This study aims to examine how camouflaging and diagnostic overshadowing contributed to delayed autism recognition in an autistic woman, and how adversity complicated the clinical pathway and case formulation.
The authors conducted an instrumental single-case study using a qualitatively driven embedded mixed-methods design in a private clinical practice setting. Data sources included documentary history, collateral developmental information, descriptive self-report measures (Empathy Quotient and Multidimensional Assessment of Interoceptive Awareness) and an in-depth semistructured interview analyzed using the framework method. Qualitative and descriptive clinical data were integrated through narrative synthesis and a joint display.
Three interrelated processes characterized the delayed pathway: prolonged help-seeking organized around prior psychiatric diagnoses and low autism suspicion; camouflaging strategies that reduced clinical detectability despite substantial subjective cost; and adversity-related experiences that intensified internalizing distress and reinforced non-neurodevelopmental interpretations. The participant also presented multimodal sensory hypersensitivity and an interoceptive profile marked by high noticing alongside low self-regulation and low body trust. Overall, the case suggests that delayed autism recognition may arise from the interaction of socially mediated adaptation, diagnostic interpretation bias and contextual vulnerability.
This study provides a clinically grounded, Latin American case-based account of delayed autism recognition in an autistic woman, showing how camouflaging, diagnostic overshadowing and contextual vulnerability may interact across a clinical pathway. It highlights the value of integrating developmental history, examining discrepancies between observable social performance and subjective burden and critically reconsidering prior psychiatric diagnoses when socio-communicative and sensory differences persist.
