Unmasking Autism by Devon Price is a book that’s been recommended to me quite a lot as a self-determined autistic adult, so I’m glad I finally got a chance to dig in. Price focuses on “masked autism” not as a subtype of autistic presentation, but as the experience autistic folks who aren’t cis, white, male, and financially privileged tend to have—where our autism isn’t recognized from a young age because we either don’t match a stereotypical presentation or can’t access assessment, and are thus forced to attempt blending into a neurotypical world. I’m finding this language helpful to describe my own experience, but also that of most of the autistic folks I work with.
When I first encountered the possibility that I might be autistic at age 35, a friend of mine explained my confusion based on gender. Autism in women and non-binary folks, they explained, looks different from the stereotypical presentation of an aggressive, disruptive, tantruming little boy who’s incapable of socializing with neurotypicals. My assumption that I couldn’t possibly be autistic because I’m able to have conversations in group settings didn’t account for the possibility that I might have more of a “female-presenting autism,” where I’d learned social skills because I was socialized female and thus tended to stim more discreetly and have special interests that are socially acceptable. This explanation encouraged me to dig more into the possibility that I might be autistic, and ultimately to conclude that yep, I definitely have an AuDHD neurotype.
According to this book, my friend was both right and wrong. Price makes an important key observation in theorizing autism—it’s not that autism has distinct gendered subtypes, exactly, but more that we respond to autism differently in marginalized folks. The DSM criteria I couldn’t see myself within were in fact modeled on a particular cis white male presentation, but it’s not that there’s a biological difference in how autism shows up based on gender that we need to add on to that definition. Instead the problem is that we only take autism seriously, and flag it for assessment, in one specific population of children.
Price offers examples of a number of different folks whose autism was “missed” for different reasons, and explains how social dynamics affect each population differently. In many girls, for example, these “female-presenting” traits are a result of how they’re punished from an early age for violent or aggressive behaviors that are more accepted in boys, as well as how their behaviors are interpreted differently.
The same meltdown that gets a white boy flagged for autism assessment might be seen in a white girl as an “emotional outburst” or a sign of “sensitivity,” while in a child of color it’s flagged as threatening behavior and a sign of criminality, or possibly a highly stigmatized personality disorder. On the other hand, a young trans girl whose autistic presentation includes special interests or stims seen as “feminine” might be missed because she’s seen as a boy and doesn’t act like autistic boys her age. Many folks whose parents can’t afford assessment, or who couldn’t be assessed as kids because of their age, similarly slip by.
All of these folks are forced to find ways to live in the world that we can describe as a “mask,” and so Price describes this phenomenon as “masked autism,” which tends to follow a pattern of attempted compliance to neurotypical norms up to a point in adulthood where the autistic adult inevitably burns out, and perhaps is forced to confront their autistic neurotype for the first time.
I appreciate the way this explanation acknowledges the role of power and privilege, as well as the oppressive nature of the medical model, in how we conceive of autism. Price’s emphasis on self-determination over medical diagnosis is particularly welcome. As a non-binary person who grew up in the 90s, a time where “label avoidance” to avoid stigma was extreme, as Price notes, I very much relate to the general trajectory he describes. I came to understand myself as autistic during a period of burnout in my mid-thirties, and as Price writes I’ve also found the unmasking process to be both exhausting and liberating, with the benefits of authenticity and community but not a lot of real, material change in my life.
I also felt seen in how Price describes masking as an overcorrection for the most painful flaws our peers and authority figures tells us we have. Some of these forms of overcorrection don’t necessarily look autistic or obviously relate to autism, but I saw myself in a lot of them—from becoming a confidant to adults when my peers saw me as childish, to analytically studying interests that were seen as acceptable to fit in. Unfortunately, the challenges of maintaining such a mask can also push us into destructive behaviors—I recognized in myself the predictability and sense of accomplishment that disordered eating provided in my 20s, the way drugs and alcohol dull sensory sensitivities, and how social detachment can seem like the solution to social difficulties. The stories of masked autistic folks who’ve used these strategies, including Price’s own accounts of substance use, present a compelling argument that masking is not, in fact, a harmless adaptation.
At the same time, I did find some flaws in the way Price presents this narrative. While he advocates a social model, he’s also somewhat deterministic in the way he explains autistic brains, based on science that’s (as far as I know) still just one theory of how autism works. There are also odd language choices, for example using “neurodiverse” in places where I’m pretty sure he means “neurodivergent.”
He simultaneously has an inclusive approach to how he describes autism (for example, talking about how extroverted autistics and sensory-seekers might show up differently) and describes certain things as universal to autism that had me scratching my head. Perhaps this is due to my combined neurotype of autism and ADHD—Price does include a helpful discussion of how these two neurotypes overlap, but doesn’t exactly describe what it looks like when they co-occur in the same person, or how that might affect the way we process information and take in our environments.
I also found, as did a client of mine, that the way Price presented his own experience of unmasking as super revelatory and shocking, explaining almost everything about his own experience, was a bit alienating. Folks who are chronically ill, for example, and haven’t expected to be able to “function normally” for a long time, may not relate to this description. I did love how many queer and trans voices were included, though, and how Price (who is trans) explains autistic relationships to gender, as well as covering the extra exhaustion BIPOC autistics experience learning to both mask and codeswitch.
On the whole, this is a highly useful explanation of why autism is so underdiagnosed and misunderstood, and a great recommendation for folks who are starting to question whether they might be autistic, including those who have started hearing about autism on TikTok and want to dig in deeper. Price explains many key autism concepts including meltdowns and shutdowns, autistic inertia, sensory seeking and avoiding, the double empathy problem, and more from the perspective of a late-diagnosed adult, and encourages autistic folks to engage in self-advocacy. He’s realistic about the limitations of unmasking, though he takes a somewhat idealistic view overall. I’d also recommend this book for family members and friends of autistic folks, and for professionals and educators who may have an outdated understanding of autism.
Purchases using the above link support me, as well as local bookstores!