Sarah hadn’t cried in years. Not because she didn’t feel things — she felt everything, all the time, too much — but because somewhere around her mid-twenties, she’d perfected the art of appearing fine. Eye contact at just the right intervals. Scripted small talk for the office kitchen. A mental catalogue of appropriate facial expressions. By the time she received her AuDHD diagnosis at 34, she’d been running this elaborate performance for so long that she couldn’t remember what it felt like to simply be herself.
Sarah’s story is shared by hundreds of thousands of AuDHD Australians. And now, for the first time, a landmark 2026 study has shown that the toll of this daily performance isn’t just psychological — it’s measurable in the stress hormones accumulating in your hair.
The Cortisol Evidence
Published in Molecular Autism, the co-twin control study examined 315 twins, including 69 diagnosed with autism, measuring both self-reported stress symptoms and hair cortisol concentration — a biological marker of long-term, accumulated stress. The findings were striking: individuals who engaged in more camouflaging behaviours had elevated cortisol levels, particularly among autistic adults.
This is the first study to provide biological evidence that masking autistic traits acts as a chronic stressor, activating the body’s hypothalamic-pituitary-adrenal (HPA) axis — the same stress-response system that fires during prolonged trauma or burnout. In other words, the science now confirms what AuDHD people have been saying for years: masking isn’t just exhausting. It’s physically harming us.
The twin design is particularly powerful here. By comparing twins raised in the same family, researchers could tease apart the effects of genetics and shared environment. Across the full sample, camouflaging was consistently linked to higher cortisol. But when the researchers looked within twin pairs, the picture grew more complex — suggesting that familial factors like genetics and upbringing also play a significant role in how masking and stress interact. The takeaway isn’t that masking causes stress in isolation; it’s that masking compounds stress within a system already shaped by neurodivergent biology.
The Cascade of Consequences
The cortisol study arrives alongside a growing body of evidence cataloguing the consequences of social camouflaging. A 2025 systematic review published in Development and Psychopathology synthesised research across autistic adults and youth, finding that camouflaging carries significant long-term costs including impacts on identity formation, delayed or missed diagnoses, and deteriorating mental health.
A separate systematic review, published in Research in Autism Spectrum Disorders in early 2025, found that social camouflaging among autistic adults was consistently linked to higher rates of anxiety, depression, and social anxiety, alongside lower mental wellbeing. But the review also revealed something nuanced: in the short term, masking does deliver benefits — avoidance of stigma, a sense of social connectedness, and access to alternative ways of communicating. This creates a cruel bind. The strategy that helps AuDHD people survive socially is the same one eroding their health.
For AuDHD Australians, this bind is compounded by the intersection of autism and ADHD. Where autism drives camouflaging to navigate social expectations, ADHD adds its own layer of compensation — suppressing impulsivity, forcing sustained attention, masking executive function struggles. The combined cognitive load of managing both sets of traits simultaneously is something researchers are only beginning to understand, but lived experience tells a clear story: it’s relentless.
Women Bearing the Heaviest Load
A 2026 study by Dr Emma Craddock, published in Health, explored the lived experiences of women diagnosed with both autism and ADHD in adulthood. Using interpretative phenomenological analysis, Craddock found that women inhabiting this “residual diagnostic category” — AuDHD isn’t formally represented in the DSM-5 as its own entity — experience profound identity fragmentation.
Participants described their autism and ADHD as “two separate parts of my brain,” while also recognising them as “two sides of the same coin.” They wrestled with the tension between neurodiversity narratives that frame autism as identity and medical models that frame ADHD as disorder. This internal conflict, Craddock argues, is itself a consequence of diagnostic systems that weren’t built with these women in mind.
The gendered dimension matters enormously. Craddock’s earlier work established that being a woman is, in participants’ own words, “100% significant” to the experience of AuDHD. Gender norms and stereotypes contribute directly to the oversight and dismissal of women’s neurodivergence, leading to later diagnoses, more entrenched masking patterns, and greater psychological harm by the time support finally arrives.
In Australia, where diagnostic waitlists can stretch beyond two years and assessment costs routinely exceed $2,000, many women spend decades masking without ever knowing why they’re so exhausted. The cortisol is accumulating long before the diagnosis arrives.
What Burnout Actually Looks Like
Autistic burnout — now increasingly understood as neurodivergent burnout when ADHD is present — is distinct from the general burnout that’s entered mainstream conversation. As Autism Spectrum Australia (Aspect) describes it, autistic burnout arises not just from life’s demands but from the sustained effort of coping in a world that frequently overlooks, misunderstands, or invalidates autistic needs. It manifests as long-term exhaustion, reduced ability to function, increased sensory sensitivity, and often a significant regression in skills that were previously manageable.
In Australia, more than one-third of autistic people are unemployed. Among those who are employed, Reframing Autism reports that many carry the compounding weight of masking, co-occurring conditions, and a history of workplace trauma. Research consistently finds that the vast majority of autistic workers receive minimal or no workplace adjustments, with one Australian study reporting that only 32% of respondents had even basic accommodations like a set work routine — a gap between need and provision that forces continued masking as a survival strategy.
This creates a vicious cycle: mask to keep your job, burn out from masking, lose the capacity to work, face unemployment and financial stress, and find that the support systems meant to catch you were never designed for the way you fall.
Breaking the Cycle
The research is clear: masking carries real physiological costs. But knowledge alone doesn’t change the conditions that make masking necessary. Breaking the cycle requires action at every level.
For individuals, Australian organisations like Reframing Autism and Autism Awareness Australia recommend starting with small acts of unmasking in safe environments — trusted friends, online AuDHD communities, or with an autism-affirming therapist. Aspect’s Self-Compassion Program for Autistic Adults (ASPAA) offers structured online support for building self-compassion and emotional regulation. Recovery from burnout requires reducing demands, especially sensory and social ones, and resisting the urge to rush back to full capacity.
For workplaces, the evidence calls for proactive accommodations rather than waiting for disclosure. Flexible work arrangements, sensory-friendly environments, clear communication norms, and management training on neurodivergence can reduce the need for masking before it begins. Under the Disability Discrimination Act 1992, Australian employees have the right to reasonable adjustments — but rights mean little when workplace culture punishes difference.
For policymakers, the research strengthens the case for integrating autism and ADHD in diagnostic frameworks, reducing assessment costs and wait times, and funding the kind of longitudinal research that tracks how masking affects AuDHD Australians across their lifespans. The $42.2 million allocated in the 2025–2026 federal budget toward autism strategy is a start, but it must reach the people spending their cortisol reserves just trying to get through Tuesday.
The Right to Be Unmasked
The 2026 cortisol study isn’t just an academic finding. It’s validation — biological, measurable, peer-reviewed validation — of something the AuDHD community has articulated for years. Masking costs something real. It accumulates in the body. And a society that demands it as the price of participation is a society that needs to change.
For the hundreds of thousands of Australians living with co-occurring autism and ADHD, the question isn’t whether masking is harmful. The science has settled that. The question is whether Australia is ready to build a world where unmasking is safe.
Sources
Bast, N. et al. (2026). “The impact of camouflaging autistic traits on psychological and physiological stress: a co-twin control study.” Molecular Autism. Read the study
Craddock, E. (2026). “Navigating residual diagnostic categories: The lived experiences of women diagnosed with autism and ADHD in adulthood.” Health. Read the study
Craddock, E. (2024). “Being a Woman Is 100% Significant to My Experiences of ADHD and Autism.” Qualitative Health Research. Read the study
“The consequences of social camouflaging in autistic adults: A systematic review.” Research in Autism Spectrum Disorders (2025). Read the review
“A systematic review of social camouflaging in autistic adults and youth.” Development and Psychopathology (2025). Read the review
Reframing Autism. “Advocating for Autistic Needs in the Workplace.” Read the article
Autism Spectrum Australia (Aspect). “Understanding Autistic Burnout.” Read the guide
Autism Awareness Australia. “Autistic Burnout and Recovery.” Read the guide
Leave a Reply