The effect of masking: What to look for when assessing girls

Masking refers to the hiding or suppressing certain natural traits or behaviors. While it’s commonly used by the autistic community today, the effect and act of masking isn’t necessarily unique to those with autism spectrum disorder (ASD).

Studies have shown that many aspects of masking are experienced by all neurotypes, for example, managing behavior or emotional responses as part of a stigma management strategy. However, as concluded by Miller et al. in their study, autistic individuals do use unique masking methods, such as stimming suppression (2021).

Masking is also used disproportionately across the gender divide. In a study, Pearson & Rose found that masking “might contribute towards disparities in diagnosis” (2021). With a current estimate that ASD is four times more common in boys than girls, this could mean a significant population of girls who are masking traits that lead to undiagnosed autism.

Understanding the lived experiences of autistic girls and women is essential to accurately assess students across the board. Knowing what to look for, how masking presents, and how to get past masking behaviors to understand a child’s true condition, strengths, and weaknesses is essential to improve outcomes and help connect children with the resources they need to better thrive.

Common signs of masking in girls and women

Masking hides the true impact of sensory overload and other challenges faced by autistic individuals. While they may appear to be “fine” on the outside due to their masking, that does not mean they are not struggling. Masking also takes a severe emotional, physical, and psychological toll on the person, leaving them feeling drained, anxious, or even depressed (Evans et al., 2023).

Being diagnosed with ASD can help relieve the pressure of masking for many. Simply learning that there is a reason why they struggle to handle things when their peers seemingly have no problem can be freeing. Being diagnosed can also help connect the child with the resources they need. That’s why you, as the assessor, must understand how masking can present so you know what to watch out for. Autistic people who are masking might be:

Suppressing aversion to loud noises, bright lights, or overstimulating environments.
Concealing or downplaying their special interests.
Forcing eye contact, especially if it causes stress or makes it more difficult to focus on the actual interaction.
Using what’s known as social camouflaging, which can include mimicking gestures, facial expressions, or social cues, despite how draining or how anxious it makes them feel.
Frequently suppressing emotions to avoid being seen as atypical, or to avoid stigma, even if it leads to an emotional disconnect.

High-masking individuals can appear perfectly content and adjusted from the outside. That’s why more in-depth diagnostic processes are essential to determine whether or not masking is impacting your assessment. Societally, we also need to destigmatize autism and highlight signs of ASD in both women and men, allowing more women and girls to self-identify and seek out professional assessments for themselves.

Use the MIDGAS-2 to best identify masking

In every case it’s always recommended to use multiple diagnostic and assessment tools. To better identify masking and understand when masking is at play during the assessment process, however, the Monteiro Interview Guidelines for Diagnosing the Autism Spectrum, Second Edition (MIGDAS™-2) stands out as an option. As an interview-based approach, you can probe deeper into the lived experiences of your patient, working to understand the motivations and potential masking strategies used in ways you can’t with direct observation only.

You can learn more about MIDGAS-2 and how it can complement other tests like ADOS-2 at WPS. They have a range of tests, courses, and services to help educators, therapists, and clinicians alike advance their diagnostic capabilities.