Adult Women Diagnosed Late with Autism Spectrum Disorder Experience Increased Mental Health Struggles
In a new study published in Autism Research, researchers have found that women diagnosed with autism as adults face significant mental health challenges that differ notably from those diagnosed in childhood. The study, which analysed data from 1,424 women and non-binary individuals enrolled in the SPARK autism research cohort, highlights the distinct struggles faced by those diagnosed later in life.
Key Differences and Challenges
The study reveals that autistic adults, particularly those diagnosed late, report higher rates of depression and anxiety, with nearly 70% experiencing these conditions at some point, compared to neurotypical peers. This group also has a markedly elevated suicide risk, with autistic individuals without intellectual disability being over nine times more likely to die by suicide.
One of the main reasons for these mental health issues is prolonged masking and camouflaging, a phenomenon more common in females. Late-diagnosed individuals tend to engage in higher levels of camouflaging—efforts to hide autistic traits to fit social norms, such as faking eye contact or scripting conversations. This masking can lead to exhaustion, anxiety, depression, reduced self-esteem, and feelings of inauthenticity.
Moreover, masking often delays diagnosis and access to support, exacerbating mental health difficulties and increasing vulnerability to social isolation, manipulation, or abuse. Because many women are diagnosed late, they often lack early intervention, which can mitigate mental health risks. Their diagnostic journey can be complicated by overlapping or misattributed psychiatric conditions (e.g., anxiety, depression).
Late diagnosis adults often show limited use of mental health services in early adulthood, partly due to misunderstanding their symptoms, which further compounds distress. Many late-diagnosed autistic adults struggle with alexithymia, meaning difficulty in identifying and expressing emotions, which can lead to confusion and avoidance of emotional conversations. This may worsen feelings of isolation and contribute to mental health symptoms like depression and anxiety.
The complexities around differential diagnosis with psychiatric conditions (e.g., borderline personality disorder, mood disorders) further delay recognition and appropriate treatment. Females often present more subtly or mask more effectively, leading to a higher chance of undiagnosed or misdiagnosed autism until adulthood.
Summary Table: Late Diagnosis in AFAB vs. Childhood Diagnosis
| Aspect | Late Diagnosis in AFAB | Childhood Diagnosis | |--------------------------------|----------------------------------------------|----------------------------------------------| | **Mental Health Outcomes** | Higher rates of depression, anxiety, suicide risk | Often earlier intervention reduces severity | | **Masking/Camouflaging** | Prolonged, frequent masking leading to exhaustion and identity issues | Less masking due to earlier understanding | | **Access to Support** | Delayed, often limited prior to diagnosis | Earlier access to tailored services | | **Emotional Awareness** | More alexithymia, difficulty expressing feelings | Better emotional support from earlier age | | **Diagnostic Complexity** | More comorbidities and misdiagnosis common | More straightforward diagnosis |
Conclusion
The study underscores the importance of developing support systems that address the distinct challenges faced by those diagnosed later in life. Lack of access to early interventions and supports for autistic individuals diagnosed in adulthood can result in navigating education, relationships, and employment without a clear understanding of their needs.
Over one-third of the full sample had experienced suicidal thoughts, and 21% reported self-harm—a concerning figure that underscores the need for targeted mental health support. Many autistic women diagnosed in adulthood may have spent years masking their symptoms, leading to identity confusion, chronic stress, and burnout.
The research calls for improving adult-focused assessment and intervention options for those diagnosed later in life. It also emphasises the need for more inclusive research in the future, particularly for individuals with higher support needs. The authors stress the importance of tailored mental health services that account for the unique experiences of autistic women and non-binary individuals.
References: Diemer, M. C., Ros-Demarize, R., Bradley, C. C., Kanne, S., Kim, S. H., Parish-Morris, J., Snyder, L. G., Wodka, E., & Carpenter, L. A. (2025). Comparative Analysis of Autistic Women Across the Lifespan: Childhood vs. Adulthood Diagnosis. Autism Research. https://doi.org/10.1002/aur.70073
- The study reveals that autistic adults, particularly those diagnosed later in life, experience higher rates of depression and anxiety, with nearly 70% experiencing these conditions at some point.
- The study highlights the significant mental health challenges faced by women diagnosed with autism as adults, showing a markedly elevated suicide risk for autistic individuals without intellectual disability.
- One reason for these mental health issues is prolonged masking and camouflaging, a phenomenon more common in females, resulting in exhaustion, anxiety, depression, reduced self-esteem, and feelings of inauthenticity.
- Masking often delays diagnosis and access to support, exacerbating mental health difficulties and increasing vulnerability to social isolation, manipulation, or abuse.
- Many women are diagnosed late, and they often lack early intervention, which can mitigate mental health risks and provide better emotional support from an early age.
- Late-diagnosed autistic adults struggle with alexithymia, meaning difficulty in identifying and expressing emotions, leading to confusion and avoidance of emotional conversations.
- The complexities around differential diagnosis with psychiatric conditions further delay recognition and appropriate treatment for autistic women diagnosed in adulthood.
- The study emphasizes the need for more inclusive research, particularly for individuals with higher support needs, and calls for the development of targeted mental health support tailored to the unique experiences of autistic women and non-binary individuals.
- The authors stress the importance of adult-focused assessment and intervention options for those diagnosed later in life to address their distinct challenges effectively and promote overall health and wellness, including mental health.
