Hidden in Plain Sight: Why So Many Women and AFAB Individuals Were Overlooked

Seeing what should have been visible all along

by Suzanne Fischer Comelo, JD, LMFT, Neurodivergent Coach

For years in my clinical work, I specialized in supporting highly sensitive teens and adults—people who often came in with some combination of entrenched anxiety, social anxiety, panic attacks, OCD, chronic depression and complex relational trauma. Many were thoughtful, bright, and had learned to function at a high level, but something about their experiences didn’t fully fit the diagnostic boxes. Traditional approaches often helped a little, but never seemed to get to the heart of what was happening.

Around the same time, someone close to my family received their own neurodivergent diagnosis, which led me down a deeper path of research—for their sake, for my clients, and ultimately for myself. That exploration opened a door I hadn’t realized I was standing next to my whole life. I began recognizing patterns that had been there all along, and in my early fifties, I chose to pursue my own formal diagnostic process.

That dual lens—clinician and late-identified neurodivergent woman—transformed how I saw my clients, my practice, and my own story.

A History of Missing the Signs

For decades, autism and ADHD research was built primarily around cisgender boys—especially white boys. Diagnostic tools and clinical assumptions followed that model. If you didn’t fit the “classic” picture, you were often overlooked, misdiagnosed, or misunderstood.

Women, girls, and AFAB (assigned female at birth) individuals often didn’t present in ways that matched those male-normed expectations. Many had intense interests in socially acceptable topics—like animals, books, or people—so their passions didn’t raise red flags. Many were articulate and skilled at mimicking social patterns, making them appear “fine” on the outside while working overtime

internally to keep up.

In clinical settings, their struggles often showed up as anxiety, panic attacks, depression, or trauma-related symptoms—not as “neurodivergence.” And so, their underlying differences were missed.

Masking: Hiding in Plain Sight

One of the biggest reasons so many women and AFAB people slip through the cracks is masking—the conscious or unconscious effort to suppress natural traits and imitate what’s expected socially. Masking can look like forcing eye contact, rehearsing conversations in advance, suppressing stims, mirroring peers, or monitoring every social interaction like a silent script.

For some of my clients, long-standing anxiety and depression finally made sense once the underlying neurodivergence was identified. For others, years of masking and living in daily conflict with their authentic selves—and constantly pushing beyond their limits to meet expectations—had led to profound nervous system dysregulation. Many experienced full-on burnout, sometimes as early as middle school, during the transition to college, or later in life during major hormonal shifts.

Midlife: When the Mask Slips

In recent years, there’s been a clear trend: many women are seeking autism or ADHD assessments in midlife, often during perimenopause or menopause. Shifts in estrogen levels can impact emotional regulation, sensory sensitivity, cognition, and executive functioning.

For people who’ve relied on finely tuned coping strategies for decades, these hormonal changes can reduce their capacity to keep masking. Traits and struggles that were previously “managed” start bubbling up in ways that can’t be ignored. What looks like a sudden breakdown is often really a revealing—a lifetime of effort becoming too heavy to carry.

While men experience hormonal changes with age as well, the gradual pace means we don’t see the same diagnostic spike later in life. This is a uniquely AFAB pattern that clinicians are only beginning to understand more fully.

Race, Culture, and Compounded Bias

Gender isn’t the only factor. Racial and cultural biases compound the problem. Research consistently shows that Black and Latine children are diagnosed later than white children, even when symptoms are comparable. Black girls, in particular, are often misinterpreted through a racialized lens—labeled as defiant, shy, or having behavioral issues—rather than being evaluated for neurodivergence.

Many women of color report receiving diagnoses only in adulthood, after years of misinterpretation and self-doubt that have affected their sense of self and well-being. When gender and racial bias intersect, the diagnostic gap widens even more.

Looking Back—and Forward

When I think about my earlier years in practice, I can now see how many clients’ stories held clues I didn’t yet have the language or framework to recognize. They weren’t “mystery cases” after all. They were women and AFAB individuals whose neurodivergence had been hidden in plain sight—by research gaps, cultural stereotypes, diagnostic blind spots, and their own extraordinary masking.

Once I began reassessing through this lens, many pieces fell into place. Symptoms that once seemed stubborn or “treatment resistant” made more sense in the context of identity, nervous system needs, and lifelong adaptation.

As more research emerges and awareness grows, we as clinicians, coaches, and allies have the opportunity—and responsibility—to look more deeply. To ask better questions. To see beyond the surface.

Final Thoughts

If any of this resonates with your own story or someone you support, know that you’re not alone. Many are discovering their neurodivergence later in life—not because it’s new, but because the lens finally shifted.

Recognition isn’t about labeling—it’s about understanding. And from understanding comes the possibility of gentler self-acceptance, more effective support, and finally, relief.

Further Reading & Resources

• Hull et al., 2020 – Camouflaging in Autism

• Mandell et al., 2007 – Racial/Ethnic Disparities in Identification

• The Female Autism Phenotype and Camouflaging

---

Begin Your Gentle Reset

You’ve spent years adapting to a world that didn’t fully see you. Now, it’s time to turn inward and reclaim what’s yours.

If you’re ready to begin your unmasking journey with kindness and intention, my Reclaiming Your Capacity self-paced e-course offers a gentle, structured starting point.

This program is designed to help late-identified neurodivergent adults interrupt burnout, reconnect with their nervous systems, and build sustainable rhythms — at a pace that honors your energy.

👉 Explore the course and start your journey here

Go gently — this isn’t about pushing harder. It’s about making space for the real you to breathe.

-Suzanne