Why so many women and highly masked people are diagnosed with autism and ADHD late

If you've spent most of your life feeling like you were just about keeping up, working harder than everyone around you seemed to need to, all while wondering why everything felt so much more effortful than it looked for other people, you're not alone! And there's a good chance nobody thought to look for a reason.

Late diagnosis of autism and ADHD in women and highly masked individuals is not a rare occurrence. It's extremely common. In fact, it’s what I spend so much of my time figuring out with people. And it's not happening because these people hid their difficulties particularly well. It's happening because the systems designed to identify neurodivergence were never really built with them in mind.

The diagnostic criteria were designed around a very specific picture

The diagnostic criteria for both autism and ADHD were developed largely based on research conducted on young white boys. And the picture that research produced (the hyperactive, disruptive child; the socially obvious, rigid, intensely focused autistic person) became the template against which everyone else has been measured ever since.

The problem is that neurodivergence doesn't look like one thing (it never did). And we know that now. But for decades, if you didn't fit that narrow picture, the assumption was often that you couldn’t possibly be neurodivergent.

Masking changes everything

One of the most significant reasons women and highly masked people are missed is masking. Masking is the process of adapting and suppressing your natural responses in order to fit in. It's not a choice, at least not a conscious one. It develops early, usually in response to repeated experiences of being misunderstood or left out.

And some people become extraordinarily good at it.

By the time many of my clients reach assessment as adults, they have spent decades developing sophisticated strategies for appearing fine. They've learned to make eye contact even when it's uncomfortable. They've rehearsed conversations in advance and replayed them afterwards. They've studied other people carefully and mirrored what they saw. They've built systems and routines and workarounds that mean, from the outside, they look capable and together.

What nobody sees is how much it costs. The exhaustion that's always just underneath. The way they've been running on adrenaline for so long that rest doesn't feel safe anymore.

Masking doesn't make neurodivergence go away. It makes it invisible. And invisible things don't get diagnosed.

The referral pathway wasn't designed for them either

Even when someone does seek help, the pathway isn't always straightforward. A lot of women and highly masked people spend years being told their difficulties are explained by anxiety or depression. And anxiety and depression are real of course, and often present alongside neurodivergence. But they're frequently a consequence of years of unrecognised neurodivergence rather than the whole picture.

When someone has spent years masking and struggling and not quite understanding why, the mental health impact is significant. But treating the anxiety without recognising the underlying neurodivergence means the root cause stays invisible, and the person keeps being asked to manage symptoms rather than understand themselves.

The presentation looks different

It's worth being specific about this, because I think its really important.

ADHD in women and highly masked individuals often doesn't look like the hyperactive, impulsive presentation most people picture. It looks like being the most organised person in the room because the alternative is chaos. Perfectionism as a coping strategy. An internal experience of noise and overwhelm that nobody around you can see.

Autism often doesn't match the presentations that historically dominated research either. It can look like carefully rehearsed social scripts, an ability to mimic and adapt that makes social situations look effortless. What it doesn't show is how much energy that takes, or what's happening underneath.

None of this is because these individuals are less autistic or ADHD. It's because they learned, early on, that fitting in was necessary, and they found ways to do it.

What a late diagnosis actually means

For a lot of people, getting a diagnosis later in life brings a complicated mix of feelings. There's often relief, the sense of things finally making sense. But there's also grief. Grief for the years spent not understanding, and for the support that wasn't there when you needed it.

Both of those things are completely valid.

What a late diagnosis offers is a new lens. Not a fix, and not an excuse. Just a way of understanding your own story that finally accounts for how hard everything has felt. It makes sense of things that never quite made sense before

And for many people, that's the beginning of being able to do things differently.

If this sounds familiar

A good assessment, with a clinician who understands masked presentations, will look at the whole picture. Your history, your strategies, the gap between how you present and how things actually feel from the inside.

That's what assessment should do. And its absolutely what you deserve.