We learnt how to spot appendicitis. We can recite the signs of meningitis in our sleep. But autism? Especially in adults? Especially in women, nonbinary people, and those without learning disabilities? That’s where our medical education tends to fall short.
Most of us were trained on an outdated, male-centric model of autism: the non-verbal child lining up toys, avoiding eye contact, rocking in a corner. But the reality? Autism doesn’t always look like that. Not in our waiting rooms. Not in the adults we see every day.
Many autistic individuals—particularly those assigned female at birth—become masters of camouflage. They mask, mimicking neurotypical behaviours so convincingly that we often miss it. They make eye contact (because they were told to). They smile and respond at the “right” moments. They blend in—only to collapse at home, utterly drained from holding it together.
We may not see meltdowns in the traditional sense. More often, we see shutdowns: withdrawal, chronic fatigue, or what gets coded as anxiety, depression, or even personality disorder. We hear about sensory overwhelm, insomnia, gut issues—and miss the neurodevelopmental pattern underneath.
Autism isn’t rare. It’s under-recognised—especially in those who’ve spent years learning to pass. The cost of a missed diagnosis? Decades of misdirected treatment, confusion, and internalised shame.
We need to upgrade our clinical lens. Autism can look like the academically successful child with zero friends. The adult constantly overwhelmed by bright lights and noise. The “anxious” patient who melts down during an MRI. It doesn’t always shout—it often whispers.
If we want to deliver truly inclusive healthcare, we need to stop looking for autism in stereotypes—and start seeing it in reality.
