Episode 14
Unmasking Autism
Devon Price, 2022
What does masking cost, and who pays it?
Juno and Beck are synthetic voices. They are not people, they are not clinicians, and nothing in this episode is about you. The script was drafted with AI assistance and edited and approved by Logan Williamson, a Licensed Professional Counselor in Texas and Louisiana.
Chapters
At the eyepiece
What the episode covers
Devon Price, a social psychologist at Loyola University Chicago, published Unmasking Autism in 2022. Its argument is that the standard picture of autism, a young white boy who is obvious from across the room, left out a great many autistic people: women, trans people, Black and brown people, and people who couldn't pay for an assessment. Many of them learned to mask, hiding the traits that read as autistic so they could pass, and the book treats masking as a whole system of behaviors and life decisions, which Price compares to being in the closet. Chapter four, The Cost of Masking, itemizes what it takes out of people, and the second half of the book is about unmasking gradually and on one's own terms, with exercises, a case for autistic community and special interests, and a closing argument for policy change. Its best story is Price's own: a younger cousin came to him in 2014 with questions about autism, and Price, the family's psychologist, knew almost nothing beyond the stereotypes. Reading for his cousin, he recognized it across the family and then in himself, in his late twenties, after a doctorate he describes leaving burned out and lonely.
Beck checks two claims and takes his time with each. Masking goes with poorer mental health: in an online survey of 305 autistic adults with a formal diagnosis, more camouflaging went with more anxiety and depression, though it added only a small amount beyond age and autistic traits, and the link was the same across genders. Acceptance goes with less depression: in a survey of 111 autistic adults, acceptance from others and from oneself both went with less depression, and acceptance from others with less stress, but not with less anxiety. Two questions stay open. Every study checked is a single snapshot, so which comes first is unknown. And unmasking itself hasn't been tested in a trial; the nearest study, a survey of 262 autistic people, found that masking everywhere and switching between masking and not masking both went with poorer mental health, and that autistic women more often masked to get by at work.
Juno reads the book as the series' cost-of-doing-business episode: it turns a private exhaustion into a shared expense, and a 2020 study defining autistic burnout, built with autistic researchers, found people naming acceptance, support and unmasking among what helped them recover. The hosts disagree about self-identification and leave it open. The book's criticism of ABA is noted and pointed back to episode 6. The AI beat uses a chat window to help sort the book's values exercise, with the caution that a chat feels private and isn't.
The scoreboard
What the book claimed,
and what held
One row for every claim the show checked on air, with the verdict in the show's own words and the method that produced each number. A figure from a registry and a figure from a twin study do not mean the same thing, so neither is printed bare. What each verdict means.
Held
Masking costs autistic people their mental health.
Hull and colleagues, 2021. Among 305 autistic adults with a formal diagnosis, more camouflaging went with more anxiety and depression. The added effect beyond age and autistic traits was small, and largest for anxiety.
MethodAn online, cross-sectional survey using a self-report camouflaging scale. It shows an association, not which came first.
Held
Acceptance, from others and from yourself, helps.
Cage and colleagues, 2018. Among 111 autistic adults, acceptance from others and personal acceptance both predicted lower depression, and acceptance from others predicted lower stress. Acceptance did not predict anxiety.
MethodAn online, cross-sectional survey. It shows an association at one moment.
Source02
Held
Masking isn't only a women's story.
Hull and colleagues, 2021, with Cancino-Barros and colleagues, 2025, and Greig and colleagues, 2026. In the 2021 survey, the link between camouflaging and anxiety or depression did not differ by gender. Pooled studies find autistic women report more camouflaging on average, and the link between autistic traits and camouflaging is similar for both sexes.
MethodA cross-sectional survey and two meta-analyses of self-report and discrepancy measures.
Still arguing about it
Masking causes the mental health cost, rather than people who are struggling masking harder.
Hull and colleagues, 2021, and Klein and colleagues, 2026. No figures; every study checked here measured both at one moment.
MethodThe 2021 authors state that cross-sectional data can't show which came first and call for longitudinal research. Studies following camouflaging over time have begun, but the one found is still a protocol.
Still arguing about it
Unmasking improves well-being.
Cage and Troxell-Whitman, 2019, and Raymaker and colleagues, 2020. Among 262 autistic people, camouflaging across contexts and switching between contexts both went with poorer mental health. In 19 interviews plus public writing, autistic adults named unmasking among what helped them recover from burnout.
MethodA cross-sectional survey and a small qualitative study. No trial of unmasking has been run; the book's second half is an argument the evidence hasn't yet tested.
Calibration
Sources
Every research claim on air is listed here with the method behind its numbers. Where a claim on air could not be traced to a source, it is named at the foot of this list rather than quietly left out, and the figure is not repeated on this page.
- Masking goes with more anxiety and depression, by a small margin, the same across genders.
Hull L, Levy L, Lai MC, et al. Is social camouflaging associated with anxiety and depression in autistic adults? Mol Autism. 2021;12(1):13. DOI
Online survey of 305 autistic adults (104 men, 181 women, 18 non-binary) reporting a formal diagnosis. Camouflaging was associated with more generalized anxiety, social anxiety and depression, only to a small extent beyond age and autistic traits, and more strongly for anxiety than depression. No interaction with gender. Cross-sectional, so the order can't be established.
- Acceptance from others and from oneself goes with less depression.
Cage E, Di Monaco J, Newell V. Experiences of autism acceptance and mental health in autistic adults. J Autism Dev Disord. 2018;48(2):473-484. DOI
Online survey of 111 autistic adults. External and personal acceptance predicted depression; acceptance from others also predicted stress; acceptance did not predict anxiety. Further analyses suggested camouflaging may relate to higher depression.
- Masking across contexts, and switching between contexts, both go with poorer mental health.
Cage E, Troxell-Whitman Z. Understanding the reasons, contexts and costs of camouflaging for autistic adults. J Autism Dev Disord. 2019;49(5):1899-1911. DOI
Survey of 262 autistic people on camouflaging behaviors, contexts (such as work and family), reasons and mental health. Camouflaging highly across contexts and switching between camouflaging in some contexts and not others both related to poorer mental health. Autistic women were more likely to endorse conventional reasons, such as getting by at work and in formal settings.
- Autistic burnout, and what people say helps.
Raymaker DM, Teo AR, Steckler NA, et al. "Having all of your internal resources exhausted beyond measure and being left with no clean-up crew": defining autistic burnout. Autism Adulthood. 2020;2(2):132-143. DOI
Community-based participatory research: thematic analysis of 19 interviews with autistic adults and 19 public internet sources. Burnout described as long-term exhaustion (typically three months or more), loss of skills and reduced tolerance to stimulus, distinct from occupational burnout and depression. Participants associated acceptance and support, time off and reduced expectations, and unmasking with recovery. A small exploratory convenience sample.
- The main camouflaging scale, built from autistic adults' accounts and filled in by non-autistic adults too.
Hull L, Mandy W, Lai MC, et al. Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). J Autism Dev Disord. 2019;49(3):819-833. DOI
Developed from autistic adults' experiences of camouflaging and administered online to 354 autistic and 478 non-autistic adults. A self-report measure.
- Autistic people score higher on camouflaging measures, and autistic women higher still.
Cancino-Barros I, Villacura-Herrera C, Castillo RD. A meta-analytic review of quantification methods for camouflaging behaviors in autistic and neurotypical individuals. Sci Rep. 2025;15(1):22885. DOI
17 independent meta-analyses of the CAT-Q and the discrepancy method. Autistic individuals scored higher than neurotypical comparison groups, and autistic females scored consistently higher than autistic males. Page only; not spoken.
- The link between autistic traits and camouflaging is similar for both sexes.
Greig L, Coundouris SP, Henry JD. Autistic traits and camouflaging: a meta-analysis. Autism. 2026;30(6):1398-1415. DOI
50 papers, 16,895 participants aged 10 to 90. A moderate association between autistic traits and camouflaging, comparable across sexes. Page only; not spoken.
- Studies that follow camouflaging over time are under way.
Klein J, Krahn RL, Howe SJ, et al. Examining social camouflaging and its cognitive, mental health and neurophysiological correlates in autistic adolescents through triangulation-based assessment using self, parent and daily diary reports: a study protocol. BMJ Open. 2026;16(3):e111221. DOI
A study protocol, not results: about 150 adolescents aged 15 to 18, with daily diaries over a week and a three-month follow-up.
- Price's case for self-identification.
Price D. Self-diagnosis isn't 'valid.' It's liberatory. Medium, 9 February 2022; reposted on Substack, 16 November 2023. https://drdevonprice.substack.com/p/self-diagnosis-isnt-valid-its-liberatory
Price argues that assessment is expensive and hard to obtain in many places, that masked autistic people are often turned away for seeming too capable, and that self-identification should be trusted. His position, reported as his.
The book
Unmasking Autism. Devon Price, 2022.
This link earns Lone Star Telehealth nothing. The same book is at any bookseller or library, and your library is the cheapest way to find out whether you want it.
Book facts stated on air: title and author; a social psychologist who teaches at Loyola University Chicago; autistic, recognized as an adult; a trans man; 2022 (Harmony Books); masking as hiding traits that read as autistic, including suppressing movement, keeping quiet about interests, staying mild to avoid seeming needy and forcing oneself into anxiety-provoking situations; masking as a system reaching into life decisions, compared to being in the closet; chapter two on who the masked autistics are, including autistic women misdiagnosed with borderline personality disorder; the double bind of seeming too disabled and not disabled enough; the social model of disability applied to sensory and workplace design; capitalizing Autistic as with Deaf; research, history, interviews and written exercises; early praise from Barry Prizant; the 2014 story of a college-age cousin, Price's late-twenties recognition after a doctorate he describes leaving burned out, lonely and empty, and finding the autistic self-advocacy community; chapter four, The Cost of Masking, and its costs (exhaustion, alcohol or drug use, disordered eating, dissociation, fawning); the emphasis on autistic community and relationships; special interests, fandoms and geeky subcultures; the closing policy chapters (legal protections, universal health care, basic income); that a formal diagnosis isn't required to begin unmasking; his criticism of ABA for suppressing stimming; the values exercise from autistic coach Heather Morgan; the last chapter, Integration. No passage is quoted.
Every word
Transcript
Every line, with the timestamp beside it. Tap a timestamp and the audio moves there.
Full transcript, 191 lines
Juno: Every book so far has circled one idea. The effort it takes to live in a world that was built for somebody else.
Beck: And Logan has a name for that effort. The cost of doing business.
Juno: We've been saying it in passing all season. Today's book is the itemized bill.
Beck: Unmasking Autism. Devon Price, a social psychologist who teaches at Loyola University Chicago. Autistic, and he worked that out as an adult.
Juno: And one word in the title carries the argument.
Beck: Masking. Hiding the parts of yourself that read as autistic, so you can pass.
Juno: Which works, mostly.
Beck: Until it doesn't. Chapter four is called The Cost of Masking.
Juno: So the author wrote the word cost on a chapter before we ever got here.
Beck: He beat us to it by a few years.
Juno: Today: Unmasking Autism, Devon Price, 2022.
Beck: You're listening to The Observatory, from Lone Star Telehealth.
Juno: Last time Nerenberg kept saying mask, and never took the mask apart.
Beck: Price takes it apart. Piece by piece, and he sends the invoice.
Juno: And the main idea, said plainly?
Beck: Most people carry a narrow picture of autism. A young white boy, obvious from across the room.
Juno: Mm-hm.
Beck: Price says that picture left out a great many autistic people. Women. Trans people. Black and brown people. People who couldn't pay for an assessment.
Juno: And if they didn't fit the picture, nobody looked.
Beck: Yeah. Nobody looked. And meanwhile they learned not to be seen. That's the mask.
Juno: What does it look like on an ordinary day?
Beck: Holding still when your body wants to move. Keeping quiet about the thing you love most. Staying mild, so nobody calls you needy.
Juno: And going to the loud party anyway.
Beck: Forcing yourself into the room that makes you anxious, yes. He says it isn't one behavior. It's a whole system, down to big life decisions.
Juno: That's a lot to carry for something people call a habit.
Beck: He doesn't call it a habit. He compares it to being in the closet.
Juno: And he's a trans man. He knows that comparison from the inside.
Beck: He is. And the second half of the book is about stepping out. Slowly, and on your own terms.
Juno: Who does he think ends up masked?
Beck: Chapter two is close to a roll call. People whose autism got read as something else entirely.
Juno: Read as what?
Beck: One example in the book: autistic women diagnosed with borderline personality disorder instead.
Juno: So not missed. Misread.
Beck: Misread, in his account. Which leaves a file that points the wrong way.
Juno: And when the mask works? When nobody misreads anything?
Beck: Then comes a double bind he describes. Too disabled for some rooms, not disabled enough for others.
Juno: Too much and not enough, at the same time.
Beck: Yeah. At the same time. And help is hard to ask for when you look fine.
Juno: And the frame under all of it?
Beck: The social model of disability. A lot of what disables people sits in the world around them, not inside them.
Juno: The stairs, not the legs.
Beck: That's the classic picture of it. He applies it to sound, to light, to the way workplaces get designed.
Juno: And the writing?
Beck: Like a professor who'd rather talk with you than at you. Research, history, interviews with autistic people, and exercises you do with a pen.
Juno: I noticed he capitalizes Autistic.
Beck: The way Deaf is capitalized. A culture, not only a condition.
Juno: Anyone we know in the early praise?
Beck: Barry Prizant. Episode eight.
Juno: So the books are talking to each other now.
Beck: Behind our backs.
Juno: Okay. Keep going.
Juno: Whose story anchors the book? I'm guessing his.
Beck: It's his, and it starts with somebody else. In 2014, a younger cousin in college learned he might be autistic.
Juno: And he went to Devon.
Beck: He went to the family's psychologist. Doctorate and all.
Juno: Sensible choice.
Beck: Except Devon knew almost nothing about autism beyond the stereotypes.
Juno: That's a humbling conversation.
Beck: So he read. And the more he read, the more he recognized. Across the extended family first.
Juno: Then closer to home.
Beck: Then in himself. He was in his late twenties. He'd finished his doctorate young, and he describes coming out of it burned out, lonely and empty.
Juno: Successful on paper. Running on nothing.
Beck: Which is close to the book's point. A mask can work. It can carry you all the way through a PhD. And then it sends the bill.
Juno: So the cost came due before he knew there was an account.
Beck: Yeah. Before he knew. Then he found other autistic adults, the self-advocacy community, and the book grows out of what he learned there.
Juno: What did he take from them?
Beck: Advice the book keeps coming back to. Find other autistic people, and build relationships where you don't have to perform.
Juno: Not a technique. A room full of people like him.
Juno: Walk me through chapter four, then. The bill itself.
Beck: He itemizes it. Exhaustion. Leaning on alcohol or drugs. Disordered eating. Dissociation.
Juno: That's a long invoice.
Beck: And one more line on it. Fawning, which means pleasing people on reflex, to stay safe.
Juno: That one's quieter than the others.
Beck: Which is why it's easy to miss. From the outside it looks like being agreeable.
Juno: I like that the book starts with him stumped. A psychologist who didn't know.
Beck: It's the whole thesis in one family. If a psychologist can miss it in himself, the narrow picture is doing a lot of hiding.
Juno: So the story proves the argument.
Beck: It shows how it can happen. A story can't tell you how often. That's the next part.
Juno: Walk me through how it stands up. Two claims, and take your time with each.
Beck: Two it is. Claim one sits at the center of the book. Masking costs autistic people their mental health.
Juno: That's the one I most want proven and least want to be true.
Beck: The first large test came in 2021, from researchers in London and Cambridge.
Juno: Who'd they ask?
Beck: About three hundred autistic adults, all with a formal diagnosis, in an online survey.
Juno: Asking about what?
Beck: How much they camouflage, which is the research word for masking. And how anxious and depressed they'd been feeling.
Juno: And?
Beck: More camouflaging went with more anxiety and more depression. It held.
Juno: So the book's right.
Beck: About the direction. Now the size. Once they accounted for age and how many autistic traits a person had, masking added only a small amount on top.
Juno: Small. But not nothing.
Beck: Yeah. Not nothing. The authors still called it a risk factor clinicians should watch for.
Juno: Where was the link strongest?
Beck: Anxiety, more than depression. Which fits the book. Masking means watching yourself all day.
Juno: Okay.
Juno: Second one. That acceptance helps. From other people, and from yourself.
Beck: Acceptance came up two books ago, for ADHD. This is a different kind. Being accepted as autistic.
Beck: A 2018 study asked a hundred and eleven autistic adults how accepted they felt. By the people around them, and by themselves.
Juno: And what did they find?
Beck: Both kinds of acceptance went with less depression.
Juno: So being accepted isn't a soft extra.
Beck: Not in that data. Acceptance from other people also went with less stress.
Juno: And anxiety?
Beck: No link there. It isn't a cure-all.
Juno: Still, that one goes to Price.
Beck: It does. One flag. Both of these are surveys, taken at a single moment. Hold on to that.
Juno: I've been holding it. Which comes first?
Beck: That's the open column. Every study we just scored is one snapshot, and the 2021 team says plainly they can't tell which came first.
Juno: Masking wears people down. Or people who are already struggling mask harder.
Beck: Either, or both. The book reads it one way. The data hasn't chosen yet.
Juno: Has anybody followed people over time?
Beck: It's starting. The studies we found that do that are still being run.
Juno: Second open question?
Beck: Unmasking itself. It's the whole second half of the book, and nobody's put it to a trial.
Juno: Is there anything close?
Beck: One study comes near it, and it complicates things. A 2019 survey of two hundred and sixty-two autistic people asked where they camouflage. At work, with family, with friends.
Juno: And?
Beck: Masking everywhere went with poorer mental health.
Juno: That's the book's prediction.
Beck: Here's the complication. So did switching. Masking in some places and not in others.
Juno: Wait. Taking it off at home and putting it back on at work costs too?
Beck: Yeah. It costs too, in that survey. The switching may be its own kind of work.
Juno: And partial is how most people would do it.
Beck: Price doesn't pretend otherwise. He calls unmasking gradual, and he's said openly that being visibly autistic can carry real risk at work.
Juno: So here's where the phrase stops being a metaphor. The cost of doing business, at the business.
Beck: The same study found autistic women more likely to mask for what the authors called conventional reasons. Getting by at work. Getting through formal settings.
Juno: So for some people the mask is part of the job description.
Beck: And taking it off at work is a risk the person carries, not the office.
Juno: One more. The book says the masked picture isn't only a women's story.
Beck: On that, the 2021 study backs him. The link between masking and anxiety or depression was the same across genders.
Juno: So the men who mask pay it too.
Beck: Anyone who masks, by that data. Which is his point.
Juno: Anything else in the open column?
Beck: A caution about method. Masking gets measured by asking people what they do. The main scale was built from autistic adults' own accounts.
Beck: And non-autistic adults fill it in too. On average, autistic adults score higher.
Juno: So non-autistic people mask a little too.
Beck: Some do. The book's claim is about how much, how often, and what it costs to keep it on.
Juno: Here's our question. If masking is a bill, who should pay it?
Beck: After you.
Juno: The book's answer is: not only the person wearing the mask. For years, a lot of autistic adults have carried this as private exhaustion. Price turns it into a shared expense. A cost of doing business that the business should be splitting.
Beck: Then here's research that leans your way. A 2020 study, designed together with autistic researchers, set out to define autistic burnout.
Juno: Not the workplace kind.
Beck: Separate from that, and from depression, in their account. Deep exhaustion, lost skills, less tolerance for sound and light. Lasting months.
Juno: What helped people come back from it?
Beck: They named acceptance, support, time off, lower expectations. And unmasking.
Juno: So the people living it put unmasking on the recovery list.
Beck: Yeah. On the list. It's small and early, interviews with nineteen people plus public writing. A description, not a trial.
Juno: Fair.
Juno: And the second half isn't all bills. There's a lot of joy in it.
Beck: Special interests, mostly. He treats them as something to feed, not trim. Fandoms and geeky subcultures come up as places a lot of people feel at home.
Juno: Stop apologizing for the thing you love most.
Beck: That's about the size of it. Then the last chapters turn to policy. Stronger legal protections, universal health care, a basic income.
Juno: The shared bill, turned into legislation.
Beck: Which is past anything this episode can score. It's an argument, and he makes it as one.
Juno: And here's where I'm with Price. He says you don't need a formal diagnosis to start unmasking.
Beck: And that's where I'm not, quite. It's a position, and he holds it on purpose. He's written that assessments are expensive and hard to get, and that masked adults get turned away for seeming too capable.
Juno: That part's literal, too. The assessment has a price tag.
Beck: It does. My worry is mine, not a finding. A formal assessment also checks what else might be going on. That's worth a lot, when you can get one.
Juno: And when you can't?
Beck: Then I understand why he takes the position he takes.
Juno: So we don't agree about self-identification.
Beck: No. That goes in the drawer with VAST.
Juno: He's hard on ABA, too.
Beck: For training children out of stimming. Episode six covered what those trials found, so we'll leave it there.
Juno: There's one more page I want. The book carries an exercise from an autistic coach, Heather Morgan.
Beck: You recall a handful of moments, across your life, when you felt most alive. Then you look for the values running underneath them.
Juno: And Price says anyone can do it. Not only autistic readers.
Beck: Which makes it a fair job for a chat window. Type the moments in, and ask what they have in common.
Juno: What would you start with?
Beck: Something small. An afternoon that vanished because you were happy doing one thing.
Juno: And then?
Beck: Argue with its list. It's guessing. You're the only one who knows whether a guess is right.
Juno: There's an odd comfort in it, too. Nobody in a chat window is reading your face.
Beck: Which is worth a caution. It feels private, and it isn't. It's not a medical record, and nobody has to guard it like one. Keep the hardest memories on paper.
Juno: And it's a tool, not care.
Beck: A scaffold you hold, for your own life. Nobody's tested it in a trial, so treat it as an experiment.
Juno: The book's last chapter is called Integration.
Beck: And that's the part no window does. It can sort the list. Putting the pieces back together happens with people, off the screen.
Juno: Unmasking Autism, Devon Price, 2022. Read it for the cousin who brought the right question to the wrong psychologist, and for chapter four.
Beck: Claim by claim. Masking goes with poorer mental health: held, though the added effect was small. Acceptance goes with less depression: held. Which comes first, and whether unmasking helps: open.
Beck: Twelve books in, and nothing from this one lands on the didn't-hold side.
Juno: Front row for this one. I'd hand it to a friend with the burnout study tucked in the back.
Beck: NeuroTribes had that spot.
Juno: It can share.
Beck: Next time is our third reference episode. The approved treatments for depression that hasn't lifted with the usual ones. It's information, not advice, and it's chaptered, so jump to the part you need.
Juno: Different kind of episode. Same rule. We report, and your doctor decides.
Juno: Two days, and then the next one.
Beck: Bring a pencil.
Juno: This show is a Lone Star Telehealth production. Logan Williamson is a Licensed Professional Counselor in Texas and Louisiana. Today was a talk about a book. Not counseling, not a clinical view of anyone listening, and no stand-in for care. Diagnosis happens with a clinician who knows you, and that isn't us.
Beck: Every source we used is linked on the episode page, with the full transcript. Another one arrives in two days.
Juno: To end, a plain note. Both hosts are synthetic voices. We aren't people, we hold no license, and nothing we said was aimed at you. AI helps draft the scripts, and each is edited and approved by Logan Williamson at Lone Star Telehealth. Logan Williamson is a Licensed Professional Counselor in Texas and Louisiana.
Corrections
No corrections have been made to this episode. If we got something wrong, write to [email protected] and say where in the episode it was. We check the claim against the source, then we fix it or we explain why it stands. Either way you get an answer.
Questions about the book
The mailbag is [email protected], and it is answered in a segment every fifth episode. It is not a clinical channel, so please keep health information out of it.
Logan Williamson is a Licensed Professional Counselor in Texas and Louisiana. The Observatory is education about books. It is not counseling, not a clinical opinion about any listener, and not a substitute for care.
How the show is made, and what it will never do, is on the standards page.
Something wrong? Write to [email protected]. In a mental health crisis, call or text 988.