hardautism spectrum disorderadult femalesmaskingcamouflagingsocial anxiety differentialsensory sensitivityneurodevelopmental disorders
A 32-year-old female presents with a chief complaint of social exhaustion and chronic anxiety. She reports that social interactions at work leave her feeling drained and she requires hours alone to recover. She describes developing detailed mental scripts before social interactions and consciously mimicking coworkers' facial expressions and tone of voice to appear engaged. She has intense, focused interests in specific topics that she researches extensively. She reports sensory sensitivities including distress from fluorescent lighting and certain fabric textures. She was a high-achieving student who was described as "shy" and "quirky" but was never evaluated for developmental conditions. She has been previously diagnosed with social anxiety disorder and treated with SSRIs with minimal improvement in her core social difficulties. Her current GAD-7 is 12 and PHQ-9 is 7. What diagnosis should the PMHNP prioritize in the differential?