Until recently, the sex ratio for autism was estimated to be four boys to one girl. However, girls and women are increasingly being referred to specialists for diagnostic evaluation, and a recent study found a sex ratio of two to one. Why has the true prevalence of autism in girls and women not been previously identified? The answer is that girls and women often engage in masking, consciously or unconsciously concealing their autism traits in social situations, which makes it harder for them to be diagnosed.
One of the main characteristics of autism is impaired communication and social interaction. The social and interpersonal aspects of life are a challenge. So how does a person with autism adapt to these challenges?
Masking
A person with autism can acquire successful social and interpersonal skills by observing peers and people in general, analyzing and interpreting their social behavior, and then copying the observed social rules and conventions and thereby effectively masking their social difficulties. The individual creates a social “mask.” Masking was first thought to be an adaptation in autism in girls and women, but is now recognized to occur in men as well.
Examples of masking in people with autism
Disguising autism may involve trying to consciously:
- Change their tone of voice.
- Making certain facial expressions.
- Making eye contact with other people.
- Using phrases that other people say in similar situations.
- Changing your body language.
Autistic people with higher skill levels can change all of these things in an effort to conform to accepted social norms.
Some might say that everyone does something similar – changing the way they hold themselves and speak depending on the situation. However, for non-autistic people, this is natural behavior; it’s normal for them to respond to social cues to become more successful in a situation. For autistic people, things are different.
First, autistic people disguise themselves simply to avoid serious negative consequences, such as rejection by others or bullying. Second, they may not be able to perceive social cues, and they have to act not intuitively, but constantly consciously control themselves. For example, constantly reminding themselves to look the other person in the eye, which may make it harder for them to understand what is being said. Thirdly, this constant control over themselves becomes a source of great overstrain and stress.
What consequences can masking lead to
Research shows that it is linked to phenomena such as:
- Physical, emotional, and intellectual exhaustion.
- Increased anxiety, depression, low self-esteem.
- Negative self-perception, loss of the ability to understand who you are.
- Emotional burnout.
- Suicidal thoughts.
On the other hand, research also shows that advanced masking ability helps autistic people in employment and reduces the risk of social isolation. Poor masking skills have even been linked to the risk of verbal abuse and even physical assault. Attempts to ‘unmask’ and talk openly about their autism can have very negative consequences.
Why it is important to recognize masking autism
The problem is that masking often makes autism difficult to diagnose, especially in girls and women. Many traditional diagnostic criteria and tests were developed based on observations of boys with autism, and do not take into account the specificity of symptom presentation in other genders. As a result, girls may go undiagnosed for years or receive misdiagnoses such as anxiety disorder, depression, eating disorders or borderline personality disorder.
Late diagnosis results in a long period of time without the support the individual needs. Instead of targeted help, autistic people are forced to spend a great deal of energy on constantly adjusting to the world around them, which over time depletes their internal resources.
How to recognize masking autism
Recognizing autism in a person who actively uses masking can be difficult, even for experienced professionals. However, there are some signs that may indicate this:
- A constant feeling of social fatigue after interacting with others.
- A feeling of having to “play a role” in social situations.
- Difficulty understanding your own emotions and needs.
- High levels of anxiety, especially in social situations.
- Perfectionism in trying to “be normal” and fear of being wrong.
- Often people around them may perceive such people as “shy,” “perfectionist,” or “very adaptive,” unaware of the true reason for their behavior.
How to help people who mask autism
Supporting people with autism should start with recognizing their unique needs and respecting their way of being themselves. Rather than encouraging further masking, it is important to create an environment where they can safely express their authentic personality without fear of judgment or rejection. This may include:
- Accepting different ways of socializing (e.g., less eye contact).
- Allowing rest after social interactions.
- Support in forming real, not just masked, social connections.
- Open discussion of autism features in the community to reduce stigma.
Early diagnosis and the right support enable autistic girls and women to discover their abilities without constant self-monitoring and fear of being misunderstood.
Conclusion
Masking autism is an important but still under-recognized part of the autistic experience, especially in girls and women. In an effort to conform to societal expectations, they are forced to hide their true characteristics, with serious emotional and physical consequences. Understanding masking as a defensive strategy rather than as evidence of ‘no problem’ requires a rethinking of approaches to diagnosing and supporting people with autism.
Creating a safe, accepting environment, recognizing the signs of autism early, and avoiding the pressure to “be like everyone else” helps autistic people build fulfilling, aware, and harmonious lives. Rather than demanding that they constantly conform, society must learn to value the diversity of human experience and support everyone’s right to be themselves.
