Autism in Females: Masking & Camouflaging

At The Autism Pathway, we have seen an increase in referrals for diagnostic assessments for females. This is in line with research suggesting that the number of male-to-female individuals who are referred for assessments has risen from 4:1 to 2:1 (Rutherford, McKenzie and Johnston 2016). One of the reasons for this increase is the ability of females to mask their neurodiversity to meet neuro-majority societal expectations.

Masking

Masking can be viewed as a coping mechanism autistic individuals employ to 'fit in' with a neurotypical majority. Masking can occur in many different contexts, including school, work, public, and when interacting with others.

Masking can also be referred to as camouflaging, as individuals attempt to hide their true authentic selves for fear of being misunderstood or judged.

Masking is thought to be more common in females. However, it is also present among males. More research is needed to find out about the lived experience of masking in different groups of people.

How do people mask?

Masking can be learned by closely observing, monitoring and copying the behaviours and interactions of other people. This can include celebrities, TV or book characters, or real-life people. Examples of masking behaviours may consist of copying facial expressions, forcing eye contact, changing the way you talk, hiding the urge to stim, hiding sensory overwhelm, rehearsing conversations, and trying to engage in conversations that you don't enjoy.

The impact of camouflaging

Masking means that people feel forced to hide their true authentic selves, which can have negative consequences, including:

Meltdowns, shutdowns and withdrawals following periods of masking. When people are in a 'safe space' such as at home, they can finally gain relief by being their true selves.
Autistic burnout as a result of exhaustion.
Increased risk of mental health difficulties, including anxiety, low mood and suicidality.
Feeling lonely and not having a sense of belonging.
Struggling to find an identity.
Lacking confidence and having low self-esteem.
Increased vulnerability to being taken advantage of.

How do you assess people who mask?

Masking can be a challenge for inexperienced clinicians as standard assessments do not always capture the nuances of their experiences. At The Autism Pathway, we take additional steps in order to ensure that we can explore possible experiences of masking. The following helps us to do this:

Our clinical lead has lived experience of masking and camouflaging and will be involved in complex cases where masking is suspected.
Our clinicians are experienced and have training in picking up masking during observations such as the ADOS-2.
Our clinicians may ask you about your experiences of masking to find out about your lived experiences.
We use the Camouflaging Autistic Traits Questionnaire (CAT-Q) to explore masking, if necessary.
We understand that special interests in females may have a more neuro-typical focus (e.g. in make-up, fashion, barbies, crochet or celebrities). Our clinicians are skilled in assessing if such interests can be considered from an autistic lens.
If we need to gain additional information in the form of second observations, interviews or questions, we will contact you to make sure we have all the information needed to consider masking. There is no additional costs if this happens.

Towards acceptance and awareness

It is important for society to recognise and support autistic females so that they do not need to rely on masking in order to ‘fit in’ and find acceptance. By highlighting the challenges faced by autistic females who mask and camouflage, we can work towards a more compassionate and inclusive society for all.

by Dr Kuly Heer

(BSc; PhD; DClinPsy; ADI-r, ADOS-2 & MIGDAS trained; HCPC Registered)

Clinical Psychologist & Clinical Lead