Maybe you spend a lot of energy getting through social situations. You plan what to say, watch how others behave and copy it, then need time to recover. From the outside, you seem fine. This is often called masking. This page explains what it is, what it can cost and why it can delay a diagnosis.
What is masking?
Researchers often call it “camouflaging”. Most people simply say “masking”. It means hiding autistic characteristics, and using strategies to make up for the social and communication gaps that autism can create.
In practice, it means putting a great deal of thought into things other people do without thinking. One adult described it as like solving complex mental maths in your head all day long while carrying on as normal.
Masking is not dishonesty, and it is not a flaw. Research describes it as something people do for understandable reasons.
Why do people mask?
In one study, adults gave two main reasons:
- To avoid standing out. Some wanted to avoid bullying or losing a job.
- To connect with others. Masking was seen as a way to make friends and form relationships.
Some also said it gave them access to work, friendships and relationships, and protection from harm. Many asked themselves whether it meant “thriving or surviving”.
How masking can delay a diagnosis
When someone works hard to fit in, the people around them may see less of what they are going through. Adults in two studies said masking sometimes delayed their diagnosis. In one, people also said it led to their diagnosis being questioned or support being withheld.
Timing matters too. Adults diagnosed after 50 described growing up when autism was poorly recognised. Some had been treated for anxiety and depression, and felt isolated and “alien” growing up.
The research cannot tell us how many people have been missed, or exactly why. It draws on what diagnosed adults say about their own lives.
What can it cost?
In the studies we looked at, the most consistent thing adults described was exhaustion: tiredness, and needing time alone to recover. Some describe “shut down” days, or feeling “fake”, or as though they had lost the “real me”.
Research also links more masking with more anxiety and depression. That is a link, not proof that masking causes these difficulties. The researchers say it is plausible that people who already feel anxious or low mask more. They caution that their risk estimates cannot be used to diagnose anyone or to predict what will happen to one person.
Can ADHD be masked too?
Research on this is newer. A 2024 study found that adults with ADHD masked more than a comparison group, though autistic adults masked more than adults with ADHD. In that study, autistic traits, rather than ADHD traits, were linked to masking whatever a person’s diagnosis. So masking is not only an autism experience. This research cannot tell us how it relates to the timing of an ADHD diagnosis.
What can a later diagnosis mean?
People respond to a diagnosis in different ways. Some adults diagnosed after 50 saw it as a positive step. It helped them see themselves differently and recognise their own needs. Others said they masked less after a diagnosis, or when they were with accepting people. A review of adult diagnosis notes that strong emotions are common afterwards and that support services for adults are limited.
These are the experiences of people who chose to take part in research. Not everyone feels the same, and a diagnosis does not change how a person has lived.
NICE guidance on adult autism says that assessments should be adapted where needed, including the setting and the length and pacing of the appointment. If sensory or social demands worry you, it is reasonable to ask about this beforehand.
Recognising yourself is not a diagnosis
Seeing yourself on this page does not mean you are autistic or have ADHD. Tiredness, anxiety and low mood have many possible causes. A diagnosis comes from a full assessment by qualified clinicians, who look at your history, your strengths and your difficulties together.
NICE describes when to consider an autism assessment: persistent difficulties in social interaction or communication, or restricted interests and resistance to change, alongside things like trouble at work or in education, difficulty with relationships, or earlier contact with mental health services.
If you would like to talk it through
You do not have to decide anything today. Some people want an answer. Others just want to understand why life has felt harder than it looks from outside.
Curious Minds offers a free 20-minute phone consultation, where you can ask questions and talk through what is involved. Assessments take place in person in Dundee, with clinicians from three professions: clinical psychology, nursing and prescribing, and speech and language therapy. There are six pathways.
You can read more about adult autism assessment, adult ADHD assessment or a combined autism and ADHD assessment. If you are not sure yet, there is also information on neurodiversity screening. NHS vs private assessment sets out the differences, the FAQs cover common questions, and you can get in touch whenever you are ready.
The research behind this pageOptional reading
- What masking is. In a 2017 study of 92 adults with a clinical autism diagnosis (55% of them British), researchers described camouflaging as combining masking (hiding autistic characteristics) and compensation (strategies to make up for social and communication gaps). Adults gave two main reasons for it. Tiredness and needing time alone to recover was the most consistent effect they described. Participants said masking sometimes led to their diagnosis being questioned or delayed, and to support being withheld.
- A second study. A 2021 study of 277 adults who identified as autistic (206 of them with a diagnosis), mainly in the UK, analysed written answers about masking. One adult described it as like solving complex mental maths all day. Many questioned whether it meant “thriving or surviving”. Delayed diagnosis was one of the harms people linked to masking. 73 people used the word “exhausting”. Of the 72 who mentioned mental health, 44 mentioned anxiety and 23 depression. Separately, 17 of the 277 described feeling “fake”, and 15 described having lost the “real me”. Participants said they masked less after a diagnosis, or with accepting people.
- Diagnosis after 50. A small interview study of nine adults diagnosed after 50 found that they saw their diagnosis as a positive step. They described growing up when autism was poorly recognised, being treated for anxiety and depression, and feeling “alien”.
- A broad review of adult diagnosis notes that more adults are now being assessed, that the route to diagnosis can be unclear and different for each person, that strong emotions are common afterwards and that adult support services are limited.
- Masking and mental health. A survey of 305 autistic adults aged 18 to 75, mostly recruited in the UK, found that people who reported more masking also reported more symptoms of generalised anxiety, social anxiety and depression. This held after age and level of autistic traits were taken into account. The link was stronger for anxiety than for depression, and for depression it was small. The survey was a single snapshot, so the authors could not tell which came first. They say it is plausible that existing mental health difficulties lead people to mask more, and that their risk estimates “should not be considered as either diagnostic or deterministic”.
- ADHD. A 2024 study compared masking in adults with autism, adults with ADHD and a comparison group. Adults with ADHD scored higher than the comparison group on overall masking, and on one part of the questionnaire about trying to fit in. Autistic adults masked more than adults with ADHD. Autistic traits, not ADHD traits, were what pointed to more masking, whatever a person’s diagnosis.
Where this information comes from
This page is based on the official and published sources below, so you can read them yourself.
- Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai M-C, Mandy W. “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions. Journal of Autism and Developmental Disorders, 2017;47(8):2519-2534. https://doi.org/10.1007/s10803-017-3166-5 (PMC5509825). Published online 19 May 2017. Accessed 2026-10-09. Population: 92 adults with a clinical ASC diagnosis, 15 nationalities (55% British); qualitative online survey.
- Bradley L, Shaw R, Baron-Cohen S, Cassidy S. Autistic Adults’ Experiences of Camouflaging and Its Perceived Impact on Mental Health. Autism in Adulthood, 2021;3(4):320-329. https://doi.org/10.1089/aut.2020.0071 (PMC8992917). Published 7 December 2021. Accessed 2026-10-09. Population: 277 adults who identified as autistic (206 with a diagnosis, 71 self-identified) reporting lifetime camouflaging, mainly UK; written answers to open survey questions.
- Hull L, Levy L, Lai M-C, Petrides KV, Baron-Cohen S, Allison C, Smith P, Mandy W. Is social camouflaging associated with anxiety and depression in autistic adults? Molecular Autism, 2021;12:13. https://doi.org/10.1186/s13229-021-00421-1. Accepted 3 February 2021 (online date not stated in the copy read). Accessed 2026-10-09 (UCL Discovery PDF copy). Population: 305 autistic adults aged 18 to 75, mostly UK; cross-sectional online survey.
- Stagg SD, Belcher H. Living with autism without knowing: receiving a diagnosis in later life. Health Psychology and Behavioral Medicine, 2019;7(1):348-361. https://doi.org/10.1080/21642850.2019.1684920. Published 6 October 2019. Accessed 2026-10-09 (WestminsterResearch record). Population: 9 adults over 50, recently diagnosed; interviews.
- Huang Y, Arnold SR, Foley K-R, Trollor JN. Diagnosis of autism in adulthood: A scoping review. Autism, 2020;24(6):1311-1327. https://doi.org/10.1177/1362361320903128. Online date not stated in the copy read. Accessed 2026-10-09 (Autism CRC summary page of the abstract).
- van der Putten WJ, Mol AJJ, Groenman AP, Radhoe TA, Torenvliet C, van Rentergem JAA, Geurts HM. Is camouflaging unique for autism? A comparison of camouflaging between adults with autism and ADHD. Autism Research, 2024;17(4):812-823. https://doi.org/10.1002/aur.3099. Published online 7 February 2024. Accessed 2026-10-09 (Europe PMC record of PMID 38323512; abstract level only).
- National Institute for Health and Care Excellence. Autism spectrum disorder in adults: diagnosis and management (CG142). https://www.nice.org.uk/guidance/cg142. Published 27 June 2012, last updated 14 June 2021. Accessed 2026-10-09.
This page is general information. It is not a diagnosis or medical advice.
