Unmasking Autism: Discovering the New Faces of Neurodiversity

by Devon Price

We’re at an elevated risk of eating disorders,[32] alcoholism and drug addiction,[33] and insecure attachments to others.[34] We tend to maintain shallow relationships, out of fear that people would hate getting to know our “real selves.” We may withdraw from other people, leading to negative emotional and psychological outcomes. And the more isolated we are, the less practice we get socializing, leading to a feedback loop of social disempowerment and shame. Autism is also highly correlated with physical symptoms such as gastrointestinal issues,[35] connective tissue disorders,[36] and seizures[37] largely for genetic reasons. It co-occurs with other disabilities such as Attention Deficit Hyperactive Disorder (ADHD)[38] and dyslexia at a high rate.[39] Many Autistic people have trauma histories and post-traumatic stress symptoms, and as I’ve already mentioned, a lifetime of masking puts us at a high risk of conditions like depression and anxiety.[40] These are some of the most common conditions that co-occur alongside Autism, but later in the book we’ll discuss additional disorders that overlap (or are mistaken for) Autism.

When Autistic girls engage in self-stimulatory behavior, it tends to be less physically damaging: less arm biting, more hair twirling or opening and closing a book quietly many times.[4] When Autistic girls are shy and withdrawn, people are less concerned by it than they would be if a boy exhibited the same reticence. On the flip side, when Autistic girls have meltdowns, it tends to get written off as an emotional outburst. When they do act out or behave aggressively, they’re more likely to be punished severely for not being ladylike, resulting in them learning to censor their aggression at an earlier age than most boys do.[5] Adults speak to young girls using more emotion-related words than they do when speaking to boys,[6] which means Autistic girls often get a leg up in social and relational skills. Much of the play that girls stereotypically engage in (and are encouraged to engage in) involves mimicking adult social interactions, such as playing house or pretending to run a store.[7] As a result many Autistic girls learn how to fake their way through routine conversations at a younger age than boys do. For these and a variety of other reasons, Autistic girls are assessed and diagnosed at older ages.[8]

Only about 4 percent of all mental health providers in the United States are Black,[30] though Black people make up 13.4 percent of the country’s overall population.

Approximately 50 percent of people who are killed by police have disabilities,[48] and Black and brown Autistics are at an especially elevated risk.[49] Being identified as Autistic can be socially and emotionally perilous for women and gender minorities, regardless of race; for Black and brown Autistics, being visibly disabled can be deadly.

If anything about them seemed unusual, ADHD was probably what people guessed. Incidentally, Autism and ADHD co-occur at very high rates, and are diagnostically quite difficult to untangle.[69] Psychologists often call them “sister conditions” because both of them impact things like distractibility, sensory seeking, and being deeply pained by social rejection. This brings me to the next group of Autistics who often get overlooked: those with comorbid and overlapping conditions.

Autism can also look a lot like an anxiety disorder. Most of us are anxious nearly every moment we’re around other people, after all. Overstimulating, unpredictable surroundings will tend to activate our fight-or-flight response. The rituals and repetitive behaviors we develop to cope with stress can look a lot like Obsessive-Compulsive Disorder. Autistic burnout presents very much like a major depressive episode. All too often, these negative mental health consequences of masking are what a therapist recognizes, rather than the untreated disability that’s caused it. Some undiagnosed Autistic people (particularly women) identify as “highly sensitive persons.”[73] Highly sensitive persons are generally described as intuitive, emotionally astute, and easily overwhelmed. Even the creator of the term, Elaine N. Aron, has revealed that some of the highly sensitive family members she has described in writing later found out they were Autistic.[74] The stigma that comes with Autism (and its very male, standoffish associations) may be part of why so many women on the spectrum find labels such as anxious and highly sensitive to be far more resonant.

Researchers Zablotsky, Bramlett, and Blumberg set out to understand how parents perceive the “severity” of their Autistic kids’ symptoms.[9] They surveyed nearly a thousand families raising Autistic kids, and also measured the Autism symptom severity of the children themselves. What the researchers found was that parents did not accurately perceive the level of their kids’ suffering. Instead, parents based their ratings of Autism “severity” on how much their kids’ behavior bothered them and required a lot of their time and attention. Many children described by parents as “high functioning” were quietly coping with debilitating sensory pain, or were falling behind academically or socially in significant ways. This carries over to how Autistic adults are perceived, and the expectations that neurotypical institutions place on us to appear “normal.”

Forty-six percent of Autistic adults who underwent ABA therapy as kids report having Post-Traumatic Stress Disorder (PTSD) as a result of the experience.[16]

Sadly, the comfort and convenience of the neurotypical teachers and parents are prioritized, so ABA remains the one and only “evidence-based” treatment for Autism that most insurance plans will cover. Becoming “well behaved” is more important than being psychologically well.

Autism and eating disorders are highly correlated, especially among women,[20] trans people,[21] and maskers diagnosed late in life.

Clinical research has found that somewhere between 20 and 37 percent of diagnosed anorexia nervosa sufferers are Autistic.[24]

However, recent research by Griffiths and colleagues (2019) does describe Autistic adults as having an elevated vulnerability to financial exploitation, domestic violence, relational abuse, and emotional manipulation.[43]

Masking is a practice of silencing ourselves and letting neurotypical expectations dominate our actions, rather than being guided by our core personal values.

A study of Autistic schoolchildren found that many had trouble paying attention in classrooms where the walls were covered in distracting, bright posters, and the shelves were stuffed with books and toys.[3]

Just as we crave direct communication, we’re equally good at dishing it out—sometimes too good, in fact. Throughout our lives, masked Autistics are punished for requesting clarity, being blunt, or saying directly the things others would rather imply.

Though Autistic people have a reputation for being “bad” at communicating, the data shows that really isn’t the case. A study by Crompton et al. published in 2019 found that when two Autistic people were paired together to work on a task, they were very efficient social communicators. They spread a lot of knowledge and nuance in a short span of time, completed the task quickly, and connected to one another easily.[12] However, when paired with non-Autistic conversation partners, Autistics were frequently misunderstood and not listened to. This study suggests that much of what researchers consider the “social deficits” of Autism aren’t really deficits at all; they’re just differences in our communication style that neurotypicals don’t adjust to.