Diagnosing Subtle or Mild Autism
Most people associate autism spectrum disorder with outwardly visible traits: flapping hands, difficulty making eye contact, or trouble with conversation. But not everyone presents this way. Some autistic individuals develop coping strategies that allow them to “blend in” or suppress their differences. Others have traits that are simply less obvious to outsiders. As a result, many go undiagnosed for years, sometimes well into adulthood.
This post explores the experience of missed or late-diagnosed autism, especially when traits are more covert or hidden behind high levels of social camouflage.
The Problem with Stereotypes
One major reason for missed autism diagnoses is the persistent stereotype of what autism “looks like.” When a specific presentation is expected, such as a lack of speech, frequent meltdowns, or repetitive behaviors, they may overlook individuals who:
Speak fluently but struggle with social nuance
Follow rules, but feel intense internal anxiety
Perform well in school but feel exhausted by social demands
Are described as “shy,” “quirky,” “sensitive,” or “perfectionistic”
These are not necessarily mild cases of autism, just less visible ones.
Subtle Signs of Autism That Are Often Missed
Autistic traits can be internalized or masked, especially in individuals with high cognitive skills or those who have learned to adapt from a young age. Some subtle signs of autism include:
Deep fatigue after social interaction (social exhaustion)
Intense or narrow interests that are pursued independently
Reliance on routines or rituals that others don’t notice
Difficulty with open-ended tasks or vague instructions
Trouble navigating unspoken social rules
Sensory sensitivities that are managed privately (e.g., discomfort with certain fabrics, lights, or sounds, but not mentioning it)
Why Some Groups Are More Likely to Be Missed
Certain groups are at a higher risk of late autism diagnosis due to the way their traits are expressed:
Girls and women often display different patterns of social behavior and may be more likely to mask. This has led to underdiagnosis and misdiagnosis for years.
BIPOC individuals may have their behaviors misinterpreted through a biased lens, leading to diagnoses like conduct disorder or anxiety instead.
High-masking individuals (sometimes called “high-functioning,” though this term is falling out of favor) may appear to cope well outwardly, even as they struggle internally.
Going undiagnosed can have a lasting impact. Many people who receive an autism diagnosis later in life describe feeling confused, misunderstood, or "broken" growing up. They often internalize their struggles as personal failings rather than recognizing them as part of a neurological difference.
When the diagnosis finally comes, it can bring immense relief, but also grief for the years spent without adequate understanding or support.
What to Do if You Suspect Hidden Autism
If you or someone you care about seems to be “holding it together” but struggling beneath the surface, it may be time to look deeper. A comprehensive neuropsychological or developmental evaluation can help clarify whether autism is part of the picture.
When seeking an evaluation, it’s important to work with professionals who:
Understand the full range of autism spectrum presentations
Are familiar with autism masking and camouflaging behaviors
Recognize how autism may show up differently in girls, women, and marginalized groups
Autism doesn’t always look like what you expect. When traits are subtle, masked, or misunderstood, it can take years for someone to get the right diagnosis. By expanding our understanding of what autism can look like, we create more opportunities for people to access support, self-acceptance, and community at any age.
If you suspect that subtle or internalized traits of autism are being overlooked, consider reaching out for a comprehensive evaluation with a clinician experienced in high-masking autism and neurodiversity-affirming assessment. The right diagnosis can open the door to understanding, support, and connection.
Contact us to talk it through!