An assignment written as part submission to my MA Autism
*Autism spectrum disorder in under 19s: recognition, referral and diagnosis. Clinical guideline [CG128]
Language
During this article I will use the word ‘professionals’ to include those involved in assessment; paediatricians, speech and language therapists, occupational therapists and clinical psychologist’s as well as the gatekeepers to assessment; teachers, Special Educational Needs Coordinator’s (SENCo’s), mental health practitioners, health visitors and General Practitioners (GP’s).
The word ‘masking’ is also known as ‘social camouflaging’ (Mandy, 2019). The latter is the term I see more commonly in research, whereas masking, from my reading, appears as the dominant term used by autistic adults. As I view autistic adults as the experts in the field, I will use the term masking. Masking is defined as ‘the use of strategies by autistic people to minimise the visibility of their autism during social situations (Lai, et al., 2011). It can involve supressing emotions, stimming and mimicking others (Holliday-Willey, 1999)
To refer to non-autistic persons I will use the term predominant neurotype (PNT) a term coined by Beardon (2019a pp. 2), preferred to the often used term ‘neurotypical’ due to ‘typical’ being associated with the concept of ‘normal’ and therefore autistic individuals being positioned as ‘abnormal’ which carries negative connotations.
Rose, my 11 year old autistic daughter, is reported on throughout the assignment. Rose has consented to sharing her experiences.
Introduction
Masking is a well-documented aspect of being autistic within the autism community (Rose, 2018a), yet many professionals involved in the identification and support of autistic children have inadequate knowledge of masking and its impact on the individual (Eaton, 2016) . I will consider; the breadth and depth of masking; the significance of professional understanding or lack thereof and how recognition of masking within NICE guidelines could impact the autistic community. It has been extensively reported that masking hinders identification of autism ( Russo, 2018), is a barrier to accessing support and the mental effort involved in masking causes high levels of stress and exhaustion, autistic burn out and mental health difficulties (Hull, et al., 2017; Cage, Monaco & Newell, 2018). This assignment will explore this in greater depth.
My interest in masking comes from both personal and professional motivators. Rose’s masking led to struggles in identification and school adjustments. As a parent I was made to believe that my presumed anxiety was causing her struggles. Professionally, I am a family worker for those who fight to have their child’s autism assessed, identified and supported. Children often mask significantly in public (NAS, 2017) and the parents are blamed for the distress the child releases when back in the security of the home (BBC News, 2017). The stress that I have seen this cause families is unacceptable and I see children suffer as a result; suicide rates in those that mask are significantly higher (Cassidy, Bradley, Shaw, & Baron-Cohen, 2018). Working with children as young as 7 years who say they want to die is tragic and in my opinion, negligent.
Drivers and sub-drivers
A driver is ‘anything that you purport to have an influence on an autistic person or the autistic population’ (Beardon, 2020). In this assignment the driver is masking and its impacts. Masking is experienced by 70% of autistic adults (Cage & Trowell-Whitman, 2019). As there is no current legislation or guidelines on masking in terms of its recognition, impact or support, I will be outlining what I feel is best practice in achieving these. My focus will be on children, from toddlers to adolescence, yet as research is limited I will be discussing evidence from across all age groups.
A sub-driver is a piece of legislation, theory or policy that influences the driver. In this case I will be focusing on the NICE guidelines, which do not currently support the concept of masking. The UNICEF’s children’s rights and the Equality Act (2010) will also be discussed as sub-drivers. I will also briefly consider how theory of mind (Baron-Cohen, 1989) in autism may have contributed to lack of understanding of autistic masking.
Autistic masking and best practice
Masking in autistic children should be recognised as a common phenomenon by professionals.
Many families are unable to pass the ‘gatekeepers’ to assessment (Eaton, 2016). Initial referrals have to come via schools, health visitors and GP’s. If a child is masking and appears unaffected by autism in outside settings then referrals are refused (Eaton, 2016). Parents may voice concerns but are not believed or deemed to be overreacting as the child seen outside of the safety off the home is often ‘perfect’ and ‘fine’ (Eaton, 2016). Beardon (2014, para.2) writes ‘just because a child has the ability to mask their autism at school does not mean that they are not greatly impacted by their autism on a daily basis’. This causes high levels of distress for families and can cause trauma in an autistic child as professionals may advise parents to attend parenting classes (Eaton, 2016) and use a traditional style of discipline with a child in order to ‘manage the behaviour’. Parents are being viewed as overly anxious about their child and thus causing their child’s difficulties, I hear this view from SENCo’s, and from parents themselves. Many are being accused of being overly anxious by the second parent. This is often because the second parent is not living with the child or is not present during the periods of ‘after school collapse’. Parent ‘blaming’ will be discussed in more depth later on in this assignment. Attwood (2000, para. 3) characterises masking as:
The child who is described as a Dr. Jekyll and Mr. Hyde in that the indicators of stress are not conspicuous at school but the child is a very different character at home. They may be quiet and compliant in the classroom but intolerant and aggressive immediately when they return home.
Research into children who mask often comes from research in females and the ‘evading’ of identification e.g. Tierney, Burns and Kilbey (2016). The often discussed ratio of 1 autistic female to every 4 males says more about masking in females than actual figures (Russo, 2018). When considering numbers of adults identified as autistic the ratio closes but not fully. The ratio of men to women supported by The National Autistic Society’s (NAS) adult services was approximately 3:1, and the ratio of boys to girls in the charity’s schools was approximately 5:1 (NAS, 2015).
I have worked with many families who lack insight into masking, therefore are confused by the extremes in their child’s presentation between settings. Sitting in parents evenings being told their child is a dream student is usually something to celebrate but when your experience of your child at home is one of constant distress and meltdowns, brings about confusion, frustration and leads many parents I work with feeling their parenting is at fault. When I talk about masking with families, it’s like a weight is suddenly lifted from them. When the parents describe the ‘Jekyll and Hyde’ presentation, I have to tell them that unless school will accept their child’s needs and make adjustments there are limited strategies we can put in place at home to decrease overall distress.
The Equality Act (2010) states that discrimination occurs when a person is put at a ‘substantial disadvantage’ due to the environment, policies or practices employed. It is my opinion that the lack of NICE guidelines on masking is discriminatory, acting as a barrier to children accessing identification and support that would prevent trauma.
Professionals having knowledge about the depth and breadth of masking.
Although many professionals know of the term masking, their knowledge is limited in terms of its depths and how many children excel in their masking skills (Planet Autism blog, 2017). Many researchers and autistic adults have recorded the varying types of masking (Cage & Troxwell-Whitman, 2019; Rose, 2018a).
The high levels of ability and skill that often go into masking are grossly under-recognised in schools and assessment settings (Hull, et al., 2017). Attwood (2019) talked about many children being ‘Oscar worthy’ in their ‘performances’. Attwood quoted a lady who came to his clinic as saying ‘I have done such a great job at pretending to be normal that nobody really believes I have Asperger’s’ (Attwood, 2019).
Rose’s ‘performances’ can be exemplary, she is seemingly able to manage environments that she would show signs of distress in when with her closest family. Rose recently spent the weekend with grandparents, travelling to London, eating out, going food shopping and coffee dates. They commented on how amazing she was and how she coped so well chatting with unfamiliar people. Yet the following week Rose was unable to move from the sofa to make it into school and complained of being ‘dragged around places’. Rose describes masking as being incredibly exhausting.
It’s no wonder the extent to which people mask is so apt when the second most common reason for masking is ‘avoiding retaliation and bullying by others’ (Cage & Trowell-Whitman, 2019). When we consider this we could describe masking as a survival strategy and it seems obvious that this would quite quickly lead to exhaustion and be a continuous stress. Long term stress is known to be one of the causes of many life threatening illnesses such as diabetes and cancer (Salleh, 2008), with autistic people having higher than average prevalence of these from childhood through to adulthood (Croen, et al., 2015) and at higher risk of premature death (Smith DaWalt, Hong, Greenberg, & Mailick, 2019), we could conclude that masking could be a contributing factor to elevated stress levels and its associated health implications.
A misinterpretation of masking, in my experience, is to be deemed ‘manipulative’. Implying that the discrepancies in behaviours between settings and between care givers is down to a child trying to ‘get their own way’. This can lead to the mistreatment of a child. Children have talked to me about adults who are ‘nice in front of the adults, but unkind to me when they aren’t around’, this I see in some school staff who disbelieve parents’ concerns and resent any ‘special’ treatment a child maybe receiving. Rose was described as being ‘manipulative’ by her reception school teacher. This observation didn’t come as a shock to us as parents and we responded ‘she will make a very good leader one day’. I reframe ‘manipulation’ as a child ensuring their needs are met to prevent trauma. Poe (2019) writes about a teacher who deemed her manipulative. During her time in secondary school Poe was emotionally abused by this adult to a horrific level due to the teacher’s incorrect beliefs about Poe’s presentation. Professionals having a greater depth of knowledge of masking would increase understanding and encourage a more open dialogue between parents and professionals.
Professionals must be aware of the mental health implications of masking
The research and autistic bloggers are very much in consensus, masking causes mental health difficulties as a result of exhaustion (burnout) and loss of self-identity (Hull, et al., 2017; Cage & Troxell-Whitman, 2019; Rose, 2018a; Rose, 2018b).
The rates of suicide and suicide ideation within the autistic adult community are increased compared to PNT (Zahid & Upthegrove, 2017; Cassidy, Bradley, Robinson, Allison, McHugh, Baron-Cohen, 2014). Masking and unmet support needs are risk markers for suicidality in autism (Cassidy, et al., 2019).
The loss of self-identity can occur when individuals mask to the extent of taking on another person’s persona and although this can make individuals very successful in the acting industry (e.g. Dan Akroyd) these skills can be misinterpreted as a personality disorder (Attwood 2006, pp5). A misdiagnosis of personality disorders was talked about by Attwood (2019) as being a common for autistic adults. Furthermore masking in terms of mimicking those around you to ‘fit in’ means never knowing or understanding your true self, with often devastating impact, (Rose, 2018b).
Self-identity and esteem can also be at risk when often identification comes at a point where a child is rock bottom in terms of mental health and when the mask falls off. A child then misinterprets symptoms of a secondary mental health condition as autism, in doing so many children I see in my role reject the autism identity and/or despise it. Heppel (2019, pp21) who was identified late in life, described this as ‘I have to separate the autism itself from the wounds that have been inflicted by people over the years- some well-meaning, some not – in response to the way my autism expresses itself’. Positive autistic self-identity supports good mental health, (Cooper, Smith & Russell 2017).
Professionals must be aware of the implication masking has on access to identification, support and/or adjustments.
Masking can hinder the very first step in gaining identification (Eaton, 2016), with referrals to assessment pathways requiring ‘evidence’ from more than one setting (NAS, 2016). Therefore many children are unable to access recognition of their autism until their stress levels become so high they are no longer able to mask or suppress their difficulties and differences. Early access to assessment and formal identification is vital in preventing mental health difficulties (Zwanenberg, nd.).
Despite Rose having a formal identification of autism, school adjustments were slow to be implemented. I wrote Rose’s support plan in collaboration with her but it wasn’t always followed because they ‘saw’ no need for it. Rose’s increased after school distress and sleep onset difficulties meant I requested a referral to the specialist SEN advisory teachers. The SENCo stated she couldn’t refer because ‘we have no issues in school’. This is common, I have worked with families whose schools have disagreed with a formal identification and refuse adjustments. Recently I wrote a list of recommendations for a child’s school, warning of burnout and school refusal. Due to masking the child’s needs were not taken seriously and she has now been out of school for 6 months and struggling with suicidal ideation. In my opinion every autistic child should have a support plan that includes bespoke adjustments within the environment, based on parent’s experiences of a child in their ‘safe’ (where they feel most at ease) places and the child’s voice (as opposed to the child’s presentation in school) to prevent this kind of burnout. If masking was understood effectively then this would be commonplace.
Zwanenburg (nd. Para.6) summarises the importance of childhood identification;
As without a diagnosis this can make so many areas of life difficult, distressing and bewildering for the undiagnosed person. This can result in difficult behaviours, social isolation and young people who do not attain their best ability in school. Once diagnosed, the young person can understand themselves better and realise that are not alone in the way they feel. Their parents and the professionals working with them can all learn how best to help them. The right services can be accessed and adaptations can be put into place in the educational setting. A diagnosis can prevent so much distress as the child develops and can stop further psychiatric illnesses developing.
Denied access to assessments goes against UNICEF’s Children’s Rights Act, article 24 (health and health services). ‘Every child has the right to the best possible health. Governments must provide good quality health care……… so that children can stay healthy’. The Equality Act (2010) also states that organisations need to be proactive in making reasonable adjustments to meet the needs of autistic individuals.
Adjustments are also required for autistic people within mental health services. Without autism identification treatments for mental health illness can be inappropriate, ineffective and abusive. Research has discovered disproportionate numbers of patients in eating disorders units meet the criteria for an identification of autism (Westwood, et al., 2016; Huke, Turk, Saeidi, Kent & Morgan, 2013). Lack of identification of these patients’ leads to inappropriate treatment, often with little or no success. Shea (2016) has written about the differences in the root cause of eating disorders in autistic people and emphasises a need to look at eating behaviours and base any treatment on the motivations of the patient. Arnold (2016) supports this, reporting on a person who was confused by her eating disorder as she did not have a fear of calories or gaining weight, her psychologists were equally at a loss as to how to treat her. The lady described being fixated with a routine of exercise and limited food intake in order to muffle the feelings of constant anxiety. Once in her 40’s she sought a new psychologist who mentioned autism, which led to her being identified. Ryder (2017) tells her story of the intentions that led to her eating disorder. Ryder who was bullied believed that if she lost weight she would become good at sports and in doing so make friends.
With post-traumatic stress disorder (PTSD) being more prevalent in the autistic community due to increased risk of negative life experiences (Haruvi-Lamdan, Horesh, & Golan, 2018; Kerns, Newschaffer & Berkowitz, 2015) we can conclude that the absence of appropriate adjustments within both education and mental health settings can lead to PTSD. This has been reported by many autistic individuals who have been left traumatised by either their school experiences, their experience of mental health services or both (Poe 2019, Holliday- Willey 1999, Scott & Westcott 2019).
Parent ‘blaming’ is often experienced by those whose children mask (Eaton, 2016. This can be anything from parents being deemed overly-anxious and being seen as the cause of a child’s anxiety to parents been viewed as being desperate to ‘label’ their child. Fabricating or induced illness (FII) is a form of child abuse and one that parents of autistic children are known to be accused of (McNicholas, Slonims, & Cass 2000), particularly at risk are autistic parents (including those not identified as autistic). Autistic parents are more likely to have researched extensively, to the point where they can be more knowledgeable than a clinician (Gullon-Scott, 2020), a description fitting with the experience I had while seeking Rose’s identification. According to the NHS a child is more at risk of FII if the mother has borderline personality disorder, which a common misdiagnosis associated with autism (Pilling, Baron-Cohen, Megnin-Viggars, Lee, Taylor, 2012). The NICE Guidelines (Child maltreatment: when to suspect maltreatment in under 19’s, 1.2.12) states presentations that may indicate FII, some of which raise concerns if we consider autistic masking, such as ‘symptoms and signs only appear when the parent is present’, ‘reported symptoms are only observed by the parent’, and the National Health Service (2019) suggest considering FII when ‘the parent has good medical knowledge’. All of these could be attributed to a child that masks. Within these guidelines (child maltreatment: when to suspect maltreatment in under 19’s, 1.2.12) autism or masking is not acknowledged as a possible explanation for the presentation. Furthermore these guidelines appear to mirror ‘alerting signs’ for FII proposed by Bass and Glasser (1994) and more recently Glaser and Davis (2019). These signs have been heavily criticised by Gullon-Scott (2020) as discriminating against autistic children and autistic parents as these groups would likely present with some of them without it being FII. Gullon-Scott (2020) states that ‘families who have been investigated, erroneously for FII, report extremely high levels of trauma, distress, family breakdown, and similar as a direct result of being viewed as possible perpetrators of child abuse’. I have recently supported a family whereby parents are separated and child contact with Dad was being arranged through the family courts. Mum was withholding contact due to her daughter having incredibly distressing meltdowns prior to and returning from Dad’s care, despite her reportedly being ‘fine’ with Dad. Mum had contacted me about possible autism. Dad was concerned that Mum was looking to ‘label’ the child for financial gain and/or to give reason for her daughters behaviours which Dad felt were due to Mum’s anxiety and needing to maintain control (i.e. possible FII). With the absence of any safeguarding concerns with either party, I was able to discuss possible autistic masking. The child is now awaiting assessment and is being supported amazingly by both parents. Without the knowledge of masking, this family are likely to have ended up in a battle with Dad likely reporting his concerns to safeguarding services.
Professionals supporting children un-masking / feeling safe
There is very little literature in supporting autistic children to unmask.
In Rose’s personal experiences, the sunflower lanyard scheme has been beneficial in her removing her mask when in certain environments. The scheme involves wearing a particular lanyard produced by the scheme founders, with the aim that it is becoming nationally recognisable as a symbol for someone with a hidden condition such as anxiety or autism. Rose describes feeling less pressure to ‘perform’ when she wears hers and gave me the example of when she became overwhelmed in a restaurant and needed to take cover under the table. Rose felt that having the lanyard allowed her to do this without being judged negatively.
In terms of my professional experience, the child and I explore communication preferences, as often verbalising for self-advocacy can feel impossible and leads to masking. We use visual scales to place themselves where they feel. We produce information about themselves in the forms of posters or PowerPoints outlining their strengths, special interests, difficulties and how they would like to be supported. We then share this with agreed adults or peers, the aim being that the autistic individual feels safe to un-mask with people who accept and understand them. Teaching the skill of non-compliance is vital for these children. I praise those who have finally said ‘no’ in school after spending many years complying despite detriment to themselves. Trusting that children ‘will when they can’ and are ‘non-complying’ because they ‘can’t and not won’t’ is paramount. If children are punished for saying ‘no’ how can we expect them to practise essential self-care.
The recent campaign #TakeTheMaskOff for autistic adults spent a month raising awareness, discussing the impacts of masking and sharing strategies to unmask. A masking questionnaire (Camouflaging Autistic Traits Questionnaire, CAT-Q) has been developed and validated (Hull, Mandy & Lai, 2019) to enable further insight into adult masking, yet there is nothing available for children.
With the impact of masking and therefore the importance of unmasking being evidenced, it’s important that guidance on supporting children to unmask is developed further. Alongside this it’s vital for autistic individual’s safety that the PNT have understanding of normal autistic behaviours to promote acceptance. With autistic adults in mental health units being over represented, we have to consider that some autistic behaviours are misunderstood (Scragg & Shah 1994). Currently unmasking in public runs the risk of being deemed mentally unwell.
Critique of driver
The NICE guidelines contribution to masking information is extraordinarily vague; ‘when older children or young people present for the first time with possible autism, signs or symptoms may have previously been masked by the child or young person’s coping mechanisms and/or a supportive environment’ (NICE, 2015, pp 1.2.5) this implies that younger children who have been identified do not mask and therefore presentation in all settings is deemed them being their true self risking missed needs. I have met very young children who mask. A is 4 years old. I met with Mum and A at home where we talked through A’s sensory differences and anxiety which presented as needing to control his environment. An observation of A in pre-school showed a different child, one very passive in his environment, agreeable to wrapping up in layers of clothing to go outside which went against his sensory sensitivities. My own son, Henry, aged 4, has recently refused pre-school and attempts to take him have resulted in very high levels of distress, telling us it’s too noisy and his friends don’t leave him alone. Staff reported that he is ‘fine’ when he was in attendance, yet on his days off he would refuse to get dressed or leave the house and sought alone time.
As a result of masking children are not being assessed, identified and supported (Russo, 2018). Denial of adjustment within education is discrimination under the Equality Act (2010), this acts as a barrier to accessing education goes against UNICEF’s Children’s Rights article 28, ‘every child has a right to education’.
Professionals should understand the extent of masking abilities and that the skill involved can mean seeing no ‘deficits’ or differences in a child. Tables 1-3 of the NICE guidelines (CG128) list a number of ‘deficits’ that clinicians should be looking for when considering autism. There is no mention of how masking can lead to those ‘deficits’ being absent in certain environments/ settings and yet present in others. The ‘Jekyll and Hyde’ (Attwood, 2009) phenomenon is noted by many autistic adults and researchers. Yet there is no information in the NICE guidelines and the myth that autism will ‘present’ in all settings is still discussed in some trusts. E.g. the Swindon neurodevelopmental pathway referral form (2020, pp3) requires ‘evidence the behaviour is causing functional problems for the child in more than just the home setting’.
It’s no surprise then that within the NICE guidelines there is no guidance on how to support a child to unmask and no mention of the devastating impact of masking. Guidance needs to be explicit about the negative impact of masking so that all professionals know the importance of it being recognised and understood.
The theory of mind could have been a driver in the misunderstanding of masking and the autistic presentation. Theory of mind in autism states that an autistic person has difficulties in placing themselves in another person’s shoes and refers to the ability to understand that others have a different perspective to their own (Baron‐Cohen 1989). Initially the theory stated a deficit in theory of mind, whereas updated versions of the theory state a delay in ability. This theory has been very influential in the people’s perspectives on autism (Kommers, 2019).
However for an individual to mask then they must have the ability to know that others have differing opinions about their natural behaviours. If an autistic person is able to mimic others in order to fit in then they must have the understanding to know that others deem certain behaviours socially unacceptable. Therefore if children as young as 3 or 4 can mask and learn ‘social norms’ then this goes against autism being a theory of mind deficit. I would however argue that altering ones behaviour or mimicking another’s behaviour in order to avoid being persecuted is a survival mechanism which does not involve theory of mind skills.
What are the desired changes to the NICE guidelines and what impact would they have on the autistic community?
NICE guidelines
For the NICE guidelines to contain information and guidance on what masking is, how it presents/how to recognise it and supporting in unmasking. All of the items would be developed with the autistic community. The information and guidance would be publicised within a national campaign and training that would target all professionals to ensure all have adequate knowledge of masking.
With the gatekeepers and assessors aware of masking we would see an increase in referrals and granting of assessment and greater accuracy in identifying autism. Early identification improves life chances as discussed.
Children will have the opportunity to work with skilled (including autistic) practitioners to unmask and find their voice ensuring that they are the driving force in accessing what they require to be successful autistic young people.
Access to adjustments and support will be given in schools and society despite others not ‘seeing’ the need, but based on the voices of experts i.e. parents, the autistic community and the child themselves.
Fabricated illness
Information on masking would be incorporated into the NICE guidelines on recognising the mistreatment of under 18’s to ensure that masking is never confused with FII. This would prevent many families going through the trauma of being investigated for FII or experience the trauma caused to those families whereby children are wrongly removed from the care of those whom they feel safe enough with to unmask.
Burnout
Autistic burnout will be recognised within mental health services to ensure appropriate recovery support is given. In my experience it is common place for children and adolescent mental health services (CAMHS) to deem burnout to be depression and/or an anxiety disorder. The recommended treatment being cognitive behaviour therapy (CBT) or family therapy (NICE, 2019). This is deeply problematic and often results in further mental health issues (Quinn, 2018). Equally PTSD in autistic children is often not being recognised (Kerns, 2018). Masking for long periods and living in survival mode means the brain is exposed to unsafe levels of stress hormones, resulting in elevated risk of mental health problems (WebMD, 2018). Yet if the professionals do not understand the complexities of masking, how can PTSD as a result be understood? If burnout as a result of masking was recognised then support could be offered in allowing appropriate recovery and future prevention.
The experience of Lighowler (2019, para. 2) portrays this, being under CAMHS from age 13, she writes ‘I was made to feel it was my fault that cognitive behavioural therapy wasn’t working’, Eventually Lightowler was sectioned, which rather than aiding her recovery, led to trauma and an increase in self-harm. Not until receiving her diagnosis age 17 years did she finally start receiving support that was appropriate to her and successful.
Sunflower scheme
The sunflower lanyard scheme is given enough publicity to support the un-masking of the autistic community safely, by educating PNT communities on normal autistic behaviours and presentations. This will prevent autistic behaviours being misconstrued as something to be fearful of. With many autistic people reporting that masking protects them we absolutely have to ensure that autistic people aren’t persecuted for being openly autistic.
Positive about autism
For individuals to feel positive about their autism, less masking would result in more children seeing openly autistic adults as role models. They would no longer feel the need to seek their tribe but they would be all around them, providing a sense of identity and belonging. In my role I meet many unidentified children, parents seek my services when at crisis point about their children’s mental health, often burnt out. Discovering you’re autistic when so distressed is damaging to self-identity. Early identification would decrease the likelihood of mental health conditions, associated suicide and increase positive life chances.
Conclusion
It’s important to recognise that although we have focused heavily on the negative implications of masking i.e. the mental health impact and reduced access to support, we must also validate the element of safety that masking can offer as well as it being a skill that can improve connectivity with the PNT community including being able to gain and maintain employment (Rose, 2018c). Although in an ideal world (Autopia, Beardon, 2019b), there would be no need to feel unsafe as an autistic person and discrimination would be banished by understanding and acceptance of autism, we are not there yet and sadly fear of difference is ingrained in society (Rose, 2019).
What is vital is that professionals are able to recognise masking and ensure accurate referrals and assessment to assist early identification. Furthermore the wider PNT community need a level of knowledge around masking that enables them to make an autistic person feel safe within their company. This would offer autistic people the feeling that they can unmask should they choose, but essentially would ensure that all autistic children have fair access to identification, education and support.
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