“Don't treat autistic people like they're a problem, because we're not!”: An exploration of what underpins the relationship between masking and mental health for autistic teenagers

Autistic people have described masking, or ‘camouflaging’, parts of the self in order to avoid repeated bullying, discrimination, social rejection and in order to meet neuro-normative social expectations. This thesis explores the relationship between autistic people’s experiences of masking and mental health. Part 1 is a conceptual introduction to autism, mental health and masking. Explanations for the increased prevalence of mental health difficulties for autistic people are explored. Masking is identified as a potential factor mediating this relationship. The review discusses different ways of conceptualising masking and explores the drivers and consequences of masking for autistic people. The review concludes with a summary of existing research into the relationship between masking and mental health difficulties. Part 2 is a qualitative study seeking to understand autistic teenager’s experiences of masking and how this relates to their mental health. Semi structured interviews were conducted with 20 autistic teenagers and transcripts were analysed using thematic analysis. Bidirectional relationships between masking and negative mental health related factors, and conversely between authenticity and positive mental health related factors, were described. Both processes were driven by social and environmental factors. The findings support a broader conceptualisation of masking and have implications for diagnostic and therapeutic clinical services. Part 3 is a critical appraisal of the research process. Personal reflexivity is used to consider the impact of the researcher’s perspective on the research. Introspection is used to identify broader theoretical perspectives to inform system-level implications of the research. Reflections on the essentiality of co-production are also presented