Too High-Functioning to Help, Too Brown to Belong: How the ‘Impairment’ Clause Excludes Autistic Girls of Colour

When Coping Looks Like Thriving: How Diagnostic Gatekeeping Disappears Autistic Girls of Colour

High-masking autistic girls of colour are vanishing in plain sight—misread as “resilient,” denied diagnosis, and left unsupported. This piece explores how survival itself becomes the barrier to being seen.

Introduction

Imagine traversing three roads at once—one as an autistic, transgender educator in a Title I school; another as a patient in a system that still doesn’t know what to do with people like me; and a third, quieter road, as a witness to what happens when neurodivergent children don’t “present” the right kind of suffering. These are not metaphorical paths. They are daily realities that intersect and blur, often leading me to the same impassable wall: a system that demands proof of impairment before it will offer help, but refuses to recognise pain when it’s masked. In a piece from last year, Contrasting Pathways, I wrote: “Imagine traversing two distinct pathways within the same healthcare labyrinth—one fraught with obstacles and dead ends, the other lined with compassion and understanding.” But what happens when there’s no compassion, no path, no system even trying to see you? What happens when survival itself becomes a barrier to being believed?

I think often of the girls in my caseload who are slowly disappearing in plain sight. They’re clever, perceptive, and exhausted. Some speak multiple languages. Some write in flourishes. Some won’t speak at all in class, but beam when they’re helping someone younger. They are so good at appearing okay that they’ve become invisible. Their grades, gently buoyed by grace and amazing teachers, hide the aching truth: they’re not fine. They’ve learned how to smile on Zoom during the pandemic. They’ve learned how to be quiet. They’ve learned that being good is the best way to be left alone. And the system is more than happy to oblige.

As someone who has spent a great deal of time fighting to be recognised as autistic, only to be told over and over that I was “too articulate,” “too functional,” or “too self-aware,” I know what it means to have your pain misread as capacity. I know the sharp confusion of performing composure so well that your distress is mistaken for wellness. These girls—many of them Black, Latina, Southeast Asian, or first-generation—are navigating the same terrain I did, but with far fewer resources, and often no advocate at all. The post-pandemic shift to virtual assessments has only made this worse. On camera, their masking becomes even more convincing. Behind a screen, no one sees the leg bouncing under the desk, or the meltdown that comes after. No one hears the silence that follows being asked one question too many. And no one asks why they look so tired all the time.

In writing this piece, I want to follow the thread I began in Who Gets to Be an Autistic Woman?—where I explored how transmisogyny in the diagnostic process erases people like me—and extend it into the classroom, the clinic, and the cold bureaucracies of the public school system. This is about the girls who don’t show up on anyone’s radar because the frameworks were never built to include them. It’s about how “impairment” has become a moving target—one that high-masking, racialised students are expected to hit in order to be seen. It’s about what happens when the system decides someone is coping too well to need help, and then uses that very coping as proof they were never struggling at all.

These are the stories we rarely tell: not just of diagnostic delay, but diagnostic denial; not just of misidentification, but complete erasure. And at the heart of it all is a question that still haunts me—if we keep building systems that only recognise trauma when it’s loud, who gets left behind in the quiet?

The Diagnostic Trap of ‘Impairment’

The Hollingdale et al. article is clear about one thing: under both the DSM-5-TR and ICD-11, a diagnosis of autism requires evidence of “impairment.” What it does not offer, however, is any meaningful clarity on what impairment actually is—or how it should be assessed. There is no standard for significance. No universal rubric. No recognition that what looks like success in one context might be survival in another. In this vagueness lies the real trap: when clinicians and school systems are left to interpret “impairment” through their own biases—gendered, racialised, classed—the result is not objectivity. It is gatekeeping. It is denial, dressed up as due process.

In the wake of the pandemic, with many assessments still taking place over Zoom, the diagnostic process has become even more skewed in favour of those who don’t need it. What can’t be seen on camera—meltdowns, shutdowns, the sheer toll of masking—doesn’t count. A child who smiles when spoken to, answers in full sentences, and has passing grades is often deemed fine, regardless of what’s happening internally. And so high-masking girls of colour are told, in effect, that unless they are failing in obvious, measurable ways, their suffering isn’t real. Unless they break, they don’t belong.

This is particularly cruel because these girls have been conditioned by the school system not to break. They are praised for being quiet, compliant, tidy. They are rewarded for not needing attention, for not being disruptive, for “doing their best” even when their best is laced with silent panic. The ideal student in a behaviourist classroom model—especially in underfunded Title I schools—is one who follows instructions, completes tasks, and causes no trouble. This is not education; it’s conditioning. It teaches children, especially girls of colour, that their value lies in invisibility. That success means disappearing their needs. That smiling is safer than asking.

And when they do all of that—when they absorb the expectations and perform them flawlessly—they are left out of the diagnostic conversation entirely. Because in the eyes of the system, they are “functioning.” And functioning students are not impaired. And students who are not impaired cannot be autistic. The diagnostic criteria may be written in clinical language, but in practice, they are enforced by the unspoken cultural norms of the classroom. And in classrooms shaped by poverty, systemic racism, and survival-based compliance, those norms are anything but neutral.

So we create the conditions that mask impairment, and then use the absence of visible impairment as a reason to withhold diagnosis. It is a closed loop, and these girls are trapped inside it. Not because they don’t need support, but because the system has taught them that needing less is the only way to be allowed to stay.

The Masking that Protects and Condemns

They pass—but that’s the problem. High-masking girls of colour in Title I schools are often too articulate, too polite, too good at suppressing their distress to be seen as struggling. Their masking has become seamless, shaped by years of expectations that reward quiet compliance and punish visible need. They get passing grades—sometimes due to their own relentless internal standards, sometimes due to the care and grace of their teachers who scaffold, reteach, and allow multiple retakes. Sometimes it’s because their trauma-trained bodies know how to survive by avoiding attention. The grades come in. The boxes get ticked. The system breathes a sigh of relief. Another student “doing fine.”

But they’re not fine. And we know it. I’ve spoken with parents—mothers, usually—who can see right through the act. They’ll tell you their daughter melts down the moment she gets home. That she refuses to eat at school. That she talks about being “wrong” or “broken” or “tired all the time.” They’ll tell you that she’s always been different but managed to keep up, and so no one ever really asked what she needed. And still, despite all this knowing, the priority remains the same: pass the classes, get the diploma. Because every parent I’ve spoken with knows what happens to young people without one. The world is not kind to those without a high school certificate—especially not to girls of colour from working-class families. They understand the system isn’t built to catch their daughters, so they push them to float above it instead.

Teachers know this too. We see it. We do what we can. We give extensions, offer after-school help, allow open-note quizzes, build small scaffolds into lessons so the student can meet the Common Core State Standards. We care. And that care sometimes looks like bending every rule we can to make sure they don’t fail. But all of that love and support evaporates when standardised testing rolls around. Suddenly, these same students are alone with the SBAC or the SAT, stripped of their adapted tools and tossed into a setting where they’re expected to perform neurotypical reasoning under pressure, unaided. The scores are low, but no one really fights over them. Because parents don’t care about those numbers—not really. They care about grades, transcripts, and whether their child walks across that stage.

Here lies the heartbreaking contradiction: many families know an autism diagnosis could open doors—accommodations in college, protection in the workplace, access to disability services—but the path to that diagnosis requires visible failure, and failure threatens the diploma. The system makes these goals mutually exclusive. In trying to protect their children from the brutality of life without credentials, families may unwittingly contribute to their child’s invisibility as a disabled person. And in turn, the system uses that invisibility as justification to deny support.

In a school system that prefers compliance to wellbeing, high-masking girls of colour don’t show up as impaired. They show up as resilient—and that’s how they disappear.

A Tale of Two Assessments

I’ve walked both roads—the one that welcomes, and the one that warns. When I sought gender-affirming care, even over Zoom, I was met with compassion. There was structure, yes, but also a kind of softness built into the process. Providers understood that I was arriving with a whole life behind me. They listened first. They didn’t make me prove anything except that I knew myself. It was care rooted in affirmation, not suspicion. In contrast, every step of my journey toward an autism diagnosis felt like a cross-examination. Even after receiving my diagnosis years ago, I found that it didn’t travel well—it had to be constantly defended, re-justified, proved anew.

Most recently, I needed an updated accommodations letter for a course I was taking. I assumed it would be a simple process—just a refresh based on existing documentation. But instead, the head of the department that handles autism services at my healthcare provider insisted that I undergo a full re-evaluation. He made it clear that his findings could “change” my diagnosis, and wanted me to acknowledge that before proceeding. It was, frankly, a threat disguised as procedure. I walked away. I didn’t go forward. I couldn’t risk losing the one label that had ever made certain parts of the world make sense. Instead, I now negotiate my accommodations case by case, classroom by classroom, always aware that what was true in 2012 might not be accepted anymore simply because I’ve learned to cope better. As if growing isn’t allowed. As if visibility of struggle is the only valid evidence of need.

This is what so many of my students face, even if they can’t yet name it. Public education mirrors this logic almost perfectly. Autism assessments in schools still rely on deficit models—on what’s seen, what’s measurable, what disrupts the room. There’s little room for nuance, for internal distress, for quiet pain. And for girls of colour, the bar to even begin the process is so high it may as well be unreachable. If they are not disruptive, if they don’t elope, if they don’t melt down in the classroom, they are not considered candidates for assessment. If they comply, they are fine. If they smile, they’re thriving. If they speak in full sentences, they’re neurotypical.

But I know what it’s like to be told that if you’re coping, you’re “cured.” That if you’re speaking, you’re not struggling. That surviving somehow disqualifies you from support. And I see it in my students’ eyes every day. They know something is off, but they don’t yet have the words for it. They don’t have the diagnostic language, or the power to demand a referral, or the safety to admit what hurts. All they have is the mask—and the mask is working too well. The system sees the mask and calls it a face.

This is the cruelty of it: the more successfully a student adapts, the less likely they are to be seen. And the less they are seen, the less support they receive. And eventually, the mask becomes the only thing holding them together. Until it isn’t. Until they break. And by then, we’ve already failed them.

Systemic Bias and the Price of Passing

The pathway to autism services in Los Angeles County runs through the Regional Center system—a sprawling network that, on paper, exists to support individuals with developmental disabilities from birth through adulthood. In practice, however, it's an opaque labyrinth. The website offers a general overview, a few links, and some phone numbers—but no clear entry point. No button that says “Click here if you suspect your child might be autistic.” No straightforward roadmap for families who are already overwhelmed, already fighting to survive. You’d never know from looking at it that autism services are even part of what they offer, let alone how to access them. If you are a parent with limited literacy, or if English isn’t your first language, or if you don’t know the bureaucratic words for what you’re seeing in your child, it might as well not exist.

Thankfully, there are people in the community who help. Advocates, care coordinators, cultural liaisons—often working quietly behind the scenes—guide families through the process of getting referrals, completing intake forms, and pushing for evaluations. But without those guides, many families—especially those receiving social benefits—simply never reach the starting line. They don’t have the time, the access, or the energy to fight through a system that assumes you already know how to ask the right questions. And all the while, their children are sitting in classrooms, masking brilliantly, passing just enough, and being left to drift.

Even when an assessment is requested, it’s often conducted remotely. Since the pandemic, regional centres have leaned heavily on Zoom-based evaluations—convenient, certainly, but far from comprehensive. These assessments miss the micro-expressions, the subtle disassociations, the deep freeze responses that so many autistic girls of colour learn to employ. They don’t see the way she grips the sides of her chair or how her smile falters the moment she’s no longer being watched. They don’t hear what her teacher hears in the quiet spaces between questions. The screen flattens everything. And if she answers clearly, sits still, and doesn’t show signs of overt distress? Well, then, she must be fine.

Layered on top of this is the deeply entrenched cultural bias in how behaviours are interpreted. The same behaviours that might raise red flags in a white child are often dismissed in children of colour as attitude problems, poor parenting, or simply “just how they are.” Internalising traits—anxiety, withdrawal, perfectionism, selective mutism—rarely register as concerning in Black and brown girls. They’re often reframed as maturity, shyness, or “good behaviour.” The cultural coding of behaviour—what’s considered worrying, what’s considered normal—is one of the most insidious forms of diagnostic gatekeeping. And it’s rarely named.

And then there’s the school’s role. In underfunded districts, every evaluation is a risk—an opening of the door that might require long-term support, service minutes, and resource allocation. Schools are under immense pressure to stretch budgets, and students with passing grades are rarely prioritised for assessment. “They’re doing fine” becomes both a shield and a sentence. Even when teachers suspect something deeper is going on, they know the unspoken truth: if the child isn’t failing, there’s little hope of an IEP. And pushing for one can mean political pushback, increased workload, or simply being told “no” by someone higher up.

When the system demands visible impairment and visible distress, masking becomes a barrier to diagnosis, not a symptom of need. For high-masking girls of colour, survival strategies are mistaken for success. And so, they fall through the cracks—deliberately, structurally, and quietly. Not because they are thriving, but because they’ve been trained to hide the ways in which they are not.

But Wait, There’s More …

There’s another twist in the maze—one that few outside the system understand, and that even those inside often struggle to explain. The Regional Centers don’t offer diagnoses. What they offer is an evaluation—a determination of whether someone qualifies for services under their internal criteria, which can include autism, but only as one of five qualifying categories under California law. These evaluations can, in theory, be used to support the addition of an autism eligibility under IDEA within the school system—but they carry no legal obligation. The school doesn’t have to accept the findings. Parents are the ones who must hand over the report, and even then, the school can decide the evidence isn't “sufficient” to warrant changing or adding an eligibility category. In this way, the Regional Center evaluation becomes a half-measure: meaningful to those who know how to use it, but toothless without institutional will.

This gap—between what a Regional Center can suggest and what a school is willing to acknowledge—is where many students are quietly lost. Families, relieved to finally have something on paper, bring it to the school expecting that it will change everything. But unless the child is visibly failing or behaving in a way that disrupts the classroom, the school often refuses to add the autism eligibility. Instead, they may keep the student listed under something more generic—“Other Health Impairment,” perhaps, or even just “Specific Learning Disability”—categories that offer fewer protections and little acknowledgement of the student’s actual neurology.

This erasure is compounded by the fact that many families never even reach the Regional Center in the first place, let alone complete an evaluation. For those navigating multiple systems—housing insecurity, public benefits, limited English access, or (more recently) immigration concerns—the thought of initiating yet another complex process can feel impossible. And for those who do persevere, the reward may still be a piece of paper that schools are free to ignore.

So once again, we’re left with a system that demands proof but refuses to define what proof looks like. It offers pathways that stop short of power. It gives parents hope, only to place the final decision in the hands of schools that are already stretched thin, incentivised to avoid costly services, and steeped in cultural assumptions about who needs help and who’s just not trying hard enough.

And in that space—between evaluation and action—high-masking girls of colour continue to vanish. Their exhaustion reads as composure. Their survival strategies are mistaken for strength. And their evaluations, if they exist at all, become just another document the system doesn’t quite know what to do with.

What Gets Lost

What gets lost is everything we claim to value. These girls don’t get IEPs. They don’t get access to speech services, sensory supports, or social-emotional counselling tailored to their needs. They don’t get connection to autistic community, or the language to name their experience, or the reassurance that they are not broken—just different in a way the world hasn’t learned to see yet. What they get instead is silence. Isolation. The quiet erosion of self-understanding.

They move through school believing their failure to thrive is a personal defect. That their exhaustion is laziness. That their overwhelm is immaturity. That their inability to keep up is a moral failing. Because when no one names the shape of your struggle, you start to believe it’s just you. You blame yourself for not being better at life.

And so they burn out. Not all at once, and not in a way that draws attention—but slowly, deeply, and alone. They become the teenager who can’t get out of bed, the college student who drops out after one term, the adult who keeps cycling through jobs, friendships, relationships—never quite able to settle, never quite knowing why. By then, the system has long since forgotten them. They passed. They graduated. The paperwork is clean. But inside, the damage lingers.

We talk about “early intervention” like it’s the holy grail—like identifying and supporting autistic children early will change the trajectory of their lives. But for whom? Who gets that kind of intervention? Who gets seen early enough to benefit from it? Intervention doesn’t happen when the system refuses to recognise distress without spectacle. It doesn’t happen when masking is rewarded and compliance is mistaken for wellness. It doesn’t happen when the price of being seen is visible failure.

What gets lost are not just services or supports. What gets lost are years—sometimes decades—of belonging, of self-knowledge, of the chance to build a life rooted in truth rather than adaptation. And we will never fully account for the cost. Because when we look at these girls—smiling, passing, quiet—we don’t see what’s missing. We only see what we’ve trained them to show.

Final thoughts …

In Who Gets to Be an Autistic Woman?, I called for a future where autism is understood not as a defect, but as a way of being—fluid, relational, complex, and deserving of care. That future feels even more urgent now. Because what this system demands—what the DSM and ICD insist upon—is impairment. Not context, not meaning, not the nuance of lives shaped by survival. Just impairment. And in doing so, it reduces our existence to what can be measured in dysfunction, what can be pathologised in isolation, what can be observed from outside. It is a framework built on deficit and spectacle—on distress that must be visible to count, and on “difference” only when it disrupts.

But what if we didn’t start there? What if, instead of asking “Are you impaired?” we asked “What has happened to you?” “How have you made sense of it?” “What do you need to survive—and more than that, to thrive?” This is the orientation offered by the Power Threat Meaning Framework (PTMF). Developed as a radical alternative to diagnostic systems rooted in Western psychiatry, the PTMF invites us to look beyond labels and ask what roles power, trauma, and survival play in shaping behaviour. It treats people as experts in their own experience, not problems to be solved. It offers understanding, not judgement. And most importantly, it doesn’t require collapse to legitimise care.

A truly liberatory framework for autism would follow that same ethic. It would recognise that masking is not the absence of need, but often the clearest indicator that support is essential. It would centre the experiences of those most often excluded—high-masking girls of colour, gender-diverse youth, those whose lives don’t map cleanly onto clinical expectations. It would acknowledge that diagnostic models which require visible impairment will always reproduce injustice, because they ignore the ways in which suffering is hidden to survive.

This isn’t about expanding labels for the sake of inclusion theatre. It’s about creating conditions where no one is excluded because they’ve done too good a job surviving. Because right now, we are raising a generation of autistic girls who don’t know they’re autistic—because the system sees only what it wants to see. And what it wants to see is someone worth saving. The rest? It lets disappear.

But we do not have to accept this. We can choose to build frameworks rooted in justice, not compliance. In care, not classification. In meaning, not impairment. And in doing so, we may yet build a world where being seen is not something we have to earn. It is something we are owed.