DOUBLE MASKING: WHAT RESEARCH SAYS ABOUT AUTISM, ADHD, AND CAMOUFLAGING IN QUEER AND TRANS ADULTS
Many queer and trans people already know what it feels like to hide parts of themselves to stay safe. Watching your voice, your posture, your reactions. Deciding, moment to moment, how much of yourself is safe to show. For a growing number of autistic and ADHD queer and trans adults, that same exhausting calculation is also happening around their neurodivergence, often without them realizing it, and often without a clinician ever asking about it.
The Overlap Is Larger Than Most Assessments Account For
A large 2020 study using data from more than 600,000 participants found that transgender and gender diverse adults are three to six times more likely than cisgender adults to be diagnosed as autistic. The same research team found that this pattern held even among people without a formal diagnosis, since transgender and gender diverse participants scored higher on self report measures of autistic traits regardless of diagnostic status.
More recent research has looked specifically at how sexual orientation affects masking behavior. A 2025 study using the Camouflaging Autistic Traits Questionnaire found that sexual minority autistic adults reported significantly higher levels of masking than heterosexual autistic adults. Researchers connected this finding to minority stress theory, the idea that carrying the weight of stigma and marginalization adds its own layer of chronic stress on top of whatever else a person is navigating.
Other work has moved beyond social masking to look at physical traits as well. A study on camouflaging of repetitive movements found that autistic people, including transgender adults, do not only hide social difficulties. Some also consciously suppress repetitive physical behaviors like stimming, a pattern that had received little research attention until recently.
Why "Double Masking" Is Its Own Kind of Load
Researchers have started using the term double masking to describe what happens when someone is suppressing both their neurodivergent traits and their gender or sexual identity at the same time. A 2024 study on transgender and non-binary autistic adults examined how autism related and gender minority related stress, combined with camouflaging, shaped mental health outcomes in this population, and found that both were relevant to understanding why this group tends to fare worse on measures of wellbeing than either autistic or transgender adults considered separately.
A separate study in Molecular Autism made a related point when discussing why this overlap deserves more clinical attention. Researchers noted that autistic adults generally report higher rates of transgender, non-binary, and gender fluid identities than the general population, and flagged that this group already faces greater mental health risk than cisgender individuals, which makes understanding the effects of camouflaging in this specific population especially important.
Qualitative research adds texture to these numbers. Interview based studies with autistic transgender adults describe camouflaging not as a single strategy but as an ongoing, effortful process of adopting behaviors to fit into neurotypical environments, one that autistic trans people describe navigating in their own words rather than through a checklist of symptoms.
Why General Assessment Tools Miss This
Most standardized measures of autistic or ADHD traits were normed on populations that did not account for the added layer of identity concealment many queer and trans people already practice. When a clinician cannot separate "trained to hide this because it feels unsafe to be different" from "does not have this trait at all," the assessment risks missing the diagnosis entirely, or misreading years of adaptive concealment as an absence of traits rather than evidence of them.
This is part of why we ask about identity history as a routine part of assessment, not an aside. Someone who has spent years managing how much of themselves is visible in public may present very differently than the diagnostic criteria expect, not because the traits are not there, but because concealment has become second nature.
What This Looks Like at CCW
When we sit down with a queer or trans client for a neurodivergence assessment, we are listening for the effort behind the performance, not just the performance itself. We ask about energy after socializing, about what changes when someone is alone versus in public, about whether behaviors that look "typical" on the surface actually take conscious, exhausting effort to maintain. We treat a lifetime of successful camouflaging as data, not as evidence against a diagnosis.
The research is still catching up to what many queer and trans neurodivergent people have already lived. Our job is to make sure the assessment room is one of the places where that lived experience gets taken seriously.
Identity Aligned ADHD & Autism Assessment Inquiry Form
If you would like to move forward with scheduling a screening phone call, please complete the Identity Aligned ADHD & Autism Assessment Inquiry Form, and Julie will reach out to you within three business days to schedule your screening.
Warrier, V., Greenberg, D. M., Weir, E., Buckingham, C., Smith, P., Lai, M. C., Allison, C., & Baron-Cohen, S. (2020). Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nature Communications, 11, 3959.
McQuaid, G. A., Lee, N. R., & Wallace, G. L. (2025). Self-reported masking in sexual minority and heterosexual autistic adults. Autism.
White, L. C. J., Vel Ixqe, K., Goodall, K., & Gillespie-Smith, K. (2024). Minority stress, camouflaging, and mental health outcomes in transgender and/or non-binary autistic adults. Autism in Adulthood.
Is social camouflaging associated with anxiety and depression in autistic adults? (2021). Molecular Autism.
Autistic trans camouflaging: an early phenomenological exploration. (2024). Psychology & Sexuality.