Demand avoidance: externalized and internalized profiles

David Smith spent years working as a therapist specializing in neurodiversity-affirming care, but it wasn't until age 56, prompted by his wife and his own clients, that he sought his own autism diagnosis. That confirmation fundamentally shifted his clinical approach from that of a white-coated expert to a fellow traveler, deepening the way he accompanies families through unmapped territory.

Today, Emily and David discuss the delicate balance between professional curiosity and humility, and why traditional therapeutic models often fail to support the fragile nervous systems of neurodivergent clients. They talk about the nuances of demand avoidance, specifically the high-masking, internalized presentation that often looks like perfectionism, and why "connection before correction" is a neurological necessity, not just a catchy phrase.

TAKEAWAYS

• Effective therapy for neurodivergent clients often requires shifting away from the traditional expert hierarchy.

• The neurodivergent brain is a "complicated, custom-made car with no user's manual."

• For neurodivergent nervous systems, stress isn't just negative trauma; it includes any destabilizing experience, including excitement and joy.

• While we often associate PDA with external defiance, the internalized profile often manifests as high-achieving perfectionism.

• Rewards and consequences often backfire with neurodivergent children because they increase anxiety.

• It's ineffective to offer a correction to a child until you have connected with them.

• There is a massive overlap between complex trauma and neurodivergence.

• A late diagnosis doesn't instantly fix struggles; it initiates a complex grieving and reframing process.

Join our live CE training, Adapting Cognitive-Behavioral Therapy for Autistic and ADHD Pediatric Clients, Friday morning, January 23, at 10:30 eastern/7:30 pacific, or get the recorded version anytime after. Get signed up or learn more here.

David Smith, LCSW is a late-diagnosed autistic therapist and licensed clinical social worker specializing in neurodiversity-affirming care for autistic and otherwise neurodivergent individuals and their families. Practicing since 2017, David opened his private telehealth practice in 2023 and now serves clients across five states from his home in southern Oregon. In addition to therapy, he offers consultation, writing, education, and advocacy to expand access to effective, affirming support for the neurodivergent community.

Diagnosed with autism in 2024 at age 56 (thanks in part to gentle nudges from his wife and clients) David continues to explore how his autistic identity shapes both his personal and professional life. His work is deeply rooted in curiosity, humility, and a commitment to learning from his clients and the broader neurodivergent community. He is also a devoted listener of this and other neurodivergence-focused podcasts. David lives with his wife, a fellow therapist originally from Peru, and is the proud father of three sons.

BACKGROUND READING

David's website, LinkedIn, authored articles

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