In the world of autism, “Autism Masking” or “camouflaging” has become an increasingly discussed concept over the past few years. The term refers to the learned behaviors that autistic individuals adopt to hide or suppress traits that are perceived as “different” from the neurotypical standard. Though often a survival strategy in social settings, Autism Masking can have a profound and detrimental impact on an autistic person’s mental health, ability to self-regulate, and overall sense of identity.
These behaviors not only make it harder for an autistic person to navigate life with confidence, but they can also significantly affect the diagnostic process, leading to delayed or incorrect diagnoses. Worse still, in some cases, Autism Masking is reinforced by industry professionals themselves, further complicating care. This blog will explore what Autism Masking is, how it impacts autistic individuals, and why clinicians must rethink traditional therapeutic approaches in favor of more neurodiverse-affirming care.
What Is Autism Masking?
Autism Masking, in the context of autism, refers to the act of concealing or minimizing autistic traits in order to fit in with societal expectations. For many autistic individuals, this behavior becomes a coping mechanism, adopted early on to avoid judgment or exclusion. While it may seem harmless at first glance, Autism Masking often involves suppressing natural behaviors—such as stimming (repetitive movements like hand flapping, toe walking, or playing with small objects)—and adopting learned behaviors that are more socially acceptable.
For example, many autistic individuals are taught, either directly or indirectly, that maintaining eye contact, a common social norm, is an essential communication skill. For some, however, this behavior can be extremely uncomfortable or even painful. Despite this, they may continue to force themselves to engage in it in order to appear more “normal.” Autism Masking can also extend to suppressing emotions or attempting to hide signs of discomfort, such as avoiding social interactions or overanalyzing verbal cues in conversations.
This behavior is particularly common among adolescents and adults, who experience increased social pressures and the external enforcement of these learned behaviors. Interestingly, many adults only come to realize that they have been masking for years once they are introduced to the term itself. Acknowledging that they have been Autism Masking can be a liberating experience, as it allows them to understand their actions and take steps to embrace their authentic selves.
The Hidden Toll of Autism Masking
While Autism Masking can offer short-term relief from social exclusion, the long-term consequences can be significant. The mental and physical toll of constantly suppressing one’s natural behaviors is immense, leading to what is often referred to as “burnout.” For many, the stress and exhaustion of maintaining a socially acceptable façade can manifest as anxiety, depression, or even physical symptoms such as headaches and fatigue.
According to Suzanne Goh, co-founder and chief medical officer of Cortica, “Autism Masking behaviors can lead to fatigue and burnout.” This emotional strain may become so overwhelming that some individuals withdraw entirely from social interactions or experience feelings of isolation. The exhaustion that comes from masking can significantly hinder an autistic person’s ability to self-regulate and advocate for themselves, making it harder to ask for the accommodations or support they need.
Moreover, Autism Masking often distorts the diagnostic process. Because autistic individuals are actively hiding certain behaviors or characteristics, it can make identifying autism much more difficult. In some cases, Autism Masking behaviors can lead to a misdiagnosis, as clinicians may attribute the emotional struggles and social challenges to other conditions, such as anxiety or depression. As a result, an autistic individual may not receive an autism diagnosis or the necessary interventions that could help them thrive.
Autism Masking and Gender Disparities in Autism
An important factor to consider in the conversation about Autism Masking is the gender disparity in autism diagnoses. Research has shown that autism spectrum disorder (ASD) is nearly four times more prevalent in boys than in girls, according to the Centers for Disease Control and Prevention (CDC). However, this disparity may not reflect a true difference in the prevalence of the condition but rather the ways in which autism manifests in different genders.
Autism Masking behaviors are thought to be more common in females than in males, which can contribute to the underdiagnosis or later diagnosis of autism in women and girls. Female autistic individuals may be more adept at masking their symptoms or may adopt social strategies that are more aligned with societal expectations for female behavior. As a result, many girls and women go undiagnosed for years, while others may be misdiagnosed with other conditions such as social anxiety or depression.
This issue highlights the need for a more nuanced understanding of autism, one that acknowledges the diverse ways in which the condition can present itself in different individuals. Clinicians need to be aware of these gender differences and the possibility that masking may be more prevalent in females to ensure that they do not overlook or misinterpret key indicators of autism.
The Challenges of Autism Masking for Diagnosis
The implications of Autism Masking extend beyond social struggles and mental health. It can also have a significant impact on the diagnostic process. Because masking often involves concealing or minimizing behaviors associated with autism, it can make the signs of the condition less obvious to clinicians, resulting in a delayed or missed diagnosis.
Lillian Vosa, regional director of speech and feeding services at Ally Pediatrics, explains that Autism Masking complicates the diagnosis of autism because “masking means that a person has found ways to minimize or hide certain personal characteristics.” This means that the usual diagnostic assessments, which rely on observable behaviors, may not indicate autism at first glance. As a result, a more in-depth assessment may be required to uncover the true nature of the individual’s struggles.
Furthermore, Autism Masking can sometimes lead to a misdiagnosis, where an autistic person is mistakenly diagnosed with other conditions such as anxiety, depression, or attention-deficit/hyperactivity disorder (ADHD). This happens because the emotional toll of masking—such as the exhaustion and stress of constantly concealing one’s true self—can manifest as mental health issues. It’s important for clinicians to ask more detailed questions and explore the individual’s history more thoroughly in order to avoid these pitfalls and provide an accurate diagnosis.
The Role of Therapy Providers in Addressing Autism Masking
Therapists and clinicians play a critical role in both recognizing and addressing masking behaviors. However, traditional therapeutic approaches have often reinforced Autism Masking, even when the intention is to help. Therapies like Applied Behavior Analysis (ABA) and speech therapy have historically focused on helping individuals with autism appear more “normal” or socially acceptable.
For example, ABA therapy has often taught children to suppress self-stimulatory behaviors such as hand flapping or rocking, as these behaviors are seen as disruptive in neurotypical settings. Similarly, speech therapists may work on encouraging eye contact, even though maintaining eye contact can be painful or overwhelming for some autistic individuals. These approaches, while well-meaning, inadvertently reinforce the idea that it’s better to mask one’s natural traits in order to fit in.
This historical focus on normalization is slowly being challenged. As more research and lived experiences from autistic individuals come to the forefront, there is a growing push for neurodiverse-affirming care. Instead of focusing on making autistic individuals fit into a neurotypical mold, the goal should be to support them in embracing their true selves.
For instance, Lillian Vosa highlights the importance of early intervention with young children, emphasizing that “my work is heavily to make sure I’m not teaching masking behaviors because I don’t want it to impact them later.” This shift in approach is essential to helping autistic individuals grow up with a healthy sense of self-worth and identity.
Shifting Toward Neurodiverse-Affirming Care
In order to better support autistic individuals, clinicians and therapists must adopt a more neurodiverse-affirming approach. This means acknowledging that autistic people may have different ways of communicating, processing emotions, and navigating social situations, and that these differences should be celebrated rather than suppressed.
Clinicians must also educate themselves on the harmful effects of Autism Masking and work to create environments where autistic individuals can feel comfortable expressing their authentic selves. This includes working with individuals to recognize when they are masking, understanding the emotional and physical toll it takes, and helping them develop coping strategies that allow them to feel safe without resorting to masking behaviors.
Moreover, family members should also be educated about masking and the impact it has on their loved ones. Family support is vital in creating a safe, accepting environment where the individual feels understood and validated. This support can go a long way in reducing the pressures to mask and fostering stronger, more authentic relationships.
Conclusion
Autism Masking is a complex and often harmful behavior that can have lasting consequences for autistic individuals. While it may seem like a coping mechanism in the short term, masking can lead to burnout, mental health struggles, and misdiagnoses, which can prevent individuals from receiving the appropriate care and support they need. To better support autistic people, clinicians must shift away from traditional approaches that prioritize normalization and adopt more neurodiverse-affirming practices. By helping individuals recognize their masking behaviors and embrace their authentic selves, we can create a more inclusive and compassionate world where all autistic individuals can thrive.
