Better Study/Diagnosis of Hidden Symptoms

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What do you think clinicians (medical and psychiatric) could start doing (or do better) to recognize, study, and diagnose neuropsychological deficits related to things that clients actually can do, but only with an abnormal amount of stress and fatigue (that has little outward manifestation)?

Related question: How can they identify/measure stress and fatigue objectively enough (not solely via self-report) to identify a certain deficit (or type of deficit) as its cause, given that outward behavior suggests little or no deficit?

I don't understand the distinction. If a person can perform all normal tasks, but it causes them anxiety to do so, I would imagine that the problem is the anxiety itself and not a developmental impairment. I mean, if a person has no outward signs of having a lack of social skills...do they really lack social skills? Even if it's hard for them, it seems like the issue would revolve around a different kind of deficit than developmental. They have the knowledge but not the stamina to apply it easily.

In any case, can't a patient self-report uncomfortable levels of stress and fatigue?

Stress in the human body is cumulative across several layers. When the stress builds up it can overload the system and lead to distress. This causes many of the abnormal behaviors that are exhibited.

As Darmok stated "the answer will come with wearable monitors that record physiology." We are at the verge of seeing this type of technology hit the store shelves.

Although changes in heart rate often co-vary with emotions, it is the pattern of the heart's rhythm that is primarily reflective of stress and emotional states, especially emotions that do not lead to large autonomic nervous system (ANS) activations or withdrawals. These changes in rhythmic patterns are independent of heart rate; that is, one can have a coherent or incoherent pattern at higher or lower heart rates. Thus, it is the pattern of the rhythm (the ordering of changes in rate over time) rather than the rate (at any point in time) that is most directly related to emotional dynamics and physiological synchronization. Also, the coherent state is fundamentally different from a state of relaxation, which requires only a lowered heart rate and not necessarily a coherent rhythm.

Physiological coherence, also referred to as heart coherence or cardiac coherence, is a functional mode, measured by heart rate variability (HRV) analysis wherein a person's heart rhythm pattern becomes more ordered and sine wave–like, at a frequency of around 0.1 Hz (10-second rhythm). The term physiological coherence embraces several related phenomena—auto-coherence, cross-coherence, synchronization, and resonance—all of which are associated with increased order, efficiency, and harmony in the functioning of the body's systems. When one is in a coherent state, it reflects increased synchronization and resonance in higher-level brain systems and in the activity occurring in the two branches of the ANS (sympathetic and parasympathetic), as well as a shift in autonomic balance toward increased parasympathetic activity.

Heart rhythm coherence is reflected in the HRV power spectrum as a large increase in power in the low frequency (LF) band (typically around 0.1 Hz) and a decrease in power in the very low frequency (VLF) and high frequency (HF) bands. A coherent heart rhythm can therefore be defined as a relatively harmonic (sine wave–like) signal with a very narrow, high-amplitude peak in the LF region of the HRV power spectrum with no major peaks in the VLF or HF regions.

Source: Resilience Training Program Reduces Physiological and Psychological Stress in Police Officers