Therapy for High-Masking Neurodivergence
Many adults are realising, often in their thirties, forties, or later, that the way they have always experienced the world makes more sense through the frame of neurodivergence. Words like “high-masking”, “AuDHD”, and “late-identified” have become widely used in the past few years, and for good reason. They describe an experience that has been overlooked for a long time.
If you have been wondering whether some of what you notice about yourself fits, you are part of a growing group of adults asking the same question. This article covers what high-masking neurodivergence looks like, why it often goes unrecognised, what therapy can offer, and how online delivery often suits neurodivergent adults particularly well.
What high-masking neurodivergence looks like
Masking is the often unconscious work of presenting in ways that feel acceptable, expected, or safe. For neurodivergent people, this can include:
- Forcing eye contact, mirroring others’ tone and pace, scripting conversations in advance
- Suppressing stims (small movements that help with regulation) or substituting with socially camouflaged versions
- Pushing through sensory environments that are genuinely overwhelming
- Performing focus, interest, or ease that does not match the internal experience
- Constantly monitoring how you are coming across and adjusting in real time
A high-masking presentation does not mean masking is happening without cost. The cost shows up in fatigue, burnout, anxiety, depression, or a sense of disconnection from one’s own self. Many high-masking adults describe a feeling of having performed a version of themselves for as long as they can remember and no longer being sure what is performance and what is real.
Why it often gets missed
Diagnostic frameworks for autism and ADHD were built on observations of presentations more visible in younger boys. Adults whose presentations are quieter, more internal, or more compensated have been routinely missed.
Common reasons high-masking neurodivergence is not identified earlier include:
- Strong academic or work performance, which is often read as “no problem here”
- Effective social camouflaging that becomes invisible to others over time
- Earlier diagnosis of anxiety, depression, OCD, or BPD that captures part of the picture but not all of it
- Cultural or family contexts where masking was implicitly required
- Gendered patterns in how autism and ADHD have historically been recognised
Coming to a realisation later in life can be equally as relieving as it can be disorienting.
What a late realisation can bring
People come to an understanding of being neurodivergent in many ways: commonly, this might happen through experiencing a child’s diagnosis, through reading or listening to someone else’s account, through a therapist raising it, or through years of putting pieces together themselves.
What follows is not the same for everyone, however, commonly reported responses include:
- Relief at finally having an explanation that fits
- Grief for the years spent assuming the difficulties were personal failings
- Reframing of past experiences in school, work, and relationships
- Anxiety about how, when, and whether to share this with others
- Overwhelm surrounding one’s own identity. For example, “if I have been masking this long, what is actually me?”
Therapy can hold this whole arc. It does not need to start with a diagnosis. It can start with simply noticing the patterns.
What neurodivergent-affirming therapy looks like
Neurodivergent-affirming therapy works from the position that being autistic, ADHD, or both (often called AuDHD) is a difference in how the brain processes and responds to the world, rather than a deficit to be corrected. The aim of therapy is not to make you appear less neurodivergent. The aim is to support understanding, regulation, sustainable functioning, and a sense of identity that fits you.
In practice, this can look like:
- Validating sensory needs as real, and shaping environments and routines around them
- Identifying where masking has helped, where it is no longer serving, and what unmasking might look like at your own pace
- Working on regulation strategies that fit your nervous system (not someone else’s!)
- Addressing co-occurring anxiety, trauma, depression, or burnout, which often travel alongside neurodivergence
- Supporting accommodation conversations at work, in study, or in relationships when those are wanted
- Working through identity questions without prescribing a particular outcome
Therapy is collaborative. Goals come from you, including the language you want to use about yourself.
The trauma and neurodivergence overlap
Trauma and neurodivergence often co-occur. Some of this is statistical: neurodivergent people experience higher rates of childhood adversity, bullying, medical experiences that did not feel safe, and relational difficulty. Some of it is structural: a sensitive nervous system in an environment that does not accommodate it can produce experiences that are traumatic in themselves.
Working on one without addressing the other often leaves the work incomplete. Therapy that integrates both is structured carefully. Stabilisation and regulation come first. and deeper processing of traumatic experiences follows when the foundation is steady. The pace stays inside what feels manageable for you.
Why online therapy suits many neurodivergent adults
Online therapy is well-suited to neurodivergent adults for reasons that are practical rather than incidental.
- Sessions happen in your own environment, where sensory load is something you control
- The friction of getting somewhere new, on time, with the right energy is removed
- Camera positioning lets you moderate eye contact, which makes attention easier to sustain
- Telehealth makes therapy accessible regardless of where you live, which matters when the local availability of neurodivergent-affirming clinicians is limited
The structure of an online session is the same as that of an in-person session. The model is not adapted down in any way. Rather, the delivery is adapted to fit how your nervous system works.
When to reach out
If any of the following sound familiar to you, it can be worth having a conversation about additional supports:
- You are noticing patterns about yourself that fit a neurodivergent frame, and want to make sense of them
- You have a new identification or diagnosis (or are considering one) and are working out what it means
- You have been managing anxiety, burnout, or depression for a long time and suspect something underneath is being missed
- You are interested in therapy that takes neurodivergence seriously without trying to make you appear neurotypical
An initial consultation is usually the most useful starting point. There is no need to have figured out the language or your position before reaching out.
Frequently asked questions
Do I need a formal diagnosis to start therapy for neurodivergence?
Not at all! Many adults look for neurodivergent-affirming therapy before, during, or without pursuing a formal assessment. Therapy can begin from a place of noticing and exploring, without requiring a diagnosis as a starting point. If a formal assessment becomes relevant to your goals, your psychologist can discuss what that pathway would look like.
What is AuDHD?
AuDHD is an informal term used to describe the co-occurrence of autism and ADHD in the same person. Both conditions frequently occur together, and the combined presentation can differ from either alone. Research suggests substantial overlap between the two, and many late-identified adults find that both fit their experience.
How is neurodivergent-affirming therapy different from standard therapy?
Neurodivergent-affirming therapy does not treat neurodivergence as something to be corrected or hidden. It works from the position that autism, ADHD, and related profiles are differences in how the brain processes the world, not deficits. The goal is sustainable functioning, self-understanding, and well-being, not appearing neurotypical.
Can therapy help if I am only just realising I might be neurodivergent?
Yes. Many adults who come to an understanding of being neurodivergent later in life find therapy helpful for processing what that means, reframing earlier experiences, and working through identity questions. Therapy does not require you to have a clear or settled position on your neurodivergence before starting.
Is telehealth suitable for neurodivergent adults?
For many neurodivergent adults, telehealth is a particularly good fit. Working from your own environment reduces sensory load, removes the friction of travel, and allows you to moderate factors like eye contact and background noise. The therapeutic model is the same as in-person; the delivery is adapted to suit how your nervous system functions.
Getting started
Therapy is offered Australia-wide via secure telehealth, with weekday and limited after-hours appointments. If you would like to explore working together, you are welcome to use the booking link below or get in touch through the contact form.
veronicawestpsychology.com | Telehealth Australia-wide
Veronica West is a registered psychologist (BPsychSc(Hons), MPH, MPsych) based on the Sunshine Coast, Queensland. She offers individual therapy for adults and adolescents via telehealth Australia-wide, with a focus on trauma, EMDR, ADHD, and neurodivergence. She is also a Board-Approved Supervisor for trainee and registered psychologists. Learn more at veronicawestpsychology.com/about.