By Dr. Oluwatosin Akande
We have grown far better, in recent years, at talking about autism in children. We have learned to praise stimming instead of suppressing it, to build visual schedules instead of demanding verbal fluency, and to treat a meltdown as communication rather than defiance. This progress matters, and it should continue. But somewhere in our collective imagination, autism quietly stops being a childhood story and becomes an adult mystery. We rarely ask what happens to the nonverbal boy who is now twenty-six, or the girl who spent her school years learning to fake eye contact so well that no one ever thought to test her. We built our understanding of autism around children because children are visible, dependent, and easy to picture in a classroom. Adults on the spectrum, by contrast, often become invisible by design, not because their autism disappeared, but because they learned, at great personal cost, how to hide it.
This piece is not an attempt to repeat what has already been well said about communication, sensory needs, or classroom inclusion. It is an invitation to sit with a harder and less comfortable question: what happens to autistic people once childhood ends, once the accommodations stop, and once the expectation becomes that they should have “outgrown” their differences? The answer, I will argue, is a phenomenon called masking or camouflaging, and understanding it may be one of the most urgent, under-discussed frontiers in how we support autistic people well into adulthood.
What Masking Actually Is
Masking, sometimes called camouflaging, refers to the conscious or unconscious suppression of natural autistic traits in order to appear neurotypical. It can look like forcing eye contact that feels physically uncomfortable, rehearsing conversations in advance so that responses sound spontaneous, mimicking the facial expressions of others a half-second late, or holding in a stim until you are alone in a car or a bathroom stall. It can mean laughing at a joke you did not understand because everyone else laughed first. None of this is deception in the way we usually think of the word. It is closer to translation, a constant, exhausting act of converting an internal experience into a performance that the world will accept.
What makes masking so difficult to see, and therefore so difficult to support, is precisely that it works. A well-practiced mask can be so convincing that teachers, employers, partners, and even clinicians miss the autism entirely. This is one reason so many autistic adults, particularly women and people from marginalized communities, go undiagnosed until their thirties, forties, or later, often only after a child of their own is diagnosed and the parent recognizes, with a jolt, their own childhood in the assessment questions.
Why People Mask in the First Place
Masking rarely begins as a strategy a child chooses freely. It begins as a survival response to an environment that punishes difference. A child who is teased for flapping their hands learns to sit on them. A child whose blunt honesty is labelled rude learns to filter every sentence through an internal committee before speaking. A student whose intense, narrow interest is mocked learns to talk about football instead of astrophysics, even though astrophysics is what actually lights them up inside.
Over years, this becomes automatic. Many autistic adults describe an almost involuntary scanning process in any new environment: reading faces, calculating acceptable eye-contact duration, monitoring the volume of their own voice, suppressing the urge to correct an inaccurate statement. None of this looks effortful from the outside. That is exactly the problem. The very success of the mask hides the cost of wearing it.
The Social Bargain Behind the Mask
It is worth naming the bargain clearly, because it explains why masking persists even when it hurts. Society offers autistic people an implicit deal: hide your differences well enough, and you may be granted access to jobs, friendships, relationships, and safety from bullying or discrimination. The bargain is rarely spoken aloud, but it is enforced constantly, in the raised eyebrow at an unusual laugh, in the promotion given to the colleague who is a smoother talker rather than the one who does better work, in the subtle social exile of the child who does not quite fit the rhythm of the playground. Masking, then, is not a personal failing or a strange quirk. It is a rational, if costly, response to a world that has not yet made room for a wider range of ways to exist.
The Hidden Cost: Autistic Burnout and Mental Health
Here is the uncomfortable truth that a childhood-centered view of autism tends to miss: the mask has a bill, and it comes due. Sustained camouflaging has been linked, in growing clinical and research literature, to elevated rates of anxiety, depression, exhaustion, and suicidal ideation in autistic adults, rates markedly higher than in the general population, and in several studies higher than for autistic people who mask less. This is not a coincidence. Constant self-monitoring consumes cognitive and emotional resources that a person would otherwise spend on rest, connection, or simply existing without vigilance.
Many autistic adults describe a state now widely referred to as autistic burnout: a period of profound exhaustion, loss of skills that were previously manageable, increased sensory sensitivity, and a kind of shutdown that can last weeks or months. Burnout is often misread by families, doctors, and employers as laziness, depression alone, or a sudden personality change, when in fact it may be the direct consequence of years spent performing a version of oneself that was never sustainable. Recovery from burnout typically requires the opposite of what caused it: reduced demands, permission to unmask, and time spent in environments where the person does not have to perform.
If we are serious about protecting the wellbeing of autistic people, we cannot only ask how a child regulates a meltdown at age seven. We must also ask how an autistic accountant survives an open-plan office at thirty-two, how an autistic mother copes with a birthday party she is expected to host and enjoy simultaneously, and how an autistic retiree makes sense of a lifetime of being told they were simply “shy” or “intense” or “difficult,” never autistic at all.
The Myth of Growing Out of It
There remains a persistent, damaging belief that autism is something children eventually outgrow, or that adults who function well in a job or a marriage cannot really be autistic. Both ideas are false, and both ideas cause real harm. Autism is a lifelong neurological difference, not a phase of childhood. What often changes with age is not the underlying wiring but the sophistication of the mask layered over it. A quiet, agreeable, seemingly independent adult may be spending every ounce of their energy holding a performance together, only to collapse into overwhelm the moment they are alone.
This myth has consequences beyond misunderstanding. It shapes who gets diagnosed, and therefore who gets access to accommodations, community, and language for their own experience. Diagnostic criteria and assessment tools were built, for decades, around how autism presents in young boys. Girls, women, and people who mask heavily are frequently missed by these same tools, not because their autism is milder, but because it looks different, quieter, more internalized, more likely to be mistaken for anxiety, an eating disorder, or a personality trait rather than a neurodevelopmental one.
Late Diagnosis: Grief, Relief, and Rebuilding
For adults who receive an autism diagnosis later in life, the moment often brings two emotions at once: relief at finally having language for a lifetime of feeling out of step with the world, and grief for the years spent believing something was simply wrong with them as a person. Many describe re-reading their own history through a new lens, the friendships that ended mysteriously, the jobs that collapsed under sensory overload, the exhausting effort of small talk at every family gathering, and recognizing, often for the first time, that none of it was a character flaw.
Supporting late-diagnosed adults well means resisting the urge to treat the diagnosis as an ending point, a label applied and then filed away. It should be a beginning: an invitation to relearn one’s own needs without the pressure to mask, to grieve what masking cost, and to build a life that does not require constant translation of the self into someone else’s language.
Rethinking Support Across the Whole Lifespan
If childhood-focused support has taught us anything useful, it is that environments can be redesigned around a person rather than demanding the person redesign themselves. The same principle must extend into adulthood, and it requires deliberate, structural change rather than individual willpower.
In the Workplace
Allow flexibility in communication style, written instructions alongside verbal ones, and permission to ask for clarification without penalty.
Offer sensory-considerate spaces: adjustable lighting, quiet rooms, and permission to wear headphones or use fidget tools without comment.
Judge performance by output and contribution, not by eye contact, small talk, or apparent enthusiasm in meetings.
Normalize direct, literal communication instead of treating it as blunt or socially deficient.
In Relationships and Family Life
Recognize that needing time alone after socializing is not rejection, it is recovery.
Ask directly about needs rather than expecting them to be inferred through social cues.
Make space for intense interests as a source of joy and connection, not something to be tolerated.
Understand that a flat tone or reduced facial expression does not signal a lack of feeling.
In Healthcare and Diagnosis
Train clinicians to recognize how autism presents in adults, women, and people who mask heavily, not only the childhood presentation.
Treat a request for adult assessment with the same seriousness as a childhood referral.
Screen for autistic burnout as a distinct experience, rather than defaulting only to a diagnosis of depression or anxiety.
A Thought Worth Sitting With
Perhaps the most provocative claim in this piece is this: the smoothness with which an autistic adult appears to function in the world is not proof that support is unnecessary. It may be proof that support has simply become invisible, outsourced entirely to the exhausting internal labor of the autistic person themselves. Every family, school, workplace, and clinician who assumes that a well-masked adult “has it together” should ask a harder question: together at what cost, and to whom is that cost being paid?
It is worth adding that none of this is an argument against strength, capability, or joy. Many autistic adults build extraordinary careers, families, and creative lives, and framing every success as evidence of hidden suffering would be its own kind of disrespect. The point is not that competence is a mask and exhaustion the only truth beneath it. The point is that competence and cost can coexist, and that noticing the cost does not diminish the achievement, it simply means we stop treating silence about struggle as proof that no struggle exists.
We do not ask a person using a wheelchair to prove their disability by demonstrating how tired they get from being forced to climb stairs anyway. Yet we routinely ask autistic adults to prove their needs are real only after the mask has cracked, after the burnout, the breakdown, or the diagnosis that arrives decades too late. A more humane approach would extend the same presumption of good faith we increasingly offer autistic children to autistic adults: that their reported experience is real, that accommodation is not indulgence, and that unmasking, even briefly, should never have to be earned through collapse.
Intersectionality: Culture, Stigma, and the African Context
Any honest conversation about masking must also reckon with the fact that the pressure to hide autistic traits is not distributed equally across cultures. In many African communities, including across Nigeria, autism is still frequently misunderstood as a spiritual affliction, a consequence of parental failure, or simply “stubbornness” that firm discipline will eventually correct. A child who does not make eye contact may be scolded for disrespect rather than supported for a genuine sensory difference. An adult who speaks bluntly, avoids crowded gatherings, or struggles with the elaborate social rituals expected at extended-family events may be quietly labeled proud, rude, or strange, with no one in the room considering autism as a possibility.
This cultural backdrop intensifies the pressure to mask. Where Western clinical settings are slowly learning to recognize camouflaging as a sign of unmet need, many African families have no vocabulary for camouflaging at all, only a sense that a child or adult who does not fit in must simply try harder. The result is a double burden: the exhausting internal labor of masking, compounded by the absence of any community language to name what is happening or why it is so tiring. For an autistic adult navigating both a demanding workplace and an extended family that equates normalcy with respectability, the mask is not optional performance, it can feel like the price of belonging to one’s own family.
This is precisely why the work of organizations advocating for autism awareness within African communities matters so deeply, and why that work must not stop at childhood. Awareness campaigns that reach parents of young children are necessary, but they are incomplete if they leave the culture’s adults, the uncles, aunties, older siblings, and community elders who themselves may be undiagnosed and unsupported, entirely out of the conversation. A truly effective cultural shift requires reaching backward across generations, not only forward toward the next one.
The Role of Community and Peer Connection
One of the most consistently protective factors against the harm of chronic masking is connection with other autistic people. Something shifts when an autistic adult, often for the first time in their life, sits in a room, physical or virtual, with people who stim without apology, who pause mid-conversation without needing to explain the silence, and who simply understand a sensory complaint without requiring it to be justified. Many describe this experience using a simple but powerful phrase: it is the first time they did not have to translate themselves.
Peer community offers something that clinical treatment alone cannot: a mirror rather than a correction. Support groups, online spaces, and autistic-led organizations give people a place to unmask gradually, to grieve years of exhausting performance, and to build an identity around their actual neurology rather than around the version of themselves they had to construct to be tolerated. Professionals working with autistic adults would do well to treat referral to autistic-led community spaces with the same seriousness as a referral to therapy or medication, not as an afterthought, but as a core part of care.
It also matters who leads these conversations. For too long, autism research, advocacy, and even service design have been shaped almost entirely by non-autistic professionals speaking about autistic people rather than with them. A more respectful model treats autistic adults, especially those who have lived through decades of masking, as the foremost experts on their own experience, and builds programs, workplaces, and diagnostic tools in direct partnership with them rather than merely for them.
Conclusion: An Understanding That Does Not Expire
Autism does not end at eighteen, and neither should our willingness to understand it. The conversation about communication, sensory needs, routine, and emotional regulation that shapes so much of early intervention must travel forward with the person into adolescence, adulthood, and old age. A child who is patiently given time to answer a question deserves an employer, years later, who extends that same patience. A child whose sensory environment is thoughtfully adapted deserves a partner, a landlord, and a healthcare system that continues that thoughtfulness long after they have left the classroom.
To truly respect autistic people is to recognize that the mask many of them wear so well is not evidence of ease, but evidence of effort, effort that deserves to be seen, named, and, wherever possible, made unnecessary. The goal is not simply to help autistic children survive childhood. It is to build a world in which autistic adults never have to disappear into a performance of normalcy just to be treated with dignity.
Understanding does not have an age limit. Neither should respect.
References
Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281-3294. https://doi.org/10.1007/s10803-016-2872-8
Hull, L., Petrides, K. V., & Mandy, W. (2020). The female autism phenotype and camouflaging: A narrative review. Review Journal of Autism and Developmental Disorders, 7, 306-317. https://doi.org/10.1007/s40489-020-00197-9
Mantzalas, J., Richdale, A. L., Adikari, A., Lowe, J., & Dissanayake, C. (2022). What is autistic burnout? A thematic analysis of posts on two online platforms. Autism in Adulthood, 4(1), 52-65. https://doi.org/10.1089/aut.2021.0021
Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., & Nicolaidis, C. (2020). “Autistic burnout is real”: Autistic adults’ perspectives on and experiences of autistic burnout. Autism in Adulthood, 2(2), 132-143. https://doi.org/10.1089/aut.2019.0079
Lai, M. C., & Baron-Cohen, S. (2015). Identifying the lost generation of adults with autism spectrum conditions. The Lancet Psychiatry, 2(11), 1013-1027. https://doi.org/10.1016/S2215-0366(15)00277-1
