Although autism diagnoses are on the rise, King’s College London found that as many as 90% of middle-aged and older adults with autism may remain undiagnosed.
Meanwhile, researchers have said that autism spectrum disorder (ASD) remains “significantly underdiagnosed” in women.
Part of the reason for that may be that women and girls are likelier to “mask” their autism than boys. But anyone can “mask” – and according to psychologist Dr Mikki Lee, who specialises in autism and ADHD assessment, you can do it without even realising.
What is masking?
Also known as camouflaging, masking “is the process of consciously or unconsciously hiding autistic traits or imitating others to appear more neurotypical (and fit in),” said Dr Lee.
People who mask might mimic the individuals they’re talking to, or draw social “scripts” from TV shows and movies. They could also try to hide or adapt behaviours like “stimming’ (doing an action like flapping your hands to help regulate your emotions and/or sensory input) or avoiding eye contact.
“Masking has been well-documented in neurodivergent individuals, especially women and girls, which is why many of them do not get diagnosed with autism until later in life,” the psychologist added.
It can be “exhausting because it involves constant monitoring and adjusting of your behaviour”.
“Research has shown that long-term masking can result in anxiety, depression, and chronic exhaustion and burnout, sometimes called autistic burnout,” he continued. “It can also lead to an unclear sense of identity (‘who am I when I’m not performing?’), and feelings of loneliness (it is hard to truly connect with others while also masking).”
Still, she said, not all masking is inherently bad. It can be a useful tool in some settings, like the workplace. “However, there may be an issue if you feel like you cannot stop masking or if there are significant negative consequences of doing so,” she added.
What are the signs you may be masking without realising it?
Dr Lee shared “some of the most common signs that a person may be masking without realising it”, though she stressed that it’s important to note these signs alone do not mean that someone is autistic.
They include:
1) Feeling like you need to study the “rules” of socialising
The expert said you might be “masking” if you feel like you’re going through the motions when you converse, perhaps by asking a follow-up question because you’ve learned you should and not because you naturally want to.
“You may find yourself studying others to see how they interact in social situations (e.g., how they gesture, make eye contact, or respond emotionally), and then consciously or unconsciously imitating them,” she explained.
2) Forcing eye contact or consciously monitoring how much is ‘enough’ eye contact
You might resort to methods like looking “at the person’s nose or between their eyes to give the impression of eye contact if it feels very difficult”, but still feel pressured to conform to the social norm, said Dr Lee.
3) Feeling the urge to “perform”
To some extent, we might all feel the need to be “on” in social settings. But if this feels tiring and/or socialising doesn’t seem to come “naturally” to you (as it seems to others) you may be masking, the psychologist said.
4) Scripting or rehearsing conversations in advance
Maybe you run through a mental list of things you’re “supposed” to say at a party or gathering before arriving. Dr Lee said this can happen among autistic people who “mask”.
5) Feeling like you need to constantly monitor yourself in social situations
“You may be asking yourself, do I look interested? Am I talking too much/smiling enough? Was my response appropriate?” the expert continued.
6) Acting very differently depending on the social setting
It’s normal to behave differently at work than you do at home. But this can be exaggerated among those who mask, the psychologist shared. You might act very differently with friends or with a romantic partner, for instance, “which can leave you feeling unsure which version is the ‘real’ you”.
7) Feeling a lot more exhausted by socialising than you might look
Another sign is that you appear very social and outgoing to others, but it requires a significant amount of effort on your part, which can then leave you feeling exhausted and needing a lot of alone time to recover, she suggested.
8) Suppressing things that feel natural to you
This can include “stimming, moving your body in ways that feel regulating, sharing intense interests, or expressing strong emotions”.
9) Pushing through sensory overwhelm
Maybe you find bright lights or loud noises very distracting and even upsetting. But around others, Dr Lee suggested, you might try to “push through” it without telling those around you how you feel or showing any signs of overload.
10) Being told you are “too much” from a young age
Sometimes, the specialist said, people with undiagnosed autism might learn that their traits are unacceptable in social settings, and so begin to monitor and adjust their actions accordingly.
“For example, you may have been told that you are too sensitive, dramatic, or intense with your words or actions. As a result, you may try to behave in a more ‘agreeable’ way,” she explained.
“It would be helpful to reach out to a professional if these signs of masking resonate strongly with you, especially if they have been present at a young age, and if they are causing you distress.”
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