Late diagnosis in senior professionals - Deeper Learning

We areincreasingly seeing scenarios where individuals are receiving a diagnosis latein adulthood. A common theme is the use of masking as a coping strategy,contributing to the build-up of stress at work.

The case studyshowcases the value of a multidisciplinary vocational rehabilitationintervention to support a career redirection. Further guidance can be foundbelow: not an assessment tool, but a list of things you may notice in anintervention, and the routes to refer on when you do.

What you might notice

In howsomeone describes their work

•     Performance sustained at a cost that never appeared inan appraisal: “nobody at work would have known”

•     Preparation out of proportion to the task: rehearsingconversations, scripting calls, arriving early to settle before others arrive

•     Deliberately copying a colleague’s phrasing, manner orstyle in order to fit

•     Describing a distinct work persona, or “switching on”for the office

In whatrecovery looks like

•     Weekends and annual leave spent recovering rather thandoing anything

•     Withdrawal from family and social contact thatincreased as work demands rose

•     Exhaustion concentrated after meeting-heavy oropen-plan days rather than physically demanding ones

•     Alcohol, caffeine, long hours or overwork used tosustain performance

In the workhistory

•     Difficulties surfacing at a point of increased demandrather than reduced capability. Promotion into management, a restructure, amove to open-plan

•     A pattern of role changes or exits coinciding withrising social or supervisory load

•     Long service without formal concerns, and then a suddenand complete stop

•     Earlier episodes of anxiety, depression or burnouttreated without the underlying pattern being identified

In howsomeone presents to you

•     Strengths framed as effort: “I’ve learned to…” ratherthan “I find that easy”

•     A fluent presentation that is visibly tiring to sustainacross a long assessment

•     A marked difference between structured conversation andunstructured conversation

This is a prompt for a conversation, not a screeninginstrument. Any one of these has many explanations; it is the pattern, and thecost the person describes, that is worth exploring.

Asking about it

•     What does it cost you to do the parts of the job thatlook easy from the outside?

•     What do you do to prepare for a meeting that otherpeople probably don’t do?

•     What do your evenings and weekends look like after abusy week?

•     Has anyone at work ever known how much effort thistakes?

Where to refer

•     The GP is the route to adult assessment. Local pathwaysand waiting times vary considerably, so set expectations honestly.

•     Specialist psychological services, also via the GP.Worth treating as a separate referral: the diagnostic route and the therapyroute are different pathways, and the second is often the more urgent of thetwo.

•     Occupational health, where the person is employed and aservice exists.

•     An employee assistance programme, where the employerhas one. Usually available straight away, without a diagnosis and without goingthrough a line manager, which matters for someone not ready to disclose.

•     Private medical insurance, where the person or theiremployer holds a policy. It can shorten waits considerably, but cover forneurodevelopmental assessment varies between policies and is often excluded, socheck rather than assume.

•     Adjustments do not require a diagnosis. The workplaceconversation can begin immediately and should not be held up waiting for anassessment.

•     Access to Work and a Health Adjustment Passport areavailable without a diagnosis, and the passport travels with the person betweenemployers.

•     If distress, burnout or risk is disclosed, that is asame-day conversation with the GP, not a referral to wait on.

Validatedmeasures of masking do exist, and they sit with diagnostic services. The VRA isnot recommending their use in vocational assessment: identifying what you areseeing and referring it on is the role here.

References and furtherreading

Hull, L., Mandy, W., Lai, M.-C.,Baron-Cohen, S., Allison, C., Smith, P. & Petrides, K.V. (2019).Development and validation of the Camouflaging Autistic Traits Questionnaire(CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819–833. doi:10.1007/s10803-018-3792-6

Sets out the threecomponents this guidance draws on: compensating, masking and assimilating.

Arnold, S.R.C., Higgins, J.M., Weise,J., Desai, A., Pellicano, E. & Trollor, J.N. (2023). Towards themeasurement of autistic burnout. Autism, 27(7), 1933–1948.doi:10.1177/13623613221147401

Found that masking anddepression each predicted burnout severity independently of sensory sensitivityor autism severity, which is why burnout is usually what presents rather thanmasking itself.

Adamou, M. (2026). Camouflaging inADHD: the need for construct validation before clinical adoption. The BritishJournal of Psychiatry. doi:10.1192/bjp.2026.10577

Argues that thecamouflaging construct does not transfer from autism to ADHD. Contested, but areason to be careful about generalising across conditions.

National Institute for Health and CareExcellence. Autism spectrum disorder in adults: diagnosis and management(CG142).

National Institute for Health and CareExcellence. Attention deficit hyperactivity disorder: diagnosis and management(NG87).

Acas. Reasonable adjustments at work:reviewing adjustments and keeping a record.

Department for Work and Pensions. Health Adjustment Passport guidance(Access to Work).