Episode 67 features a discussion between Dr. Elisa Shipon-Blum and April Ratchford, a licensed occupational therapist and creator of the popular Adulting with Autism podcast, on the intersection of autism spectrum disorder and selective mutism, specifically in adulthood.

During the course of this 51-minute discussion, Dr. E and April explore how ASD and SM often co-occur, why adults are frequently misdiagnosed or misunderstood, and practical strategies to help adults with both conditions thrive in daily life, and more.

Understanding Autism vs. Selective Mutism – Key Differences

Episode 67 begins with Dr. Elisa Shipon-Blum and April Ratchford discussing the critical importance of distinguishing between autism spectrum disorder and selective mutism, two conditions that are frequently confused with one another.

This chapter covers the language development differences that distinguish autism from SM, why the presentation of mutism can mask underlying autism traits, and how individuals with both conditions face unique diagnostic and treatment challenges.

How ASD and SM Present Differently Across Social Settings

Dr. E and April delve deeper into the nuanced differences between selective mutism and autism, examining how individuals present across various environments and contexts.

The conversation highlights that SM is situational—varying by setting and people present—while autism traits remain consistent across all environments. They discuss how individuals with SM desperately want to connect but are blocked by anxiety, while those with autism may appear disinterested because they struggle to understand social connection itself.

The WHYs Behind Mutism – Sensory Processing and Social Burnout

Dr. E and April address the underlying factors influencing communication challenges in autism, including cognitive overload, concrete thinking, sensory processing differences, and the exhaustion that comes from pre-planning social interactions in their minds before they even happen.

The focus of this chapter is understanding that autistic individuals experience communication difficulties not rooted in social anxiety alone, but in the complex interplay of executive functioning challenges, sensory sensitivities, and the energy cost of navigating an unpredictable social world.

Tailored Treatment Strategies for Dual Diagnosis Adults

In the fourth chapter of this podcast episode, Dr. E and April emphasize that effective treatment for individuals with both autism and SM requires a realistic, individualized approach that meets parents and their children where they are developmentally.

They discuss the importance of comprehensive testing, understanding each person’s unique needs, and shifting parental mindset from controlling outcomes to facilitating independence. The guidance centers on practical strategies like conversation roadmaps, scripting, role-playing, and preparing for predictable social situations.

Practical Tools and Workplace Accommodations for Success

Dr. E and April conclude this episode by discussing the reality of masking and the critical need for safe spaces where autistic individuals can “unmask” without judgment. They address parental fears about diagnosis, reframe autism as a potential gift, and provide actionable steps for real-world success.

The conversation emphasizes that autistic adults can thrive when given appropriate accommodations, real-world experiences, and support—whether in college, the workplace, or navigating romantic relationships—and that progress doesn’t have to follow society’s timeline.

Key Takeaways from Episode 67

  • Autism and SM often co-occur, but are distinct conditions requiring careful differentiation
  • Autism traits are consistent across settings, while SM presentation varies by environment
  • Comprehensive testing is essential for accurate diagnosis and effective treatment planning
  • Practical strategies like conversation roadmaps and scripting lower anxiety and increase confidence
  • Masking is exhausting—autistic individuals need safe spaces to be their authentic selves
  • Parents must shift from controlling to facilitating independence and real-world experiences
  • Autism is not a sentence—autistic adults can achieve meaningful goals on their own timeline

Resources Mentioned

About the Guests

April Ratchford, OTR/L is creator and host of Adulting with Autism, an internationally recognized podcast with over two million downloads featuring authentic stories from autistic and neurodivergent adults. As a licensed occupational therapist with two decades of clinical expertise, she combines therapeutic knowledge with lived experience as an autistic Black woman raising an autistic son.

Final Thoughts

Understanding the intersection of autism spectrum disorder and selective mutism is crucial for accurate diagnosis and effective treatment, especially in adults who have been misunderstood their entire lives. As April and Dr. E remind us, “It can be done. Yeah, it’s a challenge, but it can be done.”