Behind the Mask: Unveiling the Realities of Adult Autism

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Autism spectrum disorder (ASD), most commonly associated with childhood— can also affect adults, sometimes without their knowledge. In this article, we’ll dive into the world of adult autism, touching on the difficulties of getting diagnosed, tips for improving social skills, the stress of masking, dealing with social anxiety, managing other mental health issues, coping with autistic burnout, handling job-related challenges, and the roadblocks that often hinder the right diagnosis.

The Underdiagnosis Challenge 

Late-onset autism is still not getting enough attention, a worry that medical research has confirmed in multiple studies. The misleading perception that autism is a pediatric issue can result in many adults not receiving the necessary evaluation and support. Furthermore, diagnostic criteria have evolved over time, and many practitioners are poorly equipped to provide proper care at this stage. Many adults with autism often state they have felt “misunderstood” or “written off” during their path to diagnosis and treatment. 

Social Competence Strategies 

Studies have shown that adults with autism often come up with clever ways to handle social situations in a world that expects people to be “typical” in their behavior. These strategies often include imitation, mimicry, and the creation of social scripts (Faso et al., 2017). By using these techniques, they can interact with others more seamlessly while mitigating social challenges. This adaptability is a testament to the resilience and resourcefulness of adults with autistic traits. 

Stress and Masking 

Masking is a common coping mechanism for adults who have autism. Masking involves consciously or unconsciously suppressing autistic traits to conform to societal norms or “blend in.” While it allows individuals to fit in, it can be a source of significant stress on a 

daily basis. The effort and energy required for masking can lead to emotional exhaustion and mental health challenges. Addressing this stress is essential for providing effective support and interventions for adults with autism. 

Social Anxiety 

Social anxiety often occurs with autism in adults. The fear of judgment, difficulty in social interactions, and sensory sensitivities can intensify anxiety symptoms. Tailoring interventions to address social anxiety is crucial, as it is frequently a significant barrier to participating in work, relationships, and social activities. 

[ At OCHP, we provide a group masterclass in social skills to assist you in confidently navigating a world that may seem challenging at times. ]

Psychiatric Comorbidities 

It sounds like a handful, because it is. Psychiatric comorbidities mean having more than one mental health issue at once. It’s like dealing with multiple emotional and mental challenges together, such as feeling anxious and sad at the same time. For adults with autism, conditions like depression, anxiety, and ADHD are quite common. These additional challenges can make autism-related difficulties even harder to manage, and they need special treatments. It’s crucial for healthcare providers to pay close attention to and treat these comorbidities to improve overall well-being. Unfortunately, because there isn’t always enough awareness, some adults may not get the right care and may struggle to find the help they need. 

Employment Issues 

Adults with autism often face unique challenges in the workplace. They may possess valuable strengths such as attention to detail, dedication, and expertise in specific areas. However, difficulties with social interactions, sensory sensitivities, and executive functioning can hinder their job performance and career advancement. Supportive workplace accommodations, including sensory-friendly environments and clear communication, are crucial for their success. 

Autistic Burnout 

Autistic burnout, a well-documented phenomenon (Mantzalas et al., 2022), is characterized by profound mental and physical exhaustion resulting from the continuous need to mask and conform to a neurotypical environment. Adults with autism may be particularly susceptible to burnout, as they not only have to deal with day-to-day “adulting”, they also have to function as a part of society. Recognizing and managing autistic burnout is essential for their mental and emotional well-being. 

[ At OCHP, our team of specialized clinicians is dedicated to addressing complex conditions, ensuring that our patients receive comprehensive care, do not experience any lapses in treatment, and ultimately prevent burnout. ] 

Misinterpretations Hindering Accurate Diagnosis 

Diagnosing adult autism can be complicated due to various challenges and misinterpretations:

  1. Lack of Awareness: Both the public and healthcare professionals often lack awareness of adult autism. The misconception that autism is solely a childhood condition can lead to missed diagnoses in adults who have learned to compensate for their differences. 
  2. Changing Diagnostic Criteria: Diagnostic criteria for autism have evolved over the years. Although the most recent standards now recognize adult-onset autism, clinicians must be attentive to cases that may not precisely align with these criteria. 
  3. Gender Differences: Historically, autism research and diagnosis have focused primarily on males. As a result, females and non-binary individuals may face misdiagnosis or delayed diagnosis. Understanding the gender-specific manifestations of autism is crucial for accurate diagnosis. 

In conclusion, adult autism is a complex and often underdiagnosed condition that warrants greater recognition and understanding. By acknowledging the social competency strategies, the stress associated with masking, psychiatric comorbidities, social anxiety, autistic burnout, employment challenges, and the barriers to proper diagnosis, we can provide better support for individuals with late-onset autism. It is crucial to embrace their unique experiences and needs to foster a more inclusive and supportive society, ultimately enhancing their well-being and quality of life. 


  • Faso, D. J., Sasson, N. J., & Pinkham, A. E. (2017). Evaluating posed and evoked facial expressions of emotion from adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, <>. 
  • Mantzalas, J., Richdale, A., & Achini, A. (2022). What Is Autistic Burnout? A Thematic Analysis of Posts on Two Online Platforms, <>