SQUARE PEGS IN DISGUISE: EXPLORING THE IMPACT OF MASKING ON AUTISTIC WOMEN’S MENTAL HEALTH by SHANA N. HARRISON Bachelor of Arts, Simon Fraser University, 2021 Thesis submitted in Partial Fulfillment of the Requirements for the Degree of MASTER OF ARTS IN COUNSELLING PSYCHOLOGY in the FACULTY OF GRADUATE STUDIES TRINITY WESTERN UNIVERSITY September, 2025 © Shana N. Harrison, 2025 SPID: EXPLORING THE IMPACT OF MASKING DECLARATION OF COMMITTEE The following individuals certify that they have read, and recommend to the Faculty of Graduate Studies for acceptance, the thesis entitled: Square Pegs in Disguise: Exploring the Impact of Masking on Autistic Women’s Mental Health submitted by Shana N. Harrison in partial fulfillment of the requirements for the degree of Master of Arts in Counselling Psychology. Degree Committee Members Deepak Mathew, PhD, CCC, Counselling Psychology, Trinity Western University Thesis Advisor Estera Boldut, PsyD, Marriage and Family Therapy, Trinity Western University Degree Committee Member Grace Iarocci, PhD, RPsych, Clinical Psychology, Simon Fraser University Degree Committee Member Meredith Maroney, PhD, LP, Counselling Psychology, University of Massachusetts Boston Degree Committee Member ii SPID: EXPLORING THE IMPACT OF MASKING iii ABSTRACT A growing body of autism research has been focused on the phenomenon of masking, the extent to which neurodiverse individuals hide their traits to fit in with the rest of the population. Previous research shows masking is more prevalent in autistic women, as they feel more pressure to appear neurotypical than men. Although there is an array of literature, there is a lack of exploration of their stories and how masking affects autistic women. Using the Listening Guide methodology, this study aimed to answer the following question: “What are the voices present in autistic women’s experiences of masking?”. The purpose of the study was to highlight and empower autistic women and better inform mental health practitioners about the challenges they face. Interviews from eight autistic women were analyzed. Several voices emerged, categorized into three broad categories: voices of “masking,” voices of “unmasking,” and voices of advocacy. Keywords: Masking, Autistic Women, Mental Health, Self-Advocacy SPID: EXPLORING THE IMPACT OF MASKING iv ACKNOWLEDGEMENTS To Deepak: Thank you so much for all your support and guidance, and for being willing to walk alongside me throughout the process. I am beyond grateful to have been given the opportunity and platform to bring the stories of my community and my vision to life. I cannot thank you enough for your unwavering support and belief in me, even on the days when I doubted my ability. To Estera: Thank you for graciously stepping onto my project and for your warmth and guidance throughout the process. I am highly appreciative of both your support and care, and for never being afraid to challenge me as a researcher. To Grace: Thank you for all the kindness and guidance that you have shown me throughout the years and for allowing me to join the Autism and Developmental Disabilities Lab. Through accepting me and fostering my growth, you taught me to develop a sense of pride in my autistic identity, which helped me become the researcher I am today. To Mac, Larissa, and Gillian: Thank you for creating a safe and supportive environment in which I could flourish and develop into my own as a researcher, therapist, and individual. I have learned a great deal under your guidance, and I will carry what I have learned with me for years to come. To Vanessa: Thank you so much for not only being my practicum supervisor but also for your unwavering support and advocacy on my behalf. I used to think of autism as a deficit, but you taught me that the only way it was a stumbling block in our field was in how other people perceive me, which I have now come to realize was never my responsibility. To Doug, Steve, Crystal, and all my mentors: Thank you for taking this little spectrum kid under your wing and for believing in me. It was through supporting other SPID: EXPLORING THE IMPACT OF MASKING v autistic individuals I realized my passion, and I cannot thank you enough for your support in helping me reach my full potential and for always challenging me to set the bar higher than before. To my research assistants, Kellyanne, Amy, JJ, Jo, Dane, Gilles, Kate, and Janessa: Thank you so much for all your insights and for accompanying me on this journey as I brought this project to life. Your contributions are invaluable to me, and I am deeply grateful for your willingness to learn about the complex, sometimes challenging, yet altogether wonderful world of autistic women. To my colleagues: Thank you so much for creating an environment where I felt safe being myself and for holding space for my story with such warmth and compassion. I have not had many spaces where I felt accepted for who I was, and you taught me that in spaces where I can be authentic, the right people emerge. To my family: Thank you for always believing in me and for loving me unconditionally. From challenging me to push myself out of my comfort zone, to celebrating my wins, for holding space for me during the dark times, and fighting tirelessly for my right to be seen and heard in spaces where I have often been dismissed so I could one day fight for myself, you have been there for me through it all, and I cannot thank you enough. To my friends: Thank you for always being by my side, fully loving and embracing me in all my capacities, and for teaching me that no one is too weird or broken to be worthy of love and acceptance. To the women who participated in this study: Words cannot express how grateful I am for you lending your voices and being a part of my study. I am in awe of your strength SPID: EXPLORING THE IMPACT OF MASKING vi and courage, and I am forever touched by your willingness to participate and by the sense of community that you have given me. To everyone who helped me get to where I am now, and even to those who hurt me: You ignited my passion for using my platform as a researcher to help others like me, and that is the greatest gift of all. Finally, I would like to acknowledge the unceded traditional territories of the Katzie, Kwantlen, Semiahmoo, Kwikwetlem, Qayqayt, Stó:lō, and Tsawwassen First Nations peoples, who have cared for these lands since time immemorial, and are now colonially known as Surrey and Langley, British Columbia, where I reside and work. SPID: EXPLORING THE IMPACT OF MASKING vii DEDICATION To all the autistic women who felt that they needed to sacrifice who they are to fit in: I see you, I hear you, and I know where you have been. It is my sincerest hope that one day we will be able to fully thrive and have a multitude of spaces in which we are loved and entirely accepted for who we are. To the autistic women, particularly Temple Grandin, who embraced their authentic selves and paved the way for young people like me to conduct my research and find pride in being my authentic self. To 10-year-old me who just found out she was autistic and wondered if she would ever make friends, finish school, or be able to hold a job: We did all that and even more. SPID: EXPLORING THE IMPACT OF MASKING viii TABLE OF CONTENTS DECLARATION OF COMMITTEE ....................................................................................... ii ABSTRACT ............................................................................................................................ iii ACKNOWLEDGEMENTS..................................................................................................... iv DEDICATION........................................................................................................................ vii TABLE OF CONTENTS ...................................................................................................... viii LIST OF TABLES...................................................................................................................xv LIST OF FIGURES ............................................................................................................... xvi CHAPTER 1: INTRODUCTION ..............................................................................................1 The Importance of Language: Identity-First vs. Person-First ............................................ 2 Gender Differences in Autism ............................................................................................ 3 The Influence of Masking on Mental Health ...................................................................... 4 Research Purpose and Significance .................................................................................... 5 Researcher Viewpoint and Bias .......................................................................................... 5 CHAPTER 2: LITERATURE REVIEW ...................................................................................7 Theories .............................................................................................................................. 7 Social Identity Theory .................................................................................................. 7 Minority Stress Theory ................................................................................................. 8 The Double Empathy Problem ..................................................................................... 9 SPID: EXPLORING THE IMPACT OF MASKING ix Feminist Disability Theory (FDT) .............................................................................. 10 Cultural and Systemic Inequities Influencing Masking.................................................... 12 Integrating Theories and Critiques ............................................................................. 13 The Complex and Multifaceted Nature of Masking and Identity ..................................... 14 Autism in Women ............................................................................................................. 15 Female Autism Phenotype .......................................................................................... 16 Diagnostic Challenges and Biases .............................................................................. 18 Gender-Specific Experiences and Challenges ............................................................ 19 The Role of Social Expectations and Stereotypes ...................................................... 21 The Medical Model: Harms and Limitations.................................................................... 22 Applied Behaviour Analysis (ABA) and the Promotion of Masking ............................... 25 Autism and Mental Health ................................................................................................ 30 The Influence of Masking on Mental Health.............................................................. 30 Research Findings on Mental Health Outcomes ........................................................ 31 Autistic Burnout ......................................................................................................... 33 The Interplay between Masking and Co-occurring Conditions.................................. 35 Autistic Identity, Voice, and Advocacy in the Literature ................................................. 36 From Silencing to Voice: Reclaiming Narrative Authority........................................ 37 Representation and the Power to Define .................................................................... 38 SPID: EXPLORING THE IMPACT OF MASKING x Advocacy as Identity Work and Resistance ............................................................... 39 Cultural and Structural Critique ................................................................................. 40 Summary and Research Question ..................................................................................... 41 CHAPTER 3: METHODOLOGY ...........................................................................................45 Research Paradigm ........................................................................................................... 45 Ontology ..................................................................................................................... 46 Epistemology .............................................................................................................. 47 Qualitative Research ................................................................................................... 49 Listening Guide: A Qualitative Methodology .................................................................. 51 Data Collection ................................................................................................................. 54 Participant Recruitment .............................................................................................. 54 Inclusion and Exclusion Criteria ................................................................................ 55 Data Collection Procedure .......................................................................................... 56 Data Analysis .............................................................................................................. 58 Data Analysis Using the Listening Guide .................................................................. 59 Listening for the Plot .................................................................................................. 59 I Poems ....................................................................................................................... 60 Contrapuntal Voices ................................................................................................... 60 Composing the Analysis ............................................................................................. 61 SPID: EXPLORING THE IMPACT OF MASKING xi Rigour and Quality ........................................................................................................... 62 Credibility ................................................................................................................... 63 Transferability ............................................................................................................ 63 Dependability.............................................................................................................. 64 Confirmability ............................................................................................................ 64 Information Power ............................................................................................................ 65 CHAPTER 4: RESULTS.........................................................................................................72 Participants Stories ........................................................................................................... 73 Jo’s Story .................................................................................................................... 73 Lily’s Story ................................................................................................................. 79 Rachel Miller’s Story.................................................................................................. 85 Jade’s Story................................................................................................................. 91 Marie’s Story .............................................................................................................. 97 Daphne’s Story ......................................................................................................... 104 Rose’s Story .............................................................................................................. 109 Kate’s Story .............................................................................................................. 115 The Voices ...................................................................................................................... 121 The Voices of Masking ................................................................................................... 126 The voice of frustration: ........................................................................................... 126 SPID: EXPLORING THE IMPACT OF MASKING xii The voice of disconnection: ...................................................................................... 128 The voice of shame: .................................................................................................. 129 The voice of inauthenticity ....................................................................................... 131 The voice of exhaustion ............................................................................................ 132 The Voices of Unmasking .............................................................................................. 134 The voice of self-love/acceptance ............................................................................ 135 The voice of self-compassion: .................................................................................. 136 The voice of empowerment: ..................................................................................... 138 The voice of connection: .......................................................................................... 139 The Voices of Advocacy ................................................................................................ 141 The voice of anger: ................................................................................................... 141 The voice of resistance: ............................................................................................ 143 The voice of yearning ............................................................................................... 145 The voice of action: .................................................................................................. 147 Conflicting Voices: Masking and Unmasking ................................................................ 149 Harmonious Voices: Unmasking and Advocacy ............................................................ 150 CHAPTER 5: DISCUSSION ................................................................................................153 Summary of Research Question and Rationale .............................................................. 153 Researcher Reflexivity.................................................................................................... 155 SPID: EXPLORING THE IMPACT OF MASKING xiii Summary of Findings ..................................................................................................... 159 Contributions to Literature ............................................................................................. 161 Expanding Definitions of Masking........................................................................... 161 Unmasking as Resistance and Identity Formation ................................................... 163 The Emergence of Advocacy.................................................................................... 166 Contributions to Theory .................................................................................................. 168 Challenging and Extending Autism Theories ........................................................... 169 The Masking – Unmasking Integration Framework ....................................................... 172 Stage 1: Masking for Survival .................................................................................. 173 Stage Two: Conscious Emergence ........................................................................... 174 Stage 3: Integrated Authenticity ............................................................................... 175 Implications for Future Research.................................................................................... 176 Implications in Practice .................................................................................................. 178 Strengths ......................................................................................................................... 181 Limitations ...................................................................................................................... 182 Conclusion ...................................................................................................................... 183 REFERENCES ......................................................................................................................185 APPENDIX A: Recruitment Poster .......................................................................................205 APPENDIX B: Invitation Email............................................................................................206 SPID: EXPLORING THE IMPACT OF MASKING xiv APPENDIX C: Email Initial Contact ....................................................................................207 APPENDIX D: Demographic Information............................................................................209 APPENDIX E: Letter of Consent ..........................................................................................210 APPENDIX F: First Interview Guide ....................................................................................213 APPENDIX G: Debriefing Form ..........................................................................................215 APPENDIX H: Follow-Up Interview....................................................................................216 APPENDIX I: Data Analyst Confidentiality Agreement ......................................................217 APPENDIX J: Confidentiality Agreement for Transcriptionist ............................................219 APPENDIX K: The Masking-Unmasking Integration Framework ......................................221 SPID: EXPLORING THE IMPACT OF MASKING xv LIST OF TABLES Table 1. Demographic Information ................................................................................... 55 Table 2. Voices of Masking ............................................................................................... 119 Table 3. Voices of Unmasking .......................................................................................... 121 Table 4. Voices of Advocacy ............................................................................................. 122 SPID: EXPLORING THE IMPACT OF MASKING xvi LIST OF FIGURES Figure 1. Echo ...................................................................................................................... 70 Figure 2. Jo’s I-Poem ........................................................................................................... 79 Figure 3. Lily’s I-Poem ........................................................................................................ 84 Figure 4. Rachel Miller’s I-Poem ....................................................................................... 90 Figure 5. Jade’s I-Poem ....................................................................................................... 96 Figure 6. Marie’s I-Poem .................................................................................................. 102 Figure 7. Daphne’s I-Poem ............................................................................................... 107 Figure 8. Roses’s I-Poem ................................................................................................... 112 Figure 9. Kate’s I-Poem .................................................................................................... 118 SPID: EXPLORING THE IMPACT OF MASKING 1 CHAPTER 1: INTRODUCTION Autist(ic)s are the ultimate square pegs. The problem with trying to fit a square peg into a round hole is not that the hammering is hard work; it is that you're destroying the peg. - Not Even Wrong, Paul Collins (2008) Autism Spectrum Disorder (ASD or autism) is a complex neurodevelopmental condition that presents in various ways, affecting social communication, behaviours, and sensory sensitivities (American Psychological Association, 2022). In recent decades, awareness and understanding of ASD have grown considerably, with prevalence rates increasing from 1 in 150 children in the early 2000s to about 1 in 38 children today (Pellicano, 2020). This rise is partly due to improved diagnostic criteria and greater awareness of the condition; however, significant gaps still exist in understanding and diagnosing ASD, especially regarding gender differences. ASD is more commonly diagnosed in males than in females, with a ratio of roughly 4 boys to 1 girl (Lai et al., 2015). This disparity is particularly troubling, given that autistic women often display different symptoms and face unique challenges, with masking being of particular importance (Hull et al., 2017a; Mandy, 2019). Masking refers to the conscious or unconscious suppression of autistic traits to conform to societal expectations and appear neurotypical (Hull et al., 2017b). This behaviour includes a variety of strategies, such as mimicking social behaviours, scripting conversations, and hiding sensory sensitivities (Miller et al., 2021). For instance, camouflaging—a specific type of masking relevant to social situations—enables autistic individuals to navigate social environments more effectively, though often at a significant personal and psychological expense (Zener et al., 2019). The mental health effects of masking are substantial, contributing SPID: EXPLORING THE IMPACT OF MASKING 2 to conditions like anxiety, depression, and suicidality (Zener et al., 2019). It is important to recognise that while masking and camouflaging are frequently used interchangeably in autism research and literature, camouflaging usually involves more complex and subtle processes than merely hiding autistic traits (Hull et al., 2020). Autistic women are more prone to masking due to societal and gender expectations. These expectations, including being social, having large groups of friends, and participating in group activities, exert significant pressure on autistic women to compensate for their social differences (Corscadden & Casserly, 2021). This pressure can lead to serious mental health issues as these women try to meet neurotypical standards, often sacrificing their authentic selves (Cook et al., 2018). The high rates of masking among autistic women also contribute to misdiagnosis or late diagnosis, which further worsens their mental health challenges (Cook et al., 2018). The Importance of Language: Identity-First vs. Person-First The language used to describe autistic individuals influences perceptions and attitudes. In this thesis, the choice to use identity-first language (e.g., autistic person) instead of personfirst language (e.g., person with autism) is deliberate and based on the preferences of the autistic community, especially self-advocates, and the study's theoretical framework (Dwyer et al., 2022). Identity-first language considers the condition as a fundamental part of the person's identity. For many autistic individuals, autism is not just a condition they have but a core aspect of who they are. Using identity-first language recognises the importance of ASD in shaping their experiences and viewpoints (Dwyer et al., 2022). This approach supports the broader movement within disability advocacy that celebrates pride in one's identity and SPID: EXPLORING THE IMPACT OF MASKING 3 challenges the idea that disabilities are inherently negative features to be separated from the person. Conversely, person-first language highlights the person before the condition, suggesting that autism is just one part of a person’s life rather than defining them solely by their condition. Although this approach is well-meaning and aims to promote dignity and respect, it can unintentionally imply that ASD is something negative or separate from the person’s core identity. Many in the autistic community feel that person-first language does not fully reflect the holistic nature of their experiences and can foster a sense of otherness or pathology (Dwyer et al., 2022; Walker, 2021). Lastly, the choice of language also reflects the transformative paradigm adopted in this research. The transformative paradigm challenges traditional assumptions and aims to empower marginalised communities by highlighting their voices and experiences. By using identity-first language, this study strives to honour the preferences of many autistic individuals and align with the principles of self-advocacy and neurodiversity (Dwyer et al., 2022; Walker, 2021). Gender Differences in Autism Like other areas of psychology, gender biases are also evident in autism research. Historically, autism studies have focused more on males, leading to diagnostic criteria and understanding that may not fully reflect the experiences of autistic women (Cook et al., 2018). This gender bias has important consequences. Autistic women often show different traits, such as more subtle forms of stimming—like hair twirling instead of hand flapping—and socially acceptable special interests—such as animals—which can result in underdiagnosis or SPID: EXPLORING THE IMPACT OF MASKING 4 misdiagnosis (Beggiato et al., 2017; Zener et al., 2019). Additionally, societal expectations for women to be social and relational add pressure on autistic women to mask their traits. In addition to exhibiting different characteristics, research has also shown that autistic women are more likely to engage in masking due to gendered expectations and the desire to fit in with peers (Harmens et al., 2022). Autistic women often report masking as a coping mechanism to avoid bullying and discrimination (Bernardin et al., 2021; Cook et al., 2018). However, the effort required to maintain this façade can be mentally and emotionally exhausting, leading to what is known as autistic burnout - a state of extreme physical, mental, and emotional exhaustion caused by prolonged periods of masking and social camouflaging (Raymaker et al., 2020). The Influence of Masking on Mental Health The mental health implications of masking are profound. Autistic individuals who engage in masking tend to experience high levels of anxiety and depression due to the constant effort required to suppress their true selves. Additionally, the acceptance they receive from others is often conditional on their ability to conform to neurotypical standards, which can lead to feelings of inadequacy and self-doubt (Beck et al., 2020; Miller et al., 2021). Prolonged masking can lead to autistic burnout, which can increase the risk of suicidal ideation and attempts, a significant concern and leading cause of death in this community. Furthermore, masking can negatively impact access to adequate health care. Many autistic women are misdiagnosed or receive a diagnosis later in life because their masking behaviours can obscure their autistic traits (Beck et al., 2020; Harmens et al., 2022). This misdiagnosis can lead to inappropriate treatments, such as those for bipolar or borderline personality disorder, and a SPID: EXPLORING THE IMPACT OF MASKING 5 lack of understanding from healthcare providers, which can further exacerbate mental health challenges. Research Purpose and Significance The present study explored the impact of masking on the mental health of autistic women through in-depth examinations of their experiences. By combining the listening guide methodology with feminist and disability frameworks, this research sought to capture the authentic voices of autistic women and uncover the systemic issues that contribute to their mental health struggles and masking behaviours. As the primary investigator, I hope that this study will create awareness among mental health practitioners, challenge traditional assumptions held by the medical model of disability, and promote the view that neurodiverse conditions are different, not less. Researcher Viewpoint and Bias As an autistic woman and an advocate for the neurodiversity paradigm, my viewpoint significantly influences this study. In contrast to the medical model of disability, which pathologizes autism, I approach this research from a stance that affirms autistic experiences as natural variations of human diversity. Embracing neurodiversity shapes how I frame research questions, interpret participants' narratives, and critique dominant societal narratives about autism. Advocating for neurodiversity allows for an in-depth exploration of autistic women's experiences with masking; however, it also introduces potential biases, particularly in discrediting or downplaying accounts that may align with the medical model. To address this, I have employed strategies such as systemically analyzing as part of a research team to ensure a balanced representation of the participants’ voices. Recognizing these biases is SPID: EXPLORING THE IMPACT OF MASKING 6 essential for transparency and credibility in this research. A more detailed explanation of reflexivity is presented in later chapters. By highlighting the unique challenges faced by autistic women, this thesis aimed to inform therapeutic practices with an intersectional lens and encourage mental health practitioners and researchers to create more inclusive and accepting spaces. Ultimately, it is my goal as both a researcher and an autistic woman myself to uplift and amplify the voices of my community, ensuring that their experiences are heard and valued. This thesis begins with a review of the existing literature on autism, masking, and gendered experiences, with a particular focus on how these intersect in autistic women’s mental health. The methodology chapter outlines the qualitative research design and paradigm, participant recruitment, and data analysis process. The results chapter presents three overarching themes identified through participant narratives: the voices of masking, unmasking, and advocacy. The discussion chapter examines the implications of these findings in relation to existing research, theory, and clinical practice. Finally, the thesis concludes with reflections on the study’s contributions, limitations, and directions for future research. SPID: EXPLORING THE IMPACT OF MASKING 7 CHAPTER 2: LITERATURE REVIEW This chapter reviews current literature on masking in autistic women and its impact on their mental health. It begins with an overview of theoretical perspectives that offer insight into the social and cultural dynamics underpinning masking behaviours. The chapter then examines the relationship between masking and identity, specifically its impact on selfperception and self-esteem. Gender differences in autism are discussed, with a focus on the female autism phenotype and gender expressions. A critical examination of the medical model follows, highlighting its role in the historical marginalization and misdiagnosis of autistic women. The chapter also addresses the influence of applied behaviour analysis, considering how it may reinforce masking and contribute to harm. Ultimately, the psychological and emotional impact of masking is examined through personal narratives and empirical studies. The chapter concludes by identifying current research gaps and outlining the rationale for this study. Theories Throughout the literature, several theories provide insight into why autistic individuals engage in masking. The phenomenon of masking is shaped by a complex interplay of identity, stress, and social structures, which can be understood by the theories discussed below. Social Identity Theory Social identity theory, developed by Tajfel and Turner (1979), posits that individuals derive a sense of self from group memberships (Trepte & Loy, 2017). For autistic women, intersecting identities- autistic, female, and potentially other marginalized identities, such as being a person of colour or member of the 2SLGBTQIA+ community – shape their social SPID: EXPLORING THE IMPACT OF MASKING 8 experiences and contribute to masking behaviours. Social identity theory (SIT) emphasizes the significance of belonging and acceptance, suggesting that autistic women may mask to conform to the norms of their social groups (Hull et al., 2020). This drive to assimilate highlights the tension between self-authenticity and social acceptance. In their research, Hull et al. (2017) identified two primary functions of masking: assimilation and connection. To assimilate, some autistic individuals reported concealing traits to avoid stigma and discrimination. In contrast, others masked in hopes that it might help them better navigate social environments and form relationships. Bernardin et al. (2021) further corroborated these findings, showing that masking facilitates social acceptance and access to opportunities such as employment and education. However, Bernardin et al. (2021) also revealed the psychological costs of masking, including emotional exhaustion and a diminished sense of self. Minority Stress Theory While SIT provides a compelling framework for understanding the social pressures to mask, it falls short in addressing the internal conflicts and mental health implications of this behaviour. Minority stress theory, initially developed to understand the experiences of 2SLGBTQIA+ individuals, has been extended to other marginalized populations, including autistic individuals. Minority stress theory (MST) posits that individuals from marginalized communities face chronic stressors due to stigma, discrimination, and social exclusion (Botha & Frost, 2020). For autistic women, the dual minority status of being both autistic and female intensifies these stressors, often driving the need to mask as a coping mechanism (Miller et al., 2022). SPID: EXPLORING THE IMPACT OF MASKING 9 In their study on masking behaviours, Miller et al. (2020) highlighted the role of stigma in motivating masking, finding that autistic women conceal traits to avoid bullying and negative judgments. Evans et al. (2024) further demonstrated how stigma impacts first impressions, with autistic individuals rated less favourably than neurotypical peers. Together, these findings illustrate how societal biases perpetuate masking, reinforcing the need for interventions that address systemic discrimination. As a theory, MST effectively highlights external pressures to mask. Still, it does not fully account for the bidirectional nature of social interactions or the mutual misunderstandings that contribute to these challenges. The DEP addresses this gap. The Double Empathy Problem Milton's double empathy problem (2012) challenges traditional deficit-focused models of autism, such as the theory of mind. The double empathy problem (DEP) posits that communication difficulties between autistic and non-autistic individuals arise from mutual misunderstanding rather than inherent deficits in autistic individuals. Through this perspective, masking is reframed as an attempt to bridge this communication gap and align with neurotypical norms (Milton et al., 2022). Other research supports DEP by demonstrating that individuals with similar neurotypes tend to communicate more effectively with one another. For instance, Crompton et al. (2020) found that autistic individuals conveyed information more accurately to other autistic individuals compared to non-autistic individuals. Similarly, Cheang et al. (2024) showed that non-autistic participants struggled to empathize with autistic narrators, further highlighting the role of neurotypical biases in communication challenges. SPID: EXPLORING THE IMPACT OF MASKING 10 In addition to shifting the focus from individual deficits to systemic misunderstandings, DEP also highlights the cost of masking these issues. By adopting neurotypical behaviours, autistic women may temporarily reduce misunderstandings, but this comes at the expense of their authenticity and well-being (DeThorne, 2020; Milton et al., 2022). Currently, the burden of conforming to existing social norms rests with autistic individuals; however, other theories within the field of counselling psychology emphasize the need for social environments that foster mutual understanding rather than requiring autistic individuals to conform. Feminist Disability Theory (FDT) Feminist disability theory offers a critical lens for analyzing how social, cultural, and institutional norms construct and constrain the experiences of disabled individuals, particularly those whose identities intersect with gender and other axes of marginalization (Garland-Thomson, 2020). As a key theoretical framework in this thesis, feminist disability theory (FDT) helps highlight the systemic forces that render autistic women’s struggles with masking invisible or misunderstood. Developed primarily within the context of physical disability, FDT challenges dominant conceptions of normalcy and embodiment, insisting that disability is not merely a medical issue, but a social and political one (Garland-Thomson, 2020). This lens is beneficial for understanding the practice of masking as a gendered survival strategy. Burns & Tierney (2023), for example, explored how autistic women are often pressured to conform to stereotypical feminine behaviours, such as being socially graceful and emotionally regulated, standards that are frequently incongruent with autistic ways of being. From an FDT perspective, these pressures are not neutral social expectations SPID: EXPLORING THE IMPACT OF MASKING 11 but manifestations of ableist and sexist norms. Masking, therefore, becomes not just a coping mechanism but a performance conditioned by systems of power that devalue neurodivergent ways of being (Cridland et al., 2014). For autistic women of colour, these pressures are even more complex. Kourti (2018) highlights how ableism and racism intersect to compound marginalization, limiting access to an accurate diagnosis and support. These women often feel compelled to mask to avoid social judgment, professional repercussions, or physical harm. However, this form of masking, though protective, is also deeply costly, contributing to identity fragmentation and mental health challenges. FDT’s intersectional focus is crucial for capturing this complex experience (Kourti, 2018). Research by Erevelles and Abay (2024) further emphasizes that masking should not be viewed solely as an individual adaptation but as a response to entrenched social inequities. Their work argues that authentic acceptance and safety for autistic women cannot be achieved through individual accommodation alone; instead, it requires systemic change. By applying FDT to critique the power dynamics that govern whose behaviours are considered “normal” or “professional,” this thesis aligns with the values of counselling psychology. Both FDT and counselling psychology advocate for the dismantling of oppressive structures, particularly those that perpetuate ableist and sexist norms, and call for practices that foster authenticity, inclusion, and social justice. Finally, FDT not only critiques systems of oppression but also foregrounds resistance and agency (Garland-Thomson, 2020). For many autistic women, unmasking becomes a profoundly political act – one that reclaims agency and disrupts the expectation to conform. This framing shifts the conversation from personal pathology to collective transformation, SPID: EXPLORING THE IMPACT OF MASKING 12 affirming the clinician's role as a partner in advocacy, not correction. Through this lens, masking is recontextualized as a socially conditioned performance, and unmasking is reinterpreted as a form of both healing and resistance. Cultural and Systemic Inequities Influencing Masking Culture is a complex and multifaceted construct encompassing shared beliefs, values, practices, and norms within a group of people (Geertz, 1973; Hofstede, 2001; Marshall, 2020). It shapes perceptions of self and others, influencing how differences such as autism are understood and valued. Identity, similarly, is a dynamic and fluid construct formed through interactions within one's cultural and social environment (Hall, 1996); these interconnected constructs interact to shape experiences, behaviours, and societal expectations. In many societies, dominant cultural narratives emphasize gendered expectations, such as social competence, emotional regulation, and interpersonal harmony, which are often disproportionately placed on women (Connell, 2009). For autistic women, these expectations create a double bind because they are expected to conform to these norms while navigating challenges such as sensory sensitivities and unique communication styles (Kourti, 2018; Taylor & DaWalt, 2020). Consequently, autistic women may adopt masking behaviours to reconcile the tension between their authentic selves and societal acceptability. The pressure faced by autistic women extends beyond social interactions and is deeply embedded in broader cultural systems that enforce stigma and marginalization. Dominant narratives of autism, primarily shaped by a male-centric model, continue to erase or overlook the experiences of autistic women, limiting their visibility in both public discourse and clinical frameworks (Tharian et al., 2019). This invisibility often contributes to SPID: EXPLORING THE IMPACT OF MASKING 13 internalized self-criticism and psychological distress, as noted by Bernardin et al. (2021), deepening the disconnection from one’s authentic identity. For autistic women of colour, these challenges are further compounded by systemic racism and cultural exclusion, resulting in additional barriers to recognition, diagnosis, and support. Their experiences remain significantly underrepresented in both research and mainstream conversations around autism, highlighting a crucial need for intersectional perspectives that acknowledge the layered realities of gender, race, and neurodivergence (Brown et al., 2020). In addition to social and internalized stigma, systemic inequalities are evident across various domains, including employment and education. Research by Davidson & Henderson (2010) and Tharian et al. (2019) illustrates how exclusionary practices in these domains create environments where masking becomes a survival strategy. For instance, non-inclusive workplaces and educational settings can compel autistic women to conceal their traits to fit into neurotypical norms while also lacking adequate accommodations to account for their unique needs. Integrating Theories and Critiques The integration of the theories mentioned above highlights the multidimensional nature of masking among autistic women. SIT highlights the desire for social belonging, while MST situates masking within the broader context of systemic oppression and chronic stress. DEP reframes masking as a response to mutual misunderstandings rather than individual deficits, and FDT critiques the gendered and ableist expectations driving these behaviours. These theories collectively illustrate that masking is not solely an individual coping mechanism but also a response to societal and systemic inequities. However, they also reveal SPID: EXPLORING THE IMPACT OF MASKING 14 critical gaps. For instance, while SIT and MST focus on social belonging and stress, they do not fully capture the bidirectional communication challenges addressed by DEP. Similarly, DEP focuses on systemic misunderstandings but does not account for the intersecting oppressions emphasized in FDT. By critiquing these theories and integrating their insights, this review emphasizes the importance of a holistic approach that considers individual, social, and systemic factors. The Complex and Multifaceted Nature of Masking and Identity The relationship between masking and identity is inherently complex and multifaceted. Masking can be viewed as a coping strategy or survival mechanism (Miller et al., 2021) employed by autistic women to navigate the pressures of social interaction in environments that may otherwise feel hostile or overwhelming. However, masking comes at a cost. The constant suppression of authentic self-expression leads to a disconnect between one's internal experiences and external behaviours (Burns & Tierney, 2023). This dissonance can result in a profound and emotionally straining psychological experience, as maintaining a façade of normalcy requires immense cognitive and emotional effort. Prolonged masking has been shown to contribute to identity confusion and selfalienation (Evans et al., 2024; Leedham et al., 2020). Autistic women may struggle to differentiate between their valid preferences, values, and social personas. This phenomenon reflects Erving Goffman's (1959) concept of the "presentation of self," in which individuals curate different versions of themselves to suit various social contexts. For autistic women, however, the presentation of self through masking oftentimes feels forced, leading to low self-esteem, burnout, and a diminished sense of authenticity. SPID: EXPLORING THE IMPACT OF MASKING 15 At the same time, the necessity of masking can also be seen as an act of resilience. Autistic women demonstrate considerable resourcefulness in learning to mask, enabling them to function in social environments that are often exclusionary or inaccessible (Kelly et al., 2024; Miller et al., 2021). The ability to adapt through masking may provide short-term safety and social success, though it highlights the need for broader societal change. A society that is not safe enough for autistic women to be their whole and authentic selves emphasizes the need for greater acceptance, accommodation, and understanding of the experiences of autistic women. This section demonstrates how theoretical frameworks provide valuable insights into the motivations and implications of masking among autistic women. SIT highlights the role of social belonging, MST emphasizes the impact of stigma and systemic discrimination, DEP reframes communication challenges, and FDT critiques gendered and ableist norms. Cultural expectations and the relationship between masking and identity further illustrate the complex and multifaceted nature of this phenomenon. Together, these perspectives offer a comprehensive understanding of the interplay between individual behaviours and societal pressures, emphasizing the need for systemic change to promote authenticity and well-being for autistic women. Autism in Women This section of the literature review will explore the intersection between being both female and autistic. This will include the female autism phenotype, which refers to how autism presents differently in females, as well as diagnostic challenges and biases that contribute to the lack of adequate diagnoses in this community. Furthermore, this section will also address gender-specific experiences and challenges. It will conclude with how the role SPID: EXPLORING THE IMPACT OF MASKING 16 of stereotypes and societal expectations has perpetuated the challenges that autistic women and girls face. Female Autism Phenotype The concept of the female autism phenotype (FAP) has emerged from increasing recognition that autism can manifest differently in women, girls, and individuals identifying as female, irrespective of sex assigned at birth or gender identity, compared to men and boys (Hull et al., 2020). Historically, the understanding of autism has been heavily based on male presentations, leading to a diagnostic framework that often overlooks or misinterprets the characteristics seen in females. FAP typically includes more subtle communication difficulties, a greater ability to mask and socially camouflage autistic traits, and different profiles of interests and behaviours, such as having animal-focused special interests instead of vehicular ones, like trains (McFayden et al., 2019; Siracusano et al., 2024). Unlike the more overt social impairments often seen in autistic boys, girls may exhibit what appears to be better social integration on the surface. Still, they usually struggle with deep and persistent social and communication challenges (Siracusano et al., 2024). Autistic women and girls may develop advanced coping mechanisms, such as mimicking social behaviours, which can make their autism less visible to clinicians and peers. This ability to mask or socially camouflage their differences often comes at a significant personal cost, leading to higher rates of anxiety, depression, and other mental health issues (Bargiela et al., 2016). Additionally, interests in females may not align with the stereotypical “restricted interests” seen in males, such as a focus on social relationships or animals, which are less likely to be recognized as signs of autism (Hull et al., 2020). SPID: EXPLORING THE IMPACT OF MASKING 17 While FAP can aid in our understanding of gender differences in autism, it is also important to note that it is not without its criticisms and limitations. While it helps to highlight the differences in how autism may present in females, it can also perpetuate gendered stereotypes and reinforce the binary notion of gender. Autism is a highly individualized condition with significant variability within and across genders (Siracusano et al., 2024). Therefore, the experiences of autistic women and girls should be understood as part of a broader gender spectrum that includes a diversity of presentations and experiences, not confined strictly to gendered patterns (Siracusano et al., 2024). Bargiela et al. (2016) illuminated the systemic barriers confronting autistic women in receiving a timely and accurate diagnosis. Participants recounted instances of not being believed or having their traits dismissed, underscoring a fundamental lack of awareness and recognition of female autism presentation. The insidious influence of societal norms and expectations was palpable, with participants recounting experiences of being rewarded for conformity at school, only to face reprimand and shame when their masking efforts faltered. With the emergence of FAP, various characteristic features have been identified. Through several meta-analyses, some of the most common features that have emerged concerning FAP are the knowledge of and desire to be more social, social passivity, reliance on others to form social connections and friendships, tendencies to mimic the behaviours of others or mask their difficulties, and a tendency to be directive with others (Young et al., 2018). Furthermore, autistic females were found to have more appropriate linguistic vocabulary and core language skills than males, as well as less persistent and perseverative interests (Young et al., 2018). Interestingly, Ratto et al. (2016) also found that autistic women who had higher IQs and did not have an intellectual disability were less likely to SPID: EXPLORING THE IMPACT OF MASKING 18 meet the diagnostic criteria for autism spectrum disorder. Their results indicate that, because of the current diagnostic criteria, many autistic females are being missed; as previously mentioned, this poses a significant barrier to accessing adequate support because they are more likely to be misdiagnosed as either bipolar or as having borderline personality disorder (Ratto et al., 2016). This is a significant issue because misdiagnosis leads to a variety of adverse consequences, such as delayed or inappropriate treatments, emotional distress, identity confusion, and missed opportunities for connection with other autistic individuals who could provide a source of support and acceptance. Greater awareness of how autism presents differently in women is crucial to ensuring that they are correctly diagnosed and receive the support that they need. Diagnostic Challenges and Biases Diagnostic challenges and biases are significant barriers to identifying autism in women and girls. The diagnostic criteria for autism have been developed and validated primarily based on male presentations, resulting in a gender bias that underdiagnoses or misdiagnoses females. Research has shown that females often receive diagnoses later in life or are misdiagnosed with other conditions, such as mood, anxiety, or eating disorders (Cridland et al., 2014). These misdiagnoses occur because the social and communication difficulties of autistic women can be misinterpreted as symptoms of other psychiatric conditions (Cridland et al., 2014; Seers & Hogg, 2023). Clinicians may also hold unconscious biases, perceiving autism as predominantly a male condition, which can further hinder accurate diagnosis (Haney, 2016; Nadesan, 2005). This bias is compounded by the fact that girls are often better at masking their traits, leading to the misconception that they are less affected by autism (Haney, 2016; Nadesan, 2005). SPID: EXPLORING THE IMPACT OF MASKING 19 Additionally, standardized diagnostic tools and screening instruments are less effective at identifying autism in females because they do not account for the gender-specific manifestations of the condition. As a result, many women and girls go undiagnosed or are diagnosed much later in life, often after years of struggling without appropriate support. Gender-Specific Experiences and Challenges The gender-specific experiences and challenges are complex and pervasive. Social expectations and stereotypes around gender can significantly influence the way autism is experienced and expressed. For instance, societal norms often expect girls to be more socially adept and communicative, which can pressure autistic women and girls to conform and hide their difficulties (Bernardin et al., 2021). This social masking can be exhausting and lead to severe mental health issues over time, including anxiety, depression, and burnout. Autistic women and girls often face unique challenges in social interactions shaped by societal expectations and gender norms. While they may struggle with understanding social cues and maintaining friendships, these difficulties are often compounded by the pressure to conform to neurotypical social standards. Unlike males, autistic women are more likely to invest substantial effort into masking their autistic traits to fit in and avoid social exclusion (Seers & Hogg, 2023). This constant effort to mask and adapt can lead to chronic stress, emotional exhaustion, and a profound sense of disconnection from their authentic selves. The internal conflict between their identity and the socially acceptable persona they present to the world often results in a pervasive feeling of alienation and otherness. Furthermore, autistic women frequently report feeling misunderstood and isolated, as their experiences do not align with the traditional male-centred narrative of autism (Hull et al., 2020). This misalignment contributes to a lack of recognition and support within their SPID: EXPLORING THE IMPACT OF MASKING 20 social circles and clinical settings. As a result, many autistic women are either misdiagnosed or diagnosed later in life, which can exacerbate feelings of confusion and frustration (Seers & Hogg, 2023). Seers and Hogg (2023) conducted a qualitative study that delved into the experiences of autistic women diagnosed later in life. Their research, informed by feminist disability theory, sought to understand the reasons behind masking in these women and the factors that contribute to their delayed diagnoses. Through thematic analysis of interviews with eight women, all diagnosed in later adulthood, with the youngest receiving her diagnosis at 23 years old, several key findings emerged. The study highlighted the marginalization that these women faced, not only due to their autism but also because of the societal expectations tied to gender. The participants described the challenges of living outside of traditional gendered social norms, which often required them to perform social roles that felt incongruent with their identities. The psychological consequences of masking were profound, with participants reporting feelings of shame, self-doubt, and a sense of otherness that permeated their lives. Many women learned that to be accepted, they needed to adhere to a performative social context, where they felt compelled to present a version of themselves that would be more acceptable to others. This performative and masked self further emphasized their feelings of alienation, as even those who "masked all the time" found themselves excluded from typical social groups. Seer and Hogg's (2023) findings highlight the complex interplay between gender, social expectations, and the experiences of autistic women. Their study adds to a growing body of literature that calls for a more nuanced understanding of autism, one that recognizes SPID: EXPLORING THE IMPACT OF MASKING 21 the diverse experiences of autistic individuals across the gender spectrum. By centring the voices of autistic women, their research challenges traditional diagnostic criteria. It encourages clinicians and researchers to adopt more inclusive approaches that consider the unique challenges faced by this community. The Role of Social Expectations and Stereotypes Social expectations and stereotypes play a crucial role in shaping the experiences of autistic women and girls. Traditional gender roles often dictate that girls should be socially skilled and emotionally expressive, which can conflict with the characteristics of autism (Seers & Hogg, 2021). As a result, autistic girls may feel immense pressure to conform to the expectations, leading to increased masking and camouflaging behaviours. This societal pressure to fit in can result in significant emotional and psychological strain, as autistic women and girls continually suppress their true selves to meet external expectations (Seers & Hogg, 2021). Stereotypes about autism itself also contribute to the challenges faced by autistic women and girls. The pervasive image of autism as a condition that predominantly affects boys can lead to a lack of awareness and understanding of how it manifests in females (Gould, 2017). This stereotype can result in dismissive attitudes from educators, healthcare providers, and even family members, who may attribute the struggles of autistic girls to personality traits or other non-autistic factors rather than recognizing they are part of the autism spectrum (Gould, 2017). Furthermore, the intersection of gender and autism can exacerbate discrimination and stigma. Autistic women may face a double bind where they are marginalized both for their gender and neurodivergence (Foggo & Webster, 2017; Tint & Weiss, 2018). This SPID: EXPLORING THE IMPACT OF MASKING 22 intersectionality can lead to compounded social and economic disadvantages, making it even more challenging for autistic women to access the support and accommodations they need (Foggo & Webster, 2017; Smith, 2011). Gender differences in autism significantly influence the experiences and challenges faced by autistic women and girls. The FAP, diagnostic biases, gender-specific experiences, and the role of social expectations and stereotypes all contribute to the unique struggles of autistic women. Recognizing and addressing these differences is essential for providing appropriate support and fostering an inclusive understanding of autism that encompasses the diverse experiences of all autistic individuals. The Medical Model: Harms and Limitations To fully grasp the harmful effects of masking on the mental health of autistic women, it is imperative to contextualize the historical entrenchment of therapies and interventions that actively promote masking while perpetuating harm (Anderson, 2023). Central to this discussion is the Medical Model of Disability. This framework, which has dominated the field of research, diagnostics, and care since the mid-20th century, frames ASD as a pathological disorder that requires treatment or cure. While the medical model has played a significant role in advancing the diagnostic system for autism, particularly in its ability to identify and diagnose disorders earlier, it has also contributed to the reinforcement of harmful assumptions and approaches to autism (Straus, 2013). The historical roots of the medical model originate from early autism researchers like Leo Kanner and Hans Asperger in the 1940s, who first recognized autism as a distinct condition (Silverman, 2012). Their groundbreaking work laid the foundation for diagnostic criteria and early intervention strategies. However, this view mainly stemmed from research SPID: EXPLORING THE IMPACT OF MASKING 23 centred on male children, creating a male-focused understanding of autism (Straus, 2013). The initial studies by Kanner and Asperger, along with later diagnostic criteria in the DSM, were heavily biased towards behaviours and traits more frequently seen in boys (Straus, 2013). Consequently, the medical model has largely ignored how autism presents differently in females, including internalized behaviours, such as mimicking others' social actions, which often go unnoticed in clinical practice (Straus, 2013). While the medical model provided much-needed structure for diagnosing and addressing autism in its early years, it has also come under scrutiny for its reductive approach to understanding human diversity. Critics argue that the model pathologizes natural variations in human behaviours, prioritizing normalization over acceptance and support (Shyman, 2016; Silverman, 2012). Rather than focusing on the strengths and contributions of autistic individuals, they are often defined by what they cannot do compared to neurotypical standards. This deficit-focused view leads to interventions aimed at making autistic individuals appear more neurotypical, disregarding their intrinsic needs and identities and perpetuating stigma and misunderstanding (Shyman, 2016; Singer, 1999). The negative influences of the medical model on autistic women are especially pronounced. Due to gender biases in diagnosis and treatment, many autistic women remain undiagnosed or misdiagnosed well into adulthood (Bargiela et al., 2016). Diagnostic criteria and screening tools, developed based on male presentations of autism, fail to capture the more nuanced and varied expressions seen in women. This diagnostic overshadowing often leads to misdiagnoses of other conditions, such as borderline personality disorder (BPD), anxiety disorders, or eating disorders, resulting in inappropriate or ineffective treatments. Without proper diagnosis and support, autistic women frequently experience increased SPID: EXPLORING THE IMPACT OF MASKING 24 vulnerability to mental health issues such as anxiety, depression, and burnout (Hull et al., 2020). The constant pressure to conform to societal norms and the expectation to mask autistic traits can lead to chronic stress, identity confusion, and diminished self-esteem. Harmful therapies and interventions stemming from the medical model include Applied Behaviour Analysis (ABA), which was initially developed with a focus on modifying behaviours deemed undesirable without considering the individual's intrinsic needs and experiences (Anderson, 2023). The autistic community has widely criticized ABA for its intensive and often coercive techniques, which can be traumatic for autistic children, mainly when they are employed without consideration for their autonomy. The emphasis on compliance and behaviour modification often disregards the underlying causes of behaviours and fails to address the sensory, emotional, and communicative needs of autistic individuals (Anderson, 2023). Furthermore, interventions that push for social skills training without consideration for the unique needs of autistic individuals and other methods aimed at masking autistic traits can exacerbate feelings of inadequacy and alienation (McGill & Robinson, 2020). Autistic women may internalize the message that their natural way of being is unacceptable, leading to significant and lasting psychological trauma and harm (McGill & Robinson, 2020). This internalized ableism can result in a pervasive sense of inadequacy and a deep-seated belief that one’s authentic self is inherently flawed. The cumulative effect of these interventions is often a profound sense of disconnection from oneself and others, further compromising mental health and well-being. Other harmful interventions influenced by the medical model include aversive conditioning techniques, where negative stimuli are used to discourage certain behaviours. SPID: EXPLORING THE IMPACT OF MASKING 25 These methods have been widely criticized for their ethical implications and potential to cause long-term psychological harm (McGill & Robinson, 2020). Additionally, some treatments that claim to "cure' or "heal" autistic individuals, such as chelation therapy, lack scientific validation and can pose serious health risks (Brent, 2013). Furthermore, while the medical model has achieved considerable success in providing early diagnosis and intervention for autism, its focus on deficits has marginalized the voices and experiences of autistic individuals, particularly women, in research and clinical practice (Shyman, 2016). This exclusion perpetuates a cycle of misunderstanding and misrepresentation, hindering the development of more inclusive and supportive approaches (Dwyer et al., 2022). In response, the neurodiversity movement advocates for a paradigm shift towards viewing autism as a natural variation of human diversity, emphasizing strengths, acceptance, and self-determination. This shift calls for a move away from deficitfocused models towards approaches that celebrate and recognize the unique perspectives of autistic individuals (Dwyer et al., 2022). Applied Behaviour Analysis (ABA) and the Promotion of Masking ABA, developed in the 1960s by Ole Ivar Lovaas, is a widely used therapy for autistic individuals, especially children. Based on behaviourist principles, ABA seeks to change observable behaviours through reinforcement techniques. While it has been promoted as an evidence-based intervention to help autistic individuals gain functional skills and decrease problematic behaviours, it has faced notable criticism regarding its methodology and ethical concerns (Silberman, 2015). Lovaas’ primary goal when developing ABA was to conform autistic individuals to neurotypical standards (Levenstein, 2018). In an article by Leverstein (2018), which spoke SPID: EXPLORING THE IMPACT OF MASKING 26 about the harms of ABA, a quote from Lovaas was included discussing his philosophy for ABA, in which he stated the following: You see, you start pretty much from scratch when you work with an autistic child. You have a person in the physical sense – they have hair, a nose, and a mouth – but they are not people in the psychological sense. Because of this view, he emphasised the need to “make autistic children people” through various therapies. This perspective led to practices ranging from coercion to the use of electric shocks for non-compliance. Notably, during the development of ABA, Lovaas was also involved in the “feminine boy project,” a form of conversion therapy aimed at enforcing heteronormative behaviours, which has since been discredited and recognized for its harm to the 2SLGBTQIA+ community (Pyne, 2021). One of the primary critiques of ABA is its intensive and often coercive nature. ABA therapy typically involves numerous hours of structured sessions each week, where therapists use positive reinforcement (rewards) and negative reinforcement or punishment (consequences) to shape behaviours (Leaf et al., 2022). Critics argue that this approach can be dehumanizing, treating autistic individuals more like subjects in an experiment than people with unique needs and experiences. The focus on compliance and behaviour modification often disregards the underlying causes of behaviours and fails to address the intrinsic needs of autistic individuals. This can lead to significant stress and anxiety for those undergoing the therapy (Leaf et al., 2022). Furthermore, the emphasis on extinguishing “undesirable” behaviours, such as stimming, can be particularly harmful. Stimming is often a healthy regulatory coping mechanism for sensory overload, stress, or a way to express excitement. Suppressing these SPID: EXPLORING THE IMPACT OF MASKING 27 behaviours without addressing the underlying causes, if they cause harm to oneself or others, can lead to increased internal distress (Leaf et al., 2022). Autistic individuals have reported feeling invalidated and misunderstood when their natural ways of coping are discouraged or punished. This can exacerbate feelings of inadequacy and alienation, contributing to longterm psychological harm. Another primary concern with ABA is the lack of consent and autonomy for the individuals undergoing therapy. Many autistic individuals, especially children and youth, are subjected to ABA without fully understanding or consenting to the process (Leaf et al., 2022). The power dynamics in ABA sessions can lead to an individual's autonomy being compromised, as they are repeatedly directed to perform tasks or suppress behaviours intrinsic to their identity. This lack of agency can have detrimental effects on self-esteem and self-worth, as autistic individuals may internalize the message that their natural behaviours are unacceptable or wrong (Leaf et al., 2022). The focus on normalization and making autistic individuals appear more "neurotypical" is another significant criticism of ABA (Leaf et al., 2018). This approach can perpetuate the idea that autistic traits are inherently undesirable and should be hidden or eliminated. Autistic individuals often feel pressured to mask their true selves, leading to masking. Masking can lead to significant emotional and mental exhaustion, as well as a loss of identity and authenticity. Over time, the constant effort to conform to neurotypical standards can lead to burnout and other mental health issues, such as anxiety and depression (Leaf et al., 2022). Autistic adults who have undergone ABA as children often report lasting adverse effects (Anderson, 2023). Many describe the therapy as traumatic, recounting experiences of SPID: EXPLORING THE IMPACT OF MASKING 28 fear, confusion, and helplessness. The intensive and repetitive nature of ABA sessions can create a hostile and stressful environment, leaving lasting emotional scars. Additionally, the focus on external behaviours rather than internal experiences can leave autistic individuals feeling misunderstood and unsupported in their actual needs and challenges. The literature consistently highlights the negative psychological impacts of early ABA interventions on autistic individuals, with a particular emphasis on trauma, loss of identity, and long-term mental health consequences. Anderson (2023), McGill and Robinson (2020), and Kupferstein (2018) all point to the harmful effects of ABA's focus on conformity and masking autistic behaviours. These interventions, which were often physically intrusive and psychologically damaging, contributed to mental health disorders such as PTSD, depression, and anxiety. Anderson's (2023) study, for instance, reveals that participants reported experiences of physical restraint and isolation, practices that were dehumanizing and traumatic. McGill and Robinson (2020) echo these findings, showing that their participants felt forced to abandon their authentic selves in favour of neurotypical expectations. This sense of lost identity was a common theme throughout their stories. It was linked to both long-term psychological distress and the development of anger, which later fueled advocacy for more inclusive treatments. A key synthesis across these studies is the identification of forced masking as a central element of harm. Both McGill and Robinson (2020) and Kupferstein (2018) note that the pressure to conform to societal norms caused a significant emotional toll. Kupferstein’s (2018) quantitative study corroborates these findings, revealing that early ABA exposure significantly increases the likelihood of PTSD symptoms, with almost half of the participants meeting the clinical criteria for PTSD. This statistic emphasizes the long-lasting SPID: EXPLORING THE IMPACT OF MASKING 29 psychological damage inflicted by interventions that prioritize compliance over individual autonomy. These findings collectively emphasize the dangers of behaviourist models that treat autistic traits as problems to be fixed rather than natural variations of the human experience. The evidence suggests that interventions like ABA, which force compliance with neurotypical standards, not only fail to meet the actual needs of autistic individuals but also impose lasting harm. This highlights the importance of re-evaluating these practices and shifting towards more affirming approaches that prioritize mental health and authentic selfexpression. While the reviewed studies highlight the significant harm caused by early ABA interventions, it is essential to acknowledge that ABA has evolved and improved over time. Contemporary ABA has shifted away from the rigid compliance-based approaches of the past, with many practitioners now emphasizing strengths-based practices, individualized support, and a greater focus on enhancing quality of life rather than enforcing neurotypical norms. These changes reflect growing recognition of the autonomy and dignity of autistic individuals, as well as efforts to reduce psychological distress historically associated with ABA. However, the trauma reported by autistic adults who experience earlier forms of ABA cannot be overlooked. The enduring mental health consequences, including PTSD, depression, and identity loss, emphasize the ethical concerns surrounding interventions that prioritize masking over authenticity. As research continues to examine the long-term effects of ABA, it is crucial to ensure that current and future therapeutic approaches prioritize the well-being, self-determination, and unique needs of autistic individuals rather than focusing solely on behaviour modification. SPID: EXPLORING THE IMPACT OF MASKING 30 Autism and Mental Health Because of challenges such as discrimination and a lack of awareness and understanding from neurotypicals, autistic individuals are at a greater risk of developing mental health issues. Studies have shown that autistic individuals are more likely to attempt or commit suicide, develop an eating disorder, engage in non-suicidal self-injury (NSSI), and have other mental health conditions such as anxiety, depression, and PTSD when compared to their neurotypical peers (Sedgewick et al., 2021). This is a significant issue for autistic women as they have been shown to have higher rates of mental health issues when compared to both autistic men and neurotypical individuals (Sedgewick et al., 2021). This section will explore some of the current research findings on the mental health concerns associated with masking, with a particular focus on autistic burnout and co-occurring conditions, which have recently begun to emerge in autism research and literature. The Influence of Masking on Mental Health Masking can have profound psychological and emotional consequences. Chronic stress is one of the most reported effects, as the continuous effort to appear neurotypical requires significant mental energy and can lead to exhaustion (Hull et al., 2020; Miller et al., 2021). The stress is often compounded by the fear of being "outed" as autistic or exposed by others if the individual has not yet disclosed their neurodiversity, which can heighten feelings of anxiety (Cage & Troxell-Whitman, 2019). Furthermore, masking has been associated with identity confusion and a fragmented sense of self in autistic individuals, which arises from the discrepancy between their authentic identity and the persona they present to the world, leading to feelings of inauthenticity and alienation (Cook et al., 2018). has been demonstrated to have been associated with poorer mental health outcomes in autistic women SPID: EXPLORING THE IMPACT OF MASKING 31 (Raymaker et al., 2020). This can range from a variety of issues, such as anxiety, depression, and suicidal ideation. This is an exhausting process that often leaves autistic women feeling drained and, in extreme cases, can lead to autistic burnout, which is a detrimental experience that leaves many autistic women feeling hopeless and overwhelmed. Furthermore, masking can exacerbate emotional dysregulation, as individuals may struggle to manage their emotions while maintaining a socially acceptable façade. This can result in emotional outbursts or shutdowns, particularly in private settings where they feel safe enough to release the pent-up tension (Sedgewick et al., 2021). The psychological burden of masking often decreases overall well-being and can negatively impact self-esteem as individuals may internalize social rejection and stigmatization (Sedgewick et al., 2021). Research Findings on Mental Health Outcomes Empirical research has increasingly highlighted the link between masking and adverse mental health outcomes. Studies have found that individuals who engage in masking are more likely to experience higher levels of anxiety and depression compared to those who do not (Hull et al., 2020; Cremone et al., 2023). This correlation is often attributed to the mental and emotional toll of maintaining a neurotypical persona and the stress associated with doing so (Chapman et al., 2022). Research also suggests that masking is associated with lower self-esteem and worth, as individuals internalize the belief that their authentic selves are unacceptable (Cremone et al., 2023). Moreover, some studies indicate that masking can contribute to increased suicidal ideation and self-harm behaviours, particularly among individuals who feel unable to meet societal expectations despite their efforts (Cremone et al., 2023). The psychological distress associated with masking can also lead to substance abuse as a coping mechanism (Ressel et al., 2020). These findings underscore the significant SPID: EXPLORING THE IMPACT OF MASKING 32 mental health risks associated with masking and highlight the need for increased awareness and support for autistic individuals, particularly in clinical and educational settings. A study conducted by Bradley et al. (2021) examined the influence of masking on the mental health of autistic adults through a survey in which 277 participants were asked questions about masking and the impact that it has on their mental health. With a substantial portion of the participants being autistic women, one of the most prevalent themes that emerged was the dangers of masking (Bradley et al., 2021). This refers to the fact that the more time that the individual spent hiding their autistic features, the higher the prevalence of the mental health issues that they faced. Some of the challenges that they reported were exhaustion, isolation, anxiety, depression, loss of identity, low self-esteem, self-harm, and suicidal ideation. These findings were further supported by Chapman et al. (2022) through their study, which examined the influence of masking on the mental health of autistic teenagers. Using a qualitative approach, the researchers interviewed twenty autistic teenagers and then analyzed the results using Reflexive Thematic Analysis (RTA). The results of the study demonstrated that most of the participants experienced a variety of adverse mental health outcomes related to masking, such as anxiety, depression, exhaustion, and disconnection (Chapman et al., 2022). One example of this is when the participants describe going into sensory overload or when an autistic person becomes too overwhelmed by their environment. Instead of doing what is natural to them (such as covering their ears, exiting the room, or stimming), the participants described having to stay silent and try to appear as neurotypical as they can by pushing themselves to be social and ignoring their sensory needs (Chapman et al., 2022). This often leads to them experiencing intense exhaustion and, in some cases, meltdowns SPID: EXPLORING THE IMPACT OF MASKING 33 once they return home because they cannot engage in the self-stimulatory behaviours (stimming) that they need to self-regulate in those situations (Chapman et al., 2022). Although the sample was limited in terms of gender identity, with the only categories being cisgender male and female, the study emphasized the influence that masking has on the mental health of autistic individuals and, through thematic analysis, highlighted various aspects of masking that are harmful such as masking being in sensory overload (Chapman et al., 2022). Throughout the literature, it is evident that masking has detrimental effects on the mental health of autistic individuals (Chapman et al., 2022). These include exhaustion from having to be constantly self-aware and engaging in masking, a profound sense of isolation and disconnection, and long-term consequences such as chronic stress, burnout, and the development of mental health issues (such as anxiety and depression). These effects are even more apparent in autistic women, as they are in constant conflict between embracing their autistic identity and conforming to neurotypical standards (Hull et al., 2017c). Because of these factors and additional pressure, they are at a greater risk of developing adverse mental health outcomes due to masking. Autistic Burnout As previously stated, autistic burnout is a significant phenomenon that affects many autistic women, resulting from the chronic effort to mask and conform to neurotypical expectations. This state of burnout manifests as severe mental and physical exhaustion, leading to crises that can jeopardize friendships, careers, daily activities, and overall wellbeing. As Raymaker et al. (2020) highlight, autistic burnout often stems from the overwhelming challenges of navigating environments that can cause sensory overload. SPID: EXPLORING THE IMPACT OF MASKING 34 Despite being a pressing issue within the autistic community, academic acknowledgment of autistic burnout has only recently begun to emerge. Raymaker et al. (2020) conducted a community-based participatory study involving interviews with thirty-eight autistic individuals to explore the characteristics of autistic burnout. Participants reported experiencing chronic exhaustion, loss of skills, reduced tolerance to stimuli, and, in severe cases, suicidal ideation. The study revealed that these symptoms were frequently triggered by ongoing life stressors and the relentless pressure to mask autistic traits. Notably, the average duration of an autistic burnout episode exceeded three months. A significant factor contributing to this burnout was the lack of understanding from neurotypical individuals, who often dismissed these experiences as temporary phases. Although the study had a limited sample size, it was one of the first studies to explore and emphasize the severe consequences of autistic burnout. It validated the experiences of autistic individuals, which is crucial for developing informed and empathetic support systems. Further supporting these findings, Higgins et al. (2022) interviewed twenty-three autistic adults to deepen the understanding of autistic burnout. Utilizing the Delphi Method, the researchers sought consensus on the definition of autistic burnout among autistic individuals. They found that while autistic burnout shares some similarities with classic occupational burnout, such as exhaustion, cynicism, and decreased work performance, it is far more severe and debilitating. Participants described prolonged periods of social withdrawal, emotional numbness, and heightened feelings of depression and suicidality. Unlike autistic meltdowns, which are marked by intense emotional outbursts, autistic burnout is characterized by an overwhelming sense of emotional numbness. Although the study relied SPID: EXPLORING THE IMPACT OF MASKING 35 heavily on the subjective reports of self-advocates and lacked a standardized definition of autistic burnout, it provided an accurate depiction of the condition and the factors contributing to it, thereby raising awareness of the challenges associated with masking. In addition to defining and describing autistic burnout, emerging research has begun to identify risk and protective factors. Mantzalas et al. (2022) investigated these factors, finding that a lack of understanding from neurotypical individuals, the pressures of masking, and sensory sensitivity were significant risk factors for burnout. Conversely, protective factors included social support, the freedom to engage in special interests without fear of judgment, and the ability to participate in stimming- repetitive movements or sounds that help with self-regulation. These findings highlight the critical role of supportive environments and acceptance in reducing the need for masking and promoting better mental health outcomes for autistic individuals. The Interplay between Masking and Co-occurring Conditions The relationship between masking and co-occurring conditions such as anxiety and depression is complex and bidirectional. On the one hand, the effort to mask can exacerbate existing anxiety disorders, as individuals constantly worry about being perceived as different or "odd" (Cage & Troxell-Whitman, 2019). This heightened anxiety can, in turn, lead to increased masking as a strategy to avoid negative social consequences. Similarly, the emotional burden of masking can contribute to depressive symptoms, as individuals may feel hopeless or powerless in their ability to be accepted as they are (Raymaker et al., 2020). Conversely, pre-existing mental health conditions can also influence the extent and frequency of masking behaviours. For example, individuals with social anxiety may be more likely to engage in masking to mitigate their fears of social judgment and rejection (Bradley SPID: EXPLORING THE IMPACT OF MASKING 36 et al., 2022). The pressure to fit in and avoid scrutiny can intensify anxiety, leading to more frequent and rigid masking efforts (Chapman et al., 2022). Additionally, those with obsessive-compulsive tendencies may experience a heightened need for control in social situations, leading to more rigid and consistent masking behaviours (Hull et al., 2017a). This need for control is often driven by the desire to mitigate uncertainty and avoid situations that might trigger discomfort and distress. The interplay between masking and these co-occurring conditions can create a vicious cycle where each element exacerbates the other, resulting in complex challenges that significantly impact overall well-being (Raymaker et al., 2020). Because of this, it is essential to recognize and address these interconnected factors by advocating for systemic changes that reduce the need for masking. This involves promoting acceptance and understanding of neurodiversity, creating supportive environments that prioritize the mental health and well-being of autistic individuals, and challenging the societal norms that perpetuate the pressure to conform (Chapman et al., 2022). Autistic Identity, Voice, and Advocacy in the Literature Traditional autism research has frequently marginalized the voices of autistic people, particularly women, by privileging clinical observation and neurotypical interpretations of autistic behaviour over lived experience. In recent years, however, a significant shift has emerged toward recognizing voice, agency, and self-advocacy within autistic communities (Heasman & Gillespie, 2019; Milton & Bracher, 2013). This section examines how recent literature addresses the intertwined dimensions of voice, representation, and advocacy, particularly as they relate to the experiences of autistic women navigating identity, masking, and societal expectations. SPID: EXPLORING THE IMPACT OF MASKING 37 From Silencing to Voice: Reclaiming Narrative Authority The concept of “voice” within autism research has evolved significantly, especially concerning autistic women whose narratives have long been filtered, ignored, or reinterpreted through neurotypical frameworks. Traditional models often reduced autistic individuals to passive subjects of observation, framing them through a lens focused on pathology and deviation from normative standards of development. However, recent literature highlights a growing reclamation of narrative authority among autistic women – an active process of asserting one’s experiences, meanings, and truths in the face of medicalized misrepresentation (Leedham et al., 2020). Voice, as defined in this thesis, is not limited to literal speech or communication; it encompasses the broader ability to assert one’s perspective, influence discourse, and participate in knowledge production. Thammathorn (2024) and Kelly et al. (2024) examined how many autistic women describe their autism journey as one marked by years of misrecognition, during which their experiences were misattributed to anxiety, trauma, or personality disorders. Receiving a diagnosis and self-recognition of autistic identity, particularly in adulthood, often becomes a turning point – not only in self-understanding but in reclaiming the right to define and speak one’s truth (Bagatell, 2010; Bagenstos, 2004; Heasman & Gillespie, 2019). This reclamation involves challenging the authority of clinicians, educators, and even well-meaning allies who speak over or for autistic individuals. Botha et al. (2021) further highlight how the emergence of voice occurs within—and is constrained by—larger systems of social power. Autistic individuals, particularly women and gender diverse people, must navigate a cultural landscape in which their expressions of SPID: EXPLORING THE IMPACT OF MASKING 38 identity often run counter to dominant gender norms. Speaking authentically about autistic identity is thus a political act, exposing individuals to scrutiny, invalidation, and social risk. O’Dell et al. (2016) articulate this tension by showing how discourses of risk and vulnerability often silence autistic voices under the guise of protection, privileging nonautistic authority in decisions about care, diagnosis, and support. Representation and the Power to Define A critical component of voice is representation – how autistic individuals are depicted in media, policy, education, and research, and who is afforded visibility. Historically, the dominant images of autism have centred on white, cisgender males, marginalizing those who do not fit this prototype. Cohen et al. (2022) note that autistic women, especially those from racialized and working-class backgrounds, are often rendered invisible across contexts, from schools to healthcare systems. These omissions are not accidental but reflect entrenched epistemological hierarchies that exclude those who do not align with normative assumptions about autism. Waltz (2023) critiques this systemic marginalization by analyzing how traditional research methodologies, such as case studies where researchers often provided a third-person account of an autistic individual’s behaviour, have objectified autistic people, positioning them as subjects to be studied rather than partners in inquiry. This epistemic exclusion reinforces a power imbalance wherein autistic voices are filtered through academic, medical, or parental lenses. In response, autistic-led organizations such as the Autistic Self Advocacy Network (ASAN) reject the notion of passive subjecthood and assert the primacy of lived experience. Their motto, “Nothing about us without us,” encapsulates a broader demand for SPID: EXPLORING THE IMPACT OF MASKING 39 epistemic justice, recognizing autistic people as knowers, storytellers, and decision-makers (ASAN, n.d.). ASAN and other organizations not only advocate for autistic inclusion in policy and research but also promote frameworks such as neurodiversity and disability justice, which foreground the value of difference and the need for structural change. These frameworks emphasize the intersectional realities of autistic lives, particularly for women, trans, and nonbinary individuals, whose experiences disrupt normative expectations of autism and whose insights are vital to a fuller understanding of autism. Advocacy as Identity Work and Resistance For many autistic women, advocacy becomes a means of both personal transformation and social resistance. The literature emphasizes that this process is often nonlinear, marked by periods of grief, disorientation, and self-interrogation, especially following a late diagnosis. Wilson et al. (2023) describe how many autistic women initially grapple with internalized stigma, having spent years adapting to neurotypical norms through masking – consciously or unconsciously suppressing their traits to gain social acceptance. Over time, however, many begin to reclaim suppressed aspects of themselves, developing a sense of pride and solidarity grounded in autistic identity. This shift is often supported by relationships and communities that affirm autistic ways of being. Leedham et al. (2020) found that validation from peers and affirming professionals is crucial in enabling women to take on advocacy roles, not only for themselves but also for others facing similar challenges. These forms of peer validation are essential given the social isolation that many autistic women report before or after community connection. SPID: EXPLORING THE IMPACT OF MASKING 40 Online platforms have become essential arenas for this advocacy and identity work. Harmens et al. (2022) examine how autistic women utilize blogs, Instagram, and other digital media to document their experiences, challenge stereotypes, and foster a collective understanding. These platforms function as participatory archives – what Waltz (2023) calls “technologies of voice” – where marginalized individuals can narrate their stories in their terms, forge community, and resist erasure. Such spaces provide alternatives to medicalized or pathologizing narratives, offering instead authenticity, nuance, and empowerment. Cultural and Structural Critique A growing body of literature within critical autism studies argues that understanding autism requires attention not just to individuals’ experience but to the cultural, political, and structural conditions that shape it. O’Dell et al. (2016) advocate for an approach that interrogates the societal forces that render certain voices authoritative and others illegible. This includes an examination of how intersecting identities – such as gender, race, sexuality, and class – affect who is seen as credible, who is granted access to diagnosis and support, and who is deemed a Level 1, 2 or 3 autistic, which was previously labelled as high, moderate and low functioning. Botha et al. (2021) extend this critique by challenging the nature of much autism research, in which autistic people are studied without meaningful participation in the research process. They call for participatory and emancipatory research methods that prioritize collaboration, shared authorship, and the redistribution of epistemic power. These scholars emphasize that inclusive research is not simply a methodological choice but a matter of justice – one that requires dismantling hierarchical structures that have long silenced autistic people, particularly women. SPID: EXPLORING THE IMPACT OF MASKING 41 The shift from silencing to voice in autism research marks a profound reorientation in how we understand autistic experience, especially for women, who have historically been excluded, misdiagnosed, or misunderstood. Voice, representation, and advocacy are not ancillary concerns but central to the project of epistemic and social justice. As the literature increasingly affirms, autistic women are not merely subjects of research or recipients of services, but agents of knowledge, architects of identity, and leaders in the pursuit of more inclusive futures. Their narratives, advocacy, and insights challenge impairment-focused frameworks and offer transformative possibilities for what autism research—and autistic life—can become (Sasson & Morrison, 2019). Summary and Research Question Throughout the research on masking and its subsequent influence on autistic women's mental health, several significant themes emerge. First, various theories offer a conceptual framework for understanding the reasons behind masking, emphasizing a desire to belong, a fear of discrimination, and being misunderstood due to communication differences as primary motivations (Miller et al., 2021; Milton, 2012). These theories suggest that masking often responds to social pressures and the need for acceptance. Second, the FAP highlights the unique presentation of autistic traits in women, such as challenges with emotion regulation, imitation of others' behaviours, and animal-related special interests, which often go misdiagnosed or undiagnosed due to a lack of awareness (Bargiela et al., 2016; Seer & Hogg, 2023). This misrecognition hinders access to appropriate treatment and support, further complicating the mental health landscape for these women. Third, the medical model, which views autism as a condition to be cured, has led to the development of therapies such as ABA that have promoted masking and pseudoscience- SPID: EXPLORING THE IMPACT OF MASKING 42 based therapies that are dangerous and not backed by science (Shyman, 2016; Brent, 2013). Such approaches can have detrimental effects, including increased rates of PTSD and depression, and have been criticized for causing significant harm to the autistic community (Anderson, 2023). Finally, the act of masking itself has been linked to adverse mental health outcomes due to chronic stress and exhaustion from constantly hiding one's true self (Raymaker et al., 2020). These converging factors highlight the urgent need for approaches that center autistic voices, promote accurate and inclusive representation, and support self-advocacy. Embracing neurodivergence not only reduces the pressure to mask but also fosters environments where autistic individuals, particularly women and gender-diverse people, can experience greater belonging, validation, and empowerment (Leedham et al., 2020; Tierney et al., 2016). Moving beyond deficit-focused models, such approaches reframe autism through the lens of lived experience, identity, and justice. Expanding representations of autism, fostering inclusive environments, and dismantling systemic inequities are essential steps to reduce the need for masking. By addressing cultural and systemic barriers, these efforts can empower autistic women to embrace authenticity while challenging the broader societal norms that perpetuate masking behaviours (Tierney et al., 2016). Despite the growing body of research on masking and mental health in autistic women, several gaps in the literature persist. One notable gap is the insufficient differentiation by gender in samples, which limits the ability to empirically and conceptually compare masking patterns. While masking occurs across all genders, women are particularly affected, making them a critical population for research in this area. Another gap is the limited focus on the specific experiences of autistic women within the broader scope of SPID: EXPLORING THE IMPACT OF MASKING 43 autism research. More gender-specific research studies are needed to capture this community's unique challenges, coping strategies, and support needs. A central gap is that much of the existing research is conducted by neurotypical researchers, which may not fully capture the authentic experiences of masking due to the DEP. As mentioned previously, neurotypical and autistic individuals often experience difficulties in understanding each other. For instance, neurotypical individuals usually rely on non-verbal communication cues, such as facial expressions and tone of voice, which can be difficult for autistic individuals to interpret. Conversely, autistic individuals may require more direct and literal communication, which can lead to potential misinterpretations. Finally, while many studies have touched on self-concept, they do not delve deeply into how these narratives are shaped through internal dialogue, particularly in response to the processes of masking and unmasking. The way autistic women internally negotiate societal expectations, stigma, and self-advocacy largely remains under-researched. The study aimed to address these gaps by exploring the following research question: What are the voices present in autistic women’s experiences of masking? This research seeks to empower women by providing a platform for them to share their stories and perspectives on how masking affects their mental health. As an autistic woman with over 20 years of experience with masking, I, the principal investigator, aim to offer a more nuanced understanding of this phenomenon by relating to the participants on a personal level. This shared experience may foster deeper connections and insights than would typically occur with a neurotypical researcher. By employing the Listening Guide method, this study aimed to provide a more authentic and in-depth exploration of masking and its influence on mental health, ultimately contributing to more informed and compassionate support and treatments. SPID: EXPLORING THE IMPACT OF MASKING 44 SPID: EXPLORING THE IMPACT OF MASKING 45 CHAPTER 3: METHODOLOGY This chapter describes the researcher's transformative paradigmatic stance in developing this project, which centers on the voices of autistic women. The following section overviews how the transformative paradigm aligns with the project's voice and relationshipfocused nature. From there, procedures are described, including recruitment strategies, sampling, data collection, and analysis. Finally, research quality, trustworthiness, and the researcher’s reflexivity and position are discussed. Research Paradigm A research paradigm is a foundational framework underpinned by philosophical assumptions shaping the researcher's approach and perspective (Mertens, 2019). This study is grounded in a transformative paradigm, integrating perspectives from feminist and disability theory. The selection of this paradigm was driven by the overarching aim of amplifying the voices of autistic women, who have historically been marginalized in research and fostering a more profound understanding to inform more effective treatments and care for this population. The transformative paradigm was deemed most appropriate due to its emphasis on challenging existing power structures, promoting social justice, and centring the experiences of marginalized groups. Within this paradigm, ontological assumptions revolve around the belief in the fluidity and socially constructed nature of reality, acknowledging the diverse lived experiences of individuals. Epistemologically, the transformative paradigm advocates for participatory and collaborative approaches to knowledge generation, recognizing the value of subjective perspectives and lived experiences in shaping understanding (Mertens, 2019). Axiologically, this paradigm prioritizes values of equity, inclusivity, and empowerment, seeking to address power differentials and promote positive SPID: EXPLORING THE IMPACT OF MASKING 46 social change (Mertens, 2019). By aligning with feminist and disability theories, which similarly advocate for challenging dominant narratives and empowering marginalized communities, this study embraces a holistic and intersectional approach that foregrounds the voices and agency of autistic women (Hurtado, 2015). Ontology The ontological stance of the transformative paradigm asserts the existence of multiple socially constructed realities, acknowledging that power and privilege play pivotal roles in shaping the nature of these realities (Hurtado, 2015). Within this paradigm, the nature of reality is understood by examining diverse viewpoints influenced by political, cultural, and economic factors (Phelps, 2021). Central to this ontological stance is recognizing that specific perspectives become dominant or favoured narratives due to prevailing power dynamics. It is essential to identify the factors that contribute to the construction of different realities, including age, sexual orientation, gender identity, ethnicity, and disability status (Hurtado, 2015). The transformative paradigm emphasizes reflexivity among researchers, urging them to critically examine their biases and privileges to avoid perpetuating harm within their study communities. In the context of this research, I aim to represent the multiplicity of realities experienced by autistic women, recognizing the influence of cultural backgrounds and familial upbringing. As a transformative researcher, I am committed to highlighting issues of power and privilege throughout the narratives of these women, striving to understand how these dynamics have shaped their lived experiences and constructed realities. SPID: EXPLORING THE IMPACT OF MASKING 47 Epistemology The epistemological assumptions of the transformative paradigm assert that knowledge is culturally constructed and reflects the power dynamics and privileges of its creators (Mertens, 2019). Within this paradigm, the relationship between the researcher and participant is characterized by egalitarianism, which involves recognizing and addressing power differentials and acknowledging cultural nuances. Complementing the transformative paradigm, feminist perspectives highlight the historical marginalization of women in research and emphasize the value of incorporating their lived experiences into knowledge production (Doucet & Mauthner, 2006). Feminist scholarship extends beyond gender to address intersecting issues such as racism, homophobia, transphobia, and ableism, challenging patriarchal norms and advocating for the empowerment of marginalized voices (Mertens, 2019). By centring women and other marginalized groups in social inquiry, feminist researchers strive to promote autonomy and uniqueness while challenging dominant narratives. Similarly, disability theory challenges the medical model of disability, advocating for acceptance and accommodation of neurodiverse conditions rather than seeking a cure. This includes adopting identity-first language, creating sensory-friendly environments, and amplifying the voices of autistic individuals (Mertens, 2019). The choice of transformative, feminist, and disability theory ideologies for this research project is grounded in their shared commitment to addressing power differentials and empowering marginalized voices. Despite increased awareness, autistic women continue to face discrimination based on both gender norms and disability status. Prevailing stereotypes dictate that autistic traits are incompatible with traditional femininity, perpetuating harmful beliefs about women's roles and behaviours (Bargiela et al., 2016). This SPID: EXPLORING THE IMPACT OF MASKING 48 project seeks to challenge these beliefs by highlighting their detrimental influence on the autistic community and affirming the diverse ways of knowing and being that autistic women possess. Through the lens of transformative, feminist, and disability theories, this research aims to disrupt entrenched power structures, amplify the voices of marginalized individuals, and foster a more inclusive and equitable understanding of autistic experiences. Axiology Transformative research is grounded in three fundamental principles: respect, justice, and beneficence (Mertens, 2019). These principles extend beyond conventional research ethics by emphasizing respect for diverse cultures, promoting social justice, and safeguarding human rights (Mertens, 2019). The transformative paradigm is particularly attuned to the needs of vulnerable populations that experience systemic oppression and discrimination. It is not merely concerned with generating knowledge, but with using that knowledge to advocate for the welfare and rights of research participants (Doucet & Mauthner, 2006). This approach calls for policies grounded in a social justice framework, aiming to rectify issues of inequality by amplifying the voices of historically marginalized groups. From an axiological perspective, the transformative paradigm emphasizes treating all participants with dignity and respect while being committed to minimizing harm and fostering positive outcomes (Doucet & Mauthner, 2006). This aligns with my values as a researcher and advocate. I am acutely aware of the power dynamics inherent in research, and I am committed to using this platform to elevate the voices of autistic women. This community has long been marginalized and excluded from research and academia. I aim to journey alongside my participants, learn from them, and highlight that they are the true experts in their lives. SPID: EXPLORING THE IMPACT OF MASKING 49 While I recognize that the scope of a master's thesis may not lead to immediate societal change, I hope this research will contribute to a broader understanding of masking and the associated challenges that autistic women face. By situating this study within the transformative paradigm, I aim to foster greater empathy and insight among professionals and others involved in autism studies, ultimately contributing to more informed and equitable support systems. The choice of the transformative paradigm for this study is not incidental; it reflects the deep-seated values of social justice and change that I strive to uphold. Autistic women represent a complex and often misunderstood community, and their experiences intersect with various forms of oppression, including those related to gender and disability. By integrating elements of disability theory and feminism, this research seeks to provide a more nuanced understanding of the internal and external barriers that prevent these women from fully expressing their authentic selves. This approach aligns with the principles of the transformative paradigm and ensures that the research is both inclusive and reflective of the lived experiences of those it seeks to empower. Qualitative Research The strength of qualitative research lies in its ability to delve deeply into the complexities of human experience, making it an ideal methodology for exploring the nuanced relationship between masking and mental health issues among autistic women (Mertens, 2019; Tolman & Brydon-Miller, 2001). This study, which seeks to uncover the intricate and interwoven voices within the realm of masking, is inherently aligned with the principles of qualitative inquiry. At the core of this research is the desire to understand and SPID: EXPLORING THE IMPACT OF MASKING 50 interpret the distinct human experiences that emerge from the practice of masking, an objective that qualitative methods are uniquely equipped to fulfill (Morrow et al., 2012). Unlike quantitative research, which aims to produce generalizable findings across broad populations, qualitative research focuses on gaining profound insights into participants' subjective experiences (Mertens, 2019). This distinction is crucial in the context of this study, where the goal is not to generalize but to gain a deep understanding of the experiences of autistic women. Through qualitative methods, this research can capture the richness and diversity of these experiences, providing a more comprehensive understanding of how masking influences mental health (Morrow et al., 2012). The adoption of a qualitative approach offers several advantages in this exploration. It allows for the use of varied data collection methods, which can be tailored to the unique needs of each participant, ensuring that their voices are authentically represented (Mertens, 2019; Morrow, 2005). The flexibility inherent in qualitative research also permits the adaptation of interview protocols and the incorporation of emergent design features, which might not be as feasible within a quantitative framework. This adaptability is crucial when dealing with a community as diverse and complex as autistic women, whose experiences with masking may vary widely (Morrow et al., 2012). The qualitative approach aligns seamlessly with the research objectives by centring the study on constructing meaning from lived experiences. It is well-suited to shed light on the intricate dynamics of masking among autistic women, offering a platform for their narratives to be heard and understood in their full complexity. In essence, qualitative research enriches our understanding by allowing the voices of these women to guide the SPID: EXPLORING THE IMPACT OF MASKING 51 research, ensuring that their experiences are not only documented but also deeply explored and respected. Listening Guide: A Qualitative Methodology The Listening Guide (LG) is a qualitative method of inquiry and analysis developed by Brown and Gilligan that offers a robust framework for understanding the nuances of voice, resonance, and relationships in human experience (Brown & Gilligan, 1980, as cited in Gilligan & Eddy, 2017) Rooted in feminist theory, this method is particularly effective in examining women's experiences, especially how they navigate self-concept, conflict, and the complexities of voice within their unique social and cultural contexts (Gilligan, 2015). The concept of voice is central to LG, serving as a conduit through which participants' thoughts, emotions, and lived experiences are brought to life, reflecting the inner workings of the human psyche (Tolman & Head, 2021). Voice is never isolated; it is permanently embedded within cultural contexts, which enables a rich exploration of how the psyche and relationships intertwine, offering researchers a profound entryway into the psychic world of their participants (Tolman & Head, 2021). In this study, the concept of voice is central to the analytical framework, understood as the multiple-layered ways in which individuals express their experiences, emotions, and identities through language. Concerning LG, voice is conceptualized not as a fixed or singular expression, but as a chorus of internal and external positions that a person may take within their narrative (Tolman & Head, 2021). LG assumes that people hold multiple perspectives within themselves – sometimes conflicting, sometimes harmonious – which emerge through the words they use, the emotions they convey, and the relational stances they adopt (Gilligan, 2015). These voices are often shaped by personal history, social context, and SPID: EXPLORING THE IMPACT OF MASKING 52 power relations, and can reflect the tensions between societal expectations and inner truths (Brown & Gilligan, 1992). This approach involves a process of listening for different strands within a participant’s narrative – for instance, a compliant voice that seeks to meet social norms, a protective voice that manages vulnerability, or a resistant voice that challenges dominant social discourses. For example, an autistic individual may describe their experience of masking at work by saying. “I try hard to be the version of myself they expect, even when I feel like I’m disappearing.” In this sentence, we might hear both a voice of adaptation or compliance (trying to meet expectations) and a voice of distress or erasure (feeling like oneself is disappearing). Rather than reducing this to a singular theme of “difficulty at work,” LG invites the researcher to dwell in the multiplicity – to ask: Who is speaking here? To whom? About what? Moreover, what is the relational or emotional tone? Conceptualizing voice in this way enables a layered and relational analysis that captures the complexity of human experience, particularly in populations whose voices have been historically misunderstood, marginalized, or silenced. In the context of this research on autistic women’s experiences of masking, LG makes it possible to trace how participants navigate conflicting internal messages about identity, belonging, safety, and authenticity, It also creates space to hear not just what is said but what is left unsaid or contradicted – offering a richer, more nuanced representation of lived experience. Ultimately, voice in this study is not just a medium of communication, but a site of meaning-making and power negotiation. SPID: EXPLORING THE IMPACT OF MASKING 53 The method is grounded in relational psychology, a theoretical framework that emphasizes the critical role of relationships in human development and posits that the need to belong is an inherent human drive (Tolman & Head, 2021). Relational psychology also asserts that a sense of self is inextricably linked to connections with others and the cultural contexts within which these relationships are embedded. LG reflects this relational approach by attending to the multiple layers of the human psyche, revealing the various voices that emerge from one's experience. This participant-centred approach, which focuses on the stories told and the surrounding social and cultural frameworks, allows for a more relational and in-depth understanding of the phenomena being studied through a subjective lens (Kiegelmann, 2021). Using LG involves multiple readings of the transcripts to identify the voices that emerge from the narratives. This process is called "listening" rather than reading because it goes beyond surface-level comprehension; the researcher actively seeks to hear the voices that convey the participants’ lived experiences of the phenomena under study (Gilligan & Eddy, 2017). This method aligns with relational psychology as it involves a dynamic interplay between the researcher and the participant, where both are actively engaged in the research process, contributing to a deeper understanding of the phenomenon. LG was selected as the methodology for this study because of its relational nature and strong foundations in feminist theory. Given the study's focus on exploring the subjective experiences of autistic women, this approach offers a nuanced framework for examining the intersectionality of feminist theory and disability theory as they relate to this group. Moreover, LG aligns well with the transformative paradigm, as it is designed to uplift and empower marginalized voices, ensuring that the experiences of autistic women are both SPID: EXPLORING THE IMPACT OF MASKING 54 heard and valued. This methodology honours the complexity of their experiences and contributes to the broader goal of social justice by amplifying the voices of those who have been historically marginalized. Please refer to Table 1 for participant demographic information. Table 1. Demographic Information Name Age Ethnicity Gender Identity Kate 30 White Female Jo 26 White Female Lily 26 White Female Rachel Miller 48 White Female Jade 27 White Nonbinary Femme Daphne 40 White Female Marie 45 White Female Rose 36 Metis Female Data Collection This section outlines the concrete procedures that will be employed for participant recruitment, data collection, data analysis, and ethical considerations for data collection and analysis, as well as ensuring research quality in the context of qualitative research. Participant Recruitment This study explored the influence of masking on the mental health of autistic women through their stories and narratives. Participants were recruited through a poster shared on SPID: EXPLORING THE IMPACT OF MASKING 55 Facebook (see Appendix A), direct invitation emails (See Appendix B), and word of mouth. Purposive and snowball sampling were employed to target the subgroup of interest – autistic women. After their interviews, a few participants were invited to recommend others who might be a good fit for the study. This approach helped expand the sample while maintaining the focus on gathering a diverse range of lived experiences within the community of autistic women. Inclusion and Exclusion Criteria To be eligible to participate in the study, participants had to be at least 18 years old, identify as women and as autistic, be able to communicate in English, and have masked their autistic features at least once in their lives. While autistic women who display the female autism phenotype can receive a diagnosis, they often also need to show traits consistent with the DSM-5 criteria, which are based on observed characteristics in boys. Including autistic women who self-identify aligned with the researcher's transformative paradigmatic stance because many lack the resources to obtain a formal diagnosis. This is due to a lack of recognition of their features and the lengthy, costly diagnostic process. After age 19, autism funding ceases in BC, which renders a diagnosis less feasible. Participants were excluded if they were under the age of 18, did not identify as a woman, femme, or autistic, or were not able to communicate in English. Because the female autism phenotype is present in those who identify as female or on the feminine end of the gender spectrum, regardless of sex assigned at birth and gender identity, cisgender and transgender women, as well as non-binary femmes, were included in the study (Hull et al., 2020). To encompass a range of experiences, both verbal and non-verbal participants were recruited, with adaptations made to the methodology. For example, transcript interviews SPID: EXPLORING THE IMPACT OF MASKING 56 were adapted to be conducted through verbal and written output to accommodate each participant's unique needs upon request. Data Collection Procedure Participants who expressed interest were contacted by email to undergo screening, during which the researcher explained the study’s purpose, scope, and their positionality (see Appendix C for the screening script). If individuals did not meet the inclusion criteria or if the study had reached capacity, they were informed with a clear and respectful rationale, thanked for their interest, and offered information about other relevant research opportunities and resources. While no participants expressed distress about ineligibility, the researcher was prepared to respond with empathy and provide additional support if needed. All personal information was kept confidential, and individuals' ineligibility was not disclosed without their explicit permission. After participants were selected for an interview, a background information questionnaire (see Appendix D) and informed consent forms (see Appendix E) were obtained to ensure that participants were informed and that they agreed to participate in the study. To ensure that participants understood their involvement in the study, the researcher checked in periodically to see if they had any questions or needed additional clarification. Furthermore, the researcher also tailored the language of the background questions and consent form to be more accessible if the need presented itself. The forms were also adapted to be administered orally to participants if they had challenges with literacy. In-depth, semi-structured interviews were conducted on a date that worked for both the researcher and the participant. This format was chosen as it allows the researcher to obtain a detailed and robust exploration SPID: EXPLORING THE IMPACT OF MASKING 57 of the participant’s experience. The interview will be guided through a semi-structured interview guide (see Appendix F). Because the listening guide is a method that values the relationship between the participant and the researcher, the interview began with the researcher sharing information about herself and her project, as well as spending time building rapport with the participants. Because the interview guide is semi-structured, it allowed for greater flexibility to explore the study’s area of interest. Interviews ranged from 45 minutes to 1.5 hours in length. Once the interview was finished, participants were invited to choose a pseudonym, and the interviews were then stored on an encrypted flash drive. Interviews conducted over Zoom were recorded using Zoom's built-in recording software. This platform was selected for audio transcription purposes. To ensure the participants' comfort throughout the process, the researcher checked if their access needs (such as the ability to use a fidget toy or the need for dimmer lights) were being met and allowed for breaks as needed. An encrypted Zoom account was used to store the data, which was then deleted immediately after being downloaded onto an encrypted flash drive and stored in a password-protected folder on the researcher's laptop. After the interview, the participants were thanked, and a debriefing form was sent to them (see Appendix G). This document contained information related to the study, the deadline for withdrawing their data, and the contact information of the researcher, supervisor, the HREB office, and the Office of Research and Graduate Studies, in case they had any questions or concerns about their treatment and rights as a research participant. Participants were informed that participation involved the follow-up interview; therefore, SPID: EXPLORING THE IMPACT OF MASKING 58 their data would be withdrawn from the study if they declined. Despite this, they would still receive a $20 gift card as a gesture of appreciation for their time and effort. Participants were emailed the results after the data was analyzed and written up. Depending on their preference, they could either participate in a follow-up interview to discuss the findings and provide additional insights or receive an email summarizing the results, along with a reflection to share their thoughts on the accuracy of their interpretations (See Appendix H). This flexible approach ensured that participants could engage with the research process in a manner that suited their availability and comfort levels. Feedback received through interviews or reflection forms was integrated into the final analysis to enhance the study's trustworthiness. Data Analysis After collecting the data, the next step involved editing the transcriptions of the audio recordings. Transcribing allowed the researcher to become more immersed in the participants' stories, leading to a deeper understanding of the narrative and other key details. Besides the dialogue in the transcripts, the researcher watched the videos to observe important nonverbal and paraverbal cues, such as laughter, pauses, and hand gestures. This information was crucial for the researcher's understanding of the stories. Throughout the research process, I monitored my reactions and feelings related to data analysis and immersion in the participants’ stories. I also kept a research journal to record my reflections. Although Zoom's audio transcription feature was used to assist the process, it was not flawless; therefore, the audio was replayed multiple times to verify the accuracy of the transcripts, and any missed or incorrect transcriptions were corrected accordingly. Otter.ai was also utilized to assist with transcription, leveraging artificial intelligence. Observing the SPID: EXPLORING THE IMPACT OF MASKING 59 video and audio further helped identify non-verbal and paraverbal cues, improving the understanding of how voices related to the participants' narratives. To improve the credibility and trustworthiness of the analysis, I engaged in coconstruction throughout various stages of the research process. First, I conducted paired analysis with fellow data analysts, which allowed us to compare interpretations and ensure that my own positionality did not solely shape the emerging perspectives. This process helped generate both shared insights and unique observations, contributing to a more balanced interpretation of the data. Second, I involved participants in a form of member checking and reflection by returning their individual analyses to them. Participants were invited to comment on whether their interpretations resonated with their experiences or if adjustments were needed. Their feedback provided an additional layer of validation, ensuring that the analysis remained grounded in their lived realities. Taken together, these practices reflect a collaborative approach to knowledge production, aligned with the transformative paradigm and the feminist disability orientation of the study, which prioritizes shared power. Data Analysis Using the Listening Guide The listening guide is a four-step process. These include (a) listening for the plot, (b) I poems, (c) listening for contrapuntal voices, and (d) composing an analysis (Gilligan et al., 2003). Listening for the Plot: The primary goal of the listening guide is to understand what is happening in the story through listening and how the researcher responds. The researcher attends to story elements such as metaphors, imagery, recurring words, resonances, contradictions, and inconsistencies (Gilligan et al., 2003). While doing this, the researcher is constantly aware not only of the participant's responses but also of their internal reactions, SPID: EXPLORING THE IMPACT OF MASKING 60 connections, and curiosities related to the story. Since this is a relational approach, researchers actively try to avoid abuses of power by recognizing and acknowledging their feelings and thoughts about the participant (Tolman & Head, 2021). Analysis using this method involves a variety of research assistants and other listeners to explore different perspectives and interpretations of the narrative that may have been missed by the primary researcher (Kiegelmann, 2021). I Poems: The second step of the listening guide is to explore the use of the firstperson pronoun "I." This step enables the researcher to listen to the participants' first-person voices and understand how they describe themselves (Gilligan, 2015). This is especially important for a relational approach like this because it connects the researcher to the participant, allowing them to form a more substantial relationship (Gilligan et al., 2003). There are two rules for drafting the I poems. The first rule is to take all the I-statements from a chosen passage, and the second is to put them in order, but on separate lines, much like a traditional poem. The I-poem method enables the researcher to listen to the participant's stream of consciousness and enter their psyche, thereby establishing a responsive relationship with them (Gilligan, 2015). Contrapuntal Voices: The third step of the listening guide involves listening for the contrapuntal voices that emerge in the narrative, which brings the researcher back to the initial question (Gilligan & Eddy, 2017). This involves reading the transcripts numerous times to tune into the voices that emerge throughout the narrative. This is also done with other research assistants to gain a broader understanding of the voices and ensure that everyone is on the same page. Each voice is listened to at a time, with sections of the transcript being underlined with the colour corresponding to each voice. From there, the SPID: EXPLORING THE IMPACT OF MASKING 61 multiplicity of voices is examined to see if any voices are in harmony with or contradict each other (Gilligan, 2015). After the voices are underlined, they are examined along with the poem to better understand the relationship between the voices and the narrative. Multiple rereadings are required to discover new voices and to determine whether certain voices should be revised to better capture the participants' experiences. Composing the Analysis: Once the contrapuntal voices are identified and analyzed, LG's last step is to examine the results (Gilligan, 2015). This includes the plot summary, Ipoem, and identified contrapuntal voices. These results are then compared with the research question as the researcher analyzes how the data obtained aligns with the question and is novel in the study area. Following the transcription process, the interviews were listened to several times. During this process, the researcher wrote down any highlights of the narrative and the placement of significant events or themes, which were then recorded as thoughts, summaries, and reactions. After listening to and marking the transcript, the researcher constructed a plot summary. Following the plot summary, I-poems were constructed, and contrapuntal voices were identified. As this was a subjective process and voices may be missed by the researcher alone, Gilligan (2015) strongly advocated for transcripts to be analyzed by two or more researchers, acting as listeners, to study and search for the voices. To achieve this, the researcher utilized research lab resources and the assistance of colleagues in the analysis process, as doing so will increase the rigour and credibility of the interpreted themes that emerged from the data. Voices were examined both on an individual level with the participants and as collective themes that emerged from everyone's experiences. SPID: EXPLORING THE IMPACT OF MASKING 62 Following the analysis and categorization of the voices, participants were emailed their results, along with the option to either participate in a follow-up interview or respond to the questions in the reflection form. This was intended to allow participants to reflect on the themes that have emerged from the data and offer input and feedback on the themes and results. This also allowed participants to adjust results as necessary and identify any areas they believed the researcher had misinterpreted. The study implemented the critical values of the researcher's transformative stance by including the participants in the co-construction of the data analysis process. Rigour and Quality Because the study is situated within the transformative paradigm, rigour is evaluated through the trustworthiness of the participants’ stories, which shifts the focus from merely factual reporting to a deeper, more meaningful exploration of their lived experiences and narratives (Mertens, 2019; Hurtado, 2015). The transformative paradigm is grounded in principles of social justice, empowerment, and the active deconstruction of power imbalances. As such, my role as a researcher is not just to analyze data but to actively engage with the participants in a way that centers their voices, experiences, and the socio-cultural contexts that shape them. This approach inherently challenges traditional power dynamics in research, giving participants agency in how their stories are represented and interpreted. The criteria used to assess rigour and quality of this study are drawn from Lincoln and Guba’s (1985) four-criterion framework: credibility, transferability, dependability, and confirmability, all of which are interpreted through the lens of the transformative paradigm. SPID: EXPLORING THE IMPACT OF MASKING 63 Credibility In the transformative paradigm, credibility refers to the trustworthiness and authenticity of the participants’ narratives (Cope, 2014). Ensuring credibility involves more than just accurate reporting – it requires a collaborative process where participants actively co-construct the findings with the researcher. To this end, participants were invited to engage in either follow-up interviews or respond to the reflection form after receiving their results, where they were asked to co-analyze their results, a process known as member checking. This participatory approach validates the findings and empowers the participants by giving them a direct role in how their stories are told. This aligns with the transformative goal of uplifting marginalized voices and ensuring that research outcomes reflect the participants' realities as they perceive them. Transferability Transferability in the transformative paradigm goes beyond the mere applicability of findings in other contexts; it is about inspiring change and fostering social justice in similar challenges faced by marginalized groups (Connelly, 2016). By delving deeply into the participants' experiences, especially their encounters with discrimination and the challenges of being an autist woman, this study aims to generate rich, nuanced descriptions that resonate with and inform broader social contexts. The LG method enhances transferability by providing detailed plot summaries that capture the complexity of participants' experiences, emotions, and socio-cultural contexts. This not only aids in comparing experiences across different contexts and identities but also helps build a foundation for advocacy and policy change informed by the lived realities of those most affected. SPID: EXPLORING THE IMPACT OF MASKING 64 Dependability In a transformative framework, Dependability involves ensuring that the research process is consistent and adaptable to the needs of the participants, reflecting the dynamic and often fluid nature of social justice work (Connelly, 2016). Peer debriefing with colleagues knowledgeable in the methodology and member checking ensures that the findings are not just the product of the researcher's interpretations but are co-constructed with the participants and validated by peers. The involvement of multiple analysts in data interpretation helped to mitigate bias. It ensured that the findings reflected a collective understanding. Confidentiality and ethical considerations are paramount, with all research assistants undergoing thorough training and signing confidentiality agreements to protect participants' identities. Reflexive journaling further enhanced dependability by fostering continuous self-awareness and critical reflection throughout the research process. Confirmability Confirmability in the transformative paradigm emphasizes transparency, reflexivity, and the active involvement of participants in the research process (Morrow et al., 2012). Reflexivity is central to this approach, as it involves critically examining how the researcher's background, beliefs, and positionality influence the research. The LG method supports this by incorporating multiple perspectives in the analysis, facilitating meaningful dialogue among research assistants, and ensuring the participants' voices are heard and respected. Reflexive practices, such as journaling and peer debriefing, along with openly disclosing my autistic identity and sharing my own experiences with masking with the participants, contribute to the transparency and impartiality of the study. Additionally, SPID: EXPLORING THE IMPACT OF MASKING 65 interviewing at least six participants ensures data saturation, capturing a wide range of perspectives that bolster the confirmability and robustness of the findings. Information Power Information power refers to the adequacy and richness of data collected in qualitative research, which is essential for ensuring that findings are meaningful, credible, and capable of leading to actionable insights (Mertens, 2019). In this study, grounded in the transformative paradigm, achieving information power was vital to authentically representing the voices and experiences of autistic women, particularly concerning masking and its impact on mental health. This was accomplished through several interrelated strategies. First, the research was guided by a clear and focused aim, allowing for a targeted and meaningful exploration of the phenomena and ensuring that the data collected was directly relevant to the research questions. The richness of data was further enhanced by in-depth, semi-structured interviews, which allowed participants to share their stories in their own words. The LG methodology was employed to delve deeply into participants' narratives, capturing multiple layers of meaning and nuances. Additionally, participants were actively involved in the research process, mainly through member checking, where they co-analyzed their results with the researcher. This engagement improved the trustworthiness of the data and empowered participants, aligning with the transformative paradigm's focus on social justice and amplifying the voices of marginalized individuals. The study aimed to interview at least six participants to ensure a diverse range of perspectives. While keeping the number of participants manageable, the emphasis was on depth rather than quantity, with data saturation monitored to ensure sufficient coverage of the research questions; the quality of dialogue between the researcher SPID: EXPLORING THE IMPACT OF MASKING 66 and participants was also prioritized, fostering an environment of trust and openness that led to richer and more relevant data. The ability to adapt interview protocols to meet each participant's unique needs was vital in accommodating the different communication styles of autistic women, ensuring their voices were fully heard. Lastly, my ongoing reflexivity as the principal investigator, documented in a research journal, was essential in maintaining awareness of my positionality, biases, and power dynamics that could influence data collection and analysis. Through these strategies, the study achieved a high level of information power, ensuring the data was adequate in quantity and rich in quality and relevance, aligning with the transformative paradigm's commitment to social justice and facilitating meaningful change. Position of the Researcher Reflexivity is a vital part of both the LG method and the transformative paradigm. Therefore, it is essential to critically reflect on my identity, motivations, and potential biases in relation to this research project. My journey with autism started when I was four, at the age of diagnosis. I was initially misdiagnosed by my family doctor, who dismissed autism because I could make eye contact. Fortunately, a referral to Surrey Memorial Hospital resulted in an accurate diagnosis. This early diagnosis was crucial, shaping my experience with various therapies, including ABA and the use of a weighted vest to prevent stimming behaviours, which for me was jumping. My childhood was a mix of joy from a supportive family and confusion about my different treatment compared to my peers. I was monitored for behaviour and took part in a program where students were assigned to engage with me during recess and lunch. The reactions of these students, often showing distress and reluctance, made me feel very SPID: EXPLORING THE IMPACT OF MASKING 67 alienated and self-doubting, leaving me to wonder what was wrong with me. It wasn’t until my tenth birthday, when my mother told me about my autism diagnosis, that I finally understood what was happening. I often say this was one of the best days of my life because everything finally made sense, and I had a name for why I felt so different from everyone else. Discovering my autistic identity brought clarity but also created serious challenges. During my adolescence, I desperately wanted to fit in and join larger social groups. However, this was difficult because I struggled to interpret my peers' social cues. As a result, I faced intense bullying, including physical assaults, exclusion from group activities, namecalling, public mockery of my autistic traits, and cyberbullying. A particularly traumatic incident at age fourteen, when I was followed into a school bathroom and harassed by a group of peers, prompted me to seek help from my family. This led to ongoing involvement in counselling and mental health support. To reduce bullying, I tried to hide my autistic traits. This involved physical actions to suppress stimming behaviours, such as placing a bag on my lap or squeezing my hands together and managing conversations to avoid topics related to my special interests. Additionally, I overspent on clothes and cosmetics to fit perceived social standards and gain acceptance from my peers, especially those who had previously marginalized me. This period of forced conformity caused significant emotional distress, leading to a negative selfimage and internalized stigma. Because of how I was treated, I quickly believed that my true self and natural way of being were unacceptable and that I was unlovable unless I could seamlessly blend in with neurotypicals. It wasn’t until adulthood that I recognized the extent of my internalized ableism and how, over the years, it distorted my self-perception and SPID: EXPLORING THE IMPACT OF MASKING 68 identity to the point where I no longer knew who I was. As a result of hiding my authentic self and my past experiences, I suffered from various mental health issues, such as anxiety, depression, persistent exhaustion, and suicidal thoughts, which I later understood as autistic burnout. A transformative shift occurred when I began working with other autistic individuals and became involved in autism research through the Autism and Developmental Disabilities Lab (ADDL) at Simon Fraser University. This experience allowed me to embrace my autistic identity with pride and view my traits, such as intense focus on special interests, as strengths rather than liabilities. My academic and research success during my undergraduate studies, coupled with the satisfaction of contributing to autism research, bolstered my self-confidence and sense of belonging. Despite these advancements, I continue to grapple with the residual effects of stigma, including microaggressions, stereotypes, and harmful actions from others that perpetuate feelings of shame and anxiety. Although my masking behaviours have reduced compared to my teenage years, I still engage in masking in specific social contexts, a struggle that reflects the broader challenge faced by many autistic women between maintaining authenticity and seeking acceptance. I also still struggle with allowing other people to see me fully unmasked because I fear that while others may initially be accepting, that would change over time, or I would find out that they were mocking me behind my back, which is all resulting from past trauma. As an autistic researcher, I recognize the epistemic privilege my lived experience provides. This privilege enables me to offer a nuanced perspective on masking and its effects. Yet, I am also aware of how I am advantaged, being white, straight, cisgender, SPID: EXPLORING THE IMPACT OF MASKING 69 having a supportive family, and experiencing a less profound impact of autism. These privileges have given me access to opportunities and resources, including early diagnosis and counselling, which may not be available to all autistic people. For example, my challenges with executive functioning and sensory management are less intense than those faced by some autistic women, which might shape my perspective and research approach. Because of these factors, I was consciously aware not only of how they would influence my interpretation of the data but also of how they would impact interactions with research participants from different backgrounds, who might perceive me as being unable to understand their experiences due to the factors listed above fully. I committed to approaching their narratives with empathy and an open mind to address these concerns. I maintained a research journal to document my reflections and potential biases. I also used practices to counteract power imbalances, such as sharing research findings with the participants for validation and feedback. This approach aligns with the transformative paradigm's emphasis on participant empowerment and authentic representation. Acknowledging my privileges and biases highlights my commitment to addressing gaps in resources and striving for equitable support within the autistic community. This awareness fuels my dedication to advocacy and the pursuit of a future where autistic individuals are more readily recognized and supported. As I continue my journey as a researcher and therapist, this reflexive awareness remains a cornerstone of my efforts to effect positive change and support the empowerment of autistic women. As part of the LG method, I acknowledge my voice as an integral part of the research process. LG emphasizes the presence of multiple voices within a narrative, including the researchers, and encourages reflexivity in how we engage with participants' stories. My own SPID: EXPLORING THE IMPACT OF MASKING 70 lived experience as an autistic woman inevitably informs my interpretation, shaping the way I listen, analyze, and respond. To honour this, I include the following poem – an embodiment of my reflections, struggles, and insights throughout this journey. This creative expression allows me to engage with my narrative in a way that mirrors the layered voices in my participants' stories. Below is my poem, titled “Echo,” which explores the tension between being seen and unseen, as well as the masking and the gradual journey toward unmasking. Figure 1: Echo They called me quiet But I was only waiting – For a space wide enough Soft enough Real enough To hold what I could not name So I mirrored I molded A perfect reflection in borrowed light I laughed when they laughed Nodded on cue Spoke in echoes That was never quite mine They called me easygoing They called me reserved Called me everything but what I was And I held their words like offerings, Let them shape me Smooth me Until I fit But echoes fade When no voice claims them And I – I am learning to speak in sound Not shadow To let my voice land solid. Not slip-through spaces Meant for someone else SPID: EXPLORING THE IMPACT OF MASKING 71 To exist not as a reflection But as something whole Something real Something mine Plain Language Explanation of Echo This poem describes what it feels like to hide parts of myself to fit in with others. When I say, “I mirrored, I moulded,” I mean that I copied what other people did so I would not stand out. I learned to act in ways others expected, even when it did not feel natural. The poem also discusses how this made me feel invisible, as if I were repeating other people's words and actions instead of being myself. When I say, “spoke in echoes that were never quite mine,” I mean that I said what I thought others wanted to hear instead of sharing my thoughts. Later in the poem, I talk about finding my voice. When I say, “I am learning to speak in sound, not shadow,” I mean that I am trying to be myself instead of just copying others. The last line, "To exist, not as a reflection, but as something whole, something real, something mine,” means that I am working towards being my authentic self, rather than just blending in. This poem is about my journey from hiding who I am to feeling safe to be myself. Many autistic people go through this experience, and I hope these words help others feel seen, heard and understood. SPID: EXPLORING THE IMPACT OF MASKING 72 CHAPTER 4: RESULTS The purpose of this study was to hear and explore the voices that were present in autistic women’s experiences of masking. The research question that led this study was “What are autistic women’s experiences of masking?” To answer this question, the LG methodology was used, which allowed the researcher and her team to tune in to the voices that were heard throughout their experiences of masking. As a relational method, we joined the women in their journeys and discovered voices existing within their inner worlds. Through listening and analyzing each narrative, the research team and I connected with each participant in a relational manner and could hear the development of many of the participants from exhaustion and identity confusion to self-love and acceptance, to advocacy. We examined how women viewed themselves and how their embodied voices shape their relationships with themselves and with others. I conducted 13 interviews in total. During the data screening and analysis phase, five participants were excluded in consultation with my thesis committee. Reasons for exclusion included spam responses, insufficient narrative depth, or focus on others’ experiences rather than personal accounts. For this study, spam responses refer to interview submissions that were not genuine or authentic contributions to the research. These responses were characterized by features such as nonsensical, irrelevant, or incoherent content, duplicated or near-duplicate entries, rapid completion times inconsistent with thoughtful engagement, or other indicators suggesting insincere participation. These were identified during data screening and excluded from the final analytic sample to ensure the integrity of the data. Upon comprehensively analyzing the eight interviews of sufficient quality, the team identified a diverse range of voices. The voices were noticed and labelled, as well as any SPID: EXPLORING THE IMPACT OF MASKING 73 voices that were either harmonious with or in conflict with one another. From the analysis, three broad categories emerged: the voices of masking, the voices of unmasking, and the voices of advocacy. The voices of masking included exhaustion, inauthenticity, shame, frustration, and disconnection. The voices of unmasking included self-love/acceptance, selfcompassion, connection, and empowerment. Finally, the voices of advocacy included resistance, anger, action, and yearning. Participants Stories The eight participants who were interviewed were self-identified autistic women and femmes, ranging in age from 26 to 48 at the time of the interview. The chapter begins by sharing a summary of each participant’s individual story, followed by their unique voices expressed and interpreted in each narrative. The chapter then concludes with a synthesis of the voices heard throughout the participants’ stories. Jo’s Story Jo is a 26-year-old autistic therapist who had expressed interest in my master’s thesis research, and she felt a sense of curiosity and joy upon learning that I was a fellow autistic woman, as it would be “two neurodiverse women exploring together rather than a neurotypical hearing her story and them attempting to try and change her.” Upon meeting Jo, I was instantly struck by her kind and enthusiastic spirit and automatically felt a strong sense of kinship. At one point, I had started to become emotional, as her story had so many parallels to mine, and she noticed that, and was quick to label that emotion as grief. Grief, in that so many of us have had to have the experience of hiding who we are, suffering throughout life because no one recognized that we needed support, or continuing to face discrimination when we show up as our authentic selves. I walked away from the interview SPID: EXPLORING THE IMPACT OF MASKING 74 feeling a profound sense of both connection and determination to continue doing the work that I am meant to do. Jo’s autism journey began when she was a child, where she described herself as being a “really smart kid” but got in trouble all the time because she could not sit still and was constantly dysregulated, which she described as being very confusing. Recalling her childhood, Jo shared the profound metaphor of being “frozen” in her body because everyone else wanted her to be like them, and she desperately wanted to be “unthawed,” or seen for the brilliant kid that she was. This treatment left her with the painful thought and reality that she did not belong and did not know why. Because her outer world was so unsafe and unaccommodating, Jo learned how to mask, which led to a variety of severe mental health challenges, such as dissociation and self-harm due to dysregulation, and chronic health issues. A turning point came for Jo when she realized that she was autistic. She described this insight as being one of the best days of her life, which she described in the following passage: It was like “oh my god, nothing is wrong with me, I’m the most fucking brilliant human in this world that is not made for me, and the reason I am struggling is because no one is supporting me to live in the way that I am supposed to be living. When describing her relationship with masking and now having an awareness of it, Jo, being someone who thinks in pictures and somatic processing, offered this profound illustration: SPID: EXPLORING THE IMPACT OF MASKING 75 I would explain it as this feeling of like I’m in my body and it’s taking up space as it should. That’s like my autistic self right, all the space that it needs to take up. It’s this beautiful breathing organism and it gets to just be and it’s expansive. Then, I go into a space where I have to mask, and it’s almost like I’ve had to like detach, pretty much anything within me, and go back to being a shell of a human. It feels like I’m losing myself completely, like you’re losing access to yourself. Despite this, Jo has found areas where she can unmask and be more of her authentic self, which began with more minor things, such as telling a long-time friend that she does not like nachos, to making clothing choices that are more sensitive to her sensory needs. She also credits having safe people, such as her partner, around whom she can be unmasked, which has been a strong source of support for her. Jo also sees her autism as a gift because it makes her more in touch with her humanness, somatically aware, and attuned to the world around her, which she shares in the following: I see a wall of mugs at a coffee shop, and my body goes, this is so joyful that we are going to flap our arms, I’m like, how fucking brilliant. I have a body that literally is so expansive within its emotion that it wants to show the world how it feels. Beautiful, expansive, wonderful, what an amazing connection point right? As I reflected on Jo’s narrative, the first voice that emerged was one of disconnection, which marked her childhood and her experience with what she would now recognize as masking. Disconnection was a prominent voice throughout the interview, symbolizing how SPID: EXPLORING THE IMPACT OF MASKING 76 she learned to safeguard herself from the perceived dangers of the outside world and how it influenced her relationship with herself and others, as illustrated in the following passage: I’m going back as a kid and realizing so much derealization and dissociation, because that was my only option. It was like go internal and live inside my body and explore the world totally inside, or be outside my body and like I’m unsafe, completely unsafe. So, I think it’s interesting too, because I don’t have a ton of childhood memories. Just intermittent memories that are like really horrible and nothing else. The voice of disconnection was then followed by a voice of frustration, which resonated throughout the narrative. The voice of frustration was a symbolic representation of the struggle that Jo experienced to be seen and heard by those who were there to support her, most notably the professionals in the counselling profession, and the suffering because of the discrimination she experienced as an autistic woman. This voice came to the forefront when Jo shared her experiences of conditional acceptance from her colleagues, in which her voice noticeably raised with anger: You go into a meeting with a bunch of professionals or a training, or last night, a Christmas Party, and you don’t have a seat at the table with those professionals, unless you are masking your autism. Your autism is wonderful when you are a clinician with your clients and the doors closed and you’re helping them to be their authentic selves, but if your way of showing up makes any professionals uncomfortable on their time off, even you being a professional, there’s an issue. While frustration and disconnection were dominant voices in the beginning half of Jo’s narrative, a new and profound voice emerged: the voice of connection. This voice began SPID: EXPLORING THE IMPACT OF MASKING 77 as a slight undercurrent, then grew stronger and more pronounced as the interview progressed. This voice first emerged after Jo had shared her autism journey and noticed that I was visibly moved and was often paired with an undercurrent of the voice of hurt, as seen in the following passage: I’m not like a woo woo energy person in the sense of like, oh, there’s like crystals between us and their telling me energy, but like the actual, like, energies of the nervous system that like, as I’m sharing, seeing in your eyes, this like continued like nervous system that feels like it’s sunk into this like, oh I know that feeling too (….). So many of us are in this place, we’re so stuck, and no one, no one tried to understand us, and how yucky is that? For us to both understand that? As I continued to reflect on Jo’s narrative, another voice that emerged was a strong voice of self-love. The voice of self-love was marked by enthusiasm and pride in her identity and strengths as an autistic woman. This voice emerged when Jo shared about how, despite all of the challenges that she has faced in an ableist society that was not designed for her, she is proud of who she is and would not want to be any different, which she shared in the following passage: I love my brain. I don’t want to be a neurotypical. Yeah, Literally, if I could switch my brain today, girl, no thank you, I don’t want it (…) I love this brain, but it is not easy, not easy at all. It’s not easy because I’m autistic in an ableist world. Just as the voice of self-love and connection conveyed a strong sense of community and resilience, another voice emerged from the narrative —the voice of resistance. This voice pointed to the injustices that autistic women endure, and strongly encouraged neurotypicals to examine how they treat others who are different and called out harmful SPID: EXPLORING THE IMPACT OF MASKING 78 behaviours. This voice first emerged when Jo was asked what she wished was different about how society views autism, and she shared the following simple yet powerful passage: One of the things I want the world to know about autism is that you have zero right to tell someone if they are autistic or not, if you have no idea what autism is. The voice of resistance was soon joined by voices of yearning and action, which advocated for change and invited others to come in and be an ally. These voices emerged when Jo shared her wishes for how the world viewed autism and expressed her need for neurotypicals to take a more proactive approach when interacting with and supporting autistic individuals, which she shares in the following passage: I want them to learn from people who are autistic, and I think that’s the different pieces like I don’t’ need you to read like every paper on autism. I don’t need you to know every theory, I don’t need you to like have every way of understanding the different neural science of my brain compared to yours. It’s okay, you don’t have to know that., but I need you to sit in the room with me, and be with me, and learn from me and with me, and I need you to take it in. Like the information about autism from me as an autistic person. My interview with Jo left me experiencing a wide range of emotions. I felt truly inspired connecting with another autistic therapist, yet also very disheartened that a profession which prides itself on clients showing up as their authentic selves could still contain many individuals with little empathy or tolerance for neurodiversity. We still have a long way to go, but Jo taught me the importance of embracing who I am and viewing my autism as a gift in therapy, as it allows me to connect more deeply with clients and be more SPID: EXPLORING THE IMPACT OF MASKING 79 attuned due to my hyper-empathy. Below is an I-poem I created from a section of the transcript that I felt powerfully conveyed the voices that emerged during the interview. Figure 2: Jo’s I-poem I was a kid I was brilliant I’m like, frozen in this body I’m like just unthaw me I can show you I don’t belong Why don’t I belong? I’m struggling I’m supposed to be living I’m not crazy I’m not weird I’m fucking brilliant I’m fucking brilliant I’m autistic I’ve had to like detach I’m losing myself I have to be smaller I’m aware I’ll never be known I have to either choose acceptance Or be myself and no one wants me I get in my head I’m leaving myself I’m no longer in my body I have to detach I can grow I want to be authentic all the time I want to show up I show up with my mask I feel inauthentic Lily’s Story Lily is a 26-year-old autistic care home worker who also has ADHD, using the term AuDHD to describe herself. Upon meeting Lily, I was struck by her down-to-earth nature, and I found her directness when describing interactions with other neurotypicals, whom she referred to as “normies,” to be very refreshing. I felt like she was saying everything that deep SPID: EXPLORING THE IMPACT OF MASKING 80 down I had wanted to say but never dared to. Lily had an unapologetic way of being that I deeply admired, and I found myself feeling very inspired at the end of our interview. When discussing her autism journey, Lily said she always knew she was autistic; however, she faced significant pushback from those around her because she was consistently at the top of her class and did not have the typical "textbook autism look,” which usually involves a white male child with interests like trains. Most of this pushback came from family and educators, with Lily recalling an incident where a guidance counsellor refused to write her a college recommendation letter because she believed Lily was better suited for university, despite Lily sharing that she needed accommodations and wanted to attend college. After all, she struggles in structured school environments. Lily also mentioned that she had a history of misdiagnoses, including Bipolar I, Bipolar II, and borderline personality disorder (BPD). She said that being diagnosed with ADHD in her first year of university was a turning point for her, as once she received support and her autistic identity came to light, she started to allow herself to define who she is, rather than letting others define her. When asked about her relationship with masking, Lily described it as either being in there, but not “really there,” or fully engaged and just feeling extra uncomfortable because she is lying about and hiding who she is. Lily described this state of disconnection in the following passage: I will have my persona on, but I might not be in it you now, it’s like my meat puppet is doing something and my homunculus is doing something else and most of the time that is something more enjoyable, or potentially more enjoyable like what Sims family I’m going to make later. Like things that are actually genuinely interesting to me because that’s sort of what keeps my brain in check SPID: EXPLORING THE IMPACT OF MASKING 81 Despite this, Lily has been allowing herself to unmask over the past few years, which she says has been “really beneficial.” Having those small moments where she is accepted as her “little autistic self” has been very empowering. Lily also shares that through her journey, others in her social circle have begun to embrace and accept her neurodiversity. She attributes this change to her unmasking, sharing that if she was not willing to be herself around them, they might not have noticed her traits, and doing so has helped them “get to know herself” and deconstruct her experiences. As I reflected on Lily’s story, the first voice to emerge regarding masking was one of frustration. This voice was symbolic of the mistreatment that Lily had faced from others and how past mistreatment still impacts her. This voice was characterized by several emotions, such as anger and a strong sense of confusion, which, unfortunately, is all too common in the autistic community. This voice first began to emerge when she was sharing about how she has started to become more open with others in sharing her autistic identity as well as how her communication style may differ from theirs, which she shares in the following passage: When I meet somebody for the first time, that’s one of my disclaimers. I’m like, look, man, like if I say something to piss you off, chances are I don’t intend to, I’m just really autistic, and it helps because you know, people just fundamentally don’t like you, and you don’t know why. While the voice of frustration was a prominent theme throughout the interview, another voice began to emerge, one of inauthenticity. This voice reflected the constant performance that Lily had to put on to be accepted by others, describing that while it has become like a code switch it still leads to feelings of frustration, which Lily shares below in the following passage: SPID: EXPLORING THE IMPACT OF MASKING 82 I’m pretending to be more well-adjusted. I’m pretending to be more focused, I’m pretending to be more whatever, more interested, more humorous, more whatever, more personable, more kind, more anything, you know and yeah, now is just become, it’s like a code switch for me now, whereas before, I think it was more of a conscious effort. But now I don’t even notice I’m doing it a lot of the time until I start to get pissed off, and then I’m just like oh okay. While frustration and inauthenticity were prominent voices throughout Lily’s narrative, another voice emerged —a voice of connection. This voice was evident when Lily was describing the strengths of the autistic community, how she would not change being autistic, and how she began using the words “we” and “us,” which is demonstrated in the following: We are a very unique and very wonderful breed of people, I think, you know, and that’s something, you know, I’m very, like, I struggle a lot, right, as we do in worlds that are not built for us, but at the same time, I don’t think I’d change it, you know, because it’s like look at all this creativity that I have, look at all this wisdom that I feel I have (…) I just see the world in such a way that I think it really does benefit neurotypical people a lot of the time.” The voice of empowerment also emerged as Lily shared her journey towards beginning to unmask, and how it has also influenced her relationship with masking, as she stated the following: I’ve made a very conscious effort to be as authentic as I can be, like, even if I am masking, it’s not to the same extent. It's no longer a Stepford wife-like, shiny, happy people kind of thing; it’s more like an Addams family kind of thing. SPID: EXPLORING THE IMPACT OF MASKING 83 As the voice of empowerment continued to grow stronger, so did the voice of connection, which was particularly prominent when Lily shared that one of the strengths of autistic individuals is their awareness and ability to pick up on things that other neurotypicals may not be able to. As this awareness oftentimes also extends to the self, Lily also shared about how traditional talk therapy may not always be beneficial to autistic individuals because the majority already have powerful insight: We’re very aware, right? That’s the thing, it’s like we pick up on things that they might not have, as well. And then yeah, just like, the awareness, I think, is beneficial. That’s why you know, talk therapy isn’t beneficial for a lot of us, though, because we’re so self-aware already. It’s like, Dude, I know that I’m fucked up in all of these ways. Tell me what to do about it.” Another notable voice that started to emerge in Lily’s story was a voice of longing, which grew stronger in the second half of the interview. This voice combined advocacy with a desire for change, urging society to reflect on how autistic women are currently treated and how improvements can be made. This voice first appeared when Lily was asked about what she wished was different in society’s view of autism, and Lily shared the following: We are still people, and not like some kind of ill, sad little creatures, you know what I mean? It’s not like a curse inherently, it’s just something different about us, and the other thing is realizing that there are so many autistic people in the world that you are going to encounter that you are going to have no idea are autistic, because they don’t adhere to your guidelines of what you are looking for. You know, like, just understanding that it doesn’t look one type of way. We have commonalities, sure, but like there’s not one particular way to be autistic. SPID: EXPLORING THE IMPACT OF MASKING 84 The voice of yearning continued to emerge and took on a note of hopefulness when Lily was reflecting on the changes that are happening regarding autism recognition and awareness, in which she stated the following: Hopefully, at least years from now, there isn’t going to be someone like little me, that’s just like, wow, I hate my life, and I hate being here because I don’t know how to be a person. As I reflected on Lily’s narrative, I felt a wide range of emotions. I felt admiration for her process in unmasking and how she is so open about her autistic identity, which is something that I am slowly but surely becoming more comfortable with. I also found myself experiencing a real sense of empathy, as the sudden exclusion from friend groups and never knowing why, or the snide remark of "you know what you did,” is a pain that I have experienced and know all too well. This was a powerful reminder of the liberating importance of embracing one's identity, and a challenge to others to reevaluate their understanding of autism. It is a call to meet others with understanding and acceptance, rather than shutting down their experiences because they differ from what one believes to be true. Below is Lily’s I-poem, which I have constructed from a section of the transcript that I feel showcases the themes of the interview. Figure 3: Lily’s I-Poem I think just the way My life has played out I’ve made like a very conscious effort To be as authentic as I can be Even if I am masking, I’m autistic I got convinced by people That I was not autistic Even though I knew How fucked up am I? SPID: EXPLORING THE IMPACT OF MASKING 85 I’ve had so many missed diagnoses. I got misdiagnosed Why am I not getting any better? I have been going down this path I’ve been allowing myself to unmask I didn’t think I’m able to Let my guard down And be my genuine self I don’t believe it I still struggle with that I’m very paranoid I’m My little autistic self I only expect it to get better I’m really trying Being my authentic self I know it’s not always practical I know it’s not always practical To be semi-genuine like I have been I can move forward Rachel Miller’s Story Rachel Miller is a 48-year-old autistic educator and mother who was diagnosed a few years ago. When I met with Rachel, I was struck by her kind nature, and although she initially described herself as being rough around the edges, I came to see her as very warm and friendly. I also noticed that as the interview progressed and she became more comfortable, a very enthusiastic side of her emerged, especially when she shared about her advocacy work. I left feeling very inspired and in awe of how powerful a diagnosis can be in understanding and reclaiming one’s identity. Rachel’s autism journey began when she started to recognise traits in herself as her children were being diagnosed with autism. At first, Rachel found it hard to understand her experience because her kids behaved in typical ways. After her daughter’s diagnosis, the SPID: EXPLORING THE IMPACT OF MASKING 86 psychologist suggested she look into high-functioning autism in women and girls, which was a turning point for Rachel, as she shares in the following: So I did, and suddenly I was like, wait a second, this is me Rachel obtained a diagnosis quickly through a contact and shared that when she received her diagnosis, “suddenly her whole life made sense.” When asked about her relationship with masking, Rachel explains that she always masked and tried to imitate others' behaviours, which fostered a sense of shame as she became more aware of her nonverbal and paraverbal social cues, such as her tone of voice and body language. She also admitted to ruminating over past social interactions. Rachel described the process of masking as “exhausting.” While she acknowledges that masking helped her appear normal and achieve social success, the downsides included exhaustion and the internalized belief that her authentic self wouldn't be accepted by others, which she shares in the following passage: I guess I feel like, if I am who I am, then that’s how I’m going to be perceived as rude and unfeeling and too direct, and that’s not acceptable, right? In society. Throughout her journey, Rachel has begun to recognize her limits, as well as periods when she needs rest, and has developed greater self-compassion. She credits her friends, with whom she can be herself, as a tremendous support. Despite this, Rachel still feels that she is rough around the edges, is too empathetic, and constantly worries that others will perceive her as rude, cold, and unfeeling. When asked about one of the challenges of being an autistic woman, Rachel shares that she is often misinterpreted by others, which makes it difficult for her to fit in. Despite this, Rachel shares that being an autistic woman has also given her great strengths, such as her ability to compartmentalize and complete tasks quickly and efficiently, SPID: EXPLORING THE IMPACT OF MASKING 87 and has even led her to begin advocacy work. Rachel views being autistic as empowering because it helps her make sense of her life and helps her to advocate for and empower other autistic individuals. As I reflected on Rachel’s story, the first voice that emerged was a voice of shame, a persistent theme throughout the narrative. The voice of shame was representative of the sadness and self-doubt that Rachel feels after years of being told that she was rude for being her authentic self, and made its first appearance when she was sharing about how a friend once commented how her face was frowning when they were having a conversation, which then made her hyperaware of her nonverbal cues, which she shares in the following: I started checking my reflection at random times, kind of in my computer screen, and I was really shocked at like, what is my face doing? Right, and so now I’ve learned to consciously think about what my face is doing, and like if I’m in a Zoom meeting with a lot of people, I’ll shut my camera off so that I don’t have to think about it. The voice of shame was soon joined by the voice of disconnection, another recurring theme throughout the narrative. The voice of disconnection often appeared alongside shame and was characteristic of Rachel's insecurities and self-doubt related to social interactions. It also reflected her hyper-self-consciousness as she constantly monitors her non-verbal and paraverbal cues, such as her tone of voice, to avoid upsetting others. This voice also signified her disconnection from others and herself, as shown in the following passage, where Rachel shares her thoughts and feelings after a social interaction, reflecting on what happened and questioning herself: SPID: EXPLORING THE IMPACT OF MASKING 88 I go over everything like over and over. Did I say the right things? Did I do the right things? Did I pick up on everything? So there’s that kind of perseverating over did I do it right? While shame and self-doubt remained key concerns about masking, another issue surfaced: exhaustion. Exhaustion became evident when Rachel discussed her thoughts and feelings during masking, which she describes as follows: I think it’s just exhausting (…) I don’t know if I have the capacity to think about my emotions because I’m just thinking about being appropriate. But then I am exhausted, and I would say that the exhaustion definitely causes some depression. While shame, exhaustion, and self-doubt were the dominant voices in the first half of the narrative about masking, a new voice began to emerge: the voice of self-compassion. This voice reflected Rachel’s newly gained awareness of herself and her autistic identity, as well as her greater understanding of what she needs. It first appeared when she was describing, after receiving her diagnosis, how she has now been able to better understand how her brain works, which she shares below: I used to get irritated with myself, like What’s wrong with me? But now I’m like okay, that is what my autistic mind needs. I need to do that, so I’m just going to do that, right? I count things all the time, like I’m stirring, how many times did I count? How many times did I stir? How many seconds? And just realizing that my brain needs to do that and that’s okay.” The voices of self-compassion were then joined by a voice of connection, which went hand in hand as she described how the diagnosis of her daughter and how being able to SPID: EXPLORING THE IMPACT OF MASKING 89 tell others that she was autistic was very empowering for her. She reflected on what being autistic means to her and expressed her wish to share this information with the people who had misunderstood and mistreated her in the past, which she shares in the following passage. She was diagnosed three years ago, and for her it was such a relief, because she was like, there’s a reason, right? Like she had all sorts of different issues, and to be able to say, okay, it’s because I’m autistic. Like, it was so empowering for her, and I think for me to be able to say, okay, there is a reason, right? Oh, I wish that I could go back and tell everyone I’ve ever known, hey, guess what? I was autistic. Like that’s why I come across this way. The voice of self-compassion was paired with the voice of empowerment when Rachel shared how receiving her autism diagnosis has helped her to rediscover who she is, particularly after her divorce, which she described as “very, very bad,” as she shares in the following passage: I have had to rework my identity, like Who am I? Who am I without someone affirming that I’m enough right? And I think having the diagnosis is so helpful, because I can understand myself a lot better. Another voice that surfaced as I reflected on Rachel’s narrative was a voice of resistance. This voice appeared near the end of the interview and represented strong opposition to neurotypical oppressions and a challenge to reframe how autism is viewed. It emerged when Rachel was asked about society's perception of autism, and she emphasised the importance of autistic people being believed and respected when requesting accommodations, as well as how she has advocated for her own needs at work. SPID: EXPLORING THE IMPACT OF MASKING 90 We’re not making it up when we’re really tired or when the lights are too bright, and I mean, I’ve been stuck in offices where there was music playing and I’ve just gone over and shut it off because I hate background noise. I think also like, you don’t have to treat us differently. You know, you don’t have to slow down your talk, we’re not necessarily cognitively deficient. The final voice that emerged in Rachel’s narrative was a call to action. This voice urged steps that can be taken to improve the lives of autistic individuals. It was present throughout the latter half of Rachel’s interview as she discussed being on the panel, writing her children’s book, and her work around polyvagal theory and making schools safer not just for autistic children but for all children, which she shares in the following: We need to recognize how important our nervous systems are, to what we experience and how we react, and we need to make society a safer place in general. I think school is a huge part because kids spend so much time there, and like, how can we make schools a safer place? How can we make other places a safer place? Rachel’s story prompted me to reflect on many aspects. I was inspired by the transformative power of a diagnosis in affirming one’s identity and self-concept, and I agree on the importance of creating systems and advocating for change in schools, not only for autistic children but for all children. I believe I would have greatly benefited from an understanding of polyvagal theory and calmer, safer school environments, as much of my school experience involved suppressing how uncomfortable and overstimulated, I felt, only to have a complete meltdown when I got home, because that was my safe space. Rachel’s story and insights remind us to do better for and by our students and autistic individuals. SPID: EXPLORING THE IMPACT OF MASKING 91 Below is Rachel’s I-poem, which illustrates her shift from shame to a more selfcompassionate and empowering view of herself after receiving her diagnosis. Figure 4: Rachel Miller’s I-Poem I think Before I knew I was autistic I mean I’ve had very low self-esteem For most of my life Thought there was something wrong with me I just don’t fit I don’t understand Why I get misinterpreted I would say my self-esteem is a lot better than it was And I can say It’s because I’m autistic I think for me to be able to say, okay, there is a reason Oh I I wish I could go back and tell everyone I’ve ever known, hey, guess what? I was autistic I wish I could go back and say I was autistic That’s why I came across that way I used to get irritated with myself What is wrong with me? Now I’m like, That’s what my autistic mind needs I need to do that So I’m just going to do that Jade’s Story Jade (she/they) is a 27-year-old non-binary femme autistic artist and advocate. I met Jade over Zoom on a calm spring day, and I was instantly captivated by their warmth, profound insight, and compassionate energy. Jade spoke so eloquently about their SPID: EXPLORING THE IMPACT OF MASKING 92 experiences, and I was so in awe of and inspired by their advocacy work and their gentle strength, which was evident throughout the interview. Jade’s autism journey began when she was three, when her mother suspected she was autistic. However, the doctor misdiagnosed her because she made good eye contact. As a result, Jade went undiagnosed throughout her childhood and received various other diagnoses, such as obsessive-compulsive disorder (OCD) and panic disorder. When Jade finally received her autism diagnosis at 17, she described it as a “really significant” moment, because everything she and her family had suspected was confirmed, which they share in the following passage. Before I had the diagnosis, I went years and years feeling fundamentally incorrect and having no explanation for it. So it was very impactful to have that affirmation, and to say, yeah, this is what we’ve expected, that was real, that was true. When describing her relationship with masking, Jade shared that they first started masking in childhood. Although they do not remember the exact moment it happened, they realized that their way of stimming, which was jumping up and down, was not acceptable at school. As a result, they began suppressing their stimming to fit in. This experience led to masking in different areas of their life, and they express that they have a deep sense of shame when they mask — not because of who they are, but because they cannot show their full, authentic self to others, which they share in the following: In almost every instance of my life, masking has played a role; I’m never my truest self, and you know, beyond life being socially appropriate, it’s more than that. I SPID: EXPLORING THE IMPACT OF MASKING 93 don’t express happiness the way that I would if I weren’t masking, I don’t really express a lot of these core feelings and emotions and pillars of my being. Jade also shared that after their diagnosis, they began receiving ABA therapy, which they reported was unhelpful and at times insulting. One example was when they were asked whether it was appropriate to wear a wedding dress during their senior year of high school; they found this very odd and felt it did not help them understand their diagnosis better or prepare for real-world situations like obtaining a job. She also reports that she was often rewarded for successfully masking, which further perpetuated feelings of shame and exhaustion. While masking greatly influenced how Jade viewed herself, she has also started to allow herself to feel pride in her autistic identity. She shares that it has given her incredible gifts, such as her hyper-empathy and her ability to focus on her special interests, like her artwork. Jade can critique society for the challenges she has faced. She described a pivotal moment in her journey as an autistic femme and advocate as learning about her ancestors, who had similar traits and were institutionalized. This gave her a deep sense of gratitude for having others who accepted her for who she was, as well as the motivation to advocate for others. She shares this in the following: To have people that fully acknowledge your true being is something I wish I could have given to these women I never knew, because it’s really vital, it’s really necessary. As I reflected on Jade’s story, the first voice that emerged, related to masking, was one of shame. This shame represented the deep sadness Jade felt about their autistic identity and the inability to fully express themselves to the world in the way they wanted. This voice SPID: EXPLORING THE IMPACT OF MASKING 94 came to the forefront when Jade was sharing their thoughts and feelings about engaging in masking, which they described below: I’ve been thinking a lot about how kind of heartbreaking it is to know that if I were to exist in a space as my true self, there would be looks, there would be confusion, there’ll be uncertainty about what was happening. I might be perceived as existing in a different kind of vulnerable context, assumptions might be made or judgements might be cast, and that feels really, really sad, really sad and scary. Another voice quickly joined in— the voice of shame, of disconnection. This voice mirrored the confusion Jade felt from the masking she had done during her childhood and adolescence, and how it had impacted her sense of self for years, along with her ongoing struggle to discover who she truly was. When asked how masking affected their selfperception and identity, Jade shared the following: Masking as a child and adolescent, it really fogged my vision, it had clouded my vision regarding my perception of myself. So while it did serve as a form of necessary protection, it did confuse me, and it confused how I could perceive myself and understand who I was, for sure. While shame and inauthenticity dominated Jade’s narrative, a new voice began to emerge—a voice of connection. This voice emerged when Jade was asked how they navigate the terrain between being who they are and masking. They shared that, although they still struggle with community and feel shame, they have close friendships and a wonderful partner who loves and fully accepts them for who they are, which they did not think would ever happen when they were a teenager, as they shared in the following. SPID: EXPLORING THE IMPACT OF MASKING 95 It’s just been through this tremendous lesson of recognizing that masking is protection, but you don’t need to protect yourself from everyone. There are people that are safe and that are respectful and that are considerate of your true self and will hold space for that, which as a teenager I could never fathom. I had these very real fears that I would just have to hide myself forever, I would have to be this hidden being and the relief of knowing that’s not true, I mean, I can’t believe it to this day, I feel so grateful. The voice of connection was then joined by one of empowerment, which appeared in the following passage when Jade discussed how her relationship between masking and being her authentic self has evolved over the years. As I become more and more of an adult, it has become really clear to me that what I thought would never be an option, finding love, being respected in my field, being successful, finding community, that these are not necessarily predicated on how well you mask, and masking does not need to be tied to your achievements, whether you are deserving of achievements, or whether you’re deserving of anything really. As I continued to reflect on Jade’s narrative, another voice that surfaced was one of anger. This voice became prominent when Jade discussed their experiences with ABA and the harm it causes by trying to make autistic individuals conform to neurotypical norms or solely targeting their behaviours, without addressing deeper issues like sensory overwhelm and related mental health concerns, such as anxiety, which she shares as follows: It’s all about assimilating young people into greater groups of young people, and creating palatable children rather than addressing what is really going on, and SPID: EXPLORING THE IMPACT OF MASKING 96 saying I’m wondering why this person is engaging in this behaviour. Maybe it’s because of this root cause? How can we take care of that child? And that way (ABA) is an absolute bypassing of that. And you know totally focusing on well this behaviour makes me uncomfortable and is difficult for me, so I have decided that you cannot engage in it. It’s just fundamentally harmful. Very, very harmful. The voice of resistance ended the interview when Jade was asked about how they envisioned a world that supported autistic women and individuals. Jade shared the following profound suggestion: It’s just so vital to include us, not performatively, but to truly consider and include us and all disabled people in opportunities and events in life. We want to be there, we want to be part of the world in whatever capacity we each uniquely have, but we deserve a place in the world, and we have really wonderful things to contribute. We deserve to be seen and heard. Jade’s story moved me deeply, and I was constantly in awe of their ability to feel pride in themselves. Their gracious and kind nature inspired me to adopt that same virtue. At one point, I shared that I had considered becoming a behaviour consultant and felt a deep shame for having worked in the ABA field because of the potential harm I may have unintentionally caused my clients. Jade offered a simple yet powerful phrase: that I did not know any better, as it is often the only treatment promoted for autism. This was so healing and freeing for me. Jade’s story highlights the importance of supportive connections and the courage to advocate for others, helping us create a world where we honour, rather than shun, each other’s diversity. Below is Jade’s I-poem. Figure 5: Jade’s I-Poem SPID: EXPLORING THE IMPACT OF MASKING 97 I really struggled When I was a teenager I would come home and feel so much loathing I would think to myself Because I was a teenage girl Who would ever love me? I had no context I actually posted a video I felt a real necessity for advocacy I posted a video I was really into autistic advocacy I took it down I was just horrified I really need to earn things like community, love, success I ended up moving I still struggle with finding community That’s a big one for me I built close friendships I have a wonderful relationship I have my career I feel that I am respected I respect myself My true self I still mask I still engage in masking But I make no bones about My true self I trust Who my true self is Marie’s Story Marie is a 45-year-old autistic woman who is the mother of two sons, both also autistic. When I met Marie, I was immediately drawn to her warm, caring, and compassionate nature, as well as her sense of humour. I found myself deeply moved by her story, and at one point, I became very emotional as she shared how her sons are completely open about their autistic identity and have friends who are also autistic, because I so much wished I could have done the same when I was a child. I couldn't help but feel hopeful after hearing about this new generation. SPID: EXPLORING THE IMPACT OF MASKING 98 Marie was diagnosed at 34, having been labelled a “gifted” child beforehand. It wasn't until her older son was diagnosed that she started to see similarities in herself and was advised to get assessed by the consultant they were working with at the time. Marie also mentions that during that period, her initial experience with autism involved being surrounded by “autism moms” who saw autistic children as “broken, awful family tragedies” and tried to sell her false treatments. Luckily, the consultant they worked with, who is also autistic, introduced her to the concept of neurodiversity, which Marie has been teaching her kids. Receiving her diagnosis was a very meaningful moment not just for Marie, but for her kids, as she shares in the following: When I got diagnosed, my older son, like jumped for joy and was so excited and congratulated me. So I felt I did okay there and kind of breaking some of those messages that kids often like, learn about their autism. When asked about her relationship with masking, Marie explained that while it has opened doors she might not have otherwise encountered—such as career opportunities—the entire process is “completely debilitating” and affects her ability to connect meaningfully with others. This is because she is constantly concentrating on her actions and how she is perceived. Marie also mentions that because she puts so much effort into trying to be seen as neurotypical, which is very taxing, it makes her “more awkward” than she would be if she weren’t masking. She feels that others can sense this, which she shares in the following: I’m spending so much energy and focus on like how much time am I making eye contact with this person? Am I standing in a weird posture? Am I fidgeting or stimming? (laughs) All that focus on that doesn’t really allow me SPID: EXPLORING THE IMPACT OF MASKING 99 to be fully present with the other person and it causes, I guess, a bit of a breakdown in that connection and kind of furthers the social isolation, because yeah it probably makes the other person feel uncomfortable too because they’re probably picking up on some sort of a frazzled tendency. Marie also used this powerful metaphor to explain masking to those outside the community, which she shares in the following: I tend to think of masking as like to use Japan as an example. If I was to move to Japan without like, knowing their customs and the culture that well and knowing, you know the language, I could learn the language, I could learn the customs, and it would help me fit in more and be accepted more by the people there, but it would never be like my first language and it’s just always going to be exhausting and tiring. While masking has been an important part of Marie’s life, mainly as someone who is multiply disabled and diagnosed with Ehlers-Danlos Syndrome, Marie shares that she has had moments where she can be her true self. These moments include being with her children and connecting with other autistic adults. Marie also mentioned times when parents of autistic children have approached her for advice and genuinely want to learn from her. She says this has felt “good” because someone wants to “learn from and understand” the experiences of their autistic children. As I reflected on Marie’s story, the first voice that surfaced was one of exhaustion. This voice embodied the toll that masking takes on Marie and the intense effort required to maintain an image and gain acceptance from others. It first arose when Marie discussed the downsides of masking, sharing how her energy levels vary when interacting with SPID: EXPLORING THE IMPACT OF MASKING 100 neurotypicals versus other autistic individuals because of masking, which she describes in the following: If I go to a social function, I’ll need like two, three days of just crashing after (laughs), just not functional, which is different when I am spending time with autistic people. That actually feels energizing, whereas with neurotypical people, it’s a little more draining. While the voice of exhaustion was prominent throughout Marie’s narrative of masking, another voice emerged — a voice of shame. This voice appeared when Marie reflected on her past experiences, revealing that she tends to mask her true feelings in situations where she fears she will be misinterpreted or misunderstood by others. She worries about this because some of her unmasked behaviours could be seen as deceitful, as she shares below. An example of times where I am kind of extra masking is any situation where I want to make sure that I am believed. I’m worried that somebody won’t trust me or believe me because I find a lot of the natural autistic behaviours are also the behaviours that are linked to lying. So kind of like darty eye contact, and like fidgeting, and you know looking in weird directions and stuff. Similar to other participants, the voice of inauthenticity was also a prominent voice that emerged throughout Marie’s narrative. This voice appeared when she described her thoughts and feelings while engaging in masking, both as an autistic woman and someone who is multiply disabled, which she shares in the following: I guess when I am masking, I feel a bit like a fraud. I’m hiding my disability to make others feel more comfortable perhaps, which feels kind SPID: EXPLORING THE IMPACT OF MASKING 101 of cheap and dirty (…) it definitely caused like identity issues and feeling really unsure of who I am. Throughout the narrative, another voice began to emerge—one of connection. This voice symbolized Marie’s relationship with the autistic community and her children, providing a safe space for her to embrace her quirks and to mask less. It first appeared when Marie described experiences where she felt empowered by embracing her authentic self, mentioning that with them autism “feels more celebrated instead of shamed,” which she describes as "really nice.” This voice of connection was also accompanied by a voice of selfacceptance and pride, which came through strongly when Marie discussed how beneficial having an autism diagnosis has been, as she shares in the following. I’m very grateful for the diagnosis, because my view of it labelling is like without that label, there’s always going to be labels anyway. If you’re not labelled as autistic, you’re labelled as I don’t know, quirky, you’re lazy or weird, or whatever other names. So for me, it actually helped with a layer of self-criticism, because I’m very intensely self-critical. A compelling example of both the voice of connection and the voice of empowerment arose during the interview when Marie mentioned my role as both an autistic therapist and researcher, to which she responded with the following: Talking to you, I’m actually realizing like a huge benefit to unmasking is the impact on other people that have the same experiences because as soon as I heard that you’re a counsellor, you’re autistic, and you’re studying this, I was so excited. It was so empowering. I’m not sure if empowering is the right word, but I was very unsure about my own ability to like go into counselling and that sort SPID: EXPLORING THE IMPACT OF MASKING 102 of thing. Like, how would that be seen? And like, what kind of judgments would I face as an autistic person? So it’s great to see somebody in grad school, kind of doing everything and researching important topics. It’s very nice to see other people that are able to unmask to some extent, and yeah, it just makes it easier for everyone else. As I continued reflecting on Marie’s story, the final voice that surfaced was one of yearning. This represented the changes Marie hoped to see, not only for herself but for others, and it grew stronger as the interview went on. This voice emerged when Marie was asked what she wanted others to know about her, to which she shared the following: I wish the people in my life knew how hard things are for me and could support me because I could use help. I have a lot of things where I really can struggle. I can get overwhelmed, or I just get stuck in bed for like two, three days and like don’t tell anyone just because of overwhelm, overload, and burnout. I guess overall, I wish people could see me as I actually am, I wish I was able to be comfortable fully unmasking and just being myself around people and not having negative consequences. The voice of yearning also surfaced at the end of the interview when Marie was asked about how she envisioned a society that supports autistic women, to which she shared: I would like to see an understanding of how autism presents in women and a lot more acceptance around people just kind of being themselves, like not being judgmental or not determining somebody’s ability to do something, let’s say because of stimming, like, oh you know that person is not going to function because they’re doing XYZ. I guess acceptance on a grand scale, SPID: EXPLORING THE IMPACT OF MASKING 103 just acceptance of people as they are and less judgment across the board would be nice. After my interview with Marie, I felt deeply moved and in awe of her resilience. Like many others, Marie’s story reflected the shame and exhaustion that come with masking, alongside the empowerment and self-acceptance that arise from finding community and receiving a diagnosis. I was also very touched by her resolve to challenge the negative narrative around autism as a defect by teaching her children about neurodiversity and encouraging them to be their authentic selves. Below is Marie’s I-poem, which I created from excerpts of the transcript that I felt best highlighted her voice and journey. Figure 6: Marie’s I-Poem I guess I feel guilty I guess When I am masking I feel a bit like a fraud I guess I’m yeah, Hiding my disability Who I am I think I guess there’s elements of trauma I didn’t even really have an identity I feel like I’m starting to figure out Who I actually am Not what people have wanted me to be I think I do feel better The less I mask I guess I’m actually realizing I guess I heard I was so excited I was very unsure About my own ability SPID: EXPLORING THE IMPACT OF MASKING 104 What kind of judgments would I face I’m I’m grateful that people like you exist Daphne’s Story Daphne (she/they) is a 40-year-old autistic researcher and educator I met over Zoom on a spring day. When I met Daphne, I couldn't help but admire her dedication to advocacy within the school system and through her research. I also admired her ability to unmask and her unapologetic authenticity, refusing to make herself smaller for others' comfort. Daphne also encourages her students to unmask and be themselves, which I found truly inspiring and made me wish I had someone like that when I was growing up. Daphne’s journey with autism began recently when she was diagnosed in her 30s. Until that point, Daphne had been working with autistic people her entire adult life, having started working at a child development centre when she was 19. It was not until her daughter was going through the autism assessment process herself that Daphne realized she had many of the same traits her daughter was being assessed for, which she described as “interesting” because she spent so much time teaching and working with autistic individuals as well as autism professionals. Daphne shares that receiving the diagnosis was a pivotal moment for her because it helped her understand herself better and allowed her to be more of her authentic self, which she shares in the following: Once I knew I was autistic, it just started making a lot of sense why I experienced things the way I did. I think getting the diagnosis really helped me to understand how much I masked or why I would have masked in the past, and then gave me permission to not mask. SPID: EXPLORING THE IMPACT OF MASKING 105 When describing her relationship with masking, Daphne shared that she would unknowingly mask, especially before she secured a full contract as a special education teacher, by suppressing her stimming. For her, this meant being unable to keep her hands busy, primarily through knitting, which she finds relaxing. However, after an injury that led her to request accommodations, her diagnosis, and obtaining a full contract, Daphne reports that she feels she can mask less. Daphne describes masking as “really disruptive” because it prevents her from being able to show up authentically, which she shares below. When I have to mask or if I’m masking, I just feel really tired and quite frankly bored, like I can’t meaningfully engage in how I want to engage in a situation. Through her diagnosis, Daphne shares that she embraces who she is and makes a conscious effort to avoid places where she may be required to mask. She also sets healthy boundaries for herself, such as refusing to be friends with people around whom she does not feel safe being unmasked. Daphne encourages her autistic students to unmask and, through her work as an educator and researcher, advocates for the autistic community, which she credits to her experiences as follows: I understand what it feels like not to stim, so I would never do that to a student. I really understand how it can impact learning, so I’m not going to turn around and tell a student they can’t stim. So in some ways, those learning experiences have turned me into a better teacher, so I appreciate that. As I reflected on Daphne’s journey, the first voice that surfaced was exhaustion. This was a dominant voice as Daphne shared her thoughts and feelings about masking, representing both the effort it requires and the emotional and mental toll it takes on her. This SPID: EXPLORING THE IMPACT OF MASKING 106 voice rang loud and clear when Daphne described masking, to which she shares the following: It’s exhausting, it’s boring, it’s no fun, it’s stressful having to watch what you say and what you do and then analyze it afterwards. Like, I wish I would have said this, or I wish I would have done that, or why did I do this? This was so weird. Yeah, the older I got, I have way less time for situations that require masking. The voice of frustration quickly merged with the voice of exhaustion. The voice of frustration was prominent in Daphne’s story, especially regarding the actions of others who behaved insensitively and hurtfully towards her and other autistic individuals. This voice surfaced notably when Daphne discussed her experience with the teacher, who shamed her for stimming and for how the inability to regulate herself negatively affected her learning, which she shares below: I was really frustrated because I spent so much time trying to mask and look professional, because it could reflect badly on your grade or whatever. I just spent so much time and energy doing that and worrying about masking and looking a certain way that I was not learning as much or getting as much out of it our participating as much. So like it, directly negatively impacted my learning and my ability to participate in a meaningful way.” As Daphne’s story progressed, another voice emerged — the voice of self-love. This was a powerful voice that resonated throughout the narrative, reflecting Daphne’s selfacceptance and her ability to advocate for her needs while staying unapologetic about it. This voice appeared when Daphne shared how she has become more comfortable with her SPID: EXPLORING THE IMPACT OF MASKING 107 authenticity and has no time for those who do not accept her for who she is, which she expresses in the following: I’ve become pretty comfortable in my own skin, and I’ve been pretty openly autistic, like a lot of people know, I tell people I’m autistic. I don’t have a lot of energy for masking. I only have friends that I don’t have to mask around. If I have to mask around you, I am not going to be your friend. The voice of self-love was soon accompanied by the voice of self-compassion. This emergence resulted from the reframing Daphne did after her diagnosis, as she revised her understanding of herself and realized she was never broken, just unsupported, as she shares in the following passage: When I got my diagnosis, I spent some time really reframing. When I was a child, I was told I was just like a problem child, and that I had mental issues, you know, all of these things, and reframing my experiences as not a broken person, but just as an unsupported autistic person was really helpful. I find, reframing a lot of my traits as autistic traits have been great for me.” As Daphne’s story unfolded, another voice emerged—the voice of anger. This was a powerful voice throughout the narrative, representing Daphne’s opposition to how autistic people are treated and continue to be marginalized in settings such as education and research. A notable example of this voice was when Daphne expressed frustrations about how autistic individuals are often dismissed when their genuine concerns are raised and are not fairly represented or treated in both academic and professional environments, such as schools, as they share below: SPID: EXPLORING THE IMPACT OF MASKING 108 We don’t say we learn about indigenous people by listening to a white professor, or white historian, we know that’s wrong, and yet we are still allowing people who are not autistic, who don’t meaningfully engage with autistic people, whose research is not meaningfully engaging autistic people. We still let them be the experts. (…) They shouldn’t be centring themselves as someone who knows so much about it because they don’t. The final voice that started to appear throughout Daphne’s story was the voice of action. This voice represented the steps Daphne took against harmful practices affecting her autistic students. For example, she shared a troubling practice she had learned about from her autistic students, who were being made to sit on a bench until someone noticed and wanted to play with them. This deeply upset Daphne and motivated her to act, which she describes below. They (the students) were like, we want to play alone, like we didn’t want to play with anyone, we wanted a break, it was recess we wanted to be by ourselves for 15 minutes. We had to sit on this stupid bench and alert to everyone that we didn’t have a friend. So I actually called in the principal of that school, and they shared with them like your friendship bench is stupid and it ruined our recesses. Like, why would anyone think that was a good idea? Daphne’s story served as a powerful example to me of someone who uses their lived experience and voice to uplift others, both in academia and the workplace. I was inspired and moved by her authenticity and advocacy, which fuel my passion to continue conducting research and to use my platform as an autistic woman to uplift and empower my community. SPID: EXPLORING THE IMPACT OF MASKING 109 Below is Daphne’s I-poem, which highlights her journey from masking to authenticity and advocacy. Figure 7: Daphne’s I-poem I definitely mask less now I think Even when I’m going into situations I’m trying to impress I don’t mask as much I’ve become pretty comfortable In my own skin I’ve been pretty openly autistic I’ll tell people I’m autistic I don’t have a lot of energy for masking I have my friends I only have friends I don’t have to mask around If I have to mask around you I’m not going to be your friend I don’t mask I’m dealing I have to act really, really professional I think it’s different than masking I think there’s a difference I don’t feel I wouldn’t say I mask at work I went from like high masking I just don’t feel like it I’m pretty comfortable With my identity I’m pretty comfortable I’m a huge advocate for autistic people and students Rose’s Story Rose is a 36-year-old autistic mother I met over Zoom on a lovely spring day. When I talked with Rose, I was immediately attracted to her warmth and enthusiasm. I was in awe of how openly she shared her autistic identity and her dedication to being her true self in all areas of her life. SPID: EXPLORING THE IMPACT OF MASKING 110 Rose’s journey with autism began in her childhood, where she often said she "felt like an alien” because she tried to fit in like everyone else but never quite did. After her daughter was diagnosed as autistic, Rose received her own diagnosis two years ago. She has since been exploring ways to be more authentic, which she shares below. Since I’ve been diagnosed, I’m learning a lot more about it and a lot more about myself, and how I can be myself and not try to be everyone else around me. When discussing her relationship with masking, Rose explained that she dislikes it because it forces her to hide her true self, which has contributed to mental health problems like anxiety and depression. She also mentioned that masking affected her mental health so severely at one point that she visited the doctor multiple times, which she elaborates on when describing the challenges of masking. I’ve been to the doctor so many times1, and I had really bad depression, horrible anxiety, and I was on all kinds of medications for them, and that was really challenging. Going through that, and just knowing that it’s all because I don’t feel like myself. Despite these challenges, Rose shared that receiving her autism diagnosis was very liberating for her because it allowed her to realise that “she was being like everyone else,” and subsequently gave her permission to be herself. This is also a value she has instilled in her children, encouraging them to be themselves and to persist through disapproval and mistreatment from others, which she shares below: 1 I have italicized parts of quotes where there was paraverbal intensity markers such as raised speech or increased tone of voice as LG emphasizes not only listening to spoken word, but also paraverbal and nonverbal cues when listening for voices SPID: EXPLORING THE IMPACT OF MASKING 111 I can be myself, I can let my children be themselves, I can show them that, there’s nothing to be ashamed of being the way that you are. I have fully accepted myself for being autistic and the way that am. Reflecting on Rose’s story, the first voice that came up was one of inauthenticity. This voice showed the toll that masking took, not just on Rose’s sense of self but also on her mental health struggles. It first appeared when Rose discussed her thoughts and feelings while masking, including the following: It’s hard. I feel like I’m not being myself. I just don’t feel good about it. I just feel uncomfortable; it causes more anxiety for me, but depression, too. Inside of my body, it feels like this isn’t the way you should be doing it. You know, this is the way everybody else does it, but this doesn’t feel right to me. The voice of exhaustion was then joined by the voice of disconnection, which embodied both Rose’s disconnect from herself and others. Disconnection stood for various aspects, such as self-doubt and insecurity. The voice of disconnection surfaced as Rose continued to describe the thoughts and feelings that arose when she was engaging in masking, which she shares in the passage that follows. As she spoke, her speech gained momentum. It became louder, almost as if reflecting a sense of urgency and franticness related to the self-questioning characteristic of disconnection from oneself. Are you doing things right? Are you doing this the right way? Are you saying things the right way? Are you saying the right things? Are you using the right tone of voice? Are you using the right eye contact? There’s so many things to think about or I think about for sure.” SPID: EXPLORING THE IMPACT OF MASKING 112 The third voice that emerged as Rose recalled her experiences of masking was the voice of exhaustion. This voice became prominent when Rose described how masking affected not only her mental health but also her physical health, as she was constantly unwell. Fortunately, she reported that since embracing her authentic self and wearing less makeup, she has been feeling much healthier. The voice of exhaustion surfaced when Rose discussed the realisation that she was in a continuous state of autistic burnout, and how learning about masking and making a conscious effort to be herself helped her to become healthier and more confident, as she shares below: It’s just like night and day, like the shift from being really sad, exhausted, and having so many mental health issues to being completely free. I didn’t realize I was experiencing autistic burnout all the time and now that I’ve learned about that, it definitely has really helped. It makes so much sense now. As Rose’s narrative developed, another voice emerged—one of empowerment. This was a strong and consistent voice throughout the story, reflecting Rose’s ability to fully accept herself for who she is, and highlighting how freeing it was to finally have a diagnosis and an explanation for why she felt so different from others. This voice appeared when Rose shared moments of empowerment through embracing her true self, which she discusses in the following:** I just feel like, you know what, I’m just myself and you can take me as I am, and if you don’t like it, then you don’t have to be around me. So that’s how I feel now that I can just be myself. The voice of connection then blended with the voice of empowerment. This voice emerged when Rose shared how embracing her autistic identity helped her children accept SPID: EXPLORING THE IMPACT OF MASKING 113 their own. Much like the voice of empowerment, this voice remained strong throughout the interview, symbolising how connection to others—in Rose’s case, her children—was an additional strength in helping her embrace her authentic self so she could be a positive role model for them. This passage was a clear example of this when she shared her thoughts after receiving her autism diagnosis. There are benefits to it, and it’s freeing, and when you do finally find out, I don’t see it as a negative. I see it as a positive, and that, you know, maybe I’m here to help my children through this and to navigate through this just by being who they are. As I continued to reflect, another voice appeared in Rose’s narrative: the voice of resistance. This voice represented the actions Rose was taking to be true to herself and oppose neurotypical expectations in a world where conformity is often the norm. This voice first appeared when Rose shared how she navigates the space between masking and being her authentic self, the challenges she faces, yet how she actively resists masking, which she shares in the following: I do want to mask sometimes just to make things easier, but then I think about it and I’m like, 'No, that’s just going to make things worse for you.’ The final voice that emerged in Rose’s narrative was a powerful expression of longing. This voice represented the changes Rose hoped to see in the world and how it supports autistic women. It came to the forefront when Rose discussed how many autistic women, including herself, often go unnoticed or receive multiple diagnoses before autism, which she shares in the following after being asked what she wished society did differently in its view of autism and autistic women: SPID: EXPLORING THE IMPACT OF MASKING 114 Something I really wish would happen is that there would be more research on these women and how they’ve gone so many years undiagnosed, despite the signs being there, which were missed. They diagnose you with anxiety, they diagnose you with depression, they diagnose you with an eating disorder. I’ve been diagnosed with all of them. Now the autism comes across, and it was like, wow, that made sense for all of it. That’s one thing I really wish was that they would have more information out there. Rose’s story was a deeply moving account of the power of diagnosis and how the chronic stress caused by masking can lead not only to mental health issues but also to physical health problems. Throughout my research, I have often noticed that many autistic women, including several of my participants, have chronic health conditions. This often makes me reflect on how masking and trying to adapt to a world that isn’t built for us, nor recognises or accepts us, can be so damaging in many ways. Despite this, I was inspired by Rose’s enthusiasm and joy as she described how freeing it was to fully embrace her identity. I found myself feeling renewed and inspired for hours after our interview. Below is Rose’s IPoem, which highlights her diagnosis journey and her shift from masking to unmasking. Figure 8: Rose’s I-poem I have I honestly Who I really was I found out I was autistic Me My life Accept myself Who I am I really had to I was like I don’t know SPID: EXPLORING THE IMPACT OF MASKING 115 I was I just couldn’t Sense to me I was doing My whole life I was I was masking My mental health I definitely I know I’ve really worked with Myself I’m talking To be myself I felt I did I felt like I didn’t Know myself Kate’s Story Kate is a 30-year-old autistic office worker I met over Zoom on a fall morning. When I first met Kate, I couldn’t help but be drawn in by her sense of humour and candid nature. I noticed many similarities between us, such as her ability to laugh and the things in her past that might have otherwise made her cry. I find that humour has always been my go-to coping mechanism during tough times. I also resonated with her frustration when anyone called her sensitive, because she always thought it was a bad thing growing up. Now that she is older, she’s come to embrace that part of her identity and is a self-proclaimed “spoony,” a term for highly sensitive people who tend to get drained or “run out of spoons” faster than the average person. Kate’s journey with autism began recently after her husband suggested she might be autistic. Growing up, Kate explained that she always thought she was “just an introvert with anxiety, depression, low self-esteem, and high sensitivity.” A few years ago, she came across SPID: EXPLORING THE IMPACT OF MASKING 116 the term highly sensitive person or HSP for short and started to recognise many traits, such as sensitivity to bright lights and sounds, as well as becoming overstimulated in emotionally charged environments. Despite this, she did not initially consider autism until about a month ago, when her husband suggested it to her. After doing some research, she realized that she was autistic, which she shares in the following: He knows me really well, and it kind of took that outside perspective of like, okay, you’re suggesting that maybe for a reason. So then I did my own research, and I was like, okay, a lot of this is clicking for me.” When describing her relationship with masking, Kate reflects that, looking back, she had masked her entire school experience. Describing herself as a “high achiever,” Kate mentioned that she thought it was normal to “act out scripts” and memorize social situations—habits she continues to practise into adulthood. However, Kate also shared that despite having a “permanent mask,” she has found moments where she could let it slip a bit and allow others in. She explained that this first happened unexpectedly when she was planning to meet a friend for coffee during a particularly tough week. Usually composed, Kate ended up having a meltdown. Instead of running away or judging herself, the friend said this was the first time she had ever seen Kate so vulnerable. This was a real eye-opener for Kate, and she has started to embrace the autistic parts of her identity, such as her creativity and sensitivity. Despite feeling shame, she has engaged with readings and posts by other autistic creators and has begun to slowly feel more comfortable with her authentic self, which she shares in the following passage. SPID: EXPLORING THE IMPACT OF MASKING 117 This is what I present to the world, and this is who I am, and that is fine, and then when I can’t keep my mask on any longer, and people notice, then it’s like, oh, okay, things still ended up fine. Reflecting on Kate’s story, the first voice that came up about her masking was a strong one of shame. This voice was tied to many parts of Kate’s identity, like being autistic and queer. It first appeared when Kate talked about her upbringing in the church and how it led to her masking. She was open and honest about how this voice became part of her inside. She gave an example of watching a home video of herself as a child, singing a worship song and dancing. Then the video cut to black, and it showed her singing very seriously, which she thought was her mom telling her to behave differently. This shows how masking was reinforced, as she explains below. I was like four, of course I wanted to dance along to music, but that was reinforced, like well, no, you just kind of pretend you have no emotions, so I got very good at keeping everything inside.” The voice of shame resurfaced as Kate shared how her religious trauma affected her sense of self and how she tends to “gaslight” herself into believing she should not feel proud. This leads to a guilty feeling that she is “wrong” because she was taught to hide not only her autism but also other parts of her life, especially her queerness, as she explains below. That has also been a whole mess of emotions and thoughts, and the journey of entangling what that also means in my life, so like not only masking my autism, but also masking my queerness and masking other aspects of me. To most people, I wouldn’t admit that I watch anime, because that’s weird and nerdy. SPID: EXPLORING THE IMPACT OF MASKING 118 The voice of shame was also joined by the voice of exhaustion, which became prominent when Kate described the toll it takes on her when she must hide her feelings and traits. This voice surfaced when she reflected on how she is often not herself around others and has many walls, which she realized are both a masking behaviour and a self-protection strategy stemming from past trauma she has experienced, which she shares in the following: I thought it was more like a self-protection trauma response of like, being vulnerable is exhausting. So if I’m just not vulnerable, then they don’t get to know me, and I don’t get to know them, and then it’s just safer. Relationships are hard, so let’s just not put any energy into any of them. Despite shame and exhaustion being prominent throughout the narrative, a new voice emerged — the voice of self-compassion. This voice was a small but steady undercurrent. It surfaced when Kate discussed her values, during which she shared the following: I hate small talk. I really value authenticity. It’s like okay, let’s either be really close and vulnerable with each other, or like I’m gonna totally mask and you’re practically a stranger to me, even if we have known each other for years. The voice of self-compassion was soon complemented by one of empowerment when Kate shared how her relationship with masking had changed over the years. The voice of empowerment was a gentle undercurrent, yet it reflected the small steps Kate has been making towards unmasking and her growing independence from how others perceive her, which she shares in the following passage. The more I grow older and become an adult, I care less about what people think. I still really care what people think, I just don’t really really care about it. SPID: EXPLORING THE IMPACT OF MASKING 119 Like, I can logically talk myself down, like this is a stranger who doesn’t have my best interest at heart, I don’t need to be polite to them. I can be just like, no move on from that. Yeah, just finding different layers of the mask instead of it being all or nothing on or off. Knowing myself and knowing when I feel safe enough to unmask a little bit and test the waters. These voices were quickly joined by the voice of connection, which represented Kate’s engagement with autistic female creators and how they have offered insights into her challenges and fostered self-awareness. This voice emerged when Kate was sharing about an autistic content creator she follows on TikTok, who shared how validating it was to hear that therapy did not work for her as an autistic woman, which she shares in the following. There was a woman with autism, and one was particularly talking about how counselling doesn’t help her. She’s like I have anxiety and depression, and I’m neurodivergent. I go to counselling, but I’ve already practiced my script in my head, so I know what the counsellor is going to say back to me and what I’m gonna say back to them. Watching that, I was like, that’s so me! As I continued reflecting on Kate’s narrative, another voice emerged: the voice of anger. This voice surfaced when Kate was asked how masking influenced her self-perception and identity as an autistic woman now that she is aware of it, to which she shared the following: Now that I’m more aware of when and how I’m masking, I almost am like resentful that it’s necessary for me to function in society. I should just be allowed to be myself, and everyone else should be okay with it, but I know that’s not how society works.” SPID: EXPLORING THE IMPACT OF MASKING 120 As the interview went on, the voice of yearning grew louder and more noticeable. In this context, the voice of yearning symbolized hope for the future and a desire for change, despite all the obstacles and challenges that act as barriers for autistic women. This voice appeared when I asked Kate how she pictured a society that supported autistic women, to which she shared the following: For one, it would be a feminist society. It’s interesting because most days I am a pessimist and I think that “well, the world is just screwed,” but then other days I am hopeful for the future. The voice of yearning was also present in the closing lines of the narrative, where Kate expressed her acknowledgment of the progress that has already been made, but also a yearning for things to continue to change, which offered a simple statement that was echoed by several other participants, followed by a laugh: There has been progress; I would like to see more. Kate’s story evoked strong emotions in me. I found myself feeling a lot of empathy and compassion for her, as I had been in a similar situation when I was completely masked. For years, I was ashamed of being an anime kid and would hide that from others; however, the older I got, the more I have fully embraced it as a special interest. I was also happy to hear that, despite being completely masked most of the time, Kate is still finding ways to experiment with unmasking and critiquing society for having those standards in place, which signals to me that there is a beginning of a shift from self-blame to societal critique. Kate’s story was also an important reminder to me that unmasking is a subjective process, and that masking can be applied to multiple layers of identity, not just for autism and neurodiversity. SPID: EXPLORING THE IMPACT OF MASKING 121 Below is Kate’s I-poem, which highlights the shift from self-blame to recognition of the social structures that reinforce masking. Figure 9: Kate’s I-Poem I grew up I thought I don’t feel like I am welcomed I sometimes I would test the waters I didn’t realize My childhood My identity I guess that was the first place I masked I had no problem doing that I thought I’m like I thought I was having a great childhood I think a lot of parts of it were To be myself I forgot I say funny I’ll cry I was I was probably about three or four I was dancing around It’s just me singing really serious I inferred I don’t know I was like four I wanted to dance along I got really good at keeping everything inside The Voices The analysis of participants’ narratives revealed three primary categories of voices: Masking, Unmasking, and Advocacy. These voices capture the complexities of navigating one’s identity as an autistic woman, highlighting both internal struggles and transformative shifts in self-perception and external engagement. This analysis directly addresses the SPID: EXPLORING THE IMPACT OF MASKING 122 research question: “What are the voices present in autistic women’s experiences of masking?” and is framed within a transformative paradigm, informed by feminist disability theory. This paradigm centers on the lived experiences of marginalized individuals, recognizing the systemic oppression that informs these experiences and advocating for social change. Table 2: Voices of Masking Voices Description Markers Participants Frustration Experiences of Phrases such as “It’s 1,2,3,4,5,6,7,8 internal or external not fair,” Statements irritation from the of irritation with constant effort to neurotypical norms, conform to feeling fed up neurotypical expectations Shame Feelings of enforced Phrases such as “I blame and can’t be myself all internalized stigma the time,” “what is regarding autistic wrong with me?”, traits feelings of not being 1,3,4,5,7,8 enough Disconnection A lack of genuine Loneliness, feeling connection with socially detached others and the despite interactions, 1,2,3,4,5,6,7,8 SPID: EXPLORING THE IMPACT OF MASKING person stemming statements of from masking one’s dissociation 123 true self, Inauthenticity A sense of “being Expressions such as 1,2,3,4,5,6,7,8 fake” or unable to be “putting on a oneself due to persona,” “not being masking myself,” or “not being my real self” Exhaustion Physical, mental or Mentions of emotional burnout, fatigue, exhaustion resulting “crashing after from prolonged socializing,” or masking needing extended 1,2,3,4,5,6,7,8, recovery time Note: 1= Jo, 2 = Lily, 3= Rachel, 4 = Jade, 5 = Marie, 6 = Daphne, 7 = Rose, 8 = Kate Table 3: Voices of Unmasking Voices Description Markers Participants Self- Recognition and Phrases such as “I 1,2,3,4,5,6,7,8 Love/Acceptance appreciation of love my brain,” one’s autistic “who I am wouldn’t identity and traits be if I wasn’t autistic,” “I don’t want to be anyone SPID: EXPLORING THE IMPACT OF MASKING 124 else.” Recognition of traits and adherence to values Self-Compassion Treating oneself Phrases such as with kindness and “This is what I understanding in the need,” or narratives face of challenges of letting go of self- 1,2,3,4,5,6,7 criticism Empowerment A sense of strength, References to agency, and advocating for confidence gained needs, statements through unmasking such as “I deserve to 1,2,3,4,5,6,7,8 be who I am.” Connection Forming deeper, Descriptions of more authentic finding connection relationships with with other others both with self neurodiverse and others individuals, “real friendships,” and relationship where they feel fully seen and heard for who they are 1,2,3,4,5,6,7,8 SPID: EXPLORING THE IMPACT OF MASKING 125 1= Jo, 2 = Lily, 3= Rachel, 4 = Jade, 5 = Marie, 6 = Daphne, 7 = Rose, 8 = Kate Table 4: Voices of Advocacy Voices Description Markers Participants Anger Strong emotional Expressions of anger 1,2,3,4,5,6,7,8 responses to and resentment, injustice, stigma, or references to past experiences of injustice or invalidation unfairness, statements such as “it’s not fair” Yearning A deep longing for Statements such as recognition, “I wish others inclusion, or understood,” “I want systemic change a world where,” or 1,2,3,4,5,6,7,8 expressions of hope for a better future. Resistance Pushback against Phrases such as neurotypical “listen to autistic standards and individuals,” rejection of societal standing up for expectations. oneself and honouring their 1,2,3,4,5,6,7 SPID: EXPLORING THE IMPACT OF MASKING 126 needs despite pressure from others Action Active efforts to Mentions of giving 1,3,4,6,7 educate, advocate, or talks, being a part of create change on advocacy groups and behalf of oneself or movements, and the broader autistic supporting others community 1= Jo, 2 = Lily, 3= Rachel, 4 = Jade, 5 = Marie, 6 = Daphne, 7 = Rose, 8 = Kate The Voices of Masking The voices of masking—frustration, disconnection, shame, inauthenticity, and exhaustion—were deeply rooted in participants’ experiences of adjusting to neurotypical expectations. These voices highlight the emotional labour and distress that autistic women endure while navigating environments that value neurotypical behaviours. Participants described years of internalising the pressure to suppress their natural tendencies to fit in, which often led to feelings of alienation and self-doubt. The effort to conform was not only mentally draining but also created an ongoing struggle with self-perception, as these women wrestled with balancing their true selves against the personas they showed to the world. Over time, this caused a profound sense of disconnection from themselves and others, and the fear that if they embraced their full, authentic selves, they would be shunned and excluded—thus reinforcing the need for masking as a survival strategy in neurotypical spaces. The voice of frustration: Participants often expressed their annoyance with the demands of masking, noting how draining it was to constantly monitor and adjust their SPID: EXPLORING THE IMPACT OF MASKING 127 behaviour to avoid negative social consequences. The disappointment was frequently worsened by others' lack of understanding, who failed to see the significant effort needed to appear “normal.” Many participants felt they had to hide their true selves to fit in, and in some cases, even if they masked well, they were still perceived as different and left out, which caused feelings of resentment and pain. This frustration was especially clear in work and school environments, where the pressure to conform was greater. Some participants described how their frustration turned into self-blame, feeling like they had failed despite trying their best. Others expressed anger towards the broader societal structures that maintain these strict expectations, questioning why neurotypical standards set what is considered acceptable behavior. The voice of frustration surfaced when Daphne shared her experiences interacting with neurotypical professionals, whom she feels she must put on a front for and act as professionally as possible, because otherwise, she believes she will be dismissed, which she shares in the following: It just seems like there’s a hierarchy of who knows most, and I find when I come against those hierarchies I really have to play the role and like talk, you know, professionally and don’t act out in any way because I know the stereotypes of like Oh, they’re just being blunt and rude, that’s because they’re autistic, we get to discount their feelings and their thoughts. Yeah, like that, Something like coming up against non-autistic professionals who deal with autistic people is the worst (laughs), the worst! This voice also appeared in Lily and Rachel’s story as they often felt, before realising they were autistic, that they were frequently criticized for their genuine ways of knowing and SPID: EXPLORING THE IMPACT OF MASKING 128 being, and had to mask their traits so others could accept them. The voice of frustration emerged when Lily was describing past instances of people shutting her out or mistreating her, which is one of the reasons why she masks: How many times have I heard, 'You know what you did’? And I’m like, No, I don’t fucking know what I did. Please tell me! I need to know because I need to adjust my behaviour, but people don’t want to have that conversation. Many participants also discussed how others would say that they didn’t “appear” or “look autistic” as if it were a compliment, when in fact, it dismissed their lived experience. The ongoing frustration of having their needs ignored further added to their emotional distress. The effort needed to maintain masking often left them with little energy for selfcare, personal goals, or even simple daily tasks. All expressed a desire for environments where they could be fully accepted for who they are, rather than constantly adapting to fit an external mould. The voice of disconnection: Masking created a deep sense of isolation for many participants, as they felt cut off from both their true selves and others. The need to present a socially acceptable version of themselves made forming genuine relationships challenging, because they feared that showing their real selves would lead to rejection. This disconnection went beyond social ties to a broader feeling of alienation from society, reinforcing loneliness and exclusion. Participants often described feeling like outsiders, even in spaces meant to be inclusive, such as Jo and Daphne’s workplaces, as the long-term effects of masking made authentic engagement difficult. Many internalized the belief that they were fundamentally different or broken, which worsened their sense of disconnection. The ongoing feeling of SPID: EXPLORING THE IMPACT OF MASKING 129 being unseen or misunderstood took a psychological toll on many, making it harder to trust in the possibility of meaningful relationships. This voice appeared in Kate’s story as she explained that she doesn’t have many close relationships and was called out by a friend for how much she shields herself, which she shares in the following: I have a lot of people who are still stuck in the acquaintance stage. I know, one of my closer friends had just told me a couple of months ago, she’s like you have a lot of walls, like a lot. She was also living with us for like five months, and she was saying, like, I still feel like you aren’t being yourself around me, and I was like, oh yeah, I guess I’m not. This deep-rooted disconnection often led to self-doubt and confusion about identity, further reinforcing the cycle of masking. In some cases, such as Jo, it created a sense of dissociation, as she learned that the way she could escape from the outside world without the proper coping skills and ability to stim was to go inwards. The more participants masked, the less they felt connected to themselves or others, which in turn made unmasking feel even more daunting. The voice of shame: Many participants described feeling shame about their natural tendencies, a result of years of internalizing societal messages that framed neurodivergence as a deficit rather than a valid way of knowing and being. This voice of shame often originated from past experiences of being ridiculed or dismissed for behaviours that felt natural to them. Over time, shame became a strong force that reinforced masking, as participants felt compelled to hide their true selves to avoid judgment and rejection. Shame was deeply rooted in memories of childhood, school, and early adulthood, where participants SPID: EXPLORING THE IMPACT OF MASKING 130 learned that certain behaviours were considered “wrong” or “inappropriate.” Many shared how even when they began to unmask, the voice of shame persisted, making them hesitant to fully embrace their neurodivergence. This shame was not just personal but also structural, a consequence of living in a society that favours neurotypical expressions of communication, emotion, and behaviour. Shame was a powerful theme in Marie and Rachel’s stories as they recounted their experiences in abusive and unhealthy relationships with their now ex-husbands, and how dismissing their autistic traits influenced their self-perception. Marie described this experience and how it contributed to her masking: Every odd behaviour as he saw it was criticized and mocked, and he threatened to like if I ever left that he would take away my children. Saying that I was autistic and I couldn’t take care of them, and he certainly did try. He’s tried to cause harm. In that marriage I did a ton of masking because of kind of the repercussions from him and intense criticism. The voice of shame surfaced in Jade’s story when they previously attempted to unmask and advocate for autism awareness by sharing a video of themselves stimming, which they included in the following. I took it down five minutes later because the response was so vitriolic, and from that moment on, I was just horrified. You now, I thought, well, that confirms to me that my belief was true that I cannot do this, I cannot do this publicly, I cannot speak about this in the way that I would like to, and that I really need to earn things like community, love, success, outside of my true self, and that was very, very poisonous, for so many years. SPID: EXPLORING THE IMPACT OF MASKING 131 These experiences fostered a prolonged sense of inadequacy for many, making it hard for them to advocate for themselves. The shame linked to masking also hindered seeking support, as participants feared judgment or invalidation. Even in adulthood, the echoes of past criticism persisted, influencing how they viewed themselves and their role in the world. The voice of inauthenticity: Participants reflected on the disconnect between their true selves and the personas they show to the world. Many described feeling like ‘frauds’ and ‘actors’ in their own lives, constantly performing instead of living genuinely. This sense of inauthenticity took an emotional toll, causing widespread self-doubt and making it hard to develop a stable self-identity. Some felt they had lost touch with who they truly were, as years of masking made it difficult to tell authentic desires from learned behaviours. The constant need to analyse and adjust their actions for acceptance left them doubting their instincts and preferences. This loss of authenticity was not just an internal challenge but also an external one, as participants felt pressure to meet expectations in professional, social, and family settings. This voice contributed to a cycle of self-doubt and avoidance as participants struggled with whether people liked them for who they truly were or for the carefully crafted version of themselves they had built. This voice appeared in Marie’s story when she was sharing her thoughts about whether others liked her for herself or her persona, which she shared in the following: I didn’t know who I actually was, like, am I the person with the mask? Am I not? Like a lot of my friendships are based on masks. So, like, are these people friends with me for who I am versus who they think I am?” SPID: EXPLORING THE IMPACT OF MASKING 132 Some participants described feeling mournful for the lost years they had spent trying to be someone they were not or wished they could go back in time to tell everyone they were autistic, especially those diagnosed later in life. Conversely, others shared a growing resolve to reclaim their authenticity, even if it meant facing rejection or discomfort. The voice of exhaustion: The effort needed to maintain masking was mentally, emotionally, and physically draining. Participants often said that masking was “exhausting” and “debilitating” and described feeling burnt out, as the constant alertness and selfmonitoring left them depleted. Many reported needing long periods of rest after social events where they had to wear masks, often requiring solitude to unwind. Others, like Daphne, refused to attend events where masking was expected because they didn’t “have the energy for it.” This recovery process was not just about regaining energy, but also a vital survival mechanism to cope with the overwhelming cognitive and sensory overload experienced while masking. Several participants described masking as a “full-time act,” where they constantly had to monitor their words, body language, and facial expressions to seem “acceptable” in neurotypical settings. The tone of exhaustion became clear when Marie discussed the mental effort required to create social scripts or rehearse how she would present herself around other neurotypical people. It’s so tiring. It feels like you’re almost studying for an interview, like a panel interview, every time you go to do something. So yeah, it’s not comfortable to do. Lily and Rachel both shared experiences of being told they looked “angry” or “mean” when they were unmasked, which led them to constantly monitor their facial SPID: EXPLORING THE IMPACT OF MASKING 133 expressions. The cumulative stress of this performance was not only mentally and emotionally draining but also had significant physical effects. Many participants, especially Rose, Marie, Lily, and Jade, reported having co-occurring health issues and physical disabilities such as Ehlers-Danlos and Polycystic Ovarian Syndrome, which were worsened by the ongoing stress of masking. For some, particularly Rose, suppressing autistic traits and trying to conform to societal expectations triggered or intensified pre-existing health conditions, resulting in cycles of extended exhaustion that further limited their participation in daily activities. This state of constant exhaustion also made participants vulnerable to mental health issues such as anxiety, depression, and dissociation. Some participants, like Lily, described moments where they felt detached from their surroundings, as if they were on autopilot. Jo, for example, shared that she would self-harm by burning her fingertips, not to punish herself or because it felt good, but because she was “so dysregulated” and had no other way to cope. It was the only relief she could find in the absence of stimming behaviours. The inability to self-regulate in ways that felt natural to them caused deep distress, making it harder to maintain masking over time. The voice of exhaustion was clear when Rachel described her experience of autistic burnout, often a result of the fatigue from prolonged masking and the loss of skills tied to it. In her case, she had lost the ability to speak. However, it wasn’t until she participated in a panel for autistic adults and heard from another participant who had become nonverbal because of autistic burnout that she connected the dots, as she shares below. As she recounted, Rachel’s tone was frustrated and confused as she remembered the event, evident in her slower speech and how she carefully enunciated each word of the question, "What the heck was wrong with me?" SPID: EXPLORING THE IMPACT OF MASKING 134 Someone was talking about being nonverbal, and I was like, oh, that’s, I’ve never been nonverbal. But then, recently, I remembered, actually, I was. It did happen. And that was interesting, like because I remember that going back, going, what? The. Heck. Was. Wrong. With. Me? What was, was there some spiritual block? Like what? But then I realized, 'Okay, my brain was like," Nope, we’re done "(laughing).' Overall, the ongoing effort to maintain masking had a significant impact on participants’ well-being, influencing their relationships, self-perception, and overall quality of life. The overlap of chronic exhaustion, health issues, and mental distress underscored the urgent need for greater awareness and acceptance of autistic experiences beyond traditional diagnostic criteria. Without wider societal recognition of the effects of masking, many autistic women remain caught in a vicious cycle of masking and suffering due to these consequences, unable to access the support and accommodations they need to flourish. The Voices of Unmasking The voices of Unmasking—self-love and acceptance, self-compassion, empowerment, and connection—signified a crucial shift in participants’ journeys toward authenticity. These voices often surfaced when they realized they were both autistic and that masking was unsustainable and damaging to their well-being. Participants who began to unmask described a growing sense of relief and liberation as they allowed themselves to act in ways that felt natural rather than performative. The process of unmasking was often met with fear and uncertainty, as years of internalized stigma made self-acceptance a gradual and challenging journey. However, as participants engaged in this process, they started to experience a profound change in their self-perception, leading to greater self-trust and SPID: EXPLORING THE IMPACT OF MASKING 135 confidence in their neurodivergent identities. This transition often involved unlearning harmful societal messages and replacing them with a more compassionate and affirming understanding of themselves. The voice of self-love/acceptance: Participants who had embraced self-love and acceptance described it as a pivotal moment in their journey of unmasking. Many had spent years believing that their natural ways of being were flawed or unacceptable, making selflove and acceptance an act of resistance against internalized ableism. This voice emphasized a growing appreciation for their unique perspectives, abilities, and experiences. For many, self-acceptance also meant rejecting external pressures to conform and instead prioritizing their comfort and authenticity. Over time, this voice became a foundation for other aspects of unmasking, giving participants the strength to explore their identities further and their needs without fear or guilt. For many, embracing self-love and acceptance also involved a conscious rejection of social comparisons. Participants who previously measured themselves against neurotypical standards found relief in shifting their focus inward, redefining success and fulfillment on their own terms. The voice of self-love also surfaced when participants spoke about strengths associated with being an autistic woman. This voice appeared when Rose was discussing her attention to detail and how it contributed to her talent for photography, which she shares in the following: In my photography, the details of my photography are all of the smaller things. I’ve had a picture put in a magazine and different things like that. So that’s been a huge strength for me to see the small details and everything. When I’m going for a walk with people, I tell them I’m going for a walk, but I’m not going to walk the whole SPID: EXPLORING THE IMPACT OF MASKING 136 time. I’m going to be looking at everything around me and all of the details of everything. That’s a big strength that I have.” The participants also discussed the importance of creating neurodiversity-affirming spaces where they could share their experiences and feel validated, reinforcing their belief that they did not need to change to be accepted. This perspective appeared in Jade’s story when she shared how her autism helped her find community through her special interest, which was art, as she describes in the following: I would draw, like, for hours a day, entire rooms worth of paper would just be covered in drawings, it was this massive component of my life. I wouldn’t have found the safety that I did, probably to the extent that I did, if I weren’t autistic, and it’s led to my career, and it’s led to so many wonderful opportunities and clarity and answers. And so, you know, all of these qualities that autism brings. The challenges are very real, but I’m so grateful to be who I am and who I am wouldn’t be if I wasn’t autistic. The voice of self-compassion: Alongside self-love, self-compassion was crucial in helping participants process years of self-suppression without assigning blame. Many described struggling with guilt over the time spent masking, feeling as though they had betrayed their true selves. The voice of self-compassion enabled participants to recognize that masking had been a necessary survival tactic rather than a personal failing. This change in perspective helped many shift away from self-judgment toward greater patience and kindness towards themselves. Some participants also mentioned that supportive people, such as family and friends, and self-reflection assisted them in developing self-compassion, as SPID: EXPLORING THE IMPACT OF MASKING 137 these tools allowed them to reframe their past experiences in a more forgiving and understanding manner. For some, self-compassion also played a crucial role in helping them navigate the challenges of unmasking. They also discussed the need for accommodations and acknowledged their requirement for rest. The voice of self-compassion emerged when Rachel spoke about how she has become more aware and intentional about recognizing her sensory needs, which she shares in the following: That’s kind of what I’m studying right now and recognizing right now. I’m starting to notice that when I’m watching a show and I feel like, 'Wait a second, this isn't feeling good for my nervous system.' I need to not watch this show or read this. “ The voice of self-compassion emerged when Lily discussed her strong dislike of icebreaker activities and her need to share as much or as little as she feels comfortable with, which she shares in the following: I want people to know everything about me, but only when it is convenient for me, I guess, which is a little selfish, but it’s also very true. I don’t necessarily lend myself well to like a get to know you thing We did something at my last job, like a few years ago that was a get to know your staff members, and whatever it was like, share fun facts about you and stuff. I hate shit like that because it feels so disingenuous. It’s like you will get to know me by getting to know me. This voice was often associated with the increasing ability to recognize and prioritize one's own needs, replacing cycles of self-sacrifice with self-care, as well as a greater SPID: EXPLORING THE IMPACT OF MASKING 138 alignment with values such as authenticity and setting boundaries around what and how much is shared about one’s true self. The voice of empowerment: As many participants grew in self-acceptance and compassion, they started to feel a sense of empowerment. This voice signified the reclaiming of agency, where individuals recognized that they had the right to exist as they were, without constantly trying to meet neurotypical expectations. This voice appeared in Lily’s story when she described the time after her ADHD diagnosis and began to realise she was also autistic, which she shared in the following passage: I’m like yeah, no, I’m not gonna let people tell me who I am and am not anymore, and I’m just going to pursue this as if it’s true because I think it is Many participants described how empowerment gave them the confidence to set boundaries, advocate for their needs, and push back against social and institutional norms that had previously felt insurmountable. Some recalled how this newfound confidence stemmed from significant life changes, such as leaving unsupportive relationships, pursuing careers, or establishing boundaries that met their needs, and engaging with neurodiversityaffirming communities and neurodiverse content creators, where they could thrive without fear of judgment. For some, speaking openly about being themselves and creating spaces to unmask helped them connect more deeply with themselves, while for others, it allowed them to educate others about who they are. Jo shared that being autistic helped her to connect better with her clients and will help them to connect more with their bodies because of the “somatic aware(ness)” that accompanies being autistic. SPID: EXPLORING THE IMPACT OF MASKING 139 Many participants described empowerment as simply allowing themselves to take up space unapologetically, refusing to shrink themselves to avoid making others uncomfortable. These voices were evident in Rose, Daphne, and Jade’s narratives as they “made no bones about who they are.” Several also took this a step further, stating that they are “who they are,” and if others disapprove, that is on them and their perceptions. A newfound sense of resilience often accompanied this shift, as participants learned to face challenges with greater self-assurance and conviction. The voice of connection: One of the most important and transformative voices in the process of unmasking was the voice of connection. Participants shared how, for much of their lives, they felt isolated and misunderstood, often believing they were the only ones experiencing the struggles of masking and being an autistic woman, often thinking it was a “them” thing. However, when they found other neurodivergent people and supportive communities, they experienced a deep shift in their sense of belonging. The voice of connection offered validation and reassurance that they were not alone. For many, this new sense of community became a crucial source of strength, helping them embrace their true selves even more and reject social narratives that previously cast them as deficient or broken. Participants shared how engaging with others who are neurodivergent allowed them to form connections that were deeply affirming and meaningful. Kate explained how connecting with autistic content creators, such as Fern Brady, an autistic comedian, helped her better understand and recognize traits in herself. Rose, Marie, Daphne, and Rachel spoke about how their children's journey through the diagnostic process and receiving an autism diagnosis enabled them to begin their own journey, leading to the creation of “proudly SPID: EXPLORING THE IMPACT OF MASKING 140 neurodiverse” households. Jo, Lily, and Jade also emphasized the importance of having “wonderful” supportive partners and friends, both neurodiverse and neurotypical, who fully understood and accepted them for who they are. Many described feeling relief when they no longer had to constantly explain themselves, as their relationships with people whom they could fully be themselves around were built on mutual respect for neurodiverse ways of communicating and interacting. The sense of connection was also evident in participants’ descriptions of how their experiences of masking changed in safe, neurodiversity-affirming spaces, where they could drop their masks without fear of judgment. This was especially clear in Marie’s story, as she shares in the following: I listen to on YouTube, a whole bunch of different versions of the same song, like different covers, and then like, pick the one that like hits my brain the right way, just kind of really get into it. If I say that to someone who is neurotypical, I would get a really weird look, but when talking to other autistic people, especially if they share those interests, it feels really good.” The voice of connection also appeared in many of the participants’ interviews with me, as they drew me into their stories and experiences by using phrases like “I’m sure you know” or “you’ve probably experienced this,” further strengthening this voice. A clear example of this was when I asked Jo how she navigates the space between masking and being an autistic woman, during which she became visibly emotional and shared the following: I’m actually experiencing some emotion coming out because I’m like Oh, to even be asked a simple question. No one asks those questions of me. What a SPID: EXPLORING THE IMPACT OF MASKING 141 beautiful question to be asked, even to think about it, like it’s so fucking hard to be in that terrain and figuring it out, as you know. Together, these voices of unmasking highlight the deeply transformative nature of embracing neurodiversity. While the process of unmasking was not without its challenges, it ultimately led to greater self-acceptance, emotional well-being, and meaningful relationships. Through self-love, self-compassion, empowerment, and connection, participants were able to begin reclaiming their authenticity and move towards lives that honoured their true selves. The Voices of Advocacy The voices of Advocacy – anger, resistance, yearning, and action – emerged as participants moved beyond self-acceptance to challenge the structures that enforce masking. Advocacy often grew naturally from unmasking, as participants recognized the broader systemic injustices that originally necessitated masking. Many described how, once they had begun to embrace their authentic selves, they felt driven to oppose societal expectations that had previously limited them. This resistance often arose from a deep sense of injustice regarding how autistic individuals are expected to conform to neurotypical norms at the expense of their well-being. Through advocacy, participants aimed to create spaces that fostered greater acceptance and accommodations, both for themselves and other neurodivergent people. This stage of their journey was marked by a shift from internal change to external action, as many sought not only personal authenticity but also collective progress. The voice of anger: Many participants described or expressed anger when they began to realize how they had been forced to suppress their identities. This voice was often directed at societal norms, educational systems, and workplace cultures that had enforced SPID: EXPLORING THE IMPACT OF MASKING 142 conformity without considering the harm they caused. For some, anger was a necessary catalyst for change, fueling their determination to challenge ableist structures and demand greater inclusivity. Instead of viewing anger as negative, participants saw it as the realization that their needs were not being met, proof that they were no longer willing to accept mistreatment or exclusion passively. Many participants reflected on the years they spent internalizing the belief that they were “too much” or “not enough” in various social settings. As they realized, they were autistic and received diagnoses, they recognized that these feelings were not intrinsic flaws but rather reflections of a world that failed to accommodate neurodivergence. A common refrain heard throughout the interviews was that the “world was not designed for us.” This realization sparked profound anger, as they understood how much of their distress was caused by external pressures rather than personal shortcomings. The voice of anger surfaced in Jo’s narrative when she spoke about the hypocrisy in the counselling field because she is often not shown grace or given the ability to be her authentic self, which she describes in the following passage: We show up fully as ourselves, and that’s all hunky dory and beautiful, except when me showing up for myself makes me unsafe, because that’s when me showing up as myself creates harassment for me. Except when showing up as myself means that I can’t go to an AEDP or IFS training, except for when a supervisor in a practicum tells me that I can’t have any fidgets in my hands, and in my office, you know, like with clients, so like, it doesn’t work for autistic people. The world is not safe for us to show up as ourselves. SPID: EXPLORING THE IMPACT OF MASKING 143 Anger also surfaced in response to specific instances of discrimination or exclusion. Lily recounted being denied reasonable accommodations at school because her academic advisor did not believe she needed them, Daphne shared being told by a professor that her stimming was “unprofessional,” and Marie, Rachel, Rose, Jade, Jo, and Kate all recalled stories of being shamed for their autistic traits by ex-partners, classmates, family members, and coworkers who did not understand autism. This voice emerged when Kate was describing her experiences growing up Christian and how it inadvertently contributed to her masking, which she shares in the following passage: I guess that kind of was the first place I masked, like before school. It was just sit in the pew and be a good girl and follow the rules. At the time, I had no problem doing that. It’s just now looking back, then I’m like, hmm, this was kind of problematic. The intensity of their anger, shown through louder voices, leaning into the screen, and expressive hand gestures, reflected the depth of their pain and, for several, their dedication to creating meaningful change. In each case, anger was not a final point but a starting point – an acknowledgment that change was both necessary and achievable. The voice of resistance: signified an active rejection of neurotypical expectations that had previously guided participants’ behaviour. Many shared that they no longer felt obliged to force eye contact, suppress stimming, or engage in small talk just to please others. This voice was profoundly empowering, as it enabled participants to put their comfort and authenticity before social conformity. Resistance often served as a way to reclaim agency. Many participants shared how they took steps to honour their needs and advocate for themselves and others. Lily, Jo, and SPID: EXPLORING THE IMPACT OF MASKING 144 Daphne all openly stimmed during our interview, either through knitting or playing with a fidget toy. Jo mentioned that she fidgets with a stone when she is in sessions with clients, which is an act of resistance because they actively engage in stimming rather than suppressing it. Other participants also discussed how they began to unlearn what they had previously been told about themselves by others and became less apologetic about their traits, such as sharing their sensory preferences and communication needs more openly. These actions, though seemingly minor, represented powerful acts of self-advocacy and defiance against the expectation that autistic women and individuals should make themselves uncomfortable for the convenience of others. The voice of resistance surfaced when Daphne discussed her advocacy within the school system and her commitment to supporting her autistic students, as she shares in the following passage: I’m a huge advocate for autistic people and for students. So I really work hard not to mask and to teach other people about masking and to like work towards making it so people don’t have to mask as much for sure. I’m an anti-masker, but not in the COVID way. Beyond personal resistance, many participants also aimed to challenge ableist norms on a larger scale. This involved advocating for systemic changes in various institutions, especially education, mental health care, and employment. The voice of resistance related to challenging norms appeared in Jo’s interview moments when she confronted those around her about how they perceive autism, which she shares in the following: One of my favourite lines to people is when you know, someone says they’re autistic, you know, and someone says that they’re autistic or they’re not SPID: EXPLORING THE IMPACT OF MASKING 145 autistic, I’ll say, can you list five diagnostic criteria for autistic women? And no one can. No. One. Can. Then I can go, okay, once you know at least five diagnostic criteria for autism, like an adult autism diagnosis, then you can come back and have a conversation with me. I think that’s the other piece for me that’s like really hard, is like, go do some learning. Go sit with people, like be around people, be open. Be paying attention. Pay attention because I think that’s another piece. People are like Oh, that person can’t be autistic or they’re not autistic because they don’t do X, Y, and Z and I want to scream No, it’s because you don’t see them (unmasked). You’re not seeing them! The voice of resistance, clearly expressed in the interviews, was that autistic women do not need others to speak for us; we have our own voices, and we deserve to be seen, heard, and truly listened to. The voice of yearning: While resistance centred on rejecting harmful norms, yearning reflects participants’ deep desire for a world where neurodiverse individuals can exist freely and authentically without fear. Many expressed hopes for a future where unmasking was not an act of defiance, but a natural and accepted part of life. This voice carried themes of hope, longing, and a vision for societal transformation. Participants envisioned communities where they could be fully seen and valued, without the expectation of constant adaptation. A central recurring theme in participants’ stories was a desire for spaces where they didn’t have to justify their needs. Many shared their wish that others would see how difficult it is for them just to show up in a world that doesn’t understand or acknowledge their needs, and how they want to be accepted without constantly having to justify or explain themselves. SPID: EXPLORING THE IMPACT OF MASKING 146 All participants longed for cultural changes, with Kate and Jo specifically expressing a desire for societies run by women, “autistic women or gender diverse folk”, where autistic traits— such as direct communication, intense interests, and alternative social patterns like parallel play, where two people sit together and do things side by side—are understood and valued rather than viewed as disorders. This longing extended to the wider world, with participants hoping that future generations of autistic women and individuals would not face the same pressures to conform and could live freely and authentically as themselves. The voice of yearning combined with the voice of connection was also present when I asked Rose how she would envision a society that supports autistic women, to which she shared the following: I just really, really hope that there are more studies done to show and to be able to show people that okay, yes, she doesn’t have anxiety, she doesn’t have these other things, she actually has autism. So that’s what I really, really hope for, I hope that the doctors learn more, I hope that the teachers learn more, I hope that they’re going to put things out there for people to know, that’s the way I feel about it, I just wish that more people knew about this kind of stuff. Maybe it’s going to take people like us who have gone through this and are living it. Maybe it’s going to take that to change the way that it is in the world, because the world isn’t very accepting. Finally, the voice of yearning was evident in the following question posed by Lily: Hopefully, all of these weird growing pains are going to be beneficial for like future generations of little autistic kids that need some support, you know? SPID: EXPLORING THE IMPACT OF MASKING 147 The voice of action: The final voice of advocacy was action. Participants described taking tangible steps to improve conditions for themselves and others, whether through formal activism, standing up against harmful actions in the community and at their workplaces, and encouraging their children to live as authentically as possible. The voice of action was one of the most powerful expressions, representing the full-circle transformation from a completely masked existence to an empowered sense of advocacy. The voice of action appeared in several of the participants’ stories. Daphne talked about how she actively speaks out against policies or actions that are harmful to autistic students. One example was when she spoke up against staff mistreating their autistic students, which she recalls as follows: Staff were being inappropriate all over the place, and they would just say that it was the way they did things, and I was like, that’s messed up and not okay. The issue was brought to the head of the board, who supported Daphne’s position. Although it was a positive outcome, she expressed her frustration that it should be her, as the autistic person, who had to advocate for the students, which she shares in the following: As the autistic person, I had to get really upset. I had to get really loud. I had to go to multiple meetings, and I had to be investigated, and I had to be the advocate. I had to produce all this evidence to show why it wasn’t okay. I had to like, as the autistic person, it was all on me to prove why it was not OK to treat autistic people that way, as opposed to feeling safe as an autistic person in that environment. SPID: EXPLORING THE IMPACT OF MASKING 148 The voice of action also appeared in Jade’s story when she recalled standing up for a young autistic man who was the target of a hateful comment by a woman for stimming on the bus, which she shares in the following: As soon as he left, that woman was like, well, there’s something off with him, and I was just sitting there like that’s horrifically hurtful. Even if I weren’t somebody that had an autism diagnosis, that’s very unacceptable behaviour. Then, as I left, I passed her, and I am not a confrontational person. I do not speak to people in you know, these ways consistently. It’s not the way I feel safe going into the world. But I spoke to her kind of quietly and as I left, I said, you know, if he’s off, I’m off too. I’m also autistic. Finally, another notable example of the voice of action was when Rachel discussed her children’s book, which celebrates both cultural diversity and neurodiversity. She shares this in the following passage: It’s a book that celebrates diversity along with the strength of a mother’s love. We snuck the autism symbol on somebody’s t-shirt and just tried to be as inclusive as possible. Ultimately, the voice of action demonstrated how advocacy was both personal and collective. While participants initially concentrated on their individual experiences of unmasking, many felt an increasing responsibility to use their voices to support others. Their advocacy was motivated by the understanding that true acceptance required more than just self-acceptance – it involved challenging the systemic forces that made masking necessary in the first place. In doing so, they helped pave the way for a future where neurodiversity is not merely tolerated but fully embraced. SPID: EXPLORING THE IMPACT OF MASKING 149 The voices of advocacy demonstrate the transformative power of unmasking, not just as an individual process but as a catalyst for broader societal change. Anger fueled the recognition of injustice, resistance challenged harmful norms, yearning envisioned an inclusive future, and action turned these aspirations into concrete efforts towards change. Ultimately, advocacy was not just about pushing back against ableism but about creating spaces where neurodiverse individuals could thrive authentically. The voices of the participants underscore the importance of both individual empowerment and collective activism in reshaping narratives about autism, thereby paving the way for future generations to live without the burdens of concealment and suppression. Conflicting Voices: Masking and Unmasking Throughout the data, the conflict between masking and unmasking was a common source of tension among participants, as was the decision to either “hide their true selves” or be their authentic selves and have “no one (want) them.” Many participants found that masking was a deeply ingrained survival mechanism, shaped by the need to navigate societal expectations, avoid rejection, or protect themselves from perceived judgment. Participants described the experience of masking as one of self-alienation, with a sense of shame emerging from the constant need to present an image that is incongruent with their true selves. This sense of inauthenticity was also linked to feelings of disconnection, as participants expressed difficulty forming genuine relationships when they felt compelled to hide their identity. A particularly poignant aspect of masking was the exhaustion that it created. Many participants described it as “debilitating,” “exhausting,” and “stressful” due to the continuous effort required to maintain a façade. This exhaustion was not only emotional but also physical, as the constant need to manage their presentation took a toll on the SPID: EXPLORING THE IMPACT OF MASKING 150 participants' energy and mental well-being. The act of masking also created a deep sense of loneliness within many participants, as they reflected on how their outward behaviour was often at odds with their inner emotional states. In contrast, the voices of unmasking were characterized by a growing sense of empowerment and self-acceptance. Participants who had started the process of unmasking, whether by engaging with other autistic individuals or becoming more self-accepting through diagnosis, reported a notable shift towards embracing their true selves, often in defiance of societal pressures. This embrace of authenticity fostered deeper and more meaningful connections, as participants recalled experiences where they felt more understood and accepted by others, frequently through friends and family. Despite this progress, the tension between these voices persisted, with many participants feeling caught between societal expectations and the desire for authenticity. They described ongoing struggles with balancing personal comfort and external pressures, especially in professional or interpersonal settings where the risk of stigma was higher. Harmonious Voices: Unmasking and Advocacy Unlike the tension between masking and unmasking, the voices of unmasking and advocacy were often described as mutually reinforcing. Participants who engaged in unmasking reported feeling relief, self-acceptance, and improved emotional well-being, which helped them advocate for themselves and others more effectively. The act of unmasking, whether in personal relationships or public spaces, often sparked advocacy, as participants aimed to create more inclusive environments and challenge social misconceptions about autism. SPID: EXPLORING THE IMPACT OF MASKING 151 Many participants described how self-advocacy naturally developed from their journey of unmasking. This manifested in various ways, such as seeking workplace accommodations, engaging in community activities, and educating others about autism spectrum disorder. By embracing their true selves, participants felt a sense of empowerment that helped them regain control over their stories. As Jo remarked, she realized she was “being everything else except for (herself).” The voice of advocacy was directed outward and inward, fostering greater self-compassion and helping participants redefine their boundaries and needs. Through advocacy, many found a sense of belonging and purpose, affirming that their journey of unmasking was an act of self-affirmation rather than vulnerability. Ultimately, the relationship between unmasking and advocacy was described as a transformative journey. As participants let go of the pressure to conform, they discovered a newfound sense of agency that extended beyond themselves. Advocacy, in turn, strengthened their confidence in unmasking, creating a positive feedback loop where self-acceptance and external change became interconnected. This harmony between unmasking and advocacy highlights the potential for autistic women and individuals to not only embrace their own identities but also contribute to broader societal progress. The results of this study reveal the intricate relationship between masking, unmasking, and advocacy in the lives of autistic women. The tension between masking and unmasking underscores the deeply rooted societal pressures that make masking necessary for survival. However, the rise of unmasking as a counter voice highlights the growing awareness and resistance against these expectations. While this conflict continues, the shift from unmasking to advocacy signifies a more harmonious evolution in participants’ experiences. The findings indicate that while masking can lead to mental health issues and SPID: EXPLORING THE IMPACT OF MASKING 152 identity struggles, unmasking can act as a powerful gateway to advocacy and empowerment. As autistic women navigate these stages, they balance risk and authenticity, gradually creating spaces where they can be unapologetically themselves. This study stresses the importance of fostering environments that support unmasking and advocacy, decrease the need to mask, and amplify autistic voices in broader societal conversations. SPID: EXPLORING THE IMPACT OF MASKING 153 CHAPTER 5: DISCUSSION The purpose of this study was to listen to and understand the voices within autistic women’s experiences of masking. This section begins with a summary of the rationale for the study and the research question, followed by a discussion of the researcher's reflexivity. Contributions to the literature are provided, and I examine how the voices identified by my team and I add to existing research. I then propose an identity development model based on the data results. The chapter concludes with implications for research and clinical practice, as well as an analysis of strengths and limitations, and directions for future research. Summary of Research Question and Rationale This study investigated the research question: "What are the voices present in autistic women's experiences of masking?" Masking has been widely discussed in autism research, especially regarding its psychological effects. However, the specific experiences of autistic women have often been neglected, with research mainly focused on male presentations of autism. This study addressed this gap by exploring how autistic women experience masking and by amplifying their voices within academic discourse. The rationale for this study was based on the need to move away from deficit-focused models of autism that have traditionally pathologized it and its associated traits. Instead of viewing masking as a problem that autistic individuals must fix, this research emphasised the societal structures that create the need to mask in the first place. By centring autistic women’s lived experiences, this study aimed to offer a more complete understanding of how masking serves as both a coping mechanism and a source of distress, as well as the empowerment that can arise from unmasking and advocacy. SPID: EXPLORING THE IMPACT OF MASKING 154 This study was based on two interconnected theoretical frameworks: the transformative paradigm and FDT. The transformative paradigm focuses on amplifying marginalized voices and advocating for systemic change. Instead of viewing autistic women as passive subjects, this research highlights their narratives and perspectives, ensuring that their lived experiences shape academic inquiry and practical applications in mental health, education, and workplace inclusion. FDT further informed this study by challenging ableist and gendered assumptions that contribute to the pressures autistic women face in masking their autistic traits. This framework highlights how societal norms, especially those intersecting with gender expectations, contribute to the marginalization of autistic women and reinforce the need for masking as a survival strategy. Using FDT, this study critiques dominant narratives that portray autism as a deficit and instead situates it within broader systems of oppression and resistance. LG examined participants' narratives to focus on their voices, emotions, and experiences. This method enabled a detailed exploration of the complexities within each participant's story, going beyond traditional qualitative approaches that might unintentionally support dominant perspectives. The Listening Guide aligned with the study's dedication to ethical, participant-centred research, ensuring that the voices of autistic women stayed at the forefront throughout the analysis. By integrating these frameworks, this study offers a critical and intersectional analysis of masking in autistic women, as well as unmasking and advocacy. These approaches enhance the analysis and support the aim of fostering meaningful change in how autism is understood and accommodated in diverse social contexts. SPID: EXPLORING THE IMPACT OF MASKING 155 Researcher Reflexivity As mentioned in previous chapters, this was a deeply personal project for me, both as a researcher, therapist, and community member. I felt deeply moved as I engaged with my participants and reflected on their stories. Growing up, I did not have a mentor who was an autistic woman, and at times, I believed I deserved the mistreatment of others because of my autistic identity. I learned to protect myself through masking. This often proved to be a double-edged sword because, while masking gave me opportunities and friendships— especially during my teens—it also left me disconnected from who I was and others, and fostered the dark, horrifying idea that I was flawed, unlovable, and doomed to a life of endless existential loneliness. When I engaged with the women and shared parts of myself with them, I experienced profound healing. I often left those meetings feeling a sense of hope and connection with myself and others that I had never felt before. From the participants who had fully unmasked and allowed themselves to exist entirely and unapologetically as they are, I began to shed this idea of internalized ableism and recognise that I am always capable of love and friendship. As several of my participants have noted, I am a unique and wonderful person, thriving in a world that was never designed for people like me. One thing that caught me off guard during the process was how emotional I became. I was deeply moved by the outpouring of support from participants, students, friends, professors, and data analysts. A moment when this happened was while I was analysing a transcript in a research lab. The director shared with me how being part of my project made her reflect on how difference is treated in this world, how she teaches it to her two young daughters, and how difficult it must have been for me to grow up in a world that is not always welcoming or accepting of these differences. It was then that I burst into tears, not out SPID: EXPLORING THE IMPACT OF MASKING 156 of sadness but out of joy, because I felt truly seen and heard. So often, as an autistic woman, you suffer in silence and are forced to put on a brave face because others do not understand or recognise the toll of existing in spaces that are not meant for you. Furthermore, most people tend to sugarcoat the experience of being autistic, claiming it as a "superpower." While this sentiment is well-meaning, it distracts from the reality that autism can be disabling, especially given sensory sensitivities, the time spent on masking or managing social scripts, and how quickly we become exhausted. Recognizing that it is hard and realizing how often I had been mistreated provided the validation I needed to hear. Other moments of joy came from the support I received from my participants. Marie declined the gift card because she felt that being included in the research was a reward in itself. At the same time, Jade, Jo, Rose, Rachel, and Kate expressed how happy they were that I was an autistic woman conducting this research, citing it as a reason for why they signed up. I found that there were several points in the interviews where I became completely unmasked — such as when I talked with Daphne and Marie about my special interests like anime and crystals, openly stimmed with Lily and Jo, and laughed and joked with everyone about the misconceptions and stereotypes that others hold about autism. When I mentioned how most people assume I am not autistic because I make eye contact, Lily responded, "If I am not staring into your soul, I am not doing it correctly,” which made me laugh. I was amazed by how much I laughed during the interviews and how many tears I shed. Throughout the participant interviews, I observed many aspects of my journey and monitored my somatic reactions. When my participants shared instances of being mistreated and abused by others, my heart pounded in my chest, tears welled up, and I felt an intense rage. After sitting with that rage, I realized that beneath it was a grief-like sadness because so SPID: EXPLORING THE IMPACT OF MASKING 157 many of us have had these stories. I was deeply saddened as an autistic professional hearing Daphne and Jo's accounts of how hard they had to fight for spaces at the table in fields that should have already had those seats. I was also heartbroken to hear about how horrifically abusive Marie's ex-husband was to her, and I could not even imagine how painful it must have been to have her autism weaponised against her when it came to caring for her children. I was also saddened to hear that Rachel and Rose’s ex-husbands were not supportive or understanding of their autism at all, but I felt a sense of comfort in hearing them say their partners were "horrible," reflecting a shift from self-blame to critique of others. I also recognized many aspects of myself in Kate, Lily, and Jade's stories, such as hiding my interests because I did not want others to think I was weird or nerdy, being unexpectedly dropped by friends without knowing why, and the unbearable pain of being viciously bullied and how that affected my self-perception. Despite the strong reactions I experienced, I also discovered that I had more passion and drive than ever before to use my voice and lived experience as a means for positive change in the world. I was also committed to working toward creating a future where autistic women and individuals like me can be true to themselves and be fully accepted by others. For years, I believed that autism was the worst part of me, and although it does present some challenges others may not face, I now see it as my greatest strength. I have also been inspired by the opportunities that have arisen from this research. I was honoured to present my work at several organisations, including the Canadian Counselling and Psychotherapy Association (CCPA) conference in November, deliver a guest lecture at Simon Fraser University, and facilitate a Community of Practice training at Archway Community Services. SPID: EXPLORING THE IMPACT OF MASKING 158 One of the most impactful pieces of feedback I received during this research was at the CCPA conference, where a gentleman, the founder of OK Clinical, attended my presentation. After I finished, I asked if anyone had questions. He raised his hand and said he didn't have a question but a comment. With tears in his eyes, he shared that he has ADHD, had masked his traits his entire life, and hadn't realized until my presentation how much shame he had been carrying because of it. He then said, "Your presentation freed me." I remember hearing this and feeling so moved that my work could even help one person feel more comfortable in their own skin. After the presentation, he asked for my slides, and once I emailed them to him and told him how much his words meant to me, he shared that he planned to share his slides with all the clinic locations across the province, hoping everyone would find it as “wonderfully liberating” as he did. This also continued after the presentation when the conference organiser approached me with tears in her eyes, gave me a big hug, and shared that she has many late-diagnosed autistics in her family, including her transgender son, and expressed how much the work I was doing meant to her and how moving it was to see an autistic therapist and researcher thriving. When I began this research and chose the transformative paradigm, I knew that the chances of it bringing about large-scale societal change were slim. However, having a few people take something from it, along with the excitement and interest it has generated, means everything to me. This was an invaluable experience, and I hope it will be a source of healing for those who read it. I will continue my work as an autistic researcher, exploring autism for years to come. SPID: EXPLORING THE IMPACT OF MASKING 159 Summary of Findings This study identified three main categories of voices within the masking experiences of autistic women: masking, unmasking, and advocacy. These themes reflect how autistic women navigate social expectations, develop self-awareness, and challenge systemic barriers. The findings offer insight into the emotional, psychological, and societal factors that influence these experiences, highlighting both the challenges and resilience demonstrated by autistic women. Masking emerged as a core voice category, with participants describing the necessity of concealing their autistic traits to conform to social expectations. Many participants reported learning to mask from an early age, often through observing neurotypical peers and being shamed for their autistic traits, which caused them to adjust their behaviour accordingly. While masking was described as a crucial survival strategy in social and professional settings, it was also associated with significant emotional and cognitive exhaustion. The strain of masking was linked to anxiety, depression, and burnout, with all participants expressing frustration over the societal factors, such as a lack of awareness and acceptance of autism, that necessitate masking in the first place. Participants also noted that masking often delayed their autism diagnosis, as their ability to "blend in" and, for some, a lack of the characteristic autism traits, such as poor eye contact, led to their struggles being overlooked by professionals and peers. Unmasking was described as a gradual and complex process deeply connected to selfacceptance and personal growth. Many participants noted that receiving a formal autism diagnosis, connecting with other autistic people, and, for some, experiencing burnout that made masking unsustainable, helped them begin their unmasking journey. This was not SPID: EXPLORING THE IMPACT OF MASKING 160 always straightforward or entirely positive, as many shared that they still fear social rejection or discrimination because of trauma from being fully unmasked in all areas of their lives. However, many also described the freedom, relief, and empowerment that came with embracing their authentic selves. The study found that unmasking for many involved redefining personal boundaries, developing self-advocacy skills, and seeking supportive environments where authenticity was welcomed. Advocacy became the third and final key voice, with many participants channeling their experiences into efforts to promote greater autism acceptance and systemic change. Several described advocacy as both a personal and collective endeavour, including actions such as educating others about autism, advocating for workplace and educational accommodations, and encouraging their autistic children to fully embrace who they are. Some shared that their transition from masking to unmasking strengthened their desire to create more inclusive spaces for other autistic individuals, and many hoped for a future where other autistic children would not have to struggle as much as they did. Advocacy was seen as a way of reclaiming agency, challenging stigma, and fostering greater social acceptance. Overall, the findings highlight the multifaceted nature of autistic women's experiences with masking. While masking is a functional tool for navigating social environments, it comes at a considerable emotional cost. The unmasking process represents a shift toward self-acceptance, but it is accompanied by personal and societal challenges. Advocacy plays a crucial role in transforming these individual experiences into broader societal change, reflecting the resilience and determination of autistic women in reshaping societal perceptions of autism. SPID: EXPLORING THE IMPACT OF MASKING 161 Contributions to Literature This thesis contributes to the growing body of literature on autism, masking, and gender by centring the lived experiences of autistic women through the distinct yet interconnected voices of masking, unmasking, and advocacy. These three voice categories not only emerged from participants’ narratives but also serve as conceptual categories that expand existing frameworks. First, by examining the voices of masking and positing it as more than a coping mechanism but a dialogical and embodied response to social expectations and normative pressures, this study offers a more relational and situated understanding of masking. Second, the voices of unmasking are conceptualized as both an act of resistance and a form of identity formation, revealing how autistic women navigate authenticity, selfacceptance, and safety in various contexts. This reframing positions unmasking not merely as the cessation of masking, but as an intentional, identity-driven process that challenges dominant neurotypical norms. Third, the emergence of advocacy as a distinct voice category underscores how agency, community, and political consciousness evolve in the aftermath of unmasking. These voices highlight how autistic women move from self-blame and internalized marginalization towards public action and representation, contributing to broader conversations in neurodiversity and critical disability studies. Together, these three voice categories form an integrated framework that not only captures the complexity of autistic women’s lived experiences but also pushes the boundaries of current autism research and understandings of masking, signalling new directions for theory, research, and practice. Expanding Definitions of Masking Existing literature typically conceptualizes masking as a set of behaviours aimed at camouflaging autistic traits to conform to neurotypical expectations (Hull et al., 2017b; SPID: EXPLORING THE IMPACT OF MASKING 162 Livingston et al., 2020). This thesis expands that definition by uncovering the polyphonic nature of masking – the presence of multiple, often conflicting voices within that individual that guide, shape, and challenge masking behaviours. The "voices of masking" revealed how internalized scripts derived from social expectations, trauma, and delays in diagnosis contributed to a fragmented sense of self. These voices are not monolithic; they include, for many, echoes of caregivers, educators, peers, media portrayals, and diagnostic criteria. Many participants shared how masking began in early childhood, emerging as an instinctual survival strategy in response to social pressures and the unspoken rules of neurotypical expectations. This led to a profound shame for many, as they were taught that being "other" was wrong. An example of this was when Marie shared her response to being recommended to be put in a gifted classroom before she was diagnosed as autistic when she was a child, which she shares in the following: I remember having a meltdown. I was crying, and I didn't want to go (to the gifted classroom) because I didn't want to be seen as different. Even though that would be a positive difference, it was so intense at the time that you had to be like this cookie-cutter person, like everyone else in their classrooms. Something like that would probably have gotten me bullied even more, since I was already being bullied. As a result, many participants learned how to conceal their traits so that they would not be perceived as different and to prevent further bullying. Many described this experience as "not being themselves" and often spoke of "being actors" and "impersonators" in their own lives, reflecting the dissonance between their inner worlds and the expectations placed upon SPID: EXPLORING THE IMPACT OF MASKING 163 them. All participants also constantly monitored their facial expressions, tone of voice, and body language to avoid judgment. These vivid accounts emphasize that masking is not a passive or singular act but a sustained performance that exacts a profound emotional and cognitive toll. The findings of this study also supported the literature regarding the negative impacts of masking, as this was what Rose shared when asked if she would say there are any positives to masking: No, I honestly, I wouldn’t (laughs). I think that there is just negatives to it for the long run for yourself because I know for myself, it has caused a lot of problems. I don’t see anything good about it at all. The cost of prolonged masking is well-documented in mental health literature, including increased rates of anxiety, depression, identity confusion and fragmentation, and burnout (Cage & Troxell-Whitman, 2019). This thesis contributes a voice-centred phenomenological understanding to these findings, illustrating how the masking process fragments the self, creating dissonance between the public persona and the internal experience. The presence of internalized voices – ranging from self-criticism fueled by internalized messages of shame and inauthenticity resulting from mimicking behaviours deemed “normal” – illustrates the internal struggle for congruence and authenticity in a world that so often misunderstands and devalues neurodiversity. Unmasking as Resistance and Identity Formation The second major category of voices, the "voices of unmasking," highlights the transformative and often nonlinear process of unmasking. Previous literature has primarily situated unmasking within the context of burnout of post-diagnostic reflection, treating it as an endpoint or a reactive consequence (Raymaker et al., 2020). This thesis instead frames SPID: EXPLORING THE IMPACT OF MASKING 164 unmasking as a deliberate and ongoing negation – one that is intrinsically tied to the pursuit of authenticity, healing, and community. It is not necessarily the cessation of masking behaviours but a deliberate, ongoing negation that is relational, political, and deeply tied to processes of self-acceptance and liberation. Participants frequently described moments where they began to tentatively unmask in spaces that they deemed safe, such as with other neurodiverse or safe people, in online communities, or after receiving a formal diagnosis. A deep sense of vulnerability and relief marked these moments. Many participants described the feeling of realizing that they "were allowed" to take up space and to be entirely accepted for who they were. These findings align with those of Leedham et al. (2020), who emphasize the crucial role of community and belonging in promoting autistic self-acceptance. The voices of unmasking also reflected Milton's (2012) concept of the double empathy problem, as the participants spoke of moments where they were able to connect with other neurodiverse individuals and found it "energizing" and "empowering" because mutual understanding was more accessible. They could fully express themselves without translating their behaviours to be understood, as was often the case with neurotypicals. These embodied experiences of unmasking were masked by what Ahmed (2004) might call "emotional orientations" – moments when participants turned toward themselves and others with greater authenticity and self-trust. Despite this, unmasking was not uniformly experienced as liberatory. Several participants spoke of areas of their lives where they could not be fully unmasked because doing so would lead to relational disruption or add to the bullying that they have already experienced. Many participants also shared an internalized narrative based on past SPID: EXPLORING THE IMPACT OF MASKING 165 experiences and years of masking, suggesting that if they were to exist entirely as their authentic selves, "no one would want them," or they would be treated poorly and differently. Kate shared that she had unintentionally unmasked around a friend. While it was reassuring for her to know that the friend did not view her any differently and appreciated her authenticity, her mask is "always in place," which she also attributed to past trauma as well as concealing other aspects of her identity, such as belonging to the 2SLGBTQIA+ community. These dichotomies are supported by Botha and Frost’s (2020) work on minority stress as it applies to autism, which emphasizes the psychological toll of navigating environments that remain largely inaccessible or invalidating. Unmasking also facilitated a shift from self-surveillance to self-compassion. As participants began to reflect critically on their past experiences of making, they often expressed newfound empathy for their younger selves. All participants spoke about how recognizing their identity gave them more compassion for themselves. They spoke about how it was the realization that "nothing was wrong with (them)" and that they were "doing (their) best and living in a world that was never designed for (them)." These moments of selfdiscovery also allowed them to reflect on their strengths and develop compassion for their brains and how they present themselves in the world. Not one participant spoke about wanting a cure for their autism, and many shared that, given the opportunity, they would "turn it down." The process of recognizing and reclaiming identity through recognizing masking behaviours and finding pockets where it was safe to unmask, as well as connecting with other autistic individuals, was itself a form of healing. This highlights the importance of how diagnosis and self-identification of autism in identity reconstruction and positions SPID: EXPLORING THE IMPACT OF MASKING 166 unmasking as a symbolic representation of both resistance to neurotypical standards and reclamation of selfhood. This study further challenges prior conceptualizations of unmasking by emphasizing its outward, relational effects. Rather than being confined to a private realm of selfdiscovery, unmasking emerged as an act reverberating across relationships, workplaces, and communities. This finding contrasts with the existing literature, which primarily positions unmasking as a solitary or intrapersonal process (Botha et al., 2022; Miller et al., 2021). Here, unmasking is reframed as a social act that reveals the self and tests the conditions of its reception, reshaping the environments in which autistic women live and allowing them to reclaim their agency. The Emergence of Advocacy The "voices of advocacy" emerged as a powerful culmination of participants' journeys through the process of masking and unmasking. Advocacy was not a separate or final stage but a deeply integrated aspect of identity and healing. For many participants, advocacy emerged from a sense of moral imperative – a desire to prevent others from experiencing the same alienation, confusion, and marginalization they had endured. It was also a means of finding and building community. This was either self-advocacy, such as participants advocating for the right to stim and have flexible work schedules that suited their needs, or broader societal advocacy through educating others and working towards systemic change. Jade shared her position as an autistic advocate as well as her hopes for other autistic women and individuals in the following passage, which I have included in its entirety because of how beautifully it captures the importance of neurodiversity: SPID: EXPLORING THE IMPACT OF MASKING 167 Autism didn't happen to me, autism doesn't happen to people, it's not this disease or infection, it's a reality of people's brains. It's our brains; it's how our brains work. Brains work in different ways, and we need all different kinds of support as a result of how our brains work. My greatest wish would be to understand that in the context of radical acceptance rather than radical fear. Acceptance creates space for communities, fosters increased support, and promotes person-centred support systems that focus on caring for rather than preventing. In any way, autism can be taken seriously and not held at a distance because (others think) it is a frightening thing. I think removing fear would be my greatest hope because it's not scary. It’s a reality that can be difficult, and being autistic can be difficult, and it can result in difficult behaviours, but it’s not just difficult behaviours; that is not the extent of autism. Those behaviours are usually the result of something underlying, a need that isn’t being met or an environment that is upsetting, or something that requires care. So yeah, moving towards understanding autism and holding space for autism rather than fearing it. Advocacy was framed not only as outward action but also as internal realignment. Choosing to disclose an autism diagnosis or autistic identity, to speak openly about one's needs, or to resist masking in public were all acts of personal and political significance. These acts were often described as deeply emotional and embodied, as many participants described their advocacy with passion, voices becoming more assured, and speaking with both confidence, fervour, and anger towards systems that promoted inequity and continued to discriminate against autistic voices. SPID: EXPLORING THE IMPACT OF MASKING 168 These findings, along with the emergence of advocacy, challenge traditional narratives of autistic identity as isolated or passive (Miller et al., 2021). It positions autistic women as knowledge holders and change agents whose insights can reshape public discourse, educational systems, and mental health practices. Moreover, it highlights how advocacy often emerges not despite, but because of, the struggles of masking and unmasking– a testament to the resilience, creativity, and agency of autistic women. These findings also challenge deficit-focused models in the literature that position autistic people primarily as recipients of care or passive subjects of intervention (Sarrett, 2011; Pellicano et al., 2014). Instead, this thesis centers on autistic women as active participants in constructing knowledge, policy, and practice. By highlighting the voices of advocacy not only in public or institutional spaces but also within everyday encounters – speaking openly about their diagnosis with friends, family, and loved ones, correcting misperceptions and standing up for others, or asking for accommodations – this study broadens the scope of what constitutes advocacy and invites a more inclusive and intersectional understanding of how autistic women resist societal expectations and discrimination and affirm their identities. Contributions to Theory Autistic identity development has often been framed through psychological and developmental models that fail to capture the lived experiences of autistic individuals, particularly autistic women. Traditional theories emphasize deficits rather than the active, complex process of identity formation. This section proposes a novel model based on the results obtained in the study, which I have named the Masking-Unmasking Integration Framework. This framework, derived from the voices of masking, unmasking, and SPID: EXPLORING THE IMPACT OF MASKING 169 advocating, acknowledges the fluidity of autistic identity development and how external societal expectations and internal self-awareness shape it. By integrating insights from neurodiversity research and identity development models, this framework builds upon current theories by acknowledging the agency of autistic individuals in shaping their identities over time. This model highlights the roles of masking, unmasking, self-discovery, and advocacy, demonstrating how an autistic identity evolves through social and personal transformation. Challenging and Extending Autism Theories Historically, autism research has been shaped by deficit-focused frameworks, which conceptualize autistic traits primarily in terms of impairment or deviation from neurotypical norms. Foundational theories such as the theory of mind hypothesis (Baron-Cohen et al., 1985) and the extreme male brain theory (Auyeung et al., 2021; Baron-Cohen, 2002) exemplify this orientation. While historically influential, these theories have faced growing criticism for their reductive focus on pathology, gender essentialism, especially in the case of the extreme male brain theory, and failure to capture the subjective experiences of autistic individuals (Gernsbacher & Yergeau, 2019). Furthermore, these frameworks persist in diagnostic spaces and in many interventions that aim to reduce or correct autistic traits, often at the expense of authenticity and agency. However, recent research increasingly challenges these narratives by emphasizing autistic identity as fluid, relational, and contextually constructed (Kapp et al., 2013; Botha & Frost, 2020). Milton’s (2012) double empathy problem marks a pivotal shift by proposing that communication breakdowns between autistic and non-autistic individuals are bidirectional, rooted in mutual misunderstanding rather than autistic deficiency. SPID: EXPLORING THE IMPACT OF MASKING 170 A critical mechanism in this relational dynamic is the masking of emotions. While initially understood as a coping strategy, masking is now recognized as a core part of identity formation, especially for autistic women and gender diverse individuals (Hull et al., 2017c; Pearson & Rose, 2021). Rather than being a temporary or discrete phase, masking exerts a long-term influence on how autistic people come to understand themselves. It can erode selfcoherence, delay diagnosis, and create deep internal conflict between performed and authentic selves. Studies by Kelly et al. (2024), Thammathorn (2024), and Cohen et al. (2022) deepen our understanding of identity development in this context. Kelly et al. (2024) highlight how persistent masking leads to identity instability, particularly among late-diagnosed autistic individuals who have spent years constructing a false social self. Thammathorn (2024) examines how cultural norms shape the process of unmasking, reframing it not as a universally empowering experience, but as a context-sensitive process that can bring both risk and relief. Meanwhile, Cohen et al. (2022) investigate how autistic individuals reclaim identity following harmful messages received in educational settings. Their findings emphasize that identity is often actively rebuilt in adulthood as individuals work to challenge internalized stigma and articulate new, affirming understandings of what it means to be autistic. Taken together, this literature rejects a static, linear view of development. Instead, autistic identity is seen as dynamic, interactional, and shaped through complex negotiations within dominant cultural narratives. This study extends contemporary theories of autistic identity by situating masking, unmasking, and advocacy within the intersecting frameworks of MST, SIT, and DEP. Building on DEP (Milton, 2012), this research highlights masking as both a protective SPID: EXPLORING THE IMPACT OF MASKING 171 strategy and a critical site of identity construction in response to social marginalization. MST (Botha & Frost, 2021) highlights how chronic stressors related to stigma, discrimination, and internalized oppression shape autistic women’s experiences of masking. Participants’ narratives illustrate masking as a strategy to navigate and survive these stressors, linking autistic experiences with broader minority identities. SIT (Trepte & Loy, 2017) deepens the understanding of masking by emphasizing the negotiation of multiple, often conflicting social identities. Participants described how fears of exclusion from valued identities – such as being a “competent professional” or a “good mother” – led them to prioritize socially acceptable performances, highlighting the centrality of social group belonging in shaping masking. Furthermore, this study broadens FDT beyond its traditional focus on physical and visible impairments to explicitly include neurodiversity, such as autism, ADHD, and other cognitive differences. By doing so, it challenges dominant ableist and sexist norms that devalue neurodivergent ways of being and frames masking as a political and embodied response to intersecting systems of oppression. This expanded lens recognizes that masking is not a personal failing or isolated behaviour but a socio-political response to environments that pressure neurodiverse individuals to conform. By integrating these theories, this study reframes masking as a complex, relational, and socio-political process rather than a purely individual phenomenon. This reframing moves beyond static, deficit-focused frameworks and affirms the agency, resilience, and ongoing identity work of autistic women as they navigate multiple, intersecting social worlds. The model proposed in this thesis builds on this perspective. It does not depict masking, unmasking, and advocacy as stages of development, but rather as interrelated SPID: EXPLORING THE IMPACT OF MASKING 172 domains that describe how autistic individuals, particularly women, navigate and construct identity across time. Masking is treated not as a barrier to development but as an active and consequential part of the process that often gives rise to later unmasking and advocacy, as individuals reflect on their experiences, seek community, and begin to reassert ownership over their identities. By reframing identity development through these relational and narrative dimensions, this model aligns with contemporary, affirming autism research and centers autistic voices in theorizing their own lives. It asserts that autistic identity is not discovered, but constructed, often in resistance to environments that have long denied its validity. The Masking – Unmasking Integration Framework The masking-unmasking integration framework outlines a non-linear, three-stage process that captures how many autistic individuals come to understand, express, and integrate their neurodivergent identities (See Appendix I). Drawing on the voices of masking, unmasking, and advocacy, the framework reveals how masking is not merely a behavioural strategy but a deeply embodied, survival-based response to systemic ableism and gendered socialization. Unlike traditional development models that emphasize progressive steps toward maturity, this framework emphasizes identity fluidity and the pervasive influence of masking, particularly in environments dominated by neurotypical individuals. Drawing inspiration from 2SLGBTQIA+ identity development frameworks such as Cass’ (1979) model of sexual identity formation, the masking-unmasking integration framework (MUIF) similarly explores cycles of concealment, self-recognition, and external advocacy, while foregrounding the unique dynamics of autistic socialization, trauma, and resilience. The stages –Masking for Survival, Conscious Emergence, and Integrated Authenticity – do not SPID: EXPLORING THE IMPACT OF MASKING 173 suggest a fixed sequence. Instead, they reflect recurring internal negotiations shaped by age, environment, gender, race, access to support, and lived experience. Stage 1: Masking for Survival The first stage, Masking for Survival, focuses on the development of masking behaviours – strategic efforts to conceal autistic traits to conform to societal expectations. This phase is often learned implicitly in childhood, especially by autistic women and gender diverse individuals who are more likely to internalize social cues that their natural behaviours are “inappropriate” or “abnormal” (Hull et al., 2017a; Cook et al., 2018). Masking typically involves mimicking neurotypical norms, such as maintaining eye contact, suppressing self-stimulatory behaviours (stimming), or rehearsing conversational scripts, to avoid social exclusion, misunderstandings, or bullying. This stage reflects what Bargiela et al. (2016) describe as a “social survival strategy” that often results in chronic stress, identity confusion, and internalized ableism. Over time, many autistic individuals become so skilled at masking and social camouflaging that they lose sight of their authentic selves. This disembodiment can leave them emotionally drained and vulnerable to autistic burnout (Raymaker et al., 2020). The social rewards of masking (i.e. approval, job retention, safety) often come at the cost of psychological well-being and self-understanding. It is important to note that this phase is not static. For some, Masking for Survival persists well into adulthood, particularly for those who remain undiagnosed, misdiagnosed, or unsupported Others begin questioning this adaptive identity when it becomes unsustainable or when that encounter validating narratives, such as an autism diagnosis, exposure to SPID: EXPLORING THE IMPACT OF MASKING 174 neurodiversity movements or creators, or connection with other autistic individuals (Mogensen & Mason, 2015; Kapp, 2020). Stage Two: Conscious Emergence The second stage, Conscious Emergence, reflects the often disorienting yet liberatory process of self-recognition and unmasking. Influenced by the voices of unmasking, this phase marks a cognitive and emotional shift where individuals begin to distinguish between their masked selves and their authentic neurodivergent identity. This stage may be catalyzed by a diagnosis, self-identification, supportive relationships, or engagement with autistic communities (Davidson & Henderson, 2010; Rosqvist et al., 2020). This phase is marked by complex emotions, as relief, grief, anger, and excitement, which often coexist. As Cohen et al. (2022) emphasize, many autistic individuals undergo a process of identity reclamation following years of negative school messaging or invalidation, both socially and culturally. Their study found that community engagement and narrative reauthoring were key to resisting the internalized ableist beliefs and systemic oppression during the masking for survival stage. Similarly, Thammathorn (2024) and Kelly et al. (2024) explored how navigating an autistic identity can be viewed as an act of “meaning making,” often encountering tensions between social expectations and embodied neurodivergence. In the conscious emergence stage, individuals begin testing the waters of authenticity by stimming in public, declining social expectations or invitations that they lack the capacity for, or communicating differently in a way that feels true for them. This stage often brings experimentation with sensory regulation, emotional expression, and boundary setting. However, as Miller et al. (2021) note, unmasking can increase one’s vulnerability in ableist SPID: EXPLORING THE IMPACT OF MASKING 175 environments. Individuals may find themselves oscillating between masking and unmasking, depending on the perceived level of safety in their environment (Waisman-Nitzan et al., 2023). The ambiguity of this phase is critical – it reflects not just self-discovery but the social negotiation of that discovery. Stage 3: Integrated Authenticity In the third and final stage, integrated authenticity, autistic individuals begin to experience greater alignment between their inner experience and outward expression. Rather than striving to appear neurotypical, individuals accept their autistic identity as central to who they are. This stage does not imply the absence of struggle, particularly in a society that often pathologizes or misunderstands autistic traits. However, it reflects a growing sense of self-trust, boundary clarity, and empowered choice. For some, this may manifest through public self-advocacy, participation in neurodivergent-led communities, or efforts to dismantle ableist systems (Kourti, 2018; Milton, 2012). For others, it may mean simply living authentically, honouring their sensory needs, cultivating affirming relationships, or disengaging from environments that demand constant masking. As Gillespie-Lynch et al. (2017) argue, autistic adults are not just recipients of care but experts in their own experience, and this stage often includes a desire to share that expertise through peer mentorship, art, writing, or activism. The concept of thriving emerges here, not as the erasure of autistic traits, but as the integration of difference into one’s life in sustainable and affirming ways (Kapp, 2020). Importantly, this stage is not an endpoint. Life transitions, trauma, or systemic oppression may push individuals back into earlier stages. However, the difference lies in the internal resources built through prior experiences: the person now has a vocabulary, community, and SPID: EXPLORING THE IMPACT OF MASKING 176 a sense of worth that make re-masking feel less like a return to silence and more like a strategic, temporary decision. The MUIF offers a flexible, identity-affirming framework for understanding the lived experiences of autistic individuals, particularly in relation to masking. This framework highlighted how social pressures, internal reckonings, and relational experiences continually shape autistic identity. The three stages— Masking for Survival, Conscious Emergence, and Integrated Authenticity —reflect a dynamic relationship between self-expression and social safety, acknowledging that development is cyclical, context-dependent, and lifelong. This model challenges the traditional medical model view of autistic development, centring instead on the wisdom, complexity, and resilience of autistic development, and masking as a learned survival behaviour. The MUIF invites clinicians, researchers, and allies to support identity development as a form of liberation rather than normalization. Implications for Future Research The findings of this study open several avenues for future research, particularly in the areas of identity development, advocacy, and mental health. Future studies could explore the role of gender in the experience of masking and unmasking in autistic individuals, particularly among women and non-binary individuals (Bargiela et al., 2016; Hull et al., 2020; Yergeau, 2018). Understanding how these experiences differ across genders can offer valuable insights into the complexities of autism and its intersection with social expectations (Lockwood Estrin et al., 2021). Furthermore, future research should explore how intersecting identities, such as race, gender, and socioeconomic status, influence masking experiences (Crane et al., 2021; Jones & Mandell, 2020). Including non-speaking autistic individuals and those with higher support SPID: EXPLORING THE IMPACT OF MASKING 177 needs will provide a more comprehensive understanding of how masking manifests across the spectrum (Kapp et al., 2013; Gillespie-Lynch et al., 2017). Additionally, research should examine how autistic masking evolves across different life stages, from childhood to late adulthood, to assess long-term effects on mental health and overall well-being (Lai et al., 2017; Cage & Troxell-Whitman, 2019). Longitudinal studies are necessary to track the long-term impact of unmasking, including potential improvements in mental health, social connections, and self-identity (Miller et al., 2021). Such studies could also help identify factors that support a successful transition from masking to unmasking, offering valuable guidance for interventions to ease this process (Raymaker et al., 2020). Furthermore, participatory action research methodologies should actively involve autistic individuals in the research process (Nicolaidis et al., 2011; Chown et al., 2017). By positioning autistic individuals as co-researchers rather than just subjects, future studies can ensure that research agendas and findings align with the community's real needs. This approach also aligns with the transformative paradigm by challenging traditional researcher-participant power dynamics and fostering more ethical and inclusive research practices (Pellicano et al., 2014). Cultural considerations should also be explored in greater depth. Given that social expectations regarding gender and neurodiversity vary across cultural contexts, future research should examine how cultural norms influence autistic masking and advocacy (Kirkovski et al., 2013). Comparative studies across cultural backgrounds could offer insights into how societal expectations shape masking behaviours and coping strategies (Takara & Kondo, 2014). SPID: EXPLORING THE IMPACT OF MASKING 178 Additionally, research should investigate the role of digital spaces and online communities in unmasking (Parsloe, 2015; Davidson & Henderson, 2010). Many autistic individuals, including the participants, find validation and support in online neurodiverse communities, where they can engage in self-expression without the pressure to conform to neurotypical standards. Exploring the impact of these digital spaces on identity development and advocacy efforts can provide valuable insights into new avenues of support and empowerment. Future studies should also address the economic and social implications of masking and unmasking. Research on employment outcomes for autistic women who unmask in the workplace could inform policies aimed at improving workplace inclusion (Dreaver et al., 2020; Costly & Warren, 2014). Additionally, studies on how social relationships are affected by unmasking could offer insights into ways to foster stronger community support networks (Botha & Frost, 2020). Ultimately, this study advocates for the development of a more comprehensive model of autism that integrates both neurodiversity and identity development (Kapp, 2020; Milton, 2012). Future theoretical work should seek to bridge the gap between neurological understanding and the social, emotional, and identity-related aspects of autism. This integrated approach would provide a more holistic understanding of how autistic women navigate their social experiences and contribute to more inclusive and effective interventions. Implications in Practice The findings of this study, centred on the voices of masking, unmasking, and advocacy, highlight critical considerations for clinicians, educators, and policymakers working with autistic women. Participants described masking as both a protective strategy SPID: EXPLORING THE IMPACT OF MASKING 179 and a source of internal conflict and exhaustion. Therefore, mental health practitioners must move beyond pathologizing or oversimplifying masking and instead validate its complexity. Interventions should support autistic women in navigating masking and unmasking on their terms, emphasizing self-defined well-being and autonomy rather than compliance with neurotypical norms (Bargiela et al., 2016; Hull et al., 2017b; Milton, 2014). The tension between survival and authenticity revealed in participants’ narratives highlights the need for systemic change. Rather than placing the burden of adaptation on individuals, environments – workplaces, schools, and clinics – must be reshaped to reduce the need for masking in the first place (Kapp, 2020; Miller et al., 2021). For example, educational institutions should implement neurodiversity-affirming training for educators and administrators, informed by lived experience such as those captured in this study, to foster safer and more inclusive learning environments (Gould & Ashton-Smith, 2011; Tierney et al., 2016). Similarly, employment policies must reflect the nuanced ways masking manifests at work. Many participants spoke about burnout, sensory overload, and societal and gendered expectations that enforce masking – issues that many current workplace structures often ignore. Flexible accommodations, sensory-friendly environments, and clear antidiscrimination policies must be established to support autistic women in maintaining employment without compromising their mental health (Rosqvist et al., 2020; Botha et al., 2021). The voices of advocacy emerging in this study call for greater autistic involvement in shaping policy and service. In line with the transformative paradigm, this study advocates for action-oriented community-led approaches. Autistic women should be included in research, SPID: EXPLORING THE IMPACT OF MASKING 180 service design, and policy-making, not merely as participants but as leaders and co-creators (Ne’eman & Pellicano, 2022; Kourti, 2018). Funding and infrastructure must support autistic-led organizations and initiatives that reflect this participatory ethic (Waisman-Nitzan et al., 2023). In clinical practice, there is an urgent need for trauma-informed, neurodiversityaffirming therapeutic models. Some participants described traditional interventions such as ABA and social skills training as reinforcing masking and eroding self-worth. In contrast, therapeutic models should promote self-acceptance, emotional regulation, and the development of advocacy skills that align with an individual’s values and identity (Milton, 2014; Woods et al., 2022). Mental health professionals must also be trained to recognize how diagnostic disparities and gendered biases contribute to late identification and internalized stigma in autistic women (Hull et al., 2020; Lai & Szatmari, 2020). Peer-led spaces and communities of other autistic women and individuals were also emphasized as potential sites of healing and solidarity. This aligns with the communal dimensions of unmasking described by participants, suggesting that autistic women benefit from spaces where mutual understanding replaces pressure to conform (Davidson & Henderson, 2010). Peer mentorship programs and grassroots advocacy efforts can further support self-expression and identity development without judgment (Botha, 2021; Sinclair, 1993). Ultimately, the findings underscore the need for comprehensive policy reform. Governmental and institutional policies must recognize neurodiversity as a legitimate dimension of human variation. This includes funding for autistic-led research, embedding lived experience in policymaking, and creating social infrastructures that prioritize SPID: EXPLORING THE IMPACT OF MASKING 181 autonomy, inclusion, and dignity for autistic women at all levels of society (Kapp, 2020; Waisman-Nitzan et al., 2023). Strengths This study contributed valuable insights by prioritizing the lived experiences of autistic women, a population often underrepresented in autism research. The qualitative approach enabled a rich, in-depth exploration of personal narratives, ensuring that the complexities of masking and its impact on mental health, as well as the unmasking and advocacy process, were captured authentically. By employing semi-structured interviews, the study allowed participants to share their experiences in their own words, fostering a more inclusive and participant-driven research process. Additionally, the study’s alignment with the transformative paradigm enhances its impact, as it actively seeks to challenge deficit-focused frameworks and promote systemic change. The focus on unmasking and advocacy as emergent themes further strengthens the study by highlighting autistic agency and resilience rather than solely focusing on the challenges. Unlike traditional deficit-focused narratives of autism, the study highlights the strengths and capabilities of autistic women, emphasizing their self-awareness, adaptability, and determination to create systemic change. Another key strength is the study’s contribution to the broader discourse on gender and ASD. By specifically centring on autistic women, it addresses a significant gap in research that has historically prioritized male presentations of autism. The gendered perspective allows for a deeper understanding of the unique pressures autistic women face about masking and, subsequently, unmasking. Furthermore, the study's emphasis on SPID: EXPLORING THE IMPACT OF MASKING 182 advocacy provides actionable insights for clinicians, educators, and policymakers, offering a framework for supporting autistic women beyond traditional therapeutic interventions. Limitations While this study provides insight into the experiences of autistic women, it is important to acknowledge its limitations. First, all participants were level 1 or level 2 autistics who were verbal, limiting the generalizability of the findings to non-verbal or higher-support autistic individuals. A notable limitation of this study is the reduced racial diversity within the final analytic sample. Following data screening and the removal of ineligible or spam participants, only one person in the final dataset was identified as a person of colour. This limits the extent to which findings can account for the intersecting experiences of race, gender, and neurodivergence. Given that masking and identity formation may be shaped by racialized experiences of stigma, discrimination, and cultural expectations, future research should prioritize the recruitment of a more racially diverse sample to deepen understanding of how race and ethnicity intersect with autistic identity and masking behaviours (Pham & Charles, 2023). Because this was also, to my knowledge, the first study on autistic women using LG, future research should explore how to make the methodology more inclusive and adaptable for autistic women with higher support needs. Another limitation is the potential for social desirability bias. Given that the study focused on unmasking and advocacy in the latter stages of the interview process, participants may have emphasized their agency in navigating masking and unmasking while underreporting the extent of their struggles. Future studies could use longitudinal or mixedmethods approaches to capture the evolving nature of masking experiences over time. The transformative paradigm emphasizes the importance of research as a tool for empowerment; SPID: EXPLORING THE IMPACT OF MASKING 183 thus, future work should also incorporate participatory methods that position autistic individuals as co-researchers. The final limitation was that nearly all participants identified as cisgender women, with only one participant identifying as non-binary femme. This lack of gender diversity within the sample limits the depth and breadth of understanding of masking experiences, particularly non-binary and transgender women. Since masking is often shaped by societal expectations related to both gender and neurotype, the experiences of those who do not identify as cisgender may differ significantly in both form and function. As such, this study may not fully capture the nuanced ways that gender identity intersects with autism and masking. Future research studies should intentionally recruit more gender-diverse participants, including non-binary femmes, transgender women, and other gender diverse individuals, to better understand how gendered social norms and marginalization influence the practice, impact, and meaning of masking in autistic lives. Doing so would contribute to a more inclusive and intersectional understanding of this phenomenon. Conclusion This study explored the experiences of masking in autistic women, highlighting the challenges of societal expectations and the journey toward self-acceptance. The findings suggest that masking serves as a survival strategy, unmasking brings vulnerability and liberation, and advocacy fosters empowerment. These voices parallel identity development models in other marginalized groups, such as the 2SLGBTQIA+ community, emphasizing the broader implications of identity formation. 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Advances in Autism, 5(1), 213. https://doi.org/10.1108/AIA-10-2018-0041 SPID: EXPLORING THE IMPACT OF MASKING APPENDIX A: Recruitment Poster 205 SPID: EXPLORING THE IMPACT OF MASKING 206 APPENDIX B: Invitation Email Hi (insert name here), My name is Shana Harrison, and I am currently in my second year of TWU’s counselling Psychology program. My thesis research is on autistic women’s experiences of masking, or the hiding of autistic traits and how it impacts their mental health. I am looking for autistic women who have engaged in masking with the purpose of better understanding how it has affected them. My study aims to answer the following question “What are the voices (or themes) present in autistic women’s experiences of masking?” The intent of my study is to gain a better understanding of how masking impacts the mental health of autistic women and to increase awareness of this phenomenon to create better informed treatment approaches for mental health practitioners. All efforts to maintain your confidentiality will be made. As a thank-you for participating in the study, you will be given a $20 gift card of your choice. I am looking for seven to ten participants who can say “yes” to the following: • • • • Are at least 18 years of age Identify as a woman and as autistic Have engaged in masking Can participate in a 45- to 1.5-hour-long interview, either over Zoom (a secure online video calling platform) or in person, as well as a follow-up interview, which will take place over Zoom. If you are interested in participating or have any questions, please email me at (email) or by phone at (phone). Also, feel free to pass this email along to anyone who you think may be a good fit for the study. Thank you, Shana Harrison SPID: EXPLORING THE IMPACT OF MASKING 207 APPENDIX C: Email Initial Contact Introduce myself as a master’s student in counselling psychology from Trinity Western University Briefly explain the study and its purpose. • Explain that participation will involve an interview of approximately 45 to 90 minutes, followed by a follow-up interview to be conducted at a later time. • Provide information about the purpose of the study. I am looking for autistic women who have engaged in masking or the hiding of their autistic traits. • Talk about lived experience and what inspired me to conduct this research. • Talk about how voices are expressed and embodied (Explain) • Indicate that I need to ask a few questions to ensure that they are a fit for the study: o Are you at least 18 years of age? o Do you identify as a woman and as autistic? o Have you ever engaged in masking or the hiding of your autistic traits? o Are you willing to commit to an interview of approximately 45 to 90 minutes? Is there anything I can do to make the interview more comfortable for you? • Offer accommodation options. If they are a fit: • Let them know, ask them if they are interested in participating, and if they have any questions. • Thank them for their time and arrange next steps to set up an interview. SPID: EXPLORING THE IMPACT OF MASKING • 208 If the interviews are to be conducted via video-conferencing software, ensure that the participants have a safe and private location of their choice to participate in the interview. If the interviews are in-person, the participant can choose a location (within BC) that best suits them. • Ask what $20 gift card they would like to receive as a thank you for participating in the study. If they are not a fit: • Thank them for their time and briefly explain why they are not a fit. Offer to be in touch with the results of the research, as well as direct them to any ongoing research projects that they may be a fit for. SPID: EXPLORING THE IMPACT OF MASKING 209 APPENDIX D: Demographic Information Demographic Information Please feel free to leave any questions unanswered if you do not feel comfortable answering them. Questions marked with a * are required for participation in the study. 1. Name*: ____________________________________________ 2. Desired Pseudonym*: ________________________________ 3. Age*: _________ 4. Gender: __________________________ 5. Ethnicity: _________________________ SPID: EXPLORING THE IMPACT OF MASKING 210 APPENDIX E: Letter of Consent Square Pegs in Disguise: Exploring the Impact of Masking on Autistic Women’s Mental Health Principal Investigator: Shana Harrison, MA Counselling Psychology Student, Department of Counselling Psychology, Trinity Western University Faculty Supervisor: Dr. Deepak Mathew, PhD, Associate Professor, Department of Counselling Psychology, Trinity Western University Purpose: You are invited to participate in a research study exploring the impact of masking on the mental health of autistic women. You were invited to participate because you or your peer(s) and/or colleague(s) have identified you as someone who is a good fit for this research and would like to share their lived experience with us. The purpose of this study is to understand how masking has impacted the mental health of autistic women as well as the voices or themes present in their experiences. Through understanding the voices of these women through their unique perspectives and insight, the study aims to promote greater awareness of masking and the challenges that autistic women face to create better informed treatment outcomes and acceptance. Study Procedures: As a participant, you will be asked to participate in two interviews in total, Both of which will take place over the video meeting platform Zoom or in person, according to your preference and convenience, and will be recorded. The first interview will take approximately 45-90 minutes, during which you will be asked to share your experiences with masking, how you felt it has impacted your mental health, and how it has impacted your identity and self-perception as an autistic woman. Following the end of this interview, you will be able to choose a pseudonym you feel comfortable with to ensure anonymity. This pseudonym will be used instead of your real name, and any identifying information will be removed. The second follow-up interview will serve as a member check, during which you will have the opportunity to go over a summary of your transcript and engage in the interpretive process of data analysis. The researcher will ask for your input at this time to ensure the findings accurately reflect your experiences. Potential Risks and Discomforts: Risks associated with this research are minimal but may include discomfort from discussing personal views and experiences of identity development, masking, and mental health challenges in this context with an unfamiliar person. The SPID: EXPLORING THE IMPACT OF MASKING 211 researcher, who will be conducting all the interviews, will do her best to create a safe and comfortable space for you to share your experience. If at any point you feel uncomfortable or distressed, the interview will pause, and you will be able to choose to continue when you feel ready or end your participation. Potential Benefits to Participants and/or to Society: Participating in this study will assist clinicians and researchers to better understanding the voices and experiences of autistic women. The knowledge arising out of this study aims to contribute to understanding the unique experiences and challenges of this community. Further, it is the hope of the researcher to shed light on masking and to provide a safe space for fellow members of this community to grow and thrive as well as to increase awareness and acceptance from others who are not a part of this population. Confidentiality: Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be disclosed only with your permission or as required by law. For example, audio tapes and transcripts will be kept in a password-protected folder on the researcher’s computer. Paper copies of transcripts will be stored in a locked filing cabinet located within the researcher’s office. Audio tapes and transcripts will be kept until the completion of the research, and Trinity Western University has approved this study as meeting all its requirements for the completion of a thesis for the Master of Arts in Counselling Psychology program. "Please note that due to COVID-19, the interview is hosted by “Zoom" which is a video-conferencing software company located in the USA. All responses to the survey will be stored and accessed in the USA. This company is subject to U.S. laws, in particular, to the U.S. Patriot Act that allows authorities access to the records of internet service providers. It has been deemed unethical by Canadian Research Ethics Boards to save research data on a USA server for a long-term period, according to Canadian law and research ethics. However, it has been determined that for a short-term period, maximum of ten days, is acceptable to keep research data before it needs to be downloaded to a Canadian server. If you choose to participate in the interview, you understand that your responses will be stored and accessed in the USA for a maximum of ten days before being downloaded to a Canadian server. The security and privacy policy for Zoom can be viewed at http://www.zoom.us " Remuneration/Compensation: A $20.00 gift card will be provided for participating in this study. Participants will have the opportunity to select their choice of gift card. Contact for information about the study: If you have any questions or desire more information with respect to this study, you may contact the principal researcher, Shana Harrison or the faculty supervisor, Dr Deepak Mathew. Contact for concerns about the rights of research participants: If you have any concerns about your treatment or rights as a research participant, you may contact Elizabeth Kreiter in the Office of Research and Graduate Studies, Trinity Western University. Consent: Your participation in this study is entirely voluntary and you may refuse to participate or withdraw from the study at any time without losing your reward. Your withdrawal from this study is not possible after the researcher has removed all the information which may identify you, as it will then be impossible to identify who you are. If SPID: EXPLORING THE IMPACT OF MASKING 212 you choose to keep your own name as identification for your story in this research, you will be unable to withdrawal from the study after the data has been integrated into the data set. However, requests to change your name for publication of the research will be honoured. Signatures: Your signature below indicates that you have had your questions about the study answered to your satisfaction and have received a copy of this consent form for your own records. Your signature indicates that you consent to participate in this study and that your responses may be put in anonymous form and kept for further use after the completion of this study. ___________________________________________ _______________________ Research Participant ___________________________________________ Printed Name of the Research Participant Signature Date SPID: EXPLORING THE IMPACT OF MASKING 213 APPENDIX F: First Interview Guide Introductory Script: Thank you for your interest and willingness to be a part of this project. Your participation in this research is greatly appreciated. As you know, this research project seeks to understand the experiences of masking in autistic women and its impact on their mental health. I want to invite you to share as much or as little as you feel comfortable with. I have some questions that can act as a flexible guide for our conversation today, and there are no right or wrong answers; rather, I am most interested in learning about your experience. If you would like to end the interview, take a break, or skip a question, you can let me know at any time as we chat. Do you have any questions before we begin? Is there anything that would be helpful for me to know about you before starting? Is there anything I can do to make participating in the study more comfortable for you? Research Question: What are the voices present is autistic women’s experiences of masking? Guiding Questions: 1. As a way of getting started, can you tell me about your journey with autism? 2. Can you describe a specific instance or experience where you felt the need to mask your autistic traits as an autistic woman? 3. What are your thoughts and feelings when you engage in masking? 4. Can you share any stories that illustrate the challenges or benefits of masking in different contexts? 5. How has your experiences with masking evolved or changed over time, and what factors contributed to these changes? 6. How do you navigate the complex terrain of authenticity and conformity as an autistic woman? Are there moments when you've felt empowered by embracing your true self? 7. In your personal opinion, what are the challenges or benefits of being an autistic woman in our society? SPID: EXPLORING THE IMPACT OF MASKING 214 8. How do you think masking has influenced your self-perception and identity as an autistic woman? 9. What do you wish was different about how society perceives autism? What do you wish others knew about you? 10. How do you envision a society that supports and empowers autistic women? SPID: EXPLORING THE IMPACT OF MASKING 215 APPENDIX G: Debriefing Form Thank you for taking part in the present study seeking to understand the impact of masking on the mental health of autistic women. Your participation and willingness to share your experience is invaluable to this work and very much appreciated. After all the individual interviews have been conducted, an email will be sent out to schedule a follow up interview which will be conducted via Zoom. At this event, I will share preliminary findings and themes that have emerged from the data. Space and time will be provided for feedback, reflection, and engagement with the researcher. You have the right to withdraw your data from the study at any time during the analyzing period. Please contact Shana Harrison by 04/01/2024 if you would like to withdraw your data from the study. It will not be possible to withdraw data after 04/01/2024 because the results will be analyzed and used in the final thesis project. All your personal information will be confidential, and your identifying information will be fully anonymous and unidentifiable in the final project. Please feel free to contact the primary researcher, Shana Harrison or the research supervisor, Dr Deepak Mathew if you have any further questions. If you have any concerns about your treatment or rights as a research participant, you may contact Elizabeth Kreiter in the Office of Research and Graduate Studies. Thank you again for your generous participation and contribution to this project. SPID: EXPLORING THE IMPACT OF MASKING 216 APPENDIX H: Follow-Up Interview Thank you for your participation in the first interview. In this follow-up interview, we will review the summary of the results you received from your first interview to check that you feel it is accurate and reflects the content we covered, as well as your poem generated from the data analysis process. This will offer you an opportunity to debrief and ask me any questions. Questions: 1. After reading through the summary of your first interview, do you feel it is accurate and reflective of the content we covered? 2. a. What stands out to you? b. Is there anything you would like to change or clarify? c. Is there anything that surprises you? 3. What have you discovered or have you had any greater insights through this process? 4. What has this process led you to reflect on, if anything? 5. Is there anything that has not been talked about that you would like to include in your interview? 6. Do you have any questions for me? 7. What are you taking away from participating in this process? SPID: EXPLORING THE IMPACT OF MASKING 217 APPENDIX I: Data Analyst Confidentiality Agreement As a member of the team using the listening guide to analyze transcripts, you will be in possession of personal, and at times sensitive, information about individuals, possibly including their identities, locations, as well as their study transcripts. You are expected to keep all information confidential and dispose of all materials appropriately and in a timely manner. I, _______________________________, agree to maintain full confidentiality regarding all recordings and documentation received from Shana Harrison related to her project on autistic women’s experiences of masking. Furthermore, I agree: • To hold in the strictest confidence the identification of any individual that may be inadvertently revealed during the transcription or recorded interviews, or in any associated documents; • To not make copies of any recordings or computerized files of the transcribed interview texts, unless specifically requested to do so by Shana Harrison; • To store all study related recordings and materials in a safe, secure location as long as they are in my possession; • To return all recordings and study related documents to Shana Harrison in a complete and timely manner; • To delete all electronic files containing study-related documents from my computer hard drive and any backup devices. SPID: EXPLORING THE IMPACT OF MASKING • I am aware that I can be held legally liable for any breach of this confidentiality agreement, and for any harm incurred by individuals if I disclose identifiable information contained in the recordings and/or files to which I will have access. _______________________ ________________________ Printed Name Date ________________________ Signature 218 SPID: EXPLORING THE IMPACT OF MASKING 219 APPENDIX J: Confidentiality Agreement for Transcriptionist As a member of the team using the Listening guide to analyze transcripts, you will be in possession of personal, and at times sensitive, information about individuals, possibly including their identities, locations, as well as their study transcripts. You are expected to keep all information confidential and dispose of all materials appropriately and in a timely manner. I, _______________________________, agree to maintain full confidentiality regarding any and all recordings and documentation received from Shana Harrison related to her project on autistic women’s experiences of masking. Furthermore, I agree: • To hold in the strictest confidence the identification of any individual that may be inadvertently revealed during the transcription or recorded interviews, or in any associated documents; • To not make copies of any recordings or computerized files of the transcribed interview texts, unless specifically requested to do so by Shana Harrison; • To store all study related recordings and materials in a safe, secure location as long as they are in my possession; • To return all recordings and study related documents to Shana Harrison in a complete and timely manner; • To delete all electronic files containing study-related documents from my computer hard drive and any backup devices. SPID: EXPLORING THE IMPACT OF MASKING • I am aware that I can be held legally liable for any breach of this confidentiality agreement, and for any harm incurred by individuals if I disclose identifiable information contained in the recordings and/or files to which I will have access. _________________________ ______________________ Printed Name Date ______________________ Signature 220 SPID: EXPLORING THE IMPACT OF MASKING APPENDIX K: The Masking-Unmasking Integration Framework 221 SPID: EXPLORING THE IMPACT OF MASKING Note: This framework was created from the voices of masking, unmasking, and advocacy in the study, and contains the characteristics that were represented by the individual voices. 222