Clinical Relevance: Later diagnosis of autism and covering up symptoms by “autism masking” can harm mental health
- Singer Sia publicly discussed her autism diagnosis in a recent podcast.
- Her attempts to hide her condition could fit into an unconscious strategy known as “autism masking.”
- Masking, along with being diagnosed at a later age, can have mental health implications.
The singer Sia has revealed that she has autism spectrum disorder (ASD).
“I’ve felt like, for 45 years, I was like, ‘I’ve got to go put my human suit on’,” the Chandelier singer explained on an episode of the audio series, Rob Has A Podcast. “And only in the last two years have I become fully myself.”
These are the first public remarks Sia, whose full name is Sia Kate Isobelle Furler, has made about her diagnosis. During an appearance on the reality TV fan podcast, she congratulated Carolyn Wiger, a runner-up on the most recent installment of the show Survivor. During the conversation, she reacted to fan theories that Wiger herself was on the spectrum.
Wiger denied having autism, but said she had been diagnosed with ADHD and is in recovery from addiction. In response, the singer chimed in: “I’m on the spectrum and I’m in recovery and whatever.”
“And when we finally sit in a roomful of strangers and tell them our deepest, darkest, most shameful secrets, and everybody laughs along with us, and we don’t feel like pieces of trash for the first time in our lives, and we feel seen, for the first time in our lives, for who we actually are–then we can start going out into the world and operating as human beings with hearts, and not pretending to be anything,” she added.
Cover Up
The behavior the 47-year-old singer described tracks with a phenomenon known as “autism masking,” according to Hannah Louise Belcher, a clinical psychologist and lecturer at King’s College London. Because Belcher has not treated Sia personally, she was not making an official diagnosis.
“Pretending to be ‘human,’ or some people say ‘normal’ and to ‘fit in’ is exactly what autistic masking is,” Belcher explained to Psychiatrist.com. “It’s a strategy to fit in with the neurotypical world, usually to avoid experiencing bullying and stigma associated with being autistic.”
Belcher stated that children often learn masking as an unconscious protective mechanism in early childhood. Girls and women, in particular, tend to engage in the cover-up, possibly because they receive diagnoses later than males.
“I think it’s also worth pointing out that Sia performs with a physical mask, not showing her face and hiding it with her hair, which could be compared to her internal masking as an autistic person,” Belcher noted.
While masking serves as a coping and protective strategy, Belcher said that it consumes a lot of mental resources.
“Autistic people end up not expressing their true interests and suppressing themselves to hide their autism. Masking increases risk of mental health problems and even suicide,” she said.
It’s a good thing Sia is speaking out about her experiences, Belcher said. It will help educate people about neurodiversity so autistic people feel less pressured to conform. Therapy, unmasking in safe situations, and seeking out autism-friendly environments can help ease the burden, too.
Problematic Musical
Sia’s admission comes two years after what many in the autism community consider a problematic depiction of the condition in the film, Music. The musical drama, which the singer co-wrote and directed, depicted a woman who finds herself the sole caretaker of her half-sister, a teenager with non-verbal autism.
The film faced backlash because it cast a neurotypical actress in the role of the autistic teen. Critics complained that she portrayed the condition in a clunky and stereotypical manner. Some fans called for a boycott of the movie due to a controversial scene where the character forcibly held the individual face-down to control an episode of overstimulation. Despite the uproar, Music was nominated for two Golden Globe awards.
At the time, Sia called the movie “a love letter to caregivers and to the autism community.” But has since apologized for the restraint scenes and promised to remove them from all future showings.
Adult Diagnosis
Autism is defined as a serious developmental disorder identified in one in 36 children, according to the Centers for Disease Control and Prevention (CDC). The broad range of symptoms affect social skills, repetitive behaviors, intellect and speech, and nonverbal communication. Symptom severity varies widely.
Sia seems to be among a growing number of people who received a diagnosis of autism later in life. Although there are few estimates of how many people are diagnosed on the spectrum after childhood, the CDC reports that nearly 5.5 million adults in the US have ASD.
Later diagnosis can come at a cost to mental health. People diagnosed with autism in adulthood were nearly three times more likely than their childhood-diagnosed counterparts to experience additional psychiatric conditions, according to a recent study in the journal, Autism Research. They reported higher rates of co-occurring mood, anxiety, personality, or eating disorders compared to those identified with autism in childhood.
