To find the growing narrative of over diagnosis (autism, adhd and mental health) upsetting and draining

[Frazzlesforever]

There seems to be a drip drip of press headlines and change in the conversation that too many people are getting diagnosed. And that some parents are being too pushy to get extra help or trying to get be benefits etc.

As the parent of a high masking autistic girl I had to push for diagnosis although the school just saw a highly compliant, quiet anxious child. My daughter is now extremely mentally unwell through not coping in school, has had to drop out of school missing her gcses, emergency CAMHs involvement - devastating for her and us.

She is exactly the type of child who would fall under the radar. Just an anxious child with over anxious parents. Apparently seeming to cope until she just couldn't. Surely if anything we need better understanding and support for these types of children not less. Otherwise we also risk kicking the problem down the road To severe problems in adulthood. - poor mental health/outcomes etc.

everything in this list is done by most everyone in social situations. It’s madness this is being positioned as some kind of unusual behaviour - ‘asking more questions than you are comfortable with’ - lol! Who hasn’t done that?!

Thus suggesting women can’t be autistic. Links please because every expert, clinician and professional pretty much everywhere and who we come across acknowledge the damage masking causes for autistic people and how prevalent it is, particularly for women.

Can I ask what your specialism/profession/interest in ASD is? I work in this arena and have heard similar. It’s a fast moving knowledge base with so much subjective information and every changing science. And even on this thread, people reporting alleged ableism, in the hope they can shut it down as a discussion. As is par for the course in contemporary society these days….

Not to the extent it has a significant impact on life and what is being masked by autistic people. It has serious consequences for autistic people which is widely recognised.

Interesting the National Autistic Society, NHS and experts within the field don’t agree.

I'm sick of this ableist government that we have. Lots of us struggled through life and were diagnosed late (I was a "strange child" that struggled, was diagnosed last year age 38), i needed to know as I have various other health conditions that line up with this diagnosis. My two children are also neurodivergent, they will not be left to struggle like I was!.

You haven' said what your source is for that quote. I would guess it is a network or a charity which dismisses those with severe autism as learning disabled. This is part of the problem as a whole.

Autism used to be recognised as a group of severely disabled people, now the diagnosis has changed and more people are being diagnosed there is a shift in who has the 'voice' of autism/ who advocates. Those who can't advocate because of their level of severity are often excluded. Someone who fluctuates in their needs will never be as severe as someone who has severe needs all the time, every day not due to mh but due to them being severely impacted by autism all the time.

You seem very niave if you really believe that yp with autism get their mh needs assessed and met. They 'should' get seperate diagnosis but often don't.

Evidence for high-masking autism comes from a combination of validated clinical tools, neurobiological studies, and extensive qualitative research into the lived experiences of autistic individuals.

1. Validated Clinical Assessment Tools -

Because masking hides traits from traditional observation, researchers developed specific tools to measure it. It has been statistically validated across multiple languages and cultures, including English, Spanish, and Swedish.

1. Neurobiological Evidence -

Recent studies have identified measurable differences in how the brains of "high-masking" individuals process social information compared to both neurotypical people and non-masking autistic people. Unique Brain Activity: EEG studies on autistic teens who "pass" as neurotypical found they have faster automatic brain responses to faces but significantly muted emotional reactivity to subtle facial expressions. This suggests their brains may be "wired" to prioritize rapid social cue recognition as a compensatory mechanism.

Brain Structure Correlates: Research has linked higher camouflaging levels in autistic women to specific neuroanatomical differences, such as smaller volumes in the medial temporal and cerebellum regions, which were not observed in autistic men.

Self-Representation: fMRI studies show that increased camouflaging is associated with heightened activity in the ventromedial prefrontal cortex (an area linked to self-representation) during social tasks.

1. The "Cost" as Indirect Evidence -

The consistent presence of autistic burnout and severe mental health strain serves as secondary evidence of the intense cognitive effort required to mask. Increased Mental Health Risks: High self-reported masking scores are strongly correlated with higher rates of generalized anxiety, depression, and social anxiety.

Suicidality Link: Multiple studies have identified a direct link between high levels of camouflaging and an increased risk of suicidal ideation and behaviors.

"Discrepancy" Findings: Researchers use the "internal-external discrepancy" method—measuring the gap between a person's internal autistic traits (via self-report) and their external behavior (via clinician observation). These studies consistently show that many individuals score high for autism internally while appearing "typical" to observers.

1. Qualitative and Gender-Specific Data

Research into the "female presentation" of autism has provided significant evidence that societal pressure drives higher masking in women and girls.

Societal Conditioning: Studies show that girls are often socialized to be more compliant and socially attentive, which forces them to develop more sophisticated masking strategies from a young age.

Lived Experience Themes: Qualitative analysis of thousands of participants has identified universal themes of "social exhaustion," "feeling like a detective," and a "loss of sense of self" that are unique to the high-masking experience.

In short, there is plenty of evidence that autistic masking exists and is common among girls/ women. Because when you scratch beneath the surface of a high masking individual, you will see persistent deficits in social communication, in multiple contexts; and restricted, repetitive patterns of behaviour, interests, or activities.

what don’t they agree with?

The state hasn't supported my daughter or helped her thrive unfortunately. She has had a significant mental health crisis caused on the main part by her being autistic and not be able to cope with the school environment she was in. It is way more than a bit of anxiety.
The result of this lack of support is that she is now extremely unwell. She can't attend school and I can't work as I am looking after her. And she is needing significant support from camhs. This has all cost the state much more than giving her proper support initially.

Oh and also my daughter doesn't go on social media

oh and there are many so called experts in the so called field who speak contradictory codswallop. Eg, the National Autistic Society are totally captured on the subject of gender identity, when they should be concerned about the very real safeguarding risks of children/vulnerable young people and gender identity ideology as discussed by Dr. Hilary Cass in the Cass review. Their own website links to controversial organisations like Gires and Stonewall, who teach stuff like this to very young children, (so forgive me for being cynical about many self described experts)

https://www.gires.org.uk/classroom-lesson-plans/

You just need to look at the approach to transgenderism to see that the NHS and NAS place appeasing activists over evidence.

evidence

Societal Conditioning: Studies show that girls are often socialized to be more compliant and socially attentive, which forces them to develop more sophisticated masking strategies from a young age.

That is hardly autism-specific though.

You are misunderstanding the point about Tony Atwood fitting the autistic
profile but being “unaffected”. Being adversely affected by the traits is part of the diagnostic criteria and you can’t have diagnosis without it. Autism is not just a collection of traits.

I think “autistic profile” is rather careful wording and IMHO probably does not mean that he thinks he’s autistic (he can’t be if is unaffected), but I think it does mean that he thinks he has many of the traits.

Besides all that, autism is only a problem if the environment is wrong. For most autistic people, most environments are wrong and are becoming worse (eg I find many phone noises painful and I can only avoid them at home). I suspect Tony Atwood’s work environment is perfectly suited to his needs.

Well no it doesnt matter what environment my son is in He will always be severely disabled by his autism and learning disabilities, and its not just the learning disabilities that is the problem its both they are intrinsic and cant be separated

If they have a diagnosis, those strategies will be effortful.

Plus appearing to manage on the outside is not the same as managing. Even my close family thought I was managing. I wasn’t.

I can also use AI.

The problem with the concept of masking is that it’s not unique to autism.

It’s not part of the DSM.

It is a common feature of anxiety, OCD, depression and other mental health conditions, all of which autistic people can suffer from too.

I don’t know your daughter or her needs/condition, but for many many of these people autism is not a helpful
diagnosis, since it suggests that what is going on for them neurobiologically has something in common with what is going on with profoundly disabled (mostly male) people to whom the diagnosis of autism was limited up to a few decades ago when there is no evidence that they share a common disorder. I know women with PhDs and high powered careers suddenly diagnosed as autistic - I don’t doubt they have genuine problems and even some neurodiversity, but it’s not what was once understood as autism.

I’m not missing the point - that is exactly the point. Environmental contexts play out a lot in this discussion.

That sounds very unlikely. I applied for disability benefits. You can’t just say you have a problem and then they believe you. You have to provide incredibly strong evidence and even then they don’t necessarily believe you. So, my autism diagnosis report (written by a consultant psychiatrist) talks at length about various details regarding my difficulties with communicating with others, my GP also addressed this briefly in her letter, saying what she had observed. However, the physiotherapist who the DWP employed to assess me decided that because I was able to say to a customer at work “that will be £27.15, please” that proved them both wrong! Absolutely bizarre!

I also moved house due to domestic abuse, shortly after my application (but before my appointment with the physio). That apparently proved I didn’t have fatigue (caused by an illness)…… despite the fact that I had shed load of medical evidence and statements written by employers and other professionals saying how my fatigue affected me.

It is an incredibly harsh system. They comb through everything you say and try to use it to ‘prove’ that your diagnoses are exaggerated.

You seem to have an obsession to devalue autism in any autistic person who does not have a learning disability too.

Even the autism diagnosis process that uses levels acknowledges fluctuation in support needs at all levels.

You are woefully uninformed if you don’t understand that autistic people without a learning disability are also severely impacted all the time. That is how they get a diagnosis, it needs to severely impact life however support needs fluctuate throughout life.

It could be fair to say that autistic people ‘engage more intensely in common social compensation strategies.’

At the same time, if we pathologise natural learned social skills, there is a danger of framing those learnt skills as inauthentic and it may discourage skill development.

Some masking behaviour could reflect learnt skills that are a healthy adaptation, reached later than peers. But as everyone is uniique, it is important to balance that against over exertion which is likely to be harmful and lead to burn out.

Here again though, burn out is a very common human reaction to being stretched too thin.

I also think social pressures do do that a lot these days to everyone. As does education.