Lead on partnerships & Community outreach
Lead on partnerships & Community outreach
Do autistic men and boys mask? What we know & what we need to find out about masking in autistic men.
June 15-21 is Men’s Mental Health Awareness week as well as the month where global Father’s Day celebrations are being held. To mark this, we want to highlight a topic that is unfortunately extremely under-researched: masking in autistic men and boys. It’s known that masking is not a gender-specific phenomenon (Hull et al. 2017), however, it is also widely documented that women and girls mask at much higher rates than autistic men and boys (Lai et al. 2015)1. Much research has thus been the focused-on understanding this gap. More recently, an online survey of autistic adults suggests that upwards of 70% of people on the spectrum mask (Cage & Troxell-Whitman 2019).
Since masking can have negative impacts on autistic people’s mental health (Livingston and Happé 2017, Cage & Troxell-Whitman 2019,), it is critical to raise awareness about and better understand this phenomenon. So, without further ado, here’s what we know and what we still need to find out about masking.
Masking is a social phenomenon where autistic people learn, practice, and perform certain behaviors in order to appear more neurotypical (Mandy 2019). Masking is one term that’s been used to describe these strategies, others include camouflage or compensation (Hull & Mandy 2017). One example of masking might be an autistic person practicing smiling or making eye contact at moments that are considered ‘socially acceptable’ by neurotypical people, even though it feels uncomfortable and is exhausting for them. Sometimes masking is more complex - like an autistic child studying, assessing, and then mimicking the behaviors of a neurotypical child their age; from how they dress, to their interests, jokes, and social behaviors.
Research has focused largely on women who mask, as women mask at a higher rate than men do (Hull et al. 2020). Masking was put forward as one of the reasons for the significant diagnosis gap along gender lines, as well as a reason for disproportionate late diagnosis in women (Hull et al. 2017, Lai et al. 2015). However, it is simultaneously accepted that masking is not actually a gender specific phenomenon. Furthermore, recent research actually suggests that the extent of masking within the autistic community might be much more significant than previously suggested and masking might look somewhat different across gender lines (Lai et al. 2015). Hull et al. write that ‘although camouflaging has previously been described as mainly a female expression of ASC, we found that many males and individuals of other genders also reported camouflaging’ (2017). In fact, a 2019 study suggested that up to 70% of people on the autism spectrum mask (Cage & Troxell-Whitman 2019). Cage & Troxell-Whitman’s research (2019) further suggests that the motivations behind masking may vary across gender and be impacted by pre-existing gender-based norms and inequality; and that there needs to be further research into this question.
Individual respondents have given a wide range of reasons for masking - from success at work, to success in relationships - but they can pretty much be boiled down to a desire to fit in and avoid negative social consequences. Mandy (2019) writes: ‘Why do autistic people camouflage? When we asked this question of one autistic woman, she replied ‘I want to avoid the bullying mostly’ (Hull et al., 2017).’ The desire to avoid negative social outcomes, particularly bullying, is consistent across studies (Mandy 2019).
The devastating reality is that ‘(f)or many autistic people, camouflaging is experienced as an obligation, rather than a choice. It is often motivated by a sense of alienation and threat, and frequently represents an attempt to avoid ostracism and attacks’ (Mandy 2019). What this means is that masking as a phenomenon is probably the result of a society that is not accommodating or accepting of autistic people; one that actually further marginalizes autistic people for being themselves. Preliminary research suggests that both internal and external autism acceptance can be a protective factor in the mental health of autistic people, particularly in relation to depression (Cage et al. 2018).
Other than the more systemic concern that masking seems to be the result of an exclusionary society, which is obviously a problem in and of itself, both scientific research and lived experience of autistic adults of all genders seems to point very clearly to the fact that masking or camouflaging is exhausting and can have negative mental health impacts on people on the spectrum (Hull 2017, Lai et al. 2016, Livingston & Happé 2018, Kurchak 2020).
Masking is extremely taxing. The most frequently cited impact of compensation was exhaustion (Hull 2017). The substantial cognitive effort required of compensation can lead to “increased stress responses, meltdown due to social overload, anxiety and depression, and even a negative impact on the development of one’s identity” over time (Lai et al. 2016). Livingston and Happé (2018) link the prevalence of mental health struggles within the autistic community to the consequences of compensating, as do Cage et al. (2018). Healle (2018) cites a number of studies in order to illustrate the gravity of mental health struggles within the autistic community, particularly those diagnosed in adulthood. They write that ‘one study found 53% of people with ASD diagnosed in adulthood had previously sought mental health services earlier in life and had high anxiety and depression levels. Two thirds (66%) of a similar group in another study reported suicidal ideation, a much higher proportion than found among adults with ASD who were diagnosed in childhood or adolescence.’ (Healle 2018)
Masking seems often to be a survival strategy to compensate for the lack of understanding and negative behaviors and consequences that autistic people are met with within a neurotypical-centered world. Cage & Troxell-Whitmann write that ‘with the high rates of camouflaging reported in autistic people, as noted here and elsewhere (e.g. Hull et al. 2017), it appears autistic people invest a significant amount of time and energy into understanding and trying to fit into the neurotypical world (often to the detriment of their mental health), rather than neurotypical people attempting to understand autistic people’s world and adapt accordingly.’
While there’s still a lot to be understood about masking and the motivations behind it, it’s clear that taking concrete steps to building understanding amongst neurotypical people as well as institutional measures to actively include autistic people are steps that could start to reduce the obligation autistic people feel to mask in order to avoid negative consequences.
While scientific research interest in masking has spiked in the past five years, autistic people have been talking about masking for much longer. To try and understand the complexities of and the consequences of masking, we highly recommend reading some personal narratives about masking written by people on the spectrum if you’re neurotypical. Sarah Kurchak’s book I Overcame My Autism and all I got was this Lousy Anxiety Disorder is a recently published must-read, where she details how her struggle to avoid bullying lead her to alter almost all of her behaviors – at the expense of her sense of self, well-being and mental health (Kurchak 2020).
If you’re neurotypical, try and understand the experiences of people with autism and change both your behavior and work to make institutional changes accordingly. Autistic influencers, advocates, educators and activists have created movements encouraging autistic people to #takeoffthemask and shared their stories of #actuallyunmasking created by Laura Zdan - check out the hashtags on Instagram and Facebook.
Pssst... For a higher resolution, save this image to your desktop.
1. Some studies have included non-binary and agender people, but unfortunately so few participants that responses were underpowered, so could not be compared to men and women (Hull et al. 2019). More research is needed to understand how masking impacts non-binary, agender and people of other genders.↩
Cage, E., Troxell-Whitman, Z. (2019). Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 49, 1899–1911.
Cage E, Di Monaco J, Newell V. Experiences of Autism Acceptance and Mental Health in Autistic Adults. J Autism Dev Disord. 2018;48(2):473‐484. doi:10.1007/s10803-017-3342-7
Hull, L., Petrides, K.V., Allison, C. et al. “Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions. J Autism Dev Disord 47, 2519–2534 (2017). doi.org/10.1007/s10803-017-3166-5
Hull L, Lai MC, Baron-Cohen S, et al. Gender differences in self-reported camouflaging in autistic and non-autistic adults. Autism. 2020;24(2):352‐363.
Hull, L., Lai, M.-C., Baron-Cohen, S., Allison, C., Smith, P., Petrides, K., & Mandy, W. (2020). Gender differences in self-reported camouflaging in autistic and non-autistic adults. Autism, 24(2), 352–363.
Kurchak, Sarah. 2020. Overcame My Autism and all I got was this Lousy Anxiety Disorder. Douglas & McIntyre.
Lai MC, Lombardo MV, Ruigrok AN, et al. Quantifying and exploring camouflaging in men and women with autism. Autism. 2017;21(6):690‐702.
Livingston LA, Happé F. Conceptualising compensation in neurodevelopmental disorders: reflections from autism spectrum disorder. Neurosci Biobehav Rev. 2017;80:729-742.