Introduction
For many individuals socialised to prioritise social harmony or who experience marginalization by gender in medical or mental health settings, navigating the journey toward an adult autism diagnosis can feel like solving a puzzle with missing pieces. Each day may bring an elusive sense that something is “off,” a constant yet unspoken disconnection from societal norms. A late autism diagnosis often brings those pieces into focus, revealing a story of resilience, misunderstanding, and untapped strength.
Traditional estimates suggest individuals socialised as boys are four times more likely to receive an autism assessment than those socialised differently. However, nearly 80% of autistic individuals who face gendered expectations or experience misogyny remain undiagnosed by age 18 (UCLA Health, 2023). This discrepancy reflects deeply ingrained biases in autism research and diagnostic practices, leaving many people feeling unseen, unvalidated, and isolated.
This blog post delves into the factors contributing to the underdiagnosis of individuals whose autism traits are less recognisable due to societal biases. It examines the profound emotional impact of receiving an adult autism diagnosis and explores how understanding their neurotype empowers them to embrace their strengths and navigate challenges. Drawing on recent research and lived experiences, this discussion highlights the transformative power of self-discovery and validation. Whether you are reflecting on your own journey, supporting a loved one, or seeking a greater understanding of neurodivergence, this post offers insights into the diverse paths shaped by socialisation, neurodiversity, and societal expectations.
The Overlooked: Why Women and AFAB Individuals Are Underdiagnosed
Historical Bias in Autism Research
Autism’s historical framing as a “male” condition has perpetuated systemic inequities in diagnosis. Early research and diagnostic criteria focused almost exclusively on boys, assuming autism presented uniformly across genders. This male-centric perspective failed to account for how autism might manifest in individuals conditioned to prioritise social harmony and adaptability. As a result, autism was often dismissed as rare in anyone not socialised as boys (Cook & Garnett, 2018).
This oversight created significant diagnostic gaps, particularly for those raised with expectations to excel in social communication. Typically, girls and gender-diverse individuals are under-referred, misdiagnosed, or dismissed entirely. These disparities are even more pronounced in adulthood, as diagnostic tools often rely on behavioural benchmarks aligned with male presentations of autism (Hartman et al., 2023). Consequently, many navigate the complexities of neurodivergence without the validation or resources a diagnosis could provide.
The Role of Masking
Masking, a survival strategy often adopted by those under pressure to meet high social expectations, involves mimicking neurotypical behaviours. This can include imitating facial expressions, forcing eye contact, or suppressing stimming behaviours to align with societal norms (UCLA Health, 2023). While masking may help individuals navigate social settings, it frequently leads to chronic exhaustion, heightened anxiety, and physical health challenges (Hartman et al., 2023).
Individuals not socialised as boys are particularly likely to internalise their struggles, leading to co-occurring conditions such as depression or anxiety being treated without addressing the underlying neurodivergence (Cook & Garnett, 2018). Societal expectations to excel in social competence add further pressure, delaying recognition of autistic traits and perpetuating cycles of misdiagnosis or neglect.
Misinterpreted Symptoms
The nuanced presentation of autism in individuals marginalised by gender expectations often results in misinterpretation. Traits such as sensory sensitivities or intense interests are frequently dismissed as socially acceptable quirks. For instance, a fascination with a specific hobby or pop culture figure might be celebrated as typical enthusiasm rather than recognised as a defining characteristic of autism (UCLA Health, 2023).
Similarly, internalised challenges such as social anxiety or difficulties with executive function are often attributed to personality traits or external stressors rather than recognised as part of an autistic experience (Hartman et al., 2023). This misattribution delays diagnosis and prevents individuals from accessing appropriate accommodations and support.
Intersectional Considerations
For individuals marginalized by gender—especially those who were socialized to be harmonious, often encouraged to prioritise the needs and emotions of others, navigate relationships with tact, and suppress personal discomfort or assertiveness to maintain social peace—the challenges of receiving an adult autism diagnosis are compounded by the intersections of gender, neurodivergence, and systemic bias. Barriers such as limited access to affirming healthcare, heightened stigma, and pervasive discrimination can obscure or mask autistic traits (Cook & Garnett, 2018).
These intersecting challenges highlight the urgent need for inclusive diagnostic tools and approaches attuned to diverse lived experiences. By recognising and addressing systemic barriers, we can create a more equitable landscape for adult autism diagnosis and support, one that values its diverse expressions across all identities.
A Life-Changing Revelation: The Emotional Impact of a Late Diagnosis
For individuals whose neurodivergence was overlooked due to societal biases, a late autism diagnosis often represents a profound turning point. It redefines their identity and experiences, bringing clarity to challenges they’ve long grappled with, from navigating complex social interactions to managing executive function. As highlighted in Spectrum Women, this realisation can spark immense relief: “I finally felt like my experiences made sense. I wasn’t broken; I was simply different” (Cook & Garnett, 2018). For those exploring their neurotype, such moments of clarity validate their lived experiences and open the door to self-compassion.
Finding Validation and Belonging
An adult autism diagnosis is more than a connection to a neurotype—it is an invitation into a community that celebrates neurodivergence. For those who have felt isolated or misunderstood due to societal expectations, connecting with others who share similar experiences can be transformative. Such connections foster mutual validation and create a sense of belonging that may have previously felt unattainable (Hartman et al., 2023).
This understanding also provides the language to articulate one’s needs and advocate for support in various contexts. For trans+ and queer individuals, this dual lens of neurodivergence and gender identity can be especially affirming, enabling them to connect with inclusive communities that embrace all facets of their identity.
Unlocking Access to Tailored Support
A diagnosis often unlocks resources and accommodations tailored to an individual’s neurotype. Neuro-affirmative approaches, such as sensory regulation strategies, stimming tools, and executive functioning coaching, are especially valuable in navigating daily challenges (Hartman et al., 2023). For instance, sensory-friendly practices in workspaces or social settings can reduce overwhelm and honour neurodivergent needs.
Moreover, understanding their neurotype empowers individuals to prioritise self-care and set boundaries, mitigating burnout and enhancing emotional regulation. As outlined in The Adult Autism Assessment Handbook, these strategies are most effective when developed collaboratively, centring the individual’s lived experience and personal goals (Hartman et al., 2023).
Redefining Strengths and Identity
A late diagnosis reframes personal narratives, transforming perceived struggles into markers of resilience. Traits such as intense focus, creativity, and empathy—often misunderstood—become celebrated strengths that shape unique perspectives and capabilities. This reframing empowers individuals to recognise and embrace their neurotype, countering societal expectations that may have failed to accommodate their needs (Cook & Garnett, 2018).
In this light, the diagnostic journey is not a quest for correction but a celebration of identity. For trans+ and queer individuals, whose identities already challenge societal norms, this process reinforces the importance of living authentically and unapologetically.
Embracing the Journey Forward
A late autism diagnosis for older adults is both an ending and a beginning. It marks the conclusion of years of uncertainty while opening a pathway to greater self-awareness and growth. As individuals integrate this understanding, they gain the tools to embrace their neurotype with pride and navigate the world with renewed confidence.
This journey exemplifies the transformative power of understanding oneself and the strength that comes from being fully seen and accepted. In the words of one autistic individual, shared in Life on the Autism Spectrum, “Receiving my diagnosis wasn’t just a moment of realisation—it was an affirmation that who I am is enough” (Attwood & McKibbin, 2016). This truth offers hope and clarity to those still searching for their own sense of identity.
Thriving Beyond the Adult Autism Diagnosis: Embracing Strengths and Challenges
A older autism diagnosis is not merely a means to better understand one’s own human experience in a bright, loud, and often confusing social world—it is an invitation to thrive by embracing one’s strengths and navigating challenges with intention and resilience. For autistic individuals, especially those socialised to be harmonious and adaptable, this journey involves recognising the value of their unique traits, developing tools for self-regulation, and cultivating connections that foster belonging and growth.
Recognising Unique Strengths
Autistic individuals socialised to be harmonious often excel in areas shaped by their neurotype. Their remarkable focus, creativity, and heightened empathy enable them to approach problems and relationships with innovation and depth. For instance, the ability to hyperfocus can lead to significant achievements in specialised fields, while creativity often manifests in artistic and problem-solving endeavours (Cook & Garnett, 2018).
Empathy, a hallmark trait, frequently takes the form of a profound capacity to understand and support others. Though this empathy may sometimes be misunderstood due to differences in its expression, it contributes authenticity and depth to relationships when recognised and valued (Attwood & McKibbin, 2016).
Building Tools for Self-Regulation
Sensory sensitivities and emotional dysregulation, while challenging, offer opportunities for growth and self-discovery. Tailored sensory-safe environments can provide a foundation for thriving. Tools such as noise-cancelling headphones, weighted blankets, and fidget devices empower individuals to regulate sensory input in a world that often feels overwhelming (UCLA Health, 2023).
Additionally, mindfulness practices and stimming—self-soothing movements or behaviours—are powerful strategies for managing stress and emotional balance. As highlighted in The Adult Autism Assessment Handbook, embracing these tools rather than suppressing them honours the neurotype and fosters well-being (Hartman et al., 2023).
Finding Connection
Building meaningful connections is essential to thriving. For autistic individuals, finding “your tribe” can be transformative. As Barb Cook notes in Spectrum Women, “Knowing you are not alone is often the first step toward embracing your authentic self” (Cook & Garnett, 2018).
Connection can take many forms, including online communities, local support groups, or therapeutic spaces that affirm both neurodivergence and individual identities. For trans+ and queer individuals, intersectional communities offer critical validation, recognising and celebrating the unique interplay between autism and other facets of identity.
Reclaiming Agency
Thriving after a diagnosis is about reclaiming agency and aligning one’s life with personal values and aspirations. By recognising their unique strengths, using effective self-regulation tools, and fostering supportive relationships, autistic individuals can craft a fulfilling life grounded in authenticity and empowerment.
This deeply personal journey highlights a broader truth: thriving comes not from conforming to societal expectations but from embracing one’s unique path. As noted in Life on the Autism Spectrum, “Autism is not a limitation—it is a different way of experiencing the world, one full of beauty and possibility” (Attwood & McKibbin, 2016).
How to Get an Adult Autism Diagnosis in British Columbia
Obtaining an adult autism diagnosis in British Columbia can be a challenging but meaningful process. While assessments are more commonly available for children, adults seeking a diagnosis have options through both public and private systems. Here’s how you can navigate the process in BC:
1. Start with a Self-Assessment
Self-assessment tools can help identify traits that align with autism. Reliable tools include the Autism Quotient or the RAADS–R. While these tests aren’t diagnostic, they can provide valuable insights and help prepare you for discussions with healthcare professionals (Laube, 2023).
2. Seek a Referral from Your Family Doctor
In BC, a referral from a general practitioner (GP) is often the first step. Your doctor can refer you to a qualified specialist such as a psychiatrist or registered psychologist for an autism assessment. Preparing notes on your developmental history, current challenges, and self-assessment results can make your visit more productive (Laube, 2023).
3. Understand the Assessment Process
Adult autism assessments in BC typically involve:
•Structured Observation: Using tools like the Autism Diagnostic Observation Schedule (ADOS), clinicians evaluate how you engage in interactive discussions and social situations.
•Developmental History: Clinicians gather information about your childhood and developmental milestones, often speaking with a family member or reviewing records.
•Questionnaires and Timelines: You may complete written questionnaires about your experiences and provide a timeline of your educational and vocational history.
4. Choose Between Public and Private Assessments
•Public Assessments: The British Columbia Autism Assessment Network (BCAAN) coordinates publicly funded diagnostic assessments, but wait times can be significant.
•Private Assessments: Private practitioners can provide quicker access but come with out-of-pocket costs. To ensure your diagnosis meets provincial standards, assessments must include ADOS and Autism Diagnostic Interview – Revised (ADI-r) components (Government of BC, 2023).
5. Receive and Reflect on Your Results
Expect to receive a detailed report outlining the assessment findings. While these reports may use clinical language, they offer important insights into your experiences and strengths. Reflecting on the results can be an emotional but empowering step toward self-understanding (Laube, 2023).
How to Get an Adult Autism Diagnosis in Ontario
In Ontario, access to adult autism assessments has expanded alongside growing awareness and updated diagnostic criteria. Adults typically seek a diagnosis to better understand challenges with social interaction, mental health, or other life experiences.
1. Find a Qualified Provider
Autism assessments for adults in Ontario are conducted by psychologists or psychiatrists. The pathway you choose depends on funding options and provider availability:
•Psychologists: Publicly funded psychologists in hospitals or clinics require a referral from a GP. Private psychologists can be accessed directly, but assessments are fee-for-service unless covered by private insurance (Autism Ontario, n.d.).
•Psychiatrists: Diagnosis through psychiatrists is covered under the Ontario Health Insurance Plan (OHIP) but also requires a GP referral.
2. Understand the Assessment Process
Adult autism assessments often include:
•Clinical Observation: Evaluations such as ADOS help clinicians observe how you engage in discussions and navigate social interactions.
•Developmental History: Providers may interview family members or review past records to understand your childhood experiences.
•Self-Reporting: Questionnaires and discussions with the clinician allow you to share your lived experiences.
3. Public vs. Private Pathways
•Public Assessments: Covered under OHIP when conducted by psychiatrists or psychologists in public healthcare settings. However, access may be limited by long wait times and regional availability.
•Private Assessments: While private psychologists offer faster access, these services are not covered by OHIP. Costs can vary and are typically borne by the individual unless supported by an employer’s benefits plan (Autism Ontario, n.d.).
4. Reflect on Your Diagnosis
A diagnosis can validate your lived experiences and offer clarity on challenges you’ve faced. Use your diagnostic report to identify potential supports, accommodations, or tools for growth. Whether you choose to share your diagnosis or keep it private, reflecting on its meaning for your life is an important step forward.
5. Connect with Resources and Support Networks
While services for autistic adults in Ontario can be limited, connecting with organisations like Autism Ontario can help. Peer groups, educational workshops, and online communities are valuable spaces for learning and finding support.
Conclusion
A late autism diagnosis is not the end of a journey but the beginning of a transformative chapter. For those socialised to be harmonious and who have often felt unseen, it provides a lens to reframe past struggles—not as deficits, but as expressions of a neurotype that thrives in its own rhythm. It offers a foundation for self-acceptance, where challenges are understood with compassion and strengths are celebrated with pride.
This journey of discovery is deeply personal yet profoundly universal. The stories and strategies shared here remind us of the resilience inherent in neurodivergent lives. They highlight the beauty of difference and the immense power that comes from understanding oneself.
Whether it is recognising your strengths, finding your community, or embracing tools for growth, the path forward is one of self-compassion and empowerment. As we continue to explore and support the diverse expressions of autism, let us celebrate the richness that neurodivergence brings to our world.
There is strength in being seen, joy in being understood, and transformative power in living authentically. By embracing this truth, we honour not only the diversity of neurodivergent experiences but also the shared humanity that connects us all.
Continue the Convo
If the ideas in this blog resonate with you, I warmly invite you to connect with me. Whether you’re a therapist seeking neuro-affirmative approaches or someone navigating mental health concerns with an adult autism diagnosis and looking for support, I’m here to help. You may book individual therapy sessions or peer consultations online. Be sure to bookmark this blog for future insights, reflections, and updates.
References
Attwood, T., & McKibbin, G. (2016). Life on the Autism Spectrum: A Guide for Girls and Women. Jessica Kingsley Publishers.
Autism Ontario. (n.d.). Adult Assessment. Retrieved from Autism Ontario website.
Cook, B., & Garnett, M. (2018). Spectrum Women: Walking to the Beat of Autism. Jessica Kingsley Publishers.
Government of BC. (2023). How is Autism Diagnosed in BC?. Retrieved from Government of BC website.
Hartman, D., et al. (2023). The Adult Autism Assessment Handbook: A Neurodiversity-Affirmative Approach. Jessica Kingsley Publishers.
Laube, A. (2023, April 5). Six Steps to Getting an Autism Diagnosis in BC. Autism BC. Retrieved from Autism BC website.
UCLA Health. (2023, October 12). Understanding Undiagnosed Autism in Adult Females. Retrieved from UCLA Health website.
Disclaimer: This blog offers general educational information and does not constitute professional advice or establish a therapist-client relationship. Please consult a healthcare provider for personalized guidance. Any decisions based on the content are the reader’s responsibility, and Clayre Sessoms Psychotherapy assumes no liability. All case studies are hypothetical with fictional names and do not reflect actual people. We prioritize your privacy and the confidentiality of all of our clients. We are committed to maintaining a safe, supportive space for 2SLGBTQIA+ community care.
