The Gatekeeping of Autism: Misdiagnosis and Challenges in Adult Autism Testing
Navigating the world as an autistic adult can be challenging enough, but when you’re trying to seek a diagnosis and hit walls of skepticism, misunderstanding, invalidation, and outright gatekeeping, it can be downright discouraging. Unfortunately, there’s been a troubling trend in the mental health field where some providers are gatekeeping autism diagnoses, especially for adults—particularly women. If this sounds familiar, you’re not alone, and it’s something we need to talk about.
Misdiagnosis of Autism: A Common Issue, Especially for Women
First off, let’s address the elephant in the room: misdiagnosis. It’s all too common for autistic people, especially women, to be misdiagnosed with other conditions like borderline personality disorder (BPD) or bipolar disorder. Why? Because many providers are simply not up to date on what autism looks like in adults, and they certainly don’t understand how it can present differently from the stereotypical images of autism we see in children. Autism in adults can be subtle, especially in those who mask their traits—a common occurrence in women who have learned to blend in socially. Unfortunately, many mental health professionals haven’t caught up with this reality. They might dismiss someone’s lived experience or fail to recognize the nuanced signs of autism in adults, which leads to incorrect diagnoses and, ultimately, the wrong treatment.
Why Clinicians Might Withhold an Autism Diagnosis
And then there’s the bizarre notion that people are somehow “faking” an autism diagnosis. This idea is baffling, to say the least. What could anyone possibly gain from pretending to be autistic? There are no perks or advantages that come with an autism diagnosis—no secret club or special treatment. On the contrary, an autism diagnosis is a critical step toward understanding oneself, accessing appropriate support, and receiving the correct care. So, when clinicians act as gatekeepers, they’re not protecting some mythical boundary; they’re actively harming people who need help.
Some clinicians might mistakenly believe that autism is being over-diagnosed or that individuals are faking symptoms to gain attention or access to services. This misconception stems from a limited understanding of how autism manifests, particularly in adults and women who may not fit the stereotypical image of autism. Such beliefs can lead to dismissive attitudes, where genuine concerns are not taken seriously, and people seeking help are viewed with suspicion. This not only invalidates the experiences of those who are autistic but also contributes to the harmful practice of diagnostic gatekeeping, where only those who fit a narrow, outdated criteria are given a diagnosis. This creates a barrier to necessary support and resources, leaving many without the recognition and assistance they need to thrive.
The Harmful Effects of Diagnostic Gatekeeping on Autistic Adults
The bigger question we should be asking is: what are these gatekeeping clinicians getting out of withholding an autism diagnosis? It seems some think their job is to decide if someone is “autistic enough” to warrant a diagnosis, demanding that clients jump through hoops to prove themselves. This approach is not only damaging, but it’s also a betrayal of trust. People seeking an autism diagnosis are looking for answers and validation, not an obstacle course designed to test their resilience. When clinicians disregard the lived experiences of their clients and fail to listen, they not only withhold the necessary diagnosis but also prevent their clients from accessing the correct treatments, leading to more harm down the line. No one gains anything from a fake diagnosis—what they gain from a real diagnosis is understanding, access to appropriate support, and a sense of relief that comes with finally having a name for their experiences.
The Consequences of a Misdiagnosis of Autism
When autism is misdiagnosed as another condition, such as borderline personality disorder or bipolar disorder, it can lead to inappropriate treatments that fail to address the person’s actual needs. For example, therapies for mood disorders may not focus on sensory sensitivities or social communication challenges, which are core aspects of the autistic experience. Misdiagnosis can also lead to feelings of frustration, invalidation, and further mental health issues. For adults seeking clarity about their neurodiversity, the right diagnosis can be life-changing, providing a clearer path to personal growth and the right support.
The Impact of Masking on Autism Diagnosis in Adults
Many autistic adults, especially women, have developed a skill known as "masking," where they consciously or unconsciously hide their autistic traits to fit societal expectations. Masking can involve mimicking social behaviors, suppressing stims, or pretending to understand social cues, making it harder for clinicians to identify autism in adults. This can lead to further diagnostic gatekeeping, as many clinicians may not recognize the underlying autistic traits beneath the mask. Unfortunately, prolonged masking often results in mental exhaustion, burnout, and worsening mental health, making it all the more crucial that clinicians are trained to recognize these hidden signs.
Questions to Ask When Seeking Neurodiversity-Affirming Autism Testing
If you’re an adult seeking autism testing, it’s crucial to do your homework. Ask questions, and make sure the provider you’re seeing is neurodiversity-affirming and truly understands what autism looks like in adults—particularly in women (if relevant to you) and those who mask their traits. You deserve a clinician who listens to you, validates your experiences, and provides a safe space for you to explore who you are.
When looking for autism testing as an adult, it's important to choose a clinician who truly embraces a neurodiversity-affirming approach. Such a clinician will recognize that autism manifests differently in adults, particularly in women and those who have learned to mask their traits. They’ll focus on understanding your unique experiences rather than fitting you into a narrow definition of what they think autism looks like. A neurodiversity-affirming professional is current with research on adult autism and listens to your experiences with respect and validation.
The Importance of Self-Advocacy During the Diagnostic Process
If you suspect you are autistic and are seeking a diagnosis, self-advocacy is key. Don’t be afraid to ask your clinician tough questions about their experience with diagnosing autism in adults, especially those who have learned to mask or who may present differently from the outdated stereotypes. Being informed and prepared can help ensure that your voice is heard and that the clinician understands your unique experiences. If you feel that your concerns are being dismissed, it’s okay to seek out another provider who will take you seriously. The right diagnosis can open doors to the support and accommodations you deserve.
This directly ties into the dangers of diagnostic gatekeeping, where clinicians who lack this affirming approach might misdiagnose, dismiss, or deny your experiences, leading to inadequate or even harmful treatment. To avoid this, ensure that your chosen clinician is genuinely committed to understanding the broad spectrum of autism and providing an inclusive and supportive evaluation process.
Finding a Neurodiversity-Affirming Clinician for Autism Testing
As a Psychologist specializing in neurodiversity-affirming autism testing, I strive to create that safe environment. I believe in the importance of understanding and acknowledging the unique ways autism can present in adults, and I’m committed to ensuring that my clients feel heard and validated—not dismissed or judged. If you’re on this journey, know that you don’t have to face it alone, and that the right support is out there. You deserve to be understood and to receive the care that aligns with your true self.
Where Can I Find Adult Autism Testing Near Me?
If you’re feeling uncertain about the testing process or have experienced any form of gatekeeping or invalidation in the past, I encourage you to reach out to me. My approach to autism testing is rooted in neurodiversity-affirming practices, ensuring that your unique experiences and identity are respected and understood. Whether you’ve been searching for answers for a while or you’re just beginning to explore your neurodiversity, I am here to provide a safe, supportive space where you can feel heard, validated, and empowered. You deserve clarity and care, and I’m committed to helping you find it on your terms.
Author: Heather Joppich, PhD
Dr. Joppich is a Licensed Psychologist and owner of Zephyr Care Mental Health. She specializes in neurodiversity-affirming assessments for autism, ADHD, and mental health concerns. Testing is available in Nashville, TN as well as well as virtually to people in most other states.
