The Exhaustion of Performing Neurotypical
Why Late-Diagnosed Adults Are Burning Out
They've been doing it for so long, they don't even realize they're doing it anymore. The careful modulation of voice so they don't sound "too intense." The mental rehearsal of small talk before entering the coffee shop. The way they force eye contact until it feels like staring, then look away too quickly and wonder if that seemed weird, too.
This is a tiny part of the exhausting world of masking: performing neurotypicality in a world that demands conformity. And late-diagnosed (or undiagnosed) autistic adults are reaching their breaking point.
The Invisible Performance
For late-diagnosed autistic and ADHD adults, masking wasn't a conscious choice. Survival demanded it. Many learned early that their natural responses weren't acceptable. Perhaps they were told they were "too loud," "too sensitive," or "too much." They may have watched other children navigate social situations that felt like speaking a foreign language, so they became students of human behavior, cataloging facial expressions and memorizing scripts.
They got good at it. So good that they fooled everyone, including themselves.
But masking comes at a neurobiological cost. The nervous system runs a marathon every single day, and eventually, it catches up.
The Shared Language of Non-Conformity
What strikes us in clinical practice is how often neurodivergence and queerness intersect, and we're talking about more than statistics here. Both experiences involve navigating a world built around normative assumptions: neurotypical ways of processing information and heterosexual, cisgender ways of existing in the world.
Both communities understand the exhaustion of translation work. Us queer folks often have remarkably similar processes: learning to modulate our voices, monitor our gestures, and calculate the safety of authentic expression in any given space. The hypervigilance looks nearly identical: constantly assessing whether being real is safe in this moment.
And I really appreciate an old psychoanalyst’s construct here (no, not Freud).
D. W. Winnicott's concept of the true self versus false self becomes particularly relevant as a way of understanding the challenge ahead when masking has taken over.
When authentic expression gets met with rejection or harm, whether that's neurological differences or sexual and gender identity, individuals develop what Winnicott called a "false self" to protect the true self from annihilation. Over time, this protective false self can become so dominant that accessing the true self feels foreign or terrifying.
And bell hooks perhaps said it even better than Winnicott.
“Queer' not as being about who you're having sex with (that can be a dimension of it); but 'queer' as being about the self that is at odds with everything around it and that has to invent and create and find a place to speak and to thrive and to live.”
- bell hooks
The Breaking Point
Late-diagnosed adults don't usually seek help because they finally feel ready to embrace their neurodivergence. They seek help because they're falling apart.
The presentation often looks like this: successful career, seemingly good relationships, but suddenly they can't get out of bed. They're having panic attacks in Target. They're snapping at people they love. They're exhausted in a way that sleep doesn't fix, and a medical leave from work won’t even take enough pressure off.
Traditional psychiatry might label this depression or anxiety. What we often see it as is autistic burnout: the collapse of an unsustainable system of self-regulation.
Why "You Don't Look Autistic/ADHD" Causes Harm
When healthcare providers say "you don't look autistic" or "everyone's a little ADHD," they think they're being reassuring, or diagnostically responsible (not overdiagnosing normal human variation). Instead, they're dismissing decades of internal struggle and adaptive strategies, and lending credence to that voice in folks’ heads that says “see, you’re just making all this up.”
What they're really saying is: "Your performance has been so convincing that I can't see your authentic self." But that performance came at a cost. These folks have been translating every social interaction, suppressing natural movements, forcing themselves into sensory environments that feel overwhelming, and wondering why they're exhausted all the time.
The fact that someone "doesn't look neurodivergent" doesn't prove they're not neurodivergent. It proves how hard they've been working to survive in a world that wasn't built for their brain. And as providers, we have to dig deeper before coming to a decision about diagnosis.
The Medical Gaslighting Problem
Late diagnosis often comes after years of seeking help for what felt like inexplicable struggles. Many were told they had anxiety, depression, bipolar disorder, or just needed to "try harder." Others were dismissed entirely because they were "high-functioning."
Research shows that autistic traits, especially in women and AFAB (assigned-female-at-birth) individuals, are frequently misinterpreted or overlooked entirely. Attention to detail gets called "perfectionism." The need for routine gets labeled "rigidity." Sensory sensitivities get dismissed as "anxieties"
Meanwhile, these folks are trying to function in a world that feels like it's speaking a different language, and everyone keeps telling them the problem is internal, and can be solved with an SSRI, CBT, or incremental exposure to sensory triggers (no, no, and HELL NO).
The True Self in Hiding
What emerges in sessions with late-diagnosed adults is often profound grief. They're mourning more than just the years of struggle. They're grieving the authentic self that went into hiding so early that they barely remember what it felt like to exist without performing.
This mirrors what many queer folks experience, too: mourning the spontaneous, authentic expression that was sacrificed for safety. Both groups share feelings of "wearing a costume" or "playing a character" in their daily lives.
The work becomes about slowly, carefully creating space for the true self to emerge while acknowledging that this emergence happens in a world that may still not be safe for full authenticity.
Permission to Exist Authentically
Recovery from burnout doesn't mean learning better coping strategies or building more resilience. That’s just inside-out - we have to also look at outside-in interventions. Recovery means creating conditions where authentic existence becomes possible.
This might look like stimming in public without shame, taking longer to process information without apologizing, keeping camera off for some zoom meetings, asking for reasonable accommodations at work or school, or setting boundaries around social activities based on actual capacity rather than expectations.
For many, unmasking is terrifying because the mask has been protection. But unmasking is also the path to sustainable existence.
Beyond Individual Pathology
While we work with individuals on these journeys, we have to acknowledge that this problem isn't primarily individual. When neurodivergent ways of being are consistently met with correction, punishment, or exclusion, the logical response is developing protective strategies. If you keep coming at me with a knife, I will build a suit of armor to survive. That’s how I make it to adulthood. So strengthening my armor isn’t going to actually solve this problem.
This is why approaches that focus solely on helping people "cope better" miss the mark. Yes, individuals need sustainable ways of existing in the world, and some actions within their control to take that can ease pain and suffering. But they also need validation that many of their struggles stem from living in systems designed around narrow definitions of acceptable ways of being.
The Path Forward
Healing from burnout often involves several parallel processes: grieving the decades of energy spent performing, learning to trust one's own perceptions after years of being told they were wrong, and slowly building authentic relationships where the real self can exist safely.
Crucially, the work of building coping skills cannot revolve around becoming "better at being neurotypical." Recovery means finding sustainable ways to be authentically oneself while navigating systems that often don't accommodate neurological diversity.
If you recognize yourself in this description, I want to punctuate a few things.
Your exhaustion isn't weakness. It's the natural result of decades of translation work.
You deserve care that honors both your brilliant adaptations and your right to exist authentically.
Systemic problems should be met with systemic solutions - AND there are strategies, tools, and treatments that might help you be better prepared to start this courageous journey.
At Integra, we work with late-diagnosed neurodivergent adults who are ready to explore what authentic living might look like. We understand that individual struggles often reflect systemic failures to accommodate neurological diversity. If this resonates, we're here to support the journey toward sustainable authenticity.
Click here to explore assessment options.
References:
https://www.autism.org.uk/advice-and-guidance/topics/behaviour/masking
https://www.forbes.com/sites/forbeseq/2024/06/13/autistic-people-more-likely-to-identify-as-lgbtq/
https://www.sas.upenn.edu/~cavitch/pdf-library/Winnicott_EgoDistortion.pdf
https://neurodivergentinsights.com/autistic-burnout-vs-depression/
https://link.springer.com/article/10.1007/s40489-020-00197-9
