Most people who mask have no diagnosis
A 2023 study of English GP records estimated how many autistic people had never been diagnosed. The answer was more than half, and possibly as many as seven in ten.
Among 10 to 14 year olds, about 1 in 34 had a diagnosis. Among people over 70, it was about 1 in 6,000.
Those adults did not stop being autistic. Nobody noticed.
Masking is part of how that happens. Autistic adults name delayed diagnosis as one of the costs of doing it well. If you seem fine, nobody looks.
Sources: O'Nions et al. 2023, Bradley et al. 2021
The cost does not wait for a label
In a 2020 study, 58 women with autistic traits answered questions about masking and their mental health. Most did not have a formal diagnosis. Most masked anyway, and most reported significant mental health difficulties.
Masking went with feeling distressed, whether the traits were mild or more marked. The authors put it in the title. Looking good but feeling bad.
You do not have to prove what you are before the tiredness counts.
Source: Beck et al. 2020
Autistic, ADHD or just built this way
You may not know which, and you may not want to know yet. Both are reasonable.
A 2024 study compared adults with ADHD, autistic adults and adults with neither. Adults with ADHD masked more than the comparison group, and autistic adults masked most. Masking runs across both, and the study found autistic traits predicted it whatever the diagnosis.
So the performing is real in its own right. A professional can work with it without settling the question of cause first.
Source: van der Putten et al. 2024
What the NHS says
You do not need a diagnosis for NHS Talking Therapies either. The service manual is explicit:
Neither a diagnosis of autism nor awaiting an autism assessment should prevent people from receiving treatment in NHS Talking Therapies services.
NHS England's guidance for mental health services covers adults who may be autistic and have no formal diagnosis. The principle is the same in private practice. Need comes first.
Sources: NHS England: talking therapies manual, NHS England B1800
People who already understand
Peer support does not ask for a diagnosis either. Two places run by the people they serve.
A free forum where autistic people and their families connect and support one another.
A forum, not a helpline.
Peer-led resources, a podcast and a community forum, run by adults with ADHD.
Not a helpline.
What we do with that
We are a connecting service, not a clinical one. We do not assess anyone and we do not diagnose anyone.
When you talk to us, you can describe the rehearsing, the copying and the exhaustion in your own words. We treat masking as a thing to work on, separate from any diagnosis you may or may not have. The finding a professional page explains how that works.
If you later decide you do want an assessment, the waiting for an assessment page covers the route. Nothing about starting here commits you to it.
Thanks for your interest. We're not taking on new clients at the moment.
Help with the performing, not a label
We ask what matters to you, then find professionals who fit.
- I do not have a diagnosis and I do not want one yet
- I do not know if I am autistic or ADHD or just built this way
- I want help with the performing, not a label
- Nobody would believe me because I seem fine
References
- O'Nions, E., Petersen, I., Buckman, J. E. J., Charlton, R., Cooper, C., Corbett, A., Happe, F., Manthorpe, J., Richards, M., Saunders, R., Zanker, C., Mandy, W. & Stott, J. (2023). Autism in England: assessing underdiagnosis in a population-based cohort study of prospectively collected primary care data. The Lancet Regional Health Europe. doi:10.1016/j.lanepe.2023.100626
- Bradley, L., Shaw, R., Baron-Cohen, S. & Cassidy, S. (2021). Autistic adults' experiences of camouflaging and its perceived impact on mental health. Autism in Adulthood. doi:10.1089/aut.2020.0071
- Beck, J. S., Lundwall, R. A., Gabrielsen, T., Cox, J. C. & South, M. (2020). Looking good but feeling bad: "camouflaging" behaviors and mental health in women with autistic traits. Autism. doi:10.1177/1362361320912147
- van der Putten, W. J., Mol, A. J. J., Groenman, A. P., Radhoe, T. A., Torenvliet, C., Agelink van Rentergem, J. A. & Geurts, H. M. (2024). Is camouflaging unique for autism? A comparison of camouflaging between adults with autism and ADHD. Autism Research. doi:10.1002/aur.3099
- NHS England (2024). NHS Talking Therapies for anxiety and depression manual, version 7.1, section 10.3.4. Link
- NHS England (2025). Meeting the needs of autistic adults in mental health services (B1800). Link
