I received a thoughtful question in The Nook recently — a clinician shared that some of their Autistic clients experience intense anxiety in social situations, especially with unfamiliar people. They described how this often looks like avoidance rooted in a deep fear of judgment or rejection. The clinician wondered: How do I know when this is part of being Autistic… and when it points to Social Anxiety Disorder as well?
Instead of typing out a response, I decided to record a video — partly because this is a question I’ve sat with myself, and partly because I figured others might be wondering the same thing. So here’s my unfiltered brain-dump on autism, social anxiety, and how I think through whether it makes sense to add a diagnosis of Social Anxiety Disorder on top of autism.
I share why I think this question shows up so often — especially for late-identified Autistic folks who’ve spent years describing themselves as “shy,” “socially awkward,” or “anxious around people.” And I walk through the differences I look for: what’s rooted in fear versus what’s rooted in neurotype mismatch, sensory dread, or years of traumatic invalidation.
This is called “Dr. Neff Unfiltered” because I didn’t script this out (unlike my formal presentations). I received a question, pulled up some visual supports, and hit record. So what you’re witnessing here is also my own practice of unmasking — letting the thoughts come as they are.
I talk about the diagnostic overlap between autism and social anxiety, and why it’s common for Autistic people to meet some criteria for social anxiety — but not all. I reflect on how internal experience is often the key to teasing them apart, and how social avoidance might be more about protection than pathology. I also share why being around familiar or neurodivergent people can feel completely different — and how that difference often gets overlooked in traditional assessments.
Whether you're a clinician, a questioning ND adult, or someone who just feels exhausted by social spaces — I hope this brings a bit more clarity, and a whole lot of compassion.
Other Resources
https://neurodivergentinsights.com/social-anxiety-explained-dsm-5-pictures/
https://neurodivergentinsights.com/social-anxiety-or-autism/
Social Anxiety vs. Autism E-Book: https://neurodivergentinsights.com/misdiagnosis-monday/social-anxiety-vs-autism/
Social Anxiety PDF: https://neurodivergentinsights.com/dsm/social-anxiety-explained-dsm-in-pictures/
Interested In Learning More?
Check out The Lost Generation of Autistic Adults (50% off this month).
— a course that explores why so many Autistic adults were missed or misdiagnosed, and what we can do about it now.
While this one is less “Dr. Neff riffing on a question” and more thoughtfully scripted (with citations and all!), it still weaves in lived experience alongside clinical insight.
✨ It's 50% off this month — whether you're a provider or a late-identified adult, you're welcome in the learning space.
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