Symptoms of a disorder are not always easy to see. Imagine if you will, a computer programmer named Patrick. Patrick lives with his parents and has never been in a relationship. He has severe challenges with: social interactions, deciphering the moods of others, interpreting sarcasm, or making extended eye contact with anyone. Despite being a gifted coding programmer with an expansive knowledge of all things tech-related, his language production skills are weak and he displays several compulsive, repetitive ticks such as  hand motions and verbalizations that make it extremely difficult to work or socialize with others. His severe delay in speech, extremely flat affect and virtually non-existent social skills led to a very early, easy diagnosis of Autism. Growing up, Patrick had an ABA worker and remains on psychotropic drugs.

Now picture Jae, a self-described “master of adaptation.” His introversion is expressed as extroversion. His attention deficit expressed as an intense concentration. And his developmental delays developed into strengths. Jae began speaking and walking quite late, but once he started, he quickly became proficient at both. During childhood, he suffered from extreme social anxiety and shyness but was able to adapt by mimicking the socially successful. Jae spends a great deal of time paying extremely close attention to human behavior, yet he still finds it difficult to interact with others in a way in which others expect without the pitfalls that come with trial and error.

Jae is proficient in analyzing others, from a third-person point of view, yet remains unable to measure how others feel about him, such as whether they are angry at him or not. He can often be excessively objective and honest in a way that can displease others. His repetitive and mildly obsessive compulsions, such as finger flicking, go unnoticed by most. One could see him every day and not realize that his finger flicking is precise and is often accompanied by an internal series of calculations involving the counting of syllabic composition of thoughts and speech followed by segmentation of those numbers into sub-groups. Over the years, he has gradually reduced this compulsion. His intense observation of others and the ability to adapt to his situation give him the ability to seem at ease with others, say the things he is expected to say (usually) and generally seem unencumbered.

Despite a late start in speaking and language therapy for stuttering, Jae's language skills have become exceptional. While he was initially suspected of having a learning disorder, he was assessed on four separate occasions through elementary and secondary school and subsequently deemed to be highly gifted, testing in the 99th percentile for language and verbal skills, with an overall high IQ but suffering from deficits in attention, processing speed, and executive function. He becomes extremely focused on specific topics about which he assembles a mental encyclopaedia and often speaks about far too much or nothing at all. He often has difficulty with a two-way conversation.

While Jae's working memory is terrible, his long-term memory is excellent and quite detailed. He can memorize enormous amounts of data and remember small details about people, places and events that others do not but he can forget your name shortly after you introduce yourself. He sometimes says things that others take as derogatory, offensive, or funny without meaning to or knowing it. He is bothered by fluorescent lighting and electrical sounds and has extreme difficulty taking tests in a room full of the constant noises made by others. He often finds emotional regulation extremely difficult and was referred to anger management therapy as a child but conversely often finds himself unable to react at all to emotionally provocative situations.   

Patrick is clearly on the autism spectrum. This was obvious long before assessment and easy to see. Far less obviously, Jae is also on the autism spectrum, albeit in a very different place. They are not the same, nor are their symptoms. Jae’s symptoms are mostly invisible to all but himself and those who know him best. He was not easy to diagnose, needs very little support, outside of testing accommodations and methylphenidate, and he can usually speak without stuttering. Unlike Patrick, Jae finds emotional regulation challenging but not impossible. While Patrick’s symptoms of autism have always been evident, Jae’s symptoms have always been subtle and easy to conceal and he was not diagnosed until post-secondary.

Shrouded by ADHD, adaptation, strong communication skills and high achievement, most cannot see or hear his dysfunction or sense his social anxieties. While he feels fortunate to be able to appear neurotypical to most, he knows this makes him difficult for others to understand at times. His challenges are not nearly as great as those of Patrick, nor is he stigmatized in the same way. However, his challenges are not understood by others as Patrick’s are. He has become so good at hiding his symptoms that many do not believe they exists. It is important to remember that invisible symptoms are very real.

We cannot always see the struggles faced by others, be it autism, ADHD, anxiety, depression, or schizophrenia but we can try to at least be aware of our own inability to see what is hidden from view.

Written By: Brock Andrew Stephen Pollard, M. Psy. Candidate, B.A.
Edited/Reviewed By: Dr. Stacy Lekkos, C. Psych.