for It

I had never really heard of autism until my brother was diagnosed. He was young, and I was around nineteen. That was the first time I had a word for any of it.

I had suspicions after that. I did not have a diagnosis until I was thirty-three. In between were fourteen years: college, a career, and most of the dream job, all of it lived without the name. Getting an adult diagnosis in America means finding specialists, waiting for them, and paying for them, and I described that slow path in The Storage Closet.

I am not unusual in that. Clinicians now talk about a “lost generation” of autistic adults who were missed as children because the old picture of autism required obvious early delays, and because many of us learned to camouflage before anyone thought to look (Lai and Baron-Cohen, 2015). Each diagnosis I eventually received named something I had already been living with. Autism shapes how I process the social and sensory world. ADHD shapes how I regulate attention. Generalized anxiety disorder is an alarm that goes off without a fire. Severe depression is a heaviness that does not lift on its own.

Acting to Survive

The autistic community calls it masking: performing neurotypical so the room does not notice you. You rehearse the small talk. You force the eye contact. You laugh a half-second after everyone else because you were checking whether it was a joke. You script the phone call before you make it. Masking is a role you never auditioned for, and the run never ends.

It works, for a while, and that is what makes it dangerous. Every hour of it is paid for later. I paid in weekends spent in bed recovering so I could do the week again, which is what autistic burnout looks like from the inside. I paid in social anxiety. I paid in my gut. Irritable bowel syndrome is common among autistic people. A review of 144 studies found that gastrointestinal symptoms are widely reported in autism, with a median of nearly half of autistic participants reporting at least one, though nobody yet measures them the same way twice (Holingue et al., 2018). Mine is real enough that a lot of foods are simply off the table.

After college I moved to Connecticut by myself. The first time I went to the grocery store alone, it was busy. Carts everywhere, announcements overhead, every lane backed up. I filled a cart. Just before I got to checkout, I had a panic attack. I left the cart full of groceries in the aisle and walked out of the store.

That level of anxiety is something most people never have to think about. I get it doing everyday things. A busy store is the same overload as the crowded party I described in A Pepsi in a World of Coca-Cola: too many channels at once, until they collapse into one sound. Years later, I had another panic attack outside an office I had been ordered to report to, over a forgotten badge, and I wrote about it in A Wish, Not a Need. The difference between those two doors matters. Nobody could have prevented the grocery store. Somebody could have prevented the badge door, for the price of one afternoon, and chose not to.

The Dream Job

I spent more than eleven years as a Disney cast member on the technology side. The series, Eleven Years a Cast Member, tells it in eight parts. Here is the short version.

I disclosed everything. I told my managers I was neurodivergent and in the middle of the diagnosis process. When I asked my director for more written communication to help with my disability, he said, “But you’re great at verbal communication.” When I asked for accommodations, the serious answer was a storage closet with no roof. When I raised legitimate problems, the answer was “That is a job.” When the overload finally turned into a meltdown, I was written up and told my disability was not an excuse. In the same meeting, my manager called me a genius and said he needed me.

Line that up next to the sleepover. You don’t really mean that. But you’re great at verbal communication. Same sentence, decades apart. Both dismiss a stated need by telling you what you really are. The kid did not really mean it. The employee did not really need it.

With the help of the healthcare professionals I trusted, I resigned. On paper, it was a resignation. In every way that matters, I was pushed out. I wrote about what it was like to be pushed out by people with authority to lose in In Good Company. What I want to say here is simpler. I was punished for not thinking and acting like everyone else. That is exactly who I am. I am different. I have a disability. That is the disconnect.

Not Just My Story

If this were only my story, it would be a sad story about one job. It is not.

In the United Kingdom, the Office for National Statistics found that 29 percent of disabled autistic adults of working age were employed in 2021, against 81.6 percent of non-disabled adults. Autism had one of the lowest employment rates of any impairment type the survey tracked. In the United States, a Drexel University study following young autistic adults found that 58 percent had worked for pay at any point between high school and their early twenties. That was the lowest rate of any disability group in the study; young adults with learning disabilities or speech impairments were above 90 percent. Only about a third of the autistic young adults had a paid job in the first two years after high school, and the ones who worked mostly held part-time, low-wage jobs (Roux et al., 2015).

A degree does not close the gap. Among UK university graduates, 34 percent of autistic graduates were in full-time work, compared with 68 percent of graduates with no disability, and autistic graduates were five times as likely to be unemployed (Vincent and Ralston, 2024).

That is underemployment, and it is a whole demographic of talented people sitting at home. We have a lot to offer. Most of what it would take to keep us in the building is not expensive. The Job Accommodation Network has been surveying employers on this for years, and most accommodations cost nothing at all.

Some of the gap is bias, and it is measurable. In a set of studies led by Noah Sasson, strangers watched a few seconds of video of autistic and non-autistic adults and rated them. The autistic adults were rated as less likable and more awkward, and the raters said they were less willing to talk to them or spend time with them. The judgments formed within seconds and did not improve with more exposure. Then the researchers showed raters only written transcripts of what the same people said. The bias disappeared (Sasson et al., 2017).

Style, not substance. The content of what we say holds up fine on paper. It is the delivery that gets us marked down, and the delivery is the part we cannot help. Remember what I asked my director for: more written communication. The research had already explained why.

The autistic researcher Damian Milton calls this the double empathy problem: communication between autistic and non-autistic people breaks down in both directions, but only one side gets diagnosed with the breakdown (Milton, 2012). When researchers tested how well information passes along a chain of people, autistic people passed it to each other as well as non-autistic people did (Crompton et al., 2020, and a larger replication in 2025). The deficit we are blamed for does not show up when autistic people talk to each other. And yet the work of adapting is always assigned to us.

Then there is the job interview, which is a social performance test standing in front of almost every job. It grades eye contact, small talk, and the firm handshake. It screens out the person who would be a great engineer, accountant, or analyst, for failing an audition for a role nobody will ask them to play once they are hired.

The Bill

Lower income is one side of the squeeze. The other side is cost.

I do weekly therapy. That is expensive. I take multiple prescription medications, and those can be costly. I see specialists. I have food allergies, and a lot of foods trigger my IBS, so the foods I can eat cost more than the foods I cannot. None of that is optional. It is the price of staying well enough to work.

It starts before adulthood. A lot of us need special schooling or extra support in school, and that is expensive too. When Congress passed the law that became the Individuals with Disabilities Education Act in 1975, it promised that the federal government would pay up to 40 percent of the extra cost of educating children with disabilities. It has fallen short of that promise every year since. In fiscal year 2025, federal funding covered about 10 percent, roughly a quarter of the promise (Congressional Research Service). The rest falls on states, districts, and families, who pay out of pocket for private evaluations, therapies, advocates, and private placements when the public option fails.

Researchers at the National Disability Institute estimate that a household with an adult whose disability limits their work needs, on average, 28 percent more income to reach the same standard of living as a similar household without a disability. At the median income, that is about $17,690 a year. Adjust the federal poverty line for those costs and the poverty rate for those households rises from 24 percent to 35 percent.

Put the two sides together. The people most likely to be pushed out of work are the people with the highest fixed costs of staying well. Losing the job is not only losing income. In this country, it can mean losing the insurance that pays for the therapy that was keeping you afloat. My accommodations would have cost my employer almost nothing. Going without them cost me a career, and cost them the person they had just called a genius.

People hear all of this and say, everyone has problems. That is true. Everyone does. But ours are not instead of the normal human ones. They are on top of them. Rent, family, grief, deadlines, and the car making that noise again, and then the therapy appointment, the pharmacy, the safe-food list, the masking, and the recovery from the masking. That is why we are so exhausted. Chronic illness is exhausting. The chronic-illness community has a name for it, spoon theory, after Christine Miserandino’s essay about living with lupus on a fixed daily allowance of energy. We start the day with fewer spoons and more places to spend them.

“Everyone has problems” has the same shape as another sentence. When people said “Black Lives Matter,” the answer came back: “All Lives Matter.” Black Lives Matter was never an exclusionary statement. It named a specific harm. The reply used a true general statement to erase a specific one, and from the way people reacted, you would have believed the original sentence had excluded someone. I see the same move used on us. I am not comparing suffering, and I am not claiming autistic people carry what Black Americans carry. I am saying I recognize the shape of the dismissal.

Who Gets Believed

The same pattern runs through medicine, and here I have to be honest about where I stand. I am a man, and I have not had to face what follows. I can still see it.

Women have it harder at almost every step. Autism is diagnosed far more often in boys, and the commonly repeated ratio is four to one. A meta-analysis of 54 studies found that when researchers screened whole populations instead of counting existing diagnoses, the ratio was closer to three to one. Girls who meet the criteria are disproportionately missed (Loomes, Hull, and Mandy, 2017). ADHD follows the same pattern. Girls are more often inattentive than hyperactive, they are more likely to mask, and their anxiety and depression get diagnosed instead (Quinn and Madhoo, 2014). Camouflaging, the same survival skill I described above, hides girls from the people whose job is to find them.

Set autism aside and women still have an uphill battle in medicine. They routinely have to advocate for themselves more than men do. A landmark legal and ethics review, “The Girl Who Cried Pain,” found that women report more pain and more frequent pain than men but are treated less aggressively, and that providers tend to discount women’s pain reports as emotional (Hoffmann and Tarzian, 2001). In one emergency department study of patients with acute abdominal pain, men and women reported similar pain scores. Women were less likely to receive opioid pain medication, 45 percent to 56 percent, and waited longer for whatever they did receive: a median of 65 minutes, against 49 for men (Chen et al., 2008).

Black Americans receive less pain medication than white Americans for the same conditions. In one national study of children with appendicitis in emergency departments, 20.7 percent of Black children received opioid pain medication, compared with 43.1 percent of white children, and Black children in severe pain were less likely to get opioids even after adjusting for their pain scores (Goyal et al., 2015). Researchers at the University of Virginia asked why. They found that about half of a sample of white medical students and residents endorsed at least one false belief about biological differences between Black and white people, such as the claim that Black people’s skin is thicker. The trainees who held those beliefs rated a Black patient’s pain as lower and made less accurate treatment recommendations (Hoffman et al., 2016). That is straight-up prejudice, documented by the people trained to treat it.

It reaches our community too. In a study of Medicaid-eligible children in Philadelphia who were eventually diagnosed with autism, Black children were 2.6 times less likely than white children to receive the autism diagnosis at their first specialty visit, and were more likely to be diagnosed first with conduct disorder or adjustment disorder (Mandell et al., 2007). Too often, the same differences in a Black child were read as a behavior problem.

The same sentence, this hurts or I need this, carries different weight depending on who says it. People at the intersections, autistic women and Black autistic people, have to clear more than one discount before anyone takes them at their word.

Belonging

Now the hardest numbers.

In a Swedish registry study of more than 27,000 autistic people, the odds of dying by suicide were about seven and a half times higher than for matched members of the general population. For autistic people without an intellectual disability, the odds were more than nine times higher (Hirvikoski et al., 2016). ADHD carries its own risk. A meta-analysis of 57 studies found significantly higher rates of suicidal thoughts, attempts, and deaths among people with ADHD (Septier et al., 2019).

In a UK clinic that diagnoses autism in adults, 66 percent of newly diagnosed adults reported having contemplated suicide during their lives. Thirty-five percent had planned or attempted it. The average age at diagnosis in that clinic was about thirty-one (Cassidy et al., 2014). I was thirty-three.

Sit with that.

I am not going to dress this part up. I know the thoughts behind those numbers. I am not going to say more than that, and I do not need to. If you are autistic or ADHD and you recognize yourself in this section, you already know what I mean.

Here is my theory, and I want to be clear that it is a theory. I think a large part of why our numbers look like this is that we do not belong, and we are reminded of it constantly, in rooms that tell us to be ourselves and then mark us down when we are.

The research is closer to that theory than I expected. The interpersonal theory of suicide names two of the strongest risk factors: thwarted belonging, the sense that you have no real place among other people, and perceived burdensomeness, the sense that the people around you would be better off without you. Autistic adults report both more strongly than non-autistic adults, and both help explain the link between autistic traits and suicidality (Pelton et al., 2020). Another study asked autistic adults directly what predicted their suicidality. Two of the risk markers it found were specific to autism: unmet support needs, and camouflaging. Masking. Acting to survive. Even after accounting for depression, anxiety, and unemployment, the masking itself carried risk. The authors put the implication plainly:

Increasing acceptance of autistic people in society could therefore lead to a reduced need for camouflaging and increased feelings of belonging—a protective factor for suicidality. (Cassidy et al., 2018)

I see the same shape in the LGBTQ community, and especially among transgender people. In The Trevor Project’s 2024 national survey, 46 percent of transgender and nonbinary young people had seriously considered suicide in the past year. Researchers have a name for the mechanism, minority stress: stigma and discrimination create a hostile environment, and the stress of expecting rejection and hiding who you are wears down mental health over time (Meyer, 2003). Hiding who you are. The autistic community calls it masking. The queer community called it the closet long before that.

The overlap is not only metaphorical. Transgender and gender-diverse people are three to six times as likely to be autistic as cisgender people (Warrier et al., 2020). Some of us are carrying both.

The point is not to compare suffering. This is not a competition, and I am not going to rank it. But I can feel empathy for their suffering, because I recognize the wound. And their research holds the hopeful half of the story too. LGBTQ young people living in very accepting communities attempted suicide at less than half the rate of those living in very unaccepting ones. Young people with even one accepting adult in their lives were 40 percent less likely to report a suicide attempt in the past year (The Trevor Project, 2019 and 2024).

One accepting adult.

If you are in that place right now, in the United States you can call or text 988 to reach the Suicide and Crisis Lifeline, any hour of any day.

How It Becomes Normal

None of this is secret. So why does it keep happening?

Part of it is that adults like me are nearly invisible in the data. The federal government counts people with a disability: in 2025, 38.1 percent of Americans with a disability between 16 and 64 were employed, against 74.8 percent of those without one (Bureau of Labor Statistics). It does not count autistic adults. There is no reliable national unemployment rate for autistic adults in the United States. You may have seen the claim that 85 percent of autistic college graduates are unemployed. It is repeated everywhere, and nobody has been able to trace it to a study of college graduates. The truth is not that the number is lower. The truth is that nobody has measured it.

When a group is not counted, the myths fill the blank. Autistic people do not want friends. Autistic people lack empathy. Accommodations are a favor, and asking for one is asking for special treatment. Myths like these do not stay in conversation. They become policy: return-to-office mandates written for the median employee, open floor plans that were never designed with people like me in mind, accommodation processes that treat a need as a wish to be granted when someone is feeling generous. The law already says otherwise. Under the Americans with Disabilities Act, an employer is supposed to respond promptly to an accommodation request and work through it with the employee in good faith, a back-and-forth the Equal Employment Opportunity Commission calls the interactive process. On paper, it is a process. In practice, it is often a closet.

And no one ever thinks it could be that bad, because no one they know is telling them. We learned a long time ago what happens when we tell people.

What Acceptance Looks Like

Please listen to us. We are telling you what we need. We do not want our needs treated like wishes.

That is the whole thing, really. The rest is detail. But details are where acceptance either happens or does not, so here are some.

At work, acceptance looks like written agendas before meetings and written follow-ups after them, for everyone, by default, so that nobody has to disclose a diagnosis to get one. It looks like remote or quiet work being treated as a normal option rather than a privilege rationed by who your manager likes. It looks like hiring that tests the skill the job needs: a work sample, a take-home project, a conversation with the questions sent in advance, instead of a performance of eye contact. It looks like treating the interactive process as an actual process, with a timeline, a decision, and a person accountable for it.

In ordinary life, it looks like meeting us halfway. The double empathy problem runs in both directions, so the fix does too. When we ask a follow-up question, assume we want the answer. When we do not look at you, assume we are listening, because we are. When we leave the room, let us leave, and do not take it personally when we come back an hour later in better shape. When a kid tells you about the thing they love, ask a second question instead of laughing. In the 2025 replication of the communication study, simply telling people about a partner’s diagnosis improved rapport. Knowing helps. Ask.

In medicine, it looks like believing the patient first. It looks like screening tools built around how girls and women actually present. It looks like training aimed at the specific false beliefs the research has already found, not a generic module everyone clicks through.

In policy, it looks like counting us: real data on autistic adults and work, collected on purpose. It looks like adult diagnosis that does not take years and a small fortune. It looks like enforcing the accommodation duties already in the law, mental health care that does not depend on keeping the job that is making you sick, and finally paying the 40 percent Congress promised schools in 1975.

In faith communities, it looks like a bigger table, one with room for the person who asks questions.

To the kid who is different right now: fly the flag. Do the theater. You will pay something for it either way, and I can tell you from the other side which bill I wish I had paid.

As for me, I am trying to make a transition. I want to stop the performative acting, the masking I did to survive, and start acting for enjoyment. I love playing characters. But I want to live as David.

In middle school there was a laptop with a folder full of wrestling fan fiction on it: champions, challengers, feuds that ran for pages. Every name in that folder was a character. The kid at the keyboard had not learned to play one yet.