Masking, also called camouflaging, is the effort of hiding autistic traits or compensating for them in social situations. It can be as simple as rehearsing small talk, and as demanding as monitoring every conversation for how you are coming across. It is one reason some autistic adults reach adulthood without a diagnosis, and it is often discussed in relation to women.
A 2022 study in the journal Autism (Milner, Mandy, Happé and Colvert) compared young adults aged about 20 to 25: 78 with an autism diagnosis, 177 with high autistic traits and no diagnosis, and 180 with low traits. Camouflaging was measured with a self-report questionnaire. Autistic women reported more camouflaging than autistic men, and in the diagnosed group, more camouflaging went with lower psychological quality of life.
There are limits to what this shows. It was a single snapshot, so it cannot show that camouflaging causes poorer wellbeing. It relied on self-report, and the questionnaire measures how much people try to camouflage rather than how well it works. The sample was small in places, treated sex as binary, and did not look at gender identity. The authors also point out that earlier work suggests camouflaging may delay diagnosis for women and girls, but their study did not measure diagnosis, and men and women in the high-trait group camouflaged to a similar degree. Their results do not settle why women are diagnosed later, and they caution against assumptions about sex differences.
We have not found a figure we can stand behind for how often autistic women are diagnosed late, so we do not give one. What can be said is that a diagnosis depends on the person being referred, on what they can describe, and on what the assessor asks about. If masking hides difficulty in a short appointment, an assessment that only looks at what is visible in the room will miss it. NICE's guideline for adults (CG142) tells assessors to cover core features in both childhood and adulthood, how you function at home, at work or in education, and to involve someone who knows you where possible.
A good assessor asks about your childhood, your friendships, what you do to get through the day, and what a typical week costs you, not only what they can observe. It helps to bring specific examples and, if you can, someone who knew you as a child or old school reports. Exhaustion after social contact or work can have several causes, and a clinician will want to rule out others. See autistic burnout is not depression, signs of autism in adults and what happens at an adult autism assessment.
The study details come from the paper itself: Milner V, Mandy W, Happé F, Colvert E. Sex differences in predictors and outcomes of camouflaging: comparing diagnosed autistic, high autistic trait and low autistic trait young adults. Autism, 2022 (doi 10.1177/13623613221098240). The assessment points are from NICE CG142, recommendations 1.2.5 and 1.2.7. We did not use clinic websites as sources. Last checked 25 October 2026. This article describes how assessment services work. It is general information, not medical advice, and it cannot assess your individual situation. Reviewed by: Proco Team.