Understanding Camouflaging: Why Internalised Autism Is So Often Missed
- Amanda Moses Psychology
- 1 day ago
- 4 min read
Despite growing awareness of autism, internalised presentations continue to be widely misunderstood and frequently missed. These are the clients who fly under the radar—often presenting as articulate, capable, and “functioning” in ways that don’t align with traditional stereotypes of autism. But beneath the surface, many are masking significant internal distress.
Understanding how camouflaging works—and who it affects—is essential if we are to improve diagnostic accuracy, reduce harm, and offer truly affirming support.
What Is Camouflaging in Autism?
Camouflaging, a form of masking, is a survival strategy that involves suppressing natural autistic traits in order to blend in or avoid negative judgement. It might involve:
Forcing or maintaining eye contact
Imitating social behaviours
Rehearsing conversation scripts
Hiding stimming behaviours
Suppressing sensory aversions
While this can sometimes lead to short-term social acceptance, it comes at a long-term cost to mental health. Camouflaging is effortful, exhausting, and often unsustainable. It can result in autistic burnout, identity confusion, anxiety, depression, and in some cases, suicidal ideation.
Why Is Internalised Autism So Often Missed?
There are several key reasons:
1. Diagnostic Tools Prioritise What Can Be Seen
Most standardised assessment tools rely on observable, external behaviours. But when someone has spent years learning to suppress or mask their autistic traits, their presentation may not raise clinical concern—especially if the clinician isn’t attuned to the subtle indicators of masking or the internal cost of maintaining it.
2. Stereotypes Still Shape Clinical Judgement
Autism is still too often viewed through the lens of a narrow stereotype: typically a young, white, cisgender boy with overt communication and behavioural differences. Internalised presentations—more commonly seen in girls, AFAB individuals, non-binary people, and those with higher cognitive abilities—are characterised by more subtle difficulties, often missed or minimised by clinicians who have not been trained to recognise the full spectrum of autistic traits.
3. Masking Is Frequently Misread as Social Anxiety
When high-masking individuals present with anxiety in social contexts, they are often misdiagnosed with Social Anxiety Disorder. But what’s frequently overlooked is why that anxiety exists. The focus remains on the anxious presentation, without considering the cognitive and emotional labour involved in masking. Clinicians may not ask, “What’s driving this anxiety?”, or “What’s the cost of maintaining this façade?”—questions that are critical in distinguishing between relational fear and what is a processing difference.
4. Cultural and Gender Norms Reinforce the Camouflage
From an early age, many individuals—particularly girls and those from culturally marginalised backgrounds—are taught to conform to social expectations. These norms encourage behaviours that are quiet, agreeable, attentive, and socially compliant. In this context, autistic traits may be hidden, suppressed, or mistaken for personality style. Clinicians who overlook the impact of intersectionality may find these traits harder to detect—and more likely to dismiss.
What Clinicians Need to Consider
It is not enough to rely solely on tools or observable behaviours when considering autism for your clients. Affirming, accurate identification requires:
Taking a thorough developmental history that captures how someone has coped, not just how well they’ve coped
Understanding the impact of camouflaging on identity, relationships, and mental health
Using neurodiversity-affirming assessment tools and language
Listening to lived experience, especially when it doesn’t look “textbook”
Recognising the structural and historical biases in how autism has been defined and measured
p.s- I have a comprehensive intake questionnaire bundle to use in your clinical work, aimed at helping you better identify and detect those with internalised presentations.
Why This Matters
Late diagnosis isn’t a trend—it’s a course correction for decades of clinical oversight. When we miss internalised autism, we risk pathologising the wrong things, offering ineffective support, or denying people the understanding they deserve.
But when we recognise camouflaging for what it is—a strategy of survival—we can start asking better questions and offering better care.
✨ Want to Deepen Your Understanding of Autism?
For decades, our understanding of autism has been shaped by externalised, stereotypical traits. As a result, many Autistic people have been missed. But the landscape has shifted. What we now know about autism looks very different from even five or ten years ago.
Whether you're:
A parent wondering if your child (or you) might be autistic,
An educator wanting to feel more confident recognising autistic traits, or
A clinician seeking clarity on the evolving understanding of autism and how to identify it in your practice — I invite you to watch the on-demand replay of my recent live webinar:
📅 90 day replay now available
In this 3-hour training, I’ll walk you through the most current understanding of autism, including how it presents in individuals with less obvious or more internalised traits across the lifespan.
This is not a diagnostic training. It’s about helping you recognise what’s long been missed—so you can better understand your clients, your students, or your loved ones.
👉 Click here to learn more and register: https://www.amandamosespsychology.com.au/event-details/understanding-masked-autism-2
What You’ll Learn:
A clearer, up-to-date understanding of what autism really looks like—based on the latest evidence
A more holistic view of autistic traits that goes beyond the simple checklists in diagnostic manuals
Practical, real-life examples of traits that are often missed or misunderstood, across the entire lifespan
How to recognise the less obvious signs of autism with more confidence—even if you’re not the one doing the diagnosing
How Autistic traits transform at different developmental stages, including subtle indicators of Autism