Received a Diagnosis Later in Life: The Lost Generation

In 2015, a paper published in The Lancet Psychiatry described a “lost generation” of adults with autism: people who had reached adulthood without recognition, diagnosis, understanding, or appropriate support (Lai & Baron-Cohen, 2015). Although this concept applies to autistic adults more broadly, it has become especially meaningful for many women diagnosed in midlife, who often describe decades of confusion, emotional distress, self-blame, anxiety, depression, and exhaustion from trying to fit into a world that did not understand them.

For many women, receiving a diagnosis later in life is not simply about acquiring a clinical label. It can represent a profound psychological re-framing of the self. Traits that may once have been misunderstood as being “too sensitive”, “too intense”, “too anxious”, “difficult”, “shy”, “obsessive”, or “not trying hard enough” may begin to make sense through a neurodevelopmental lens.

Late diagnosis can bring relief and validation, but also grief for the years spent masking, over-adapting, and surviving without adequate understanding.A UK study reported a 787% increase in recorded autism diagnoses between 1998 and 2018, with particularly marked increases among females and adults (Russell et al., 2022). This does not necessarily mean autism itself has become more common. Rather, it reflects changes in awareness, diagnostic criteria, access to assessment, and recognition of broader autism presentations. Importantly, many autistic adults remain undiagnosed, particularly those who have learned to camouflage their differences across childhood, education, employment, relationships, and family life (Lai & Baron-Cohen, 2015; Russell et al., 2022).

Historically, autism was largely understood through male presentations. Public perception was shaped by narrow stereotypes, including the image of the socially detached, mathematically gifted white male, popularised by the film Rain Man. More than three decades later, our understanding of autism has developed considerably. Autism may also present in women who are socially motivated, emotionally expressive, articulate, creative, empathic, relational, and outwardly successful, yet internally exhausted by the effort required to function in a neurotypical world.

Many autistic girls and women learn to camouflage from a young age. They may copy peers, rehearse conversations, suppress stimming, force eye contact, monitor their tone of voice, or become highly skilled observers of social rules. While these strategies may help them “pass” socially, the psychological cost can be substantial. Camouflaging has been associated with anxiety, depression, social exhaustion, burnout, and reduced wellbeing (Hull et al., 2020; Khudiakova et al., 2024).

There is also a serious safeguarding dimension. Research suggests autistic women may be at significantly higher risk of sexual victimisation, manipulation, coercion, and abuse than non-autistic women. Cazalis et al. (2022) reported that sexual violence affects autistic women at rates two to three times higher than women in the general population. This vulnerability may relate to social naivety, difficulty detecting manipulation, alexithymia, previous exclusion, trauma, people-pleasing, or being conditioned to override discomfort in order to fit in.

Women with Autism

You may have heard that autistic people can be brutally honest. This does not mean autistic people cannot distort the truth, but rather that many find indirect communication, social performance, or “sugar-coating” unnatural, uncomfortable, or confusing. A neurotypical person may say they want honesty, while actually expecting a softened, socially acceptable version. Autistic honesty can therefore be misread as bluntness, rudeness, or naivety, when it may simply reflect a more literal and direct relationship with language.

I have often wondered whether this so-called honesty trait may be linked to a form of naive realism: the expectation that words and actions should match. Many autistic women describe “seeing the good in people”, taking others at face value, and struggling deeply when confronted with manipulation, inconsistency, or “wolves in sheep’s clothing” behaviour. This is not a lack of intelligence. It may reflect a social-processing style that values clarity, loyalty, fairness, and truth.

Contrary to the outdated stereotype that autistic people do not feel deeply, many autistic women experience emotions with extraordinary intensity. Emotional dysregulation is increasingly recognised as clinically important in autism and may contribute to anxiety, depression, eating difficulties, and interpersonal distress (Dell’Osso et al., 2023; Vuillier et al., 2020). Some autistic people may experience affective empathy very strongly, meaning they feel the emotions of others intensely, sometimes viscerally. At the same time, they may struggle to translate emotions into words, a difficulty known as alexithymia, or to respond to social cues in the expected way (Raman et al., 2023; Speyer et al., 2021). This can create a painful paradox: feeling everything, yet being accused of feeling nothing. The body may register distress before the mind can name it.

Small changes, sensory overload, rejection, injustice, uncertainty, or relational conflict may feel physically painful or overwhelming. Emotional repair may involve withdrawing, being alone, seeking animals, returning to special interests, needing sameness, or finding comfort in familiar objects. Research has also found that object personification, attributing feelings or human-like qualities to objects, may be more common among autistic people than non-autistic adults (White & Remington, 2019). For women wondering whether autism may fit, common lifelong patterns can include feeling different from childhood, struggling with friendships or relationships, sensory aversions to light, sound, touch, taste, smell, or texture, intense rumination, rigid thinking, a strong need for routine or predictability, emotional meltdowns, social exhaustion, difficulty processing information quickly, feeling safer with animals than people, and a lifelong sense of being misunderstood. None of these experiences alone confirms autism, and autism is never one-size-fits-all. However, patterns across a lifetime are clinically meaningful.

ADHD and Hormones

Alongside autism, increasing numbers of women in their 40s and 50s are also seeking assessment for ADHD. For some, this happens after their children are diagnosed and they recognise themselves in the process. For others, perimenopause appears to unmask difficulties that were previously managed through structure, intelligence, perfectionism, adrenaline, or sheer effort.Oestrogen interacts with brain systems involved in dopamine, serotonin, attention, memory, mood, and emotional regulation. When oestrogen is relatively higher, some women report that ADHD symptoms feel more manageable. During perimenopause, fluctuating and declining oestrogen may worsen attention, concentration, working memory, emotional regulation, sleep, and motivation (Kooij et al., 2025; Osianlis et al., 2025). These symptoms can overlap with menopause-related brain fog, making ADHD harder to recognise.

This does not mean menopause causes ADHD. ADHD is a neurobiological condition, and often symptoms are present from childhood, even if they were hidden, compensated for, or mislabelled. However, perimenopause can make previously manageable ADHD traits feel suddenly overwhelming. If brain fog, anxiety, low mood, poor concentration, forgetfulness, and emotional sensitivity only begin during perimenopause, hormonal change may be the primary driver. If these traits have been present for many years and are now becoming unmanageable, an ADHD assessment may be warranted.Late diagnosis can be emotional. It may involve relief, grief, anger, sadness, and liberation. But it can also offer a new beginning. Not because the past can be changed, but because the future can be approached with greater understanding, safer relationships, stronger boundaries, appropriate support, and far less self-blame.

References

Cazalis, F., Reyes, E., Leduc, S., & Gourion, D. (2022). Evidence that nine autistic women out of ten have been victims of sexual violence. Frontiers in Behavioral Neuroscience, 16, 852203.Dell’Osso, L., Lorenzi, P., & Carpita, B. (2023). Emotional dysregulation as a part of the autism spectrum continuum: A literature review. Frontiers in Psychiatry, 14, 1234518.Hull, L., Petrides, K. V., & Mandy, W. (2020). The female autism phenotype and camouflaging: A narrative review. Review Journal of Autism and Developmental Disorders, 7, 306–317.Khudiakova, V., Thorsteinsson, E. B., & McLellan, L. F. (2024). A systematic review and meta-analysis of mental health outcomes associated with camouflaging in autistic people. Research in Autism Spectrum Disorders, 113, 102373.Kooij, J. J. S., Bijlenga, D., & Quinn, P. O. (2025). Research advances and future directions in female ADHD. Frontiers in Global Women’s Health, 6, 1613628.Lai, M. C., & Baron-Cohen, S. (2015). Identifying the lost generation of adults with autism spectrum conditions. The Lancet Psychiatry, 2(11), 1013–1027.Osianlis, E., Kyriacou, A., & Theodoros, M. T. (2025). ADHD and sex hormones in females: A systematic review. Frontiers in Psychiatry, 16, 12145478.Raman, N., Bell, L., & O’Hare, A. (2023). Relationships between affect recognition, empathy, alexithymia and autistic traits. Autism Research, 16(8), 1560–1572.Russell, G., Stapley, S., Newlove-Delgado, T., Salmon, A., White, R., Warren, F., Pearson, A., & Ford, T. (2022). Time trends in autism diagnosis over 20 years: A UK population-based cohort study. Journal of Child Psychology and Psychiatry, 63(6), 674–682.Speyer, L. G., Gorman, D., & Coughlan, B. (2021). Alexithymia and autistic traits as contributing factors to empathy difficulties. Journal of Autism and Developmental Disorders, 51, 3403–3414.Vuillier, L., Carter, Z., Teixeira, A. R., & Moseley, R. L. (2020). Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology. Molecular Autism, 11, 63.White, R. C., & Remington, A. (2019). Object personification in autism: This paper will be very sad if you don’t read it. Autism, 23(4), 1042–1045.