Why Outdated Autism Assessments Are Harming Sensitive Women and High-Masking Adults by Julie Bjelland, LMFT

Most autism assessments are failing, and in many cases, harming highly sensitive adults, especially women.

Most autism assessors are still relying on outdated diagnostic criteria that were never designed to reflect the lived experience of the majority of autistic people. These criteria, rooted in narrow research samples of young, white boys, emphasize visible traits and co-occurring disorders while ignoring the nuanced profiles of highly sensitive adults, particularly women.

The result

Thousands of women seeking answers are told they cannot be autistic because they do not fit outdated stereotypes. They often hear things like:

“You do not seem severe enough to be autistic.”
Autism exists on a spectrum, and many women learn to mask their challenges for years, appearing “less affected” while struggling internally.

“You make good eye contact.”
Women are often socially conditioned to maintain eye contact even when it feels uncomfortable, which hides their authentic neurotype.

“You are too empathetic.”
We got this wrong about autism previously. Many autistic people, especially those with the Sensitive Autistic Neurotype, are deeply empathetic and emotionally attuned.

“You are too successful.”
High achievement can be a survival strategy. Many autistic women overcompensate and work tirelessly to survive in a world not designed for their neurology.

“You seem socially fine.”
Many autistic women have spent their lives studying social dynamics to fit in. What looks like ease on the outside often comes at the cost of exhaustion and burnout.

These observations dismiss the invisible reality of masking. They erase the silent suffering of women who have been conditioned since childhood to perform, pretend, and fit in. And they leave people feeling unseen, broken, and betrayed by the very systems meant to support them.

Why this dismissal happens

Limitations of current diagnostic tools
The current "gold standard" autism assessments most often used by practitioners include the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview–Revised (ADI-R).

These tools were developed using narrow research samples of young, white boys and focus primarily on visible traits and observable behaviors. As a result, they often miss autistic women and high-masking adults whose internal experiences and coping strategies differ from those early models.

Several people who waited over a year to access these assessments were told they were not autistic, only to later discover through lived-experience-informed evaluation that they were. This reflects how current diagnostic systems can fail the very individuals most in need of understanding and support.

A recent review estimated that 97% of autistic people over age 60 remain undiagnosed, and among those aged 40–59, about 89% are undiagnosed. These numbers reveal how profoundly outdated assessments are failing to identify autistic adults, particularly women and highly sensitive individuals who mask or present differently than stereotypes suggest.

Lack of practitioner training
Many practitioners are not trained to recognize high-masking autism. They rely on checklists or superficial observations instead of exploring internal lived experience.

Societal conditioning of women
From early childhood, anyone socially conditioned as female is taught to prioritize others, be agreeable, and perform socially. Many learn to force eye contact, mimic social behaviors, and suppress discomfort. To an untrained eye, this looks like “not autistic,” but in reality, it is the result of years of masking.

The harm caused by outdated assessments

Dismissal is not neutral. It causes harm.

• It reinforces shame. Being told “you are not autistic enough” confirms the painful lifelong belief of being broken or flawed.

• It denies clarity. Without recognition, adults lose access to the self-understanding and relief that come with accurate diagnosis.

• It perpetuates suffering. Many remain unsupported in families, workplaces, and healthcare systems.

• It erodes trust. People lose faith in the very professionals meant to help them.

On the other hand, recognition is transformative. When women and high-masking adults learn they are autistic, their life stories finally make sense. They replace self-blame with self-acceptance, and they begin to see both their struggles and their strengths as part of a valid neurotype.

Why knowing you are autistic matters as an adult

Receiving a diagnosis often feels like finding the missing piece of a puzzle. It brings:

Validation: confusing lifelong experiences finally make sense.
Self-kindness: blame softens into compassion.
Improved relationships: loved ones understand and support more effectively.
Belonging: connection with others who share similar experiences.
Advocacy: a name and framework for requesting support at work, in healthcare, and at home.

I have witnessed this transformation at every age. Whether diagnosed at 30, 40, or 80, the outcome is the same: the feeling of being flawed is replaced with clarity, belonging, and self-compassion. ❤️

Autism as a neurotype, not a disorder

Autism is not an illness. It is a neurotype, a natural variation in human wiring.

We do not need to cure autism. We need to support autistic people to be accepted and understood.

Just as biodiversity is essential in nature, neurodiversity is essential in humanity. Different neurotypes bring different strengths. Some of the most remarkable innovations, art, and scientific breakthroughs exist because autistic people exist.

The reality of masking

Masking is not evidence of less autism. It is evidence of survival.

Women and AFAB individuals learn that fitting in means safety.

Masking often involves suppressing stims, forcing eye contact, copying social cues, and hiding distress.

This comes at a steep cost, including burnout, anxiety, depression, and illness.

Unmasking takes years. It means learning how to accommodate one’s true needs and build a life that feels authentic. Any assessment that does not account for masking is incomplete.

Guidance for practitioners

If you are offering autism assessments, you must:

Update your lens beyond outdated criteria.
Understand masking and its impact on women and AFAB adults.
Adapt your process to explore the internal lived experience.
Listen to the voices of autistic adults, especially women.
Recognize autism as a neurotype, not a disorder.

If you cannot do these things, you are harming the very people who come to you for help.

Guidance for adults seeking assessment

If you are seeking an autism assessment as an adult, especially if you are a high masker or highly sensitive woman, ask your practitioner:

Do you have experience diagnosing masking individuals?
Do you understand how autism presents in women and AFAB people?
Have you adapted your assessment process to explore internal lived experience, not just external behavior?
Are you still relying on diagnostic criteria created many years ago, or have you updated your approach?
Have you listened to the lived experiences of autistic adult women?

If the answer is no, find someone who has.

And if deep down you believe you are autistic but a practitioner tells you that you are not, do not let that invalidate your lived experience.

A better approach

Through years of listening and research, I have developed an assessment method informed by thousands of sensitive women. It looks beyond checklists and embraces:

• The internal, lived experience and costs of masking

• The overlap of high sensitivity and autism

• The unique presentations of women

• Both struggles and extraordinary strengths

True understanding means seeing the whole person. It means asking the deeper questions that reveal lived reality, not just checking boxes.

If you are seeking answers or clarity about yourself, I offer video autism assessments based on lived experience so you are not missed and you are validated.

You deserve that clarity. You deserve that peace. You deserve to be seen.

✨ Learn more about autism assessments and resources for the Sensitive Autistic Neurotype

Also, explore my research and resources about the Sensitive Autistic Neurotype. Many people find deep validation and relief through self-understanding and community connection. You can:

• Take my Free Autism Quiz to explore how sensitivity and autism may overlap.

• Join my Adult-Discovered Autistic Group inside the Sensitive Empowerment Community to connect with others who understand your lived experience.

• Listen to my podcast, where I share insights, stories, and conversations about the Sensitive Autistic Neurotype.

• Read my autism articles on the blog for compassionate education and guidance.

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🕊 Author Bio

Julie Bjelland, LMFT, is a psychotherapist, author, and founder of the Sensitive Empowerment Community, supporting sensitive and neurodivergent people worldwide. She specializes in high sensitivity and adult-discovered autism, helping women understand the Sensitive Autistic Neurotype and embrace their authentic selves with compassion. Julie offers lived-experience-based autism assessments, online courses, and global community spaces that foster belonging and empowerment.

❤️ Explore more resources at JulieBjelland.com

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