For generations, in medicine and by the general public, autism has been viewed as a disorder to be cured. The behaviors associated with autism have been deemed socially off-putting, impolite, or just plain weird. Even in the Medieval ages, there were legends of “changelings”, children that were swapped by fairies. These children were identified by their atypical traits, like unsoothable crying, developmental differences, and unusual behavior, a presentation that many in hindsight attribute to autism. In a book compiling supernatural myths, author Katharine Mary Briggs suggested that these children were even subject to physical abuse at the hand of their parents. Since the dawn of time, people have been willing to use brute force to pressure others into conformity because the idea of compliance to social norms runs deep in the veins of organized society. Due to their natural neurodivergence, from a young age most autistic people are socialized to mimic those around them and blend in at any cost. The expectation of acting neurotypical, or non-autistic, weighs heavy on many autistic people. The neurotypical socialization of autistic individuals leads to adverse effects on the wellbeing of autistic people.
Autism as a disorder was created to categorize and clinicalize behavior that diverged from the neurotypical norm. Autism was first classified as a diagnosis in 1911 as a variation of childhood schizophrenia This mischaracterization persisted with psychologists diagnosing with scientists believing autism was a form of schizophrenia in children throughout the 1920s and 1930s. Autistic behavior was so divergent from the social norm, that a natural variation in human development was considered a result of a break from reality. Only decades later, in the 1970s, did psychologists start to examine autism as a developmental disorder. Even then, the “severity” of autism determined the diagnosis a person would receive, ranging from what was considered the milder Aspeger’s to the most severe diagnosis of childhood disintegrative disorder. These diagnoses were used to measure how far a person was from neurotypical, and often would implicitly signify their worth. Even since Autism Spectrum Disorder combined a variety of developmental traits, people continue to use labels like high and low functioning, trying to classify “how autistic” someone is. Throughout all of its variation, the diagnosis of autism has remained a classification of divergence to be treated, leading to stigma and misconceptions around autism and harming autistic people.
Societal pressure is one of many forces that socialize autistic people into camouflaging their autism or “masking” through negative social messaging about nonconformity and autism. From the time autistic children start showing traits of ASD, those traits are seen as undesirable and discouraged by their caregivers. As a result, autistic people engage in masking behaviors, which are defined by Will Mandy, the Professor of Neurodevelopmental conditions, as “investing considerable effort daily in monitoring and modifying their behavior to conform to conventions of non-autistic social behavior.” Experiences that for autistic children are highly distressing, like flickering lights and loud noises, are frequently overlooked by adults which teaches autistic children that their needs are not important, and they begin to hide, or mask, their distress. Social pressure to camouflage is also enforced by the negative messaging over the diagnosis itself. Amy Pearson, a senior lecturer with an expertise in autism claimed that autistic kids “experience a lot of negative views about autism and autistic people.” For example, many characters in sit-coms and TV shows that autistic youth might watch growing up contain characters that are based around autistic traits, and those characters too often end up being the punchline. This trope has been around for ages, whether it be Luna “Loony” Lovegood or Abed from Community, a character’s divergence from the standard way they would be expected to act becomes the comedy. Additionally, the use of the word “autistic” to refer to someone as stupid has regained popularity in recent years amongst middle and high school aged children. The message to autistic children is clear: they need to hide themselves to be accepted. This leads to development of strategies to hide one’s autism. Olivia Guy-Evans, who is an expert in the field of neurodevelopment, describes the experience of masking as feeling “the need to be ‘on’ all the time, constantly monitoring their behavior and adjusting their actions to fit in with neurotypical expectations.” Existing as a person with ASD for most means spending endless energy putting on an act just to be accepted.
While most autistic people pick up on the fact that they will not be socially accepted if they exist as their authentic selves by merely participating in society, many others are socially ostracized. Autistic people who are viewed as different due to their failure to fully mask their autism are far more likely than the general population to face mistreatment at the hands of their peers. In surveys, autistic people report “frequent experiences with bullying, harassment, and ostracization”. What was once implicit becomes explicit. When their existence leads to social ostracization, autistic people often learn to survive by hiding themselves away. A study focused on the motivations behind social camouflaging reported that a response from one autistic woman for why she masks, “I want to avoid the bullying mostly,” is echoed by most across studies. Masking their behaviors is frequently the only way for autistic people to avoid marginalization in many social settings. And this is not only the case in adolescence. Another study looking at discrimination found that “once employed, people with autism may experience bullying, including the weaponizing of autistic traits by colleagues”. From childhood to adulthood, autistic people have to learn to socially camouflage to protect themselves from harassment and discrimination, behavior that becomes second nature despite its steep emotional price.
Therapeutic practices like Applied Behavioral Analysis (ABA) perpetuate the pressure for autistic people to mask and the harm masking creates, even if their intentions are to help their patients, by explicitly teaching masking behaviors. Ari Ne’eman, who is a disability rights advocate, believes that the primary goal of ABA therapy is inherently flawed. He stated that the therapy focuses on making autistic children “indistinguishable from their peers”. ABA therapy uses techniques like positive and negative reinforcement to discourage behaviors that make their patients recognizably autistic. Consistent punishment for natural behaviors like stimming can result in devastating consequences on the psyche of a child. Research into the effects of ABA on mental health has shown that “individuals who have experienced ABA therapy were shown to be 86 percent more likely to meet [PTSD] criteria compared to those not exposed to ABA” . Being forced into hiding yourself from a young age can be and is often traumatic, leading to diagnoses like PTSD and overall decreased mental health. On top of social ostracization and shame of themselves that autistic children already experience, some are forced into programs which, instead of addressing the child’s needs, aim to make them someone else entirely. Authenticity is not only not praised, it is punished in autistic individuals.
Neurotypical socialization and learned masking behaviors have many consequences on autistic people, like making it more difficult for autistic people to receive a diagnosis. Suppression of autistic traits is completely counterproductive to receiving a diagnosis. Will Mandy wrote about how masking impacts diagnosis. “Camouflaging can delay or even prevent diagnosis – an individual who has become expert at pretending not to be autistic is less likely to be referred for an autism assessment and less likely to be diagnosed if they are assessed.” Since professionals typically are trained to look for non-masked autistic traits, many autistic people will not be able to receive a diagnosis if they have spent their entire life hiding their autism. In clinical settings, even autistic people who mask still exhibit some autistic traits, however these traits look different to what professionals expect. Therefore, according to Olivia Guy-Evans, “they may not exhibit the stereotypical behaviors associated with autism.” Since those being assessed for autism present with some symptoms, in masked individuals, their symptoms might be misinterpreted if they do not fit the stereotype of ASD. People with autism might receive a variety of diagnoses that are inaccurate. For example, they may be “diagnosed with social anxiety disorder or a personality disorder”. Especially in the cases of a misdiagnosed personality disorder, that wrong diagnosis not only prevents a correct one, but also adds the stigma of a different disorder. The behaviors that protect autistic people from social consequences are the same ones that later in life prevent them from living life comfortably because they can no longer access accurate diagnostic resources.
Masking is disproportionately an obstacle to diagnosis in marginalized populations, leading to unequal access to support. For example, autism is severely underdiagnosed in women and the average time of diagnosis is much later in life when it does occur. Many professionals link this to masking and how women are socialized differently than men. Olivia Guy-Evans wrote on the subject, “females are often better at masking their autistic traits, leading to a higher likelihood of being overlooked or misdiagnosed.” But being better at masking does not make their lived experiences any easier. On the contrary, due to a more subtle presentation of ASD, women are less likely to receive a diagnosis and hence receive support. Additionally, Black and Latino people are disproportionately affected by underdiagnosis. According to research published in the Journal of the American Academy of Child and Adolescent Psychiatry, “African-American and Latino children with autism are diagnosed at older ages than white children”. This happens due to a multitude of factors, including higher rates of poverty and lack of resources, but social camouflaging also plays a role. Masking, in many social aspects, is similar to code-switching, the practice of changing the way you act to be perceived with more respect, usually implemented by people of color due to racism. The Pew Research Center found that 40 percent of Black and Hispanic adults say they need to change the way they behave around people of other races, especially white people. To understand why people of color are underdiagnosed with ASD, an understanding of intersectionality is required. Devon Price, who is an expert on masking, says that people of color are “more likely to be seen as a problem to be contained” when dealing with autistic traits. This pressure to be “contained” and seen as less of a problem manifests into pressure to mask autistic traits, making them less likely to be diagnosed.
Lack of diagnosis of ASD or its delay leads to a lack of resources, support and understanding of one’s self. Many autistic people grow up without a diagnosis. The experience of knowing you are different and not understanding why can be damaging to a person’s self-esteem and mental health. Hannah Mae, an autistic woman, described her life before she was diagnosed as “getting to the point of feeling like you can’t carry on because you don’t know what is ‘wrong’ with you”. Growing up lacking a diagnosis often leads autistic people to think there is something wrong with them and growing frustrations due to not being able to “fix” it. Getting diagnosed with autism, even if it is later in life, can help people understand themselves and treat themselves with more grace when it comes to what they used to perceive as their shortcomings. Not only that, a diagnosis can be greatly helpful to gaining support in academic and professional spaces. For example, with a diagnosis, autistic students are able to access Individualized Education Plans, or IEPs. These plans can be helpful as “a roadmap for educators, parents, and students, outlining specific goals, accommodations, and strategies to ensure academic and social success for students with autism”. When having access to accommodations, students are better able to thrive in school, something not available to those who lack a diagnosis. Receiving a proper diagnosis can be life-changing for autistic people, but they are often robbed of this as a consequence of masking behaviors they learned from the world.
The socialization of autistic people leads to higher rates of depression and anxiety. Autistic people report elevated rates of both mental health disorders compared to the general population. In fact, nearly two thirds report a depression diagnosis and over half of autistic people have comorbid anxiety. While genetic factors may play a role, the psychological effects of masking contribute greatly to these trends. Will Mandy wrote in his article about the concept of unmasking. “in qualitative research, autistic people consistently link their camouflaging to experiences of anxiety and depression.” Autistic people feel a level of dissatisfaction with their lives and a pressure to uphold an image of neurotypicality. Because of this, they are more likely to struggle with their mental health. Research on the topic of suicidality and autism also shows evelated rates of suicidal ideation in those who self report masking behaviors. Research overwhelmingly points to the fact that masking is unhealthy and decreases quality of life, therefore it is inhumane to expect autistic people to mask their autism for the comfort of others at the price of their own wellbeing.
In addition to depression and anxiety, socialization of autistic people often puts them in circumstances in which they are more likely to develop trauma-related disorders. Autistic people are far more likely to be victims of sexual assault and emotional or physical abuse. Such circumstances can lead to the development of trauma disorders like Post Traumatic Stress Disorder, usually in cases of acute trauma, and Borderline Personality Disorder in cases of prolonged exposure to traumatic environments. Both of these disorders are more prevalent in the autistic population compared to the general population. Around 27 percent of autistic people have PTSD, and 5.3 percent have BPD, around three times the rate of the general population. Both disorders severely interfere with a person’s ability to function. PTSD often presents with flashbacks, nightmares, and paranoia, forcing the person to relive some of the most traumatic moments in their life, BPD is one of the deadliest mental disorders, with 70 percent of patients attempting suicide and an estimated 10 percent being successful in their attempt, explained by the fact that BPD is marked by extreme emotional dysregulation and unstable self esteem. For autistic people, who already experience higher levels of emotion dysregulation, trauma disorders can be life ruining and create needless suffering. In addition to having to live with frequent experiences of trauma, autistic people also live with the at times life-long consequences in the form of psychiatric disorders.
Beyond just mental health, prioritizing having your child seem “normal” over addressing their needs puts autistic children at a higher risk for sexual assault by teaching them to hide themselves and ignore their natural instinct. In the lives of kids with ASD, many things that are comfortable for others may be distressing to them. Since autistic children learn early on that their needs are not valued, they “often comply with unreasonable requests from others due to a fear of confrontation, a lack of understanding of social boundaries, or an inability to recognize victimization […]. These characteristics cause sexual offenders to view autistic and disabled children as vulnerable and purposefully target them” . When your entire life is painful and no one is listening, you do not learn to recognize when something serious or even illegal is going on. Statistically, this increased vulnerability to sexual abuse is significant. Research on the topic found “autism is strongly correlated with sexual molestation during childhood”. According to the same study, one in six autistic people will be sexually abused as a child and autistic children were more likely to “act out in a sexual way,” which is a common symptom of childhood sexual abuse. Moreover, their abuse correlated to a drastic increase in risk of sexual assault later in life. The study found that half of the autistic children who were sexual abused in childhood “will suffer from new occurrences of sexual violence later in life”. When a child is plainly told to ignore their own distress, they will. They are not equipped to judge what concern would be considered legitimate by their caregivers. Learned camouflaging might hide behaviors considered undesirable by adults, but it also makes autistic children far more vulnerable to sexual abuse.
As the trend of sexual violence continues into adulthood, autistic people are far more likely to be sexually assaulted as adults. Autistic children primed to ignore their discomfort most of the time grow into adults who do the same. A study of autistic victims of sexual assault found that “a lot of autistic people think it is normal to be hurt by people you know because it has happened to them so much”. A comprehensive study of sexual victimization of autistic women found that only 11.6 percent of autistic women surveyed were not victims of sexual violence, and only another 13 percent only experience sexual assault once in their lives, the majority were re-victimized again. Most autistic women, 56 percent, reported multiple instances of aggression with multiple different offenders. This rate of sexual assault is three times higher than amongst neurotypical women. There is no one reason that can explain a nearly nine in ten rate of sexual violence against autistic women and significantly elevated risk among all autistic individuals, but masking plays a large part. As stated by the National Autistic Society, “if you ‘blend in’ by overriding your reactions and going along with what other people want, this may not keep you safe in certain situations, such as sexual interactions”. While it is not accurate to state that masking causes this elevated rate of victimization, a strong correlation between the two remains, not only in the rates of sexual violence itself, but in the way autistic people view their experiences. When asked open ended questions, autistic women were much more likely to state that they “don’t know” whether they have been assaulted. However, when asked closed ended questions with definitions, the true rates of assault emerged. Even after being victimized, many do not know how to make sense of their experiences. How can they, when suffering was taught as a virtue, not a hindrance?
The disproportionately frequent experience of sexual violence causes autistic people to experience higher rates of metal health consequences of sexual assault. The same study that provides information on rates of sexual assault, authored by Fabienne Cazalis and other social scientists and psychologists, tracked the effects on its participants. Many reported developing a sleep disorder and an aversion to sex not previously experienced. Mental health indicators also drastically decreased after the victimization, with nearly one in five victims using substances to cope and nearly a third resorting to self-injury behaviors. Over 15 percent of those who reported sexual violence attempted suicide following the assault, which is even higher than attempted suicide rate among allistic, meaning non-autistic, victims of sexual violence. Similarly to the general population, the majority of autistic victims did not file a report. Out of those who did, over a quarter were not believed. All factors that would indicate well being decreased, and clearly the majority of autistic people suffered the severe end of the effects of trauma. Sexual violence wrecks havoc on the lives of those whom it effects, and as a population already more vulnerable to mental health challenges, autistic people are disproportionately effected by everything that sexual assault entails.
Marginalization occurs when a dominant population exerts their power over the non-dominant population. Whether it be misogyny, racism, homophobia, or any other sort of bigotry, it comes from the majority population oppressing the minority. Autism and the ableism surrounding it is no different. The vast majority of people are neurotypical, meaning they do not have a disorder that would make them neurodivergent. Even more people are allistic. This creates a norm, a specific set of ways of behaving and presenting that is deemed acceptable. A line is drawn and autism is on the other side, unacceptable. Every action that shames neurodiversity upholds the norm of ableism and discrimination of autistic people. And while that norm might be suffocating to autistic people, it does not benefit allistic people, either. Everyone is confined to social expectations that stifle self-expression, authenticity, and acceptance. A mere tolerance of autistic people is not sufficient. To allow autistic people to live without camouflaging everything about themselves, we must allow all people to live authentically. It is not enough to accommodate someone with autism at school if on the bus home they listen to their classmates use ‘autistic’ and ‘stupid’ interchangeably or throw around ableist slurs. Autism should not be the exception to the rule of the neurotypical norm; the rule should plainly not exist. When it does, autistic people can be sexually assaulted, put through abusive interventions, develop severe psychiatric disorders and lose themselves in their mask. Even when autistic people mask and become out of sight and out of mind for most, they suffer in silence. Even when their suffering is out of sight to most, it is painfully real for millions. Autistic people ought to be encouraged to exist as themselves without threat of retaliation.
