FOR decades, autism was considered a condition that looked a certain way; a young boy, probably avoiding eye contact, lining up toy cars. That image shaped how clinicians were trained, how research was funded, and critically, who got diagnosed.
There is a biased history. Leo Kanner described autism in 1943 based almost entirely on male subjects. Hans Asperger’s work followed a similar pattern. The result? Diagnostic criteria built around one presentation, leaving everyone else to fall through the cracks for generations.
Women, girls, and gender-diverse people bore the brunt of this. We now know that many autistic females are extraordinary social mimics, not because socialising comes naturally, but because they’ve spent a lifetime studying it like a second language. This “masking” is exhausting, anxiety-producing, and deeply deceptive to assessors trained on the traditional profile.
The result is late diagnosis, misdiagnosis (anxiety, BPD, depression, take your pick), and a lot of very burnt-out adults finally getting answers in their 30s, 40s, and beyond.
The ADOS-2 remains the gold standard for autism assessment as it is structured, validated, and widely respected. But it’s limitation: it’s better at capturing observable behaviours than the internal, experiential world of autism. For an adult who has spent 20+ years perfecting their performance, that’s a significant gap.
Enter the MIGDAS-2. This conversational, sensory-based assessment is gaining serious traction, particularly with adults, because it asks people about their lived experience rather than watching them perform normalcy under clinical observation. For late-diagnosed adults, it’s often revelatory.
In Australia, access to assessment remains a postcode lottery. Medicare’s Better Access scheme can subsidise costs through a GP referral, and NDIS participants may be able to use funding for assessments linked to their support needs. Neither pathway is perfect, but knowing they exist is a start.
If you’ve spent your life feeling like you were performing being human and nobody taught you the script, it might be time to ask some different questions.
