Seeing Yourself for the First Time: Late-Diagnosed Adult Autism and the Role of Gender in Recognition

By Maria Alessandro, BA, MSc, EdD Counselling Psychology

---

Why Some Adults Receive an Autism Diagnosis Later in Life

Autism spectrum disorder (ASD) is a neurodevelopmental difference that affects how people perceive, process, and interact with the world. While autism is often identified in childhood, many people, especially women, go through life without a diagnosis until adulthood.

Late diagnosis can occur for many reasons: subtle presentation, high masking ability, misdiagnosis, or a lack of awareness about what autism looks like in adults. For some, a diagnosis brings clarity, relief, and the freedom to reframe decades of self-criticism through the lens of neurodiversity (Lai & Szatmari, 2020).

The Landscape of Adult Autism

Autism isn’t a childhood condition that disappears at 18, it’s a lifelong neurotype. However, most research and diagnostic tools historically focused on young boys, creating a narrow picture of what autism “looks like” (Loomes, Hull, & Mandy, 2017).

For adults who didn’t fit this narrow mold, autism often went unrecognized, especially if they were able to meet societal expectations through masking — the conscious or unconscious suppression of autistic traits to appear neurotypical (Hull et al., 2017).

Late-diagnosed autistic adults often recall a lifetime of:

• Social exhaustion from masking in work, school, or relationships

• Sensory sensitivities (to noise, light, clothing textures)

• Difficulty with unspoken social rules

• Special interests that bring joy but may have been labeled “obsessive”

• Burnout — physical, emotional, and cognitive depletion from chronic masking

Gender Differences: Why Women Often Go Undiagnosed

One of the clearest patterns in late-diagnosed autism is the gender gap: women and girls are often identified years, or decades, after their male counterparts (Loomes, Hull, & Mandy, 2017).

1. Social Camouflage: Research shows autistic women are more likely to camouflage, intentionally or instinctively copying the speech patterns, body language, and social behaviors of peers (Hull et al., 2017). While this can help navigate social situations, it also masks underlying difficulties from teachers, doctors, and even family members.

2. Different Special Interests: In boys, intense interests often align with stereotypically “unusual” topics (e.g., train schedules, mechanics) that draw adult attention. Girls may have equally intense interests, but in ‘socially acceptable’ domains (e.g., animals, literature, pop culture), which don’t raise red flags (Lai et al., 2015).

3. Internalized Struggles: While boys may display more visible behavioral challenges, autistic women are often more likely to internalize distress, leading to anxiety, depression, or eating disorders rather than overt meltdowns (Bargiela, Steward, & Mandy, 2016). These co-occurring conditions can obscure the underlying autistic profile.

4. Diagnostic Bias: Diagnostic criteria historically relied on research based on male samples (APA, 2013). As a result, clinicians may unconsciously hold a “male prototype” of autism, leading to missed or delayed diagnoses for women.

5. Cultural Gender Expectations: Girls are often socialized to be nurturing, accommodating, and socially skilled. Many autistic women describe becoming “people pleasers” as a survival strategy, which delays recognition of their social communication differences (Bargiela, Steward, & Mandy, 2016)

The Emotional Impact of a Late Diagnosis

For many adults, receiving an autism diagnosis later in life can trigger a mix of emotions:

• Relief - “Finally, there’s a reason my brain works this way.”

• Grief - for the years of misunderstanding, misdiagnosis, or self-blame.

• Anger - at systems or professionals who overlooked the signs.

• Validation - from finding community and realizing you’re not alone.

While the diagnosis doesn’t erase past struggles, it can reshape identity in a positive, self-accepting way.

Life Before and After Diagnosis

Before diagnosis, many autistic adults report:

• Masking so much they lose touch with their authentic self

• Feeling “alien” in social spaces

• Experiencing unexplained fatigue or sensory overwhelm

• Having a history of burnout or mental health crises

After diagnosis, individuals often:

• Give themselves permission to set boundaries

• Seek accommodations at work or school

• Adjust their environment to reduce sensory triggers

• Connect with the autistic community for support and shared understanding

Therapeutic Considerations for Late-Diagnosed Adults

Therapy for late-diagnosed autistic adults can focus on:

1. Identity Integration - Understanding autism as a neurotype, not a flaw.

2. Unmasking Safely - Learning when and how to reduce masking without compromising safety or comfort.

3. Burnout Recovery - Using pacing, sensory regulation, and rest.

4. Self-Advocacy Skills - Navigating accommodations in work, education, and relationships.

5. Processing Grief - For missed opportunities or misunderstandings before diagnosis.

Cultural Considerations

Diagnosis rates and perceptions of autism are influenced by culture. In some communities, autism may be highly stigmatized, while in others, traits are seen as part of a normal personality spectrum. Late-diagnosed adults from marginalized backgrounds may also face compounded barriers — less access to diagnostic services, clinicians less familiar with adult presentations, or cultural misinterpretations of autistic traits.

A culturally sensitive approach to autism acknowledges that diagnosis is not just about symptoms, it’s about how society interprets and responds to them.

Closing Thoughts

Late-diagnosed autistic adults, especially women, often carry decades of untold stories about adaptation, resilience, and survival in a world that didn’t see them clearly.

The diagnosis is not a limitation, it’s a lens that can reveal strengths, patterns, and needs that were always there.

Autism isn’t something you “get” in adulthood. It’s something you realize, and that realization can be profoundly liberating.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 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

Botha, M., & Frost, D. M. (2020). Extending the minority stress model to understand mental health problems experienced by the autistic population. Society and Mental Health, 10(1), 20–34. https://doi.org/10.1177/2156869318804297

Hull, L., Mandy, W., & Petrides, K. V. (2017). Behavioural and cognitive sex/gender differences in autism spectrum condition and typically developing males and females. Autism, 21(6), 706–727. https://doi.org/10.1177/1362361316669087

Lai, M. C., Lombardo, M. V., Auyeung, B., Chakrabarti, B., & Baron-Cohen, S. (2015). Sex/gender differences and autism: Setting the scene for future research. Journal of the American Academy of Child and Adolescent Psychiatry, 54(1), 11–24. https://doi.org/10.1016/j.jaac.2014.10.003

Lai, M. C., & Szatmari, P. (2020). Sex and gender impacts on the behavioural presentation and recognition of autism. Current Opinion in Psychiatry, 33(2), 117–123. https://doi.org/10.1097/YCO.0000000000000575

Loomes, R., Hull, L., & Mandy, W. P. L. (2017). What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 56(6), 466–474. https://doi.org/10.1016/j.jaac.2017.03.013