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Rethinking Our Approach to Mental Health Care for Autism

A Personal Perspective: A new focus on self-discovery, identity, and community.

Key points

  • A meta-analysis suggests that a sense of identity, empowerment, and belonging are key to autistic well-being.
  • While positivity around autistic identity correlates to autistic well-being, autistic traits are often shamed.
  • Masking one's autistic traits is a common response to rejection, yet this often leads to loneliness.

My 10-year-old legs would often drag back and forth on the swings at recess. I'd try to make friends at times. Yet often I felt as if I were at the end of a joke I didn't understand. Weirdness followed me so much that I remembered asking my parents if they had adopted me from aliens (and if they would tell me if they had because I could handle it).

At age 11 or so, a new word came into my vocabulary: Asperger's Syndrome. It helped explain some of my tendencies, yet as I grew and learned of it, I resented it. I felt stereotyped. Kids with Asperger's liked routine. Kids with Asperger's didn't like non-cotton shirts. Kids with Asperger's struggled to make friends. Much of the information I heard about autism was harmful—ideas like autistic people don't truly have empathy. Though ideas such as these have since been debunked, it made me want nothing to do with "the spectrum." I felt somehow even more estranged.

Other labels followed as I entered adolescence, which I related to in varying degrees. Still, it wasn't until adulthood that I appreciated being neurodivergent as part of my identity.

Recently, the mental health crisis among autistic individuals has received a great deal of media attention. Tragedies such as the link between autism and suicide have come front and center. Still, less spotlight has been placed on autism as it relates to identity and connection or autistic well-being. Perhaps if we are to understand what lies behind the autistic mental health crisis, it would be wise to first look into what fosters autistic well-being.

Autistic Well-being

Early this year, a study published in the journal Neurodiversity investigated autistic well-being through a meta-analysis of 89 studies. Questions used to review these studies drew directly from a lived experience advisory panel adding autistic voices to the research sector. Several themes were found, including the roles of identity, empowerment, and belonging within a wider community as keys to well-being (Najeeb and Quandt, 2024).

While interventions in autism have traditionally focused on behavior and skills building, research suggests that what may be more important to autistic individuals is something less tangible: to be able to be one's self and part of the collective.

Effective neurodiversity psychotherapy can encourage journeys of self-discovery and belonging. Still, individual therapy and traditional methods of social skills delivery have limits. Here, within this social model of disability, many appeared to report social aspects of the condition as more impactful than any kind of autistic behaviors that have at times been targeted. On the contrary, some expressions of these aspects of self might be key to autistic mental health.

Autistic Identity, Identity Confusion, and Masking

A study of 42 autistic young adults found that positive associations with an autistic identity correlated positively with quality of life (Lamash et al., 2024). Sadly, another study of 30 autistic adolescents and their families uncovered that many felt "left out" and unaccepted. They cited realities of sensory overload, bullying, misunderstanding by teachers, and lack of support as important aspects of this (Trew, 2024).

As a neurodivergent youth myself, I remember walking the balance between a reality where the social and sensory behaviors that made me feel more comfortable, things like deep diving into my interests, fidgeting, and looking away, were often greeted with laughter and unkindness. Yet, to blend in, I had to change a bit of who I was. I had to "act normal."

And people do that. Masking.

Masking is a hiding of aspects of ourselves to blend in. It's something autistic people do often, and, unfortunately, traditional social skills training has sometimes encouraged this. Masking might make for more normal conversations, but it often leads to less genuine connections.

A meta-analysis has shown that loneliness is common in autism and is linked to poor outcomes, including depression, thoughts of suicide, and anxiety. Perhaps ironically, masking one's autistic traits has also been linked to loneliness in this meta-analysis (Grace et al., 2022). On the contrary, acceptance of one's self has been linked to decreased loneliness in autistic adults.

Masking has been independently shown to create damage to autistic mental health, including having connections with depression and lower self-esteem. Unsurprisingly, individuals who have experienced interpersonal rejection are more likely to mask or camouflage their autistic traits to fit in (Evans et al., 2023). Repeated masking can create a scenario where one does not know what is the self and what is the mask, leading to identity confusion and self-rejection.

Celebrating Neurodiversity and a Welcoming Community

A study of 180 autistic adults found that acceptance of autism as part of one's identity and willingness to self-disclose is linked to less camouflaging (Cage, 2020). Still, one may not always feel comfortable sharing their autistic status. Discrimination, ablism, and stereotyping are realities in our culture. Plus, while autism may be part of one's identity, not every autistic person assumes autism as their whole identity.

Connection with neurodivergent communities and having a sense of solidarity with other autistic people have been linked to measures of psychological well-being in autistic adults (Cooper et al., 2023). These relationships foster a level of understanding that encourages acceptance on all sides. Engagement in a joined community among autistic individuals has also given rise to initiatives of advocacy for a more hospitable world for neurodivergent folk in areas as diverse as education, the workforce, and healthcare.

We need more spaces where it is welcome for individuals of all ways of thinking and experiencing the world to share openly. Through community, self-acceptance, and belonging, we may do wonders for autistic mental health.

Neurodiversity-Affirming Psychotherapy

Psychotherapists and other mental health professionals have the opportunity to exemplify the celebration of neurodiversity through neurodiversity-affirming practices. This can include listening to autistic voices, engaging in blunt discussions regarding masking, and augmenting processes of self-discovery.

This is not to say that all there is to psychotherapy with autism is acceptance. Many autistic individuals seek psychotherapy for painful, real concerns, such as unwanted or obsessive thoughts, anxiety, and depression. These can be addressed with a variety of evidence-based psychotherapies within a neurodiversity-affirming context. Yet, a focus first on strengths and well-being may bring us further toward our goal of fostering autistic mental health.

To find a therapist near you, visit the Psychology Today Therapy Directory.


Cage, E., & Troxell-Whitman, Z. (2020). Understanding the relationships between autistic identity, disclosure, and camouflaging. Autism in Adulthood, 2(4), 334-338.

Cooper, K., Russell, A. J., Lei, J., & Smith, L. G. (2023). The impact of a positive autism identity and autistic community solidarity on social anxiety and mental health in autistic young people. Autism, 27(3), 848-857.

Evans, J. A., Krumrei-Mancuso, E. J., & Rouse, S. V. (2023). What You Are Hiding Could Be Hurting You: Autistic Masking in Relation to Mental Health, Interpersonal Trauma, Authenticity, and Self-Esteem. Autism in Adulthood.

Grace, K., Remington, A., Lloyd-Evans, B., Davies, J., & Crane, L. (2022). Loneliness in autistic adults: A systematic review. Autism, 26(8), 2117-2135.

Lamash, L., Sagie, D., Selanikyo, E., Meyer, S., & Gal, E. (2024). Autism identity in young adults and the relationships with participation, quality of life, and well-being. Research in Autism Spectrum Disorders, 111, 102311.

Najeeb, P., & Quadt, L. (2024). Autistic well-being: A scoping review of scientific studies from a neurodiversity-affirmative perspective. Neurodiversity, 2, 27546330241233088.

Trew, S. (2024). Made to feel different: Families perspectives on external responses to autism and the impacts on family well-being and relationships. Autism, 13623613231221684.

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