I Feel Autistic in Midlife: AQ-10, Burnout, and Why Autism in Women Over 40 Can Show Up
- Kiesa Kelly
- 12 hours ago
- 6 min read
Last reviewed: 02/27/2026
Reviewed by: Dr. Kiesa Kelly
If you’ve been googling autism in women over 40 and thinking, “Why does this feel so true now?” you’re not alone. Many women reach midlife and suddenly notice more sensory overwhelm, more social exhaustion, and more “I can’t do life anymore” moments, even if they’ve been highly capable for decades. Diagnostic bias and masking (camouflaging) can delay recognition, especially when someone has learned to look “fine” on the outside. [8]
In this article, you’ll learn:
Why midlife can be a tipping point for noticing autistic traits
What long-term masking can cost your nervous system and energy
How the AQ-10 works and what an aq 10 score can (and can’t) tell you
What a high-quality adult evaluation looks for beyond questionnaires
Next steps if you’re considering an autism diagnosis at 40 (or later)
💡 Key takeaway: Midlife “unmasking” doesn’t mean autism suddenly appeared. It often means your coping strategies are finally outpaced by stress, roles, and body changes. [5]
Why midlife is a common tipping point for autism in women over 40
Cognitive load + role demands
Midlife often stacks invisible demands: career complexity, parenting, caregiving, relationships, and the administrative burden of daily life. For someone with high masking autism in women, that can become a constant state of “performing while juggling.”
A quick demand audit can help you separate “I’m failing” from “my load is unsustainable”:
List your recurring weekly demands (work, home, social, health, caregiving).
Circle the ones that are time-sensitive and emotionally costly.
Reduce, delay, delegate, or automate one circled demand for two weeks.
Track what shifts: sleep, irritability, sensory tolerance, recovery time.
🧠 Key takeaway: Autistic burnout is linked to chronic life stress plus a mismatch between demands and available supports. Reducing demand load is often a clinical “first move,” not a luxury. [5]
Hormone shifts + sensory sensitivity changes
Perimenopause often starts in the mid‑40s (though it can begin earlier) and can affect sleep, temperature regulation, mood, and concentration. [10] When sleep is disrupted, many people have less capacity for noise, light, social complexity, and change.
Emerging research and autistic-led accounts describe menopause and perimenopause as a time when sensory sensitivities and daily functioning may worsen for some autistic people. [9,11]
🌡️ Key takeaway: Perimenopause and autism can interact through sleep disruption, stress reactivity, and sensory tolerance. If everything feels “too loud,” it may be a bandwidth problem, not a character problem. [9,10]
What masking costs over time
Shutdown, meltdowns, fatigue, “I can’t do life anymore” moments
Masking can look like being social, competent, and helpful while privately rehearsing scripts, suppressing stimming, and monitoring yourself nonstop. Qualitative work on camouflaging describes exhaustion and threats to self‑perception as common costs. [6] Tools like the CAT-Q were developed because many autistic adults, especially women, report extensive camouflaging even when they “don’t look autistic.” [7]
Over time, chronic masking can show up as:
Shutdowns (going quiet, numb, or “offline” after load)
Meltdowns (overwhelm that spills over, often followed by shame)
A shrinking window of tolerance for noise, conflict, and change
A growing need for isolation to recover
Misconceptions that keep people stuck:
“If I can hold a job or have friends, I can’t be autistic.” Many autistic adults do; the question is what it costs. [8]
“Autism always shows up in childhood.” Traits are lifelong, but recognition depends on context and bias in who gets evaluated. [8]
“Burnout just means depression.” Autistic burnout has been described as chronic exhaustion, loss of function/skills, and reduced tolerance to stimulus after prolonged mismatch and stress. [5]
🫶 Key takeaway: Autistic burnout women describe is often misread as “just anxiety” or “just stress.” Naming the pattern can make support more targeted and less blaming. [5,8]
How AQ-10 fits into the bigger picture
Using it as a signal to seek a fuller evaluation
The AQ-10 is a brief screening questionnaire used to help decide whether an adult should be referred for a comprehensive autism assessment. [1,2] On the official tool, a score of 6 or above is a common referral threshold. [1] That doesn’t mean a lower score rules autism out, and it doesn’t mean a higher score confirms it.
A steadier way to use an aq 10 score is to treat it as one data point:
Which items felt most true, and in what situations?
Do your endorsements change with stress, sleep, and sensory load?
What lifelong patterns does the score not capture (childhood history, shutdowns, sensory needs)?
Researchers also caution against using AQ-10 totals as a general “trait autism” measure in the general population because of psychometric limitations in that context. [4]
🧾 Key takeaway: Think of AQ-10 as a flashlight, not a verdict. It can point you toward a next step, but it can’t tell the whole story by itself. [1,4]
What a high-quality adult autism evaluation includes
Developmental history + pattern recognition
A strong adult evaluation doesn’t treat autism like a checklist. It looks for a consistent, lifelong pattern across settings, while also considering how camouflaging and the “female autism phenotype” can obscure traits. [6,8]
In practice, that often includes:
A detailed interview about childhood, school, friendships, sensory differences, and routines
Collateral information when possible (a parent, sibling, old report cards)
Standardized measures used appropriately, interpreted in context
Screening for overlaps and “lookalikes” such as ADHD, anxiety, OCD, trauma symptoms, and sleep problems, so one label doesn’t overshadow another [2,8]
If you’re searching “adult autism assessment near me,” look for a provider who can explain their adult process clearly and welcomes your questions.
🔎 Key takeaway: The best assessments don’t just ask, “Do you meet criteria?” They ask, “What patterns explain your lived experience, and what supports will reduce friction in daily life?” [2,8]
Clear feedback and practical recommendations
NICE guidance emphasizes comprehensive assessment and clear follow‑up planning. [2] The end of an evaluation should include practical recommendations tied to your goals and stress points.
Examples of recommendations we often see clients benefit from:
Energy pacing and burnout recovery planning
Sensory accommodations at work and home (lighting, sound, clothing, scheduling)
Communication supports that reduce mind‑reading expectations
Referrals for co‑occurring needs (sleep treatment, trauma therapy, OCD treatment)
🧭 Key takeaway: A high-quality evaluation should leave you with a map, not a mystery. You deserve feedback you can use on Monday morning. [2]
Next steps
If you want a quick starting point, you can use the ScienceWorks AQ-10 screener to review the questions and scoring. You can also pair it with broader context using our mental health screening tools so you have a fuller snapshot to discuss with a clinician.
If you’re considering late diagnosed autism in women, it helps to know what an adult evaluation includes. Our psychological assessments page outlines the process and what to expect from results.
For many people, the best next step is one small move that reduces uncertainty:
If you’re overwhelmed: do a two-week demand audit and protect recovery time.
If you want clarity: gather childhood clues (old notes, report cards, a parent call).
If you’re ready to talk options: book a conversation about fit and timing.
ScienceWorks Behavioral Healthcare offers free consultations and telehealth across Tennessee (and many other states). If you’d like to talk through next steps, you can contact our team or explore specialized therapy that supports burnout recovery and neurodivergence.
About the Author
Dr. Kiesa Kelly is a PhD-level clinical psychologist with a concentration in neuropsychology and more than 20 years of experience in psychological assessment. Her training included clinical practica, internship, and an NIH-funded postdoctoral fellowship focused on assessment and ADHD.
At ScienceWorks Behavioral Healthcare, she provides neurodiversity-affirming care for adults and teens, including assessment and specialized therapy that supports neurodivergence, OCD, trauma-related symptoms, and sleep concerns.
References
Autism Research Centre. AQ-10 Autism Spectrum Quotient (AQ) quick referral guide for adults with suspected autism who do not have a learning disability [PDF]. 2012. Available from: https://docs.autismresearchcentre.com/tests/AQ10.pdf
National Institute for Health and Care Excellence (NICE). Autism spectrum disorder in adults: diagnosis and management (CG142) – Recommendations. Last updated 14 June 2021. Available from: https://www.nice.org.uk/guidance/cg142/chapter/recommendations
Booth T, Murray AL, McKenzie K, Kuenssberg R, O'Donnell M, Burnett H. Brief report: an evaluation of the AQ-10 as a brief screening instrument for ASD in adults. J Autism Dev Disord. 2013;43(12):2997-3000. doi: https://doi.org/10.1007/s10803-013-1844-5
Taylor EC, Livingston LA, Clutterbuck RA, Shah P. Psychometric concerns with the 10-item Autism-Spectrum Quotient (AQ10) as a measure of trait autism in the general population. Experimental Results. 2020;1:e3. doi: https://doi.org/10.1017/exp.2019.3
Raymaker DM, Teo AR, Steckler NA, et al. "Having All of Your Internal Resources Exhausted Beyond Measure and Being Left with No Clean-Up Crew": Defining autistic burnout. Autism in Adulthood. 2020;2(2):132-143. doi: https://doi.org/10.1089/aut.2019.0079
Hull L, Petrides KV, Allison C, et al. "Putting on My Best Normal": Social camouflaging in adults with autism spectrum conditions. J Autism Dev Disord. 2017;47(8):2519-2534. doi: https://doi.org/10.1007/s10803-017-3166-5
Hull L, Mandy W, Lai MC, et al. Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). J Autism Dev Disord. 2019;49(3):819-833. doi: https://doi.org/10.1007/s10803-018-3792-6
Cook J, Hull L, Mandy W. Improving diagnostic procedures in autism for girls and women: a narrative review. Neuropsychiatr Dis Treat. 2024;20:505-514. doi: https://doi.org/10.2147/NDT.S372723
Karavidas M, de Visser RO. "It's Not Just in My Head, and It's Not Just Irrelevant": Autistic negotiations of menopausal transitions. J Autism Dev Disord. 2022;52(3):1143-1155. doi: https://doi.org/10.1007/s10803-021-05010-y
Cleveland Clinic. Perimenopause: age, stages, signs, symptoms & treatment. Last updated 08/08/2024. Available from: https://my.clevelandclinic.org/health/diseases/21608-perimenopause
National Autistic Society. Menopause: autism and the menopause. Available from: https://www.autism.org.uk/advice-and-guidance/physical-health/menopause
Disclaimer
This blog is for informational purposes only and does not provide medical, psychological, or diagnostic advice. If you need personal guidance, please consult a qualified healthcare professional or a licensed mental health provider.
