How can I teach an individual with autism spectrum disorder to mask social cues safely, ensuring it is optional, paced, and minimizes anxiety and burnout?

Teaching Masking to Individuals with ASD: A Harm-Reduction Framework

Do not teach masking as a primary intervention strategy, as masking is associated with increased depression, anxiety, burnout, lower self-esteem, lower authenticity, past interpersonal trauma, and suicidal ideation in autistic adults. 1, 2 Instead, focus on teaching authentic social communication skills through evidence-based developmental and behavioral interventions that enhance genuine social reciprocity rather than suppression of autistic traits. 3

Why Masking Should Not Be a Treatment Goal

The evidence strongly contradicts teaching masking as a therapeutic strategy:

• Higher masking behaviors correlate with worse mental health outcomes, including greater anxiety and depression symptoms, lower self-esteem, and lower authenticity in autistic adults. 1
• Masking leads to exhaustion and burnout, with autistic individuals reporting feeling disconnected from their true sense of identity. 2
• Masking is associated with suicidal ideation in autistic people specifically, a finding not observed in nonautistic populations who also engage in stigma management. 2
• Masking develops as a trauma response to stigma, representing an attempt to avoid harm rather than a healthy adaptive skill. 1, 4

Evidence-Based Alternative: Authentic Social Skills Development

The American Academy of Child and Adolescent Psychiatry recommends structured educational approaches with explicit teaching of pragmatic language and social reciprocity skills through integrated developmental and behavioral interventions. 3

Core Intervention Framework

Teach authentic social communication skills rather than suppression strategies:

• Pragmatic language skills training addresses how to use language functionally in social contexts without requiring individuals to hide their autistic traits. 3
• Social reciprocity interventions focus on genuine back-and-forth interaction, teaching the "why" behind socialization rather than rote mimicry. 3
• Explicit teaching of social cognitive knowledge helps individuals understand social situations without demanding they pretend to be neurotypical. 3

Developmentally Appropriate Methods

For school-age children and adolescents:

• Social skills groups provide structured practice with peers in a supportive environment where autistic traits are accepted. 3
• Social thinking curricula address underlying social cognitive knowledge required for social skills expression, promoting understanding of the reasoning behind social behaviors. 3
• Visual schedules and verbal rehearsal use written and pictorial representations to prepare for social situations without requiring trait suppression. 3
• Peer network/circle of friends programs train neurotypical peers to initiate and model appropriate interactions, creating accepting environments rather than demanding conformity. 3

Critical Implementation Principles

Active family involvement is essential:

• Parents should help set goals and priorities that align with the child's authentic self rather than neurotypical expectations. 3
• Family members can capitalize on teachable moments during daily routines to reinforce genuine social communication skills. 3
• Parental involvement increases intervention time and facilitates generalization of learned skills across environments. 3

Interventions must begin early and be intensive:

• Initiate interventions as soon as ASD is diagnosed or seriously considered, as early intensive education yields significantly improved developmental outcomes. 3
• Interventions before age 3 may have greater positive impact than those begun after age 5. 3

When Social Adaptation Skills Are Clinically Necessary

If teaching any form of social adaptation is clinically indicated (e.g., for safety or to reduce severe social isolation), apply these harm-reduction principles:

Make It Explicitly Optional

• Frame all social strategies as tools the individual can choose to use or not use, never as requirements for acceptance. 4
• Emphasize that autistic traits are not deficits requiring correction, but differences that may need navigation in a neurotypical-dominated world. 4

Focus on Specific, Functional Skills Only

• Target discrete, functional communication skills (e.g., how to ask for help, how to decline unwanted interaction) rather than broad suppression of autistic presentation. 3, 5
• Use behavioral techniques for specific problem behaviors that interfere with the individual's own goals, not behaviors that merely make others uncomfortable. 3

Monitor for Harm

• Screen regularly for anxiety, depression, and burnout, as these are elevated risks in ASD and can be exacerbated by masking. 1, 2
• Assess self-esteem and authenticity as indicators of whether interventions are supporting or undermining the individual's sense of self. 1
• Watch for signs of exhaustion or disconnection from identity, which indicate harmful levels of masking. 2

Critical Pitfalls to Avoid

Do not use Applied Behavioral Analysis (ABA) to suppress stimming or other harmless autistic behaviors:

• While ABA has demonstrated efficacy for teaching specific skills and addressing truly maladaptive behaviors, 3 using it to eliminate harmless self-regulatory behaviors (hand flapping, rocking, etc.) constitutes teaching masking and is associated with trauma. 1, 4

Do not frame neurotypical behavior as the goal:

• The goal should be functional communication and genuine social connection, not appearing non-autistic. 4
• Cognitive behavioral therapy has shown efficacy for anxiety and anger management in high-functioning youth with ASD, 3 but should address distress rather than autistic traits themselves.

Recognize that masking is often unconscious:

• Many autistic individuals develop masking behaviors without explicit teaching due to stigma and trauma. 2, 4
• Therapeutic work may need to focus on helping individuals recognize and reduce harmful masking they have already developed. 4

Addressing Comorbid Conditions That Affect Social Functioning

Screen for and treat conditions that genuinely impair functioning:

• ADHD affects more than half of individuals with ASD and should be specifically assessed and treated, as inattention and impulsivity can interfere with social learning. 3
• Anxiety and depression are increased risks, especially in adolescents, and require direct treatment rather than being dismissed as inevitable consequences of being autistic. 3
• Cognitive behavioral therapy has demonstrated efficacy for anxiety and anger management in high-functioning youth with ASD. 3

The Role of Autistic Community Connection

Higher participation in the autistic community is associated with lower masking behaviors. 1 This suggests that:

• Connecting individuals with autistic peers and role models may reduce the perceived need to mask. 1
• Fostering autistic identity and pride can serve as a protective factor against the harms of masking. 1, 4