AUTISM IN ADULTHOOD

Volume 4, Number 1, 2022

ª Mary Ann Liebert, Inc.
DOI: 10.1089/aut.2021.0021

What Is Autistic Burnout? A Thematic Analysis

of Posts on Two Online Platforms

Jane Mantzalas, GradDipPsychSt, BPsychSt (Hons),1 Amanda L. Richdale, PhD,1

Achini Adikari, BScIT (Hons),2 Jennifer Lowe, BCom (Hons),1,3 and Cheryl Dissanayake, PhD1

Abstract
Background: Compared with adults in the general population, autistic adults are more likely to experience poor
mental health, which can contribute to increased suicidality. While the autistic community has long identified
autistic burnout as a significant mental health risk, to date, only one study has been published. Early research
has highlighted the harmful impact of autistic burnout among autistic adults and the urgent need to better
understand this phenomenon.
Methods: To understand the lived experiences of autistic adults, we used data scraping to extract public posts
about autistic burnout from 2 online platforms shared between 2005 and 2019, which yielded 1127 posts. Using
reflexive thematic analysis and an inductive ‘‘bottom-up’’ approach, we sought to understand the etiology,
symptoms, and impact of autistic burnout, as well as prevention and recovery strategies. Two autistic re-
searchers with self-reported experience of autistic burnout reviewed the themes and provided insight and
feedback.
Results: We identified eight primary themes and three subthemes across the data. (1) Systemic, pervasive lack
of autism awareness. (1.1) Discrimination and stigma. (2) A chronic or recurrent condition. (3) Direct impact on
health and well-being. (4) A life unlived. (5) A blessing in disguise? (6) Self-awareness and personal control
influence risk. (6.1) ‘‘You need enough balloons to manage the weight of the rocks.’’ (7) Masking: Damned if
you do, damned if you don’t. (8) Ask the experts. (8.1) Stronger together. The overarching theme was that a
pervasive lack of awareness and stigma about autism underlie autistic burnout.
Conclusions: We identified a set of distinct yet interrelated factors that characterize autistic burnout as a
recurring condition that can, directly and indirectly, impact autistic people’s functioning, mental health, quality
of life, and well-being. The findings suggest that increased awareness and acceptance of autism could be key to
burnout prevention and recovery.

Keywords: autism, autistic burnout, exhaustion, burnout, autistic adults, thematic analysis

Community Brief
What was the purpose of this study?
Although the autistic community has talked about autistic burnout for a long time, there has not been much
research about the topic. This study aimed to investigate autistic burnout from the perspective of autistic adults
to understand what they think causes it, the symptoms and impact on their lives, and what can be done to assist
prevention and recovery.

1
Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
2
Centre for Data Analytics and Cognition, La Trobe University, Melbourne, Australia.
3
Department of Public Health, La Trobe University, Melbourne, Australia.

52
WHAT IS AUTISTIC BURNOUT? 53

Why is this an important issue?

This issue is important because autistic people have said that autistic burnout can severely affect their quality of
life and well-being and contribute to poor mental health, including the risk of suicide.

What did the researchers do?

We used a computer program to collect public posts from two online platforms to look at how autistic adults
described autistic burnout. We collected 1127 posts shared over a 12-year period by 683 users. To understand
the adults’ lived experiences, we analyzed their language at the surface level and looked for common themes
across the data.

What were the results of the study?

The adults in this study said that autistic burnout was often first experienced during adolescence, lasted
months or years, and was hard to recover from. They described severe direct and indirect consequences for
their physical and mental health, capacity to function, and ability to achieve personal goals. They described
a general lack of knowledge about autism, especially among health care professionals, which led to mis-
diagnosis and inadequate or inappropriate treatment. Masking or ‘‘camouflaging’’ to pass as nonautistic was
the most common reason participants gave for autistic burnout. Many used strategies to manage energy
levels to avoid burnout. The autistic community was an essential source of information and support for
participants. Overall, stigma, discrimination, and low awareness and acceptance of autism were responsible
for the cycle of autistic burnout.

How do these findings add to what was already known?

As one of the first studies about autistic burnout, we learned that it happens because of factors associated with
being autistic and poor autism awareness and acceptance within society. We now know that autistic people
often first experience autistic burnout when they are young, but it usually recurs, which can stop autistic people
leading fulfilling lives. We learned that difficulty identifying emotions may be a risk factor and that online
communication may help autistic people during recovery. We found that some positive consequences of autistic
burnout include autism diagnosis in adulthood, finding the autistic community, and making empowering life-
style changes.

What are the potential weaknesses in the study?

We had limited demographic information, so we do not know how diverse the sample was or how factors such
as gender, age, race, or identifying as LGBTQI may have influenced some people’s experience of autistic
burnout. The adults in this study had access to online platforms and could communicate in writing, and so,
people with higher communication support needs may not have been included.

How will these recommendations help autistic adults now or in the future?
The findings reinforce the personal stories of autistic people and show that autistic burnout is a common,
consistent, and harmful experience. The findings show it is vital for health professionals to recognize autistic
burnout to provide appropriate care and support because prevention and early detection could help stop the
harmful cycle of autistic burnout. The findings underscore the importance of reducing discrimination and stigma
against autistic people and increased acceptance.

Introduction autistic people really seem to know about it.’’1 The term
‘‘burnout’’ originated within organizational psychology to

M yriad first-person accounts by members of the

autistic community indicate the debilitating impact of
‘‘autistic burnout’’ on their mental health and well-being,
with one person describing it as: ‘‘an integral part of the life
of an autistic person that affects us pretty much from the
moment we’re born to the day we die, yet nobody, apart from
describe the state of emotional, physical, and mental ex-
haustion that develops over time from job-related stress.2
Some researchers posit that this exhaustion is associated
with a specific aspect of an individual’s life,3 which can be
nonwork related, such as a lack of recovery in athletes4 and
perfectionism in parents.5 It is, therefore, possible that
54
factors related to autism (e.g., sensory hypersensitivity) may
uniquely contribute to autistic burnout.
Until recently, studies about autism-related burnout fo-
cused on the experiences of parents, teachers, and peers of
autistic children.6–8 The first study of burnout from the per-
spective of autistic adults recently defined autistic burnout as
a syndrome ‘‘resulting from chronic life stress and a mis-
match of expectations and abilities without adequate supports
[.] characterised by pervasive, long-term (typically 3+
months) exhaustion, loss of function, and reduced tolerance
to stimulus.’’9(p9) Life stressors (e.g., masking of autistic
traits; significant life changes) and barriers to support (e.g.,
poor self-advocacy; an imbalance between demands and
coping resources) contributed to the onset of autistic burnout,
with the authors concluding that burnout has severe conse-
quences for the mental health and quality of life of autistic
adults.9
Compared with adults in the general population, autistic
adults are more likely to experience poor mental health,10,11
which can contribute to a greater risk for suicidal ideation,
self-harm, and death by suicide.12–14 Growing evidence
suggests that the use of ‘‘camouflaging’’ or ‘‘masking’’ to
hide autistic traits is strongly associated with poor mental
health and suicidality in autistic adults.12,15,16 Autistic adults
report that masking to ‘‘pass’’ as nonautistic is exhausting
over time, but is used to avoid consequences of stigma and
discrimination, including bullying and loss of opportuni-
ties.15,17 Masking can contribute to missed and delayed di-
agnosis, and qualitative studies show that prior awareness of
being different without knowing why18,19 and the lack of
appropriate support after late diagnosis can contribute to poor
mental health in autistic adults.12,20 Masking has been iden-
tified as a prominent risk factor for autistic burnout and may
represent a novel perspective for understanding suicidality
among autistic adults9; therefore, this association warrants
further investigation.
Poor awareness about the wide-ranging differences among,
and within, autistic individuals can add to autistic people’s
mental health burden through unreasonable expectations. For
example, the support needs of an autistic person with uneven
cognitive strengths (‘‘spiky profile’’), such as above average
verbal skills but poor working memory, may go unrecognized
at work.21 Health care professionals are not adequately trained
in recognizing autism in adulthood (especially in females),
leading to missed or misdiagnosis and lost opportunities for
support.20,22 It is now widely accepted that autism diagnostic
criteria and the gold-standard diagnostic tools have been in-
formed by research about male autistic children, and are thus
skewed toward the stereotypical male presentation. Therefore,
these tests are not sensitive enough to detect the unique and
subtle ways that autism manifests in females, or adults in
general.23–27 In addition, health care providers have ac-
knowledged the need to enhance their confidence in commu-
nicating with, and accommodating the needs of, autistic clients
to improve patient care.28
Autistic people face stigma and discrimination, which can
harm their mental health and well-being29 and deter them
from disclosing their diagnosis, limiting their access to ac-
commodations.30 Cage et al.31 reported that increased autism
acceptance predicted lower symptoms of depression in au-
tistic adults. Feeling supported and accepted may also protect
against autistic burnout, as well as reduced expectations, time
MANTZALAS ET AL.
off, unmasking, and the ability to do things in an autistic
way.9 Learning more about risk and protective factors for
autistic burnout is vital to help reduce vulnerability to its
onset.
The current study* aimed to examine the construct of au-
tistic burnout by examining posts about the topic on two
social media platforms. Our objectives were to investigate the
etiology and symptoms of autistic burnout, its impact on the
lives of autistic adults, and potential strategies for prevention
and recovery.
Methods
Data sources
We collected public retroactive posts from the social me-
dia platform, Twitter, and discussion forum, Wrong Planet.
We sought insight into autistic adults’ real-world experiences
and discourse about autistic burnout without researcher
prompting or interference. The sites were chosen for their
different participation styles and potential to reach a broader
range of autistic adults. While Twitter enables instant com-
munication between individuals and organizations globally,
Wrong Planet was created for the autistic community. Twitter
users share short messages (‘‘tweets’’) and use hashtags (#) to
find tweets about a trend or topic (e.g., #AutisticBurnout) or
connect with a community (e.g., #ActuallyAutistic). Alter-
natively, Wrong Planet facilitates richer descriptions about
experiences and discussions among members because post
length is not limited. Neither platform required membership
to read public posts.
Participants
The study included adults (older than 18 years) who had
shared a post to Twitter or Wrong Planet between January
2005 and November 2019 containing various search terms
related to burnout (see the Procedure section). While we
could not confirm that all individuals met the age require-
ment, posts were excluded if the user’s profile or post content
indicated they were younger than 18 years (e.g., explicit
reference to their age or school year-level).
The total sample comprised 683 individuals: 559 Twitter
users and 124 users from Wrong Planet. Of these, 612 users
were self-identified autistic adults, and 71 users (n = 69 from
Twitter and n = 2 from Wrong Planet) were nonautistic re-
searchers, disability advocates, parents, or friends of autistic
people whose posts were included because they addressed the
research objectives. We assumed autistic status if the users
referred to themselves as autistic or used the #ActuallyAu-
tistic hashtag. Demographic information for the Wrong Pla-
net users is presented in Table 1. Of the 124 forum users, 80
shared their age, which ranged between 21 and 76 years
(M = 41.4 years). Most users disclosed their gender, with an
almost equal number of males and females. Privacy regula-
tions prevented us from collecting demographic data about
the Twitter users.
*Data collection and partial data analysis for this study were
completed before the publication of Raymaker et al.’s9 pioneering
article about autistic burnout.
WHAT IS AUTISTIC BURNOUT? 55

Table 1. Demographic Characteristics they signed and returned. Where the users did not respond, or
of Wrong Planet Users their post/account had been deleted since data collection,
excerpts were included only if their identity could not be
% n traced via an internet search.
Gender (N = 124) The third author (A.A.) used a computer algorithm to ex-
Male 48.4 60 tract the posts (‘‘data scraping’’), which were saved in an
Female 49.2 61 Excel file. Details regarding the search parameters and data
Not provided 2.4 3 collected from each platform are shown in Figure 1. Twitter
Age (N = 80) users can like, share (‘‘retweet’’), and reply to posts, which
18–24 6.25 5 indicate how strongly a tweet or topic resonates with others.
25–34 28.75 23 The retained tweets recorded a total of 10,012 likes, 2669
35–49 38.75 31 retweets, and 1694 replies.
50–76 26.25 21 Figure 2 shows the yearly number of posts containing one
or more of the data search criteria per platform, starting from
the year a term was first located in the data set. An expo-
Procedure
nential yearly increase in the number of tweets about autistic
Approval for the study was obtained from the La Trobe burnout is observable, with a noticeable spike in 2018. There
University Human Research Ethics Committee (HEC20389). were fewer mentions of burnout on Wrong Planet, which
An owner of Wrong Planet approved the collection and use of remained relatively steady, year-on-year. Twitter users reg-
forum data. The first author sought permission from 35 users ularly used the platform to seek advice and share information
to quote excerpts from their posts by sending them a direct and resources about the topic, including links to blogs, vid-
message briefly describing the study and asking them to reply eos, and activist campaigns. The forum users shared re-
for further information. Eight participants responded and sources less frequently but engaged in more in-depth
were sent a participant information and consent form, which discussions about autistic burnout.

FIG. 1. Data collection and

refinement process.
56
Data analysis
The first author conducted reflexive thematic analysis and
used a critical-realist framework to identify and understand
patterns of meaning across the data.32 This approach ac-
knowledges the influence of social and cultural contexts on
reality, and that insight can be gained by interpreting the
language individuals use to describe their lived experi-
ences.33 The research methodology was informed by the
perspective that autistic people are best placed to describe
their own experiences of autism and autistic burnout. J.M.
generated the codes and themes inductively, or ‘‘bottom-up’’
from the data, rather than using predetermined ideas or the-
ories.34 The motivation for this research came from J.M.’s
personal involvement with the autistic community, including
informal discussions with people who have experienced au-
tistic burnout. J.M. read the data through the lens of neuro-
diversity, which views autism as a normal form of human
variation with inherent strengths, rather than a condition to be
cured.35 Throughout, J.M. reflected on how her pre-existing
knowledge about autistic burnout and experiences as a non-
autistic parent of young autistic children influenced her re-
action to, and interpretation of, the data.
Data analysis followed the six-phase process described by
Braun and Clarke.36
1. Data familiarization
2. Generating codes
3. Developing themes
4. Reviewing themes
5. Defining themes
6. Report writing
First, J.M. read each post multiple times and recorded in-
formal reflections and ideas in a journal. Second, excerpts
from the data relevant to the research question were selected
and organized into common groups (‘‘codes’’) using QSR
NVivo (Version 12). This was done using a ‘‘complete
coding’’ approach where each post was given equal consid-
eration; some posts were assigned to numerous codes, and
others were not coded at all.37 Consistent with a realist
framework, J.M. used semantic coding to capture a descrip-
tive narrative of people’s experiences by interpreting peo-
ple’s language at face-value, rather than searching for
implicit meanings.34 A total of 336 unique codes were gen-
MANTZALAS ET AL.
FIG. 2. Yearly posts* about au-
tistic burnout for each online plat-
form. Number of yearly posts
containing one or more of the search
criteria, from when a term was first
mentioned in the data set. *n = 955
Twitter posts; n = 172 Wrong Planet
posts.
erated and reviewed, and overlapping codes were merged.
Codes containing fewer than 10 excerpts and those not di-
rectly relevant to the research question were excluded, which
left 99 codes for further analysis. A quantitative measure of
coding inter-rater reliability is not appropriate for reflexive
thematic analysis because coding is a subjective process,
inextricably influenced by individual researchers’ theoretical
perspectives and personal experiences.34,37
During the third phase, J.M. grouped codes according to
patterns identified within the data and generated a list of
candidate themes that captured shared meanings. A series of
thematic maps were drawn to visually explore and refine the
relationships between the provisional themes. To ensure in-
terpretative depth and robustness, J.M. discussed the candi-
date themes with A.L.R. and C.D. who contributed their ideas
and feedback. The large sample size was considered suffi-
cient to achieve theme saturation given the data were
‘‘shallow’’ and comprised short descriptions about lived
experiences.37
Fourth, J.M. read the posts again to ensure that the themes
captured the essence of the data and worked together to build
a cohesive and meaningful narrative. During the fifth phase,
J.M. defined each theme and subtheme, specifying their
scope and unique characteristics, and chose supporting ex-
tracts from the data. Other members of the research team
(A.L.R., C.D., J.L.), and an autistic colleague, reviewed the
themes and subthemes to ensure readability and provided
additional insights. Our team included two autistic adults
with self-reported experience of autistic burnout. The sixth
phase consisted of writing up the report.37
Results
A thematic map showing the final set of primary themes
and subthemes about autistic burnout is presented in Figure 3.
Additional quotations to support themes and subthemes are
shown in Table 2. Excerpts have been reproduced verbatim;
therefore, may contain spelling and grammatical errors.
Theme 1: systemic and pervasive lack
of autism awareness
The lack of awareness about autism was both a stand-alone
theme and the underlying factor that connected all themes
in the study. Users frequently described a pervasive and
WHAT IS AUTISTIC BURNOUT?
FIG. 3. Thematic map of the eight primary themes and three subthemes about autistic burnout. *Theme 1 was both a
stand-alone theme and the overarching theme in our study.
systemic lack of knowledge about autism traits and presen-
tation differences that led to negative experiences within
health care, education, employment, and family systems.
These experiences included missed or late diagnosis of au-
tism, misdiagnosis, unreasonable expectations, insufficient or
nonexistent accommodations and supports, and general fail-
ure to meet their needs, which increased the burden on in-
dividuals and contributed to autistic burnout.
How do I survive autistic burn-out if neither my doctor, nor
University, nor psychologist allow me to take the rest I need in
order to function? [.] (T231){
Subtheme 1.1: discrimination and stigma. This sub-
theme captured users’ experiences of not being accepted and
illustrated how negative stereotypes and stigma surrounding
autism contributed to burnout. Many said they tried to ‘‘pass’’
as nonautistic and feared ‘‘outing’’ themselves as autistic
because of negative perceptions and stigma about autism.
Some had internalized the stigma, which impacted their
identity and confidence to self-advocate.
Do I as an #ActuallyAutistic person deserve to not have
real-life friends? To be controlled by my family? To fight for
accommodations and mental health care? To beg for money?
To put education before health? To have a burn-out each year?
Is this what I deserve? Survival? (T231)
Users experienced direct and indirect discrimination in
the workplace. Some had been dismissed after disclosing
their autism diagnosis. In contrast, others perceived that
{
Individuals from the two online platforms are distinguished by
‘‘T’’ for Twitter users and ‘‘WP’’ for forum users. For example,
(T1) refers to Twitter user number one.
57
their employers deliberately altered their working condi-
tions to make it harder for them to cope, thus forcing them
to resign.
[.] I was dismissed from my last job after I went through
autistic burnout and disclosed my autism. They weren’t
willing to make the necessary accommodations: too burden-
some. It’s the first time I’ve ever been fired. (T70)
Theme 2: autistic burnout is a chronic
or recurrent condition
Many users discussed the chronic nature of autistic burn-
out, which many first experienced during childhood or ado-
lescence and which then recurred during adulthood. Burnout
was described as an endpoint after a buildup of demands over
time that had exceeded their coping abilities. For many,
vulnerability to burnout increased at developmental transi-
tion stages (e.g., transition to and from high school) and after
stressful life events.
My first burnout was in school. The lights, sounds, business
of a full 8 hour day was too much. I was physically sick from
it. Kids need more down time and the sensory environment
needs to be considered [.] (T369)
For many of the adults, periods of autistic burnout were
long, lasting months or years, and recovery was either pro-
tracted or never fully achieved. The users often described a
lower threshold for stressors after burnout and that coping
resources were depleted more quickly. Many reported that
multiple episodes of burnout had a cumulative negative
impact on resilience and well-being.
[.] Recovered a bit, but I worry I will never be whole
again. It ate part of me. (T355)
 Table 2. Supplementary Quotes to Support the Study Themes and Subthemes
Theme 1: Systemic and pervasive lack of autism awareness
Although I have gone to a therapist, my first one flat out told me she ‘didn’t have the ability’ to help me, and after
switching to a psychiatrist they treat and worry about my ADHD/Autism while my burnout and depression just drag me
further and further down in exhaustion. (T289)
People who don’t understand Autism are seeing behaviours that they assume are mental health problems. Confusing
Burnout for depression, seeing meltdowns & only seeing it as inappropriate negative behaviour, not sensory
overwhelm. Using restraints, drugs and ineffective therapy. (T290)

Subtheme 1.1: Discrimination and stigma

I’m #ActuallyAutistic and I view Autism as a mental health issue, but not a mental illness. Lack of accommodation,
stigma, & burnout all affect my MH [.] (T260)
[.] they’ll change your schedule suddenly, or ask you to do something you’re not comfortable with and when you balk
because you’re just so stressed out you don’t have the flexibility to adapt anymore, you’ll get your first warning—then
you’ll know the end is in sight. [.] You have to wait until they fire you for just being you [.] (WP115)

Theme 2: A chronic or recurrent condition

In burnout now and going on Month 15. No end in sight. Experienced it maybe 4 times now. I crashed and burned hard.
(T386)
A couple of years ago I had a full burnout that could have potentially actually killed me and that left me permanently
changed and not for the better. (WP93)

Theme 3: Direct impact on health and well-being

[.] It feels like my thoughts are encased in taffy.[.] (T443)
How will she stand? How will she carry on? How can she breathe? The weariness of her spirit can no longer be carried.
Her fire has been extinguished. She searches for the peace of nothingness. Its quiet void echoes how she already feels.
#AutisticBurnout (T432)

Theme 4: A life unlived

With an expectation that younger people will work until they are 70 before retiring it’s [.] important to understand the
cumulative effect of repeated burnout on autistic people and develop preventive strategies [.] (T75)

Theme 5: A blessing in disguise?

Burnout [.] was huge. 39 months later and my life is very different but much more sustainable. (T476)
[.] I need to get back into my #actuallyautistic skin and stop letting others separate me from my #autistic self. I died to
get here. I must always remember that. (T400)

Theme 6: Self-awareness and personal control influence risk

[.] the only thing that would help me is beyond my control [.] I have nowhere to go where I’d avoid being
overwhelmed. (WP98)
[.] I want to do more hours, but I know this will lead to burnout for me [.] (T349)

Theme 6.1: ‘‘You need enough balloons to manage the weight of the rocks’’
Autism only gives me so much energy to work with and if I overstretch myself, I’ll be prone to meltdown and burnout
(T427)
Hoping to survive today with a lot of self-soothing and self-care [.] (T432)

Theme 7: Masking: Damned if you do, damned if you don’t

Masking is a tool that should be used to get things nothing less, nothing more. Like with anything in life overdoing it
leads to problems. With masking they can be quite serious burnout, forgetting who you are, constant anxiety from fear
of slipping and being exposed. [.] (WP9)
I get told by everyone that I seem to be managing my autism well [.] but the constant masking at work is exhausting and
I ended up in burnout this weekend. (T349)
Two main problems [.] (1) It can lead to a nasty case of burnout. (2) If people don’t see the real you they can’t love the
real you. It alienates you from people; even as it seems your relationships with people are improving, the amount of joy
you derive from it decreases. [.] (WP108)

Theme 8: Ask the experts

The autistic community has been saying burnout is a medical problem forever [.] (T90)

Theme 8.1: Stronger together

#AutisticBurnout is being talked about at last. It affects so many of us—who knew? Which is why the conversation
matters. Thanks to you I recognised the signs, took care of myself, avoided total crisis (T353)

58
WHAT IS AUTISTIC BURNOUT?
Theme 3: direct impact on health and well-being
The overt impact of autistic burnout on the users’ mental
health and cognitive abilities included widespread descriptions
of overwhelming exhaustion and the inability to function.
Many experienced a marked reduction in their ability to pro-
duce and process speech and heightened sensitivity to sensory
stimuli. They frequently described a loss of previously ac-
quired skills (including self-care), poorer attention and exec-
utive functioning skills, and feeling they had become ‘‘more
autistic.’’ Greater difficulty with emotion regulation, including
a higher incidence of meltdowns (e.g., excessive crying; be-
coming aggressive and angry) and shutdowns (e.g., dissocia-
tion; becoming withdrawn and unresponsive), before reaching
the burnout stage was typical.
I am so low on energy, I can’t cope with anything right
now. I shut down after only little stimuli.I don’t know how to
cook, how to clean the house, can’t go to the store.[.]I shut
down so badly I don’t dare to drive anymore (too dangerous).
I don’t enjoy my special interests anymore, and feel mentally
stupid [.] (WP59)
Many individuals experienced a decline in their mental
health and exacerbated conditions such as anxiety and depres-
sion during burnout. Autistic burnout often led to suicidal ide-
ation, especially when it co-occurred with depression. The users
described an inability to cope and needing a break from life.
[.] experiencing burnout so severe for so long that you
wish you could just not be here anymore. Not really suicidal,
just wanting to be finished. (T461)
[.] I was so far into autistic burnout AND a major de-
pressive episode [.] I was [.] terrified and really, really
done with suffering (T61)
Theme 4: a life unlived
This theme captured indirect consequences that the users
attributed to autistic burnout. Many individuals indicated that
experiencing burnout during adolescence had a ripple effect
that altered the trajectory of their lives, limiting education
and employment opportunities, which they perceived led to a
failure to reach their potential. Autistic burnout also con-
tributed to relationship difficulties, risk of (or actual) in-
stitutionalization, and homelessness.
Oh and good luck breaking into a different field if you
succumb to autistic burnout. [.] goodbye income goodbye
lifestyle goodbye independence [.] (T280)
Last time I had a major burnout, I ended up first in the
mental hospital and then effectively homeless [.] (WP26)
Theme 5: a blessing in disguise?
This theme described positive outcomes of the users’ au-
tistic burnout experiences. Many individuals reported that
burnout was the catalyst for their diagnosis of autism in
adulthood, which gave them a new perspective for re-
evaluating their lives. Diagnosis often led to improved
self-awareness, self-care, self-esteem, and confidence to self-
advocate, which had a resultant positive impact on the adults’
well-being. Other favorable outcomes included finding the
59
autistic community, connecting with others who shared their
lived experiences, and making positive lifestyle and career
changes to reduce stress and live more authentically. For
many, diagnosis after burnout led to an improved sense of
identity and relief at finally understanding why they had felt
different throughout their lives.
[.] A massive autistic burnout has probably saved my life
[.] Trying to [.] learn to accept myself better and move on
(T12)
At age 37, learning about autism finally gave me the key to
understanding my life (T173)
Theme 6: self-awareness and personal control
influence risk
This theme explored how self-awareness and control over
stressors affected the adults’ risk of developing autistic burn-
out. Throughout, many described a common set of factors that
contributed to burnout, including overwhelming sensory and
cognitive demands, masking or camouflaging autistic traits,
stressful life events, co-occurring conditions, autistic char-
acteristics, and lack of social support. However, their ability to
recognize the buildup of pressures and change environmental
stressors influenced whether they experienced burnout. For
example, adults who recognized sensory overstimulation in
the workplace and requested reasonable accommodations
(e.g., wearing headphones) could better manage the impact.
[.] I need to respect my own rhythms. If I’m not feeling it
then I shouldn’t force it. (WP40)
Many users also used self-stimulatory behaviors (‘‘stim-
ming’’) and time with special interests to manage sensory and
emotion regulation. Stress accumulated when they were
prevented from using these strategies, usually because of
stigma or fear of standing out, which increased their vul-
nerability to burnout.
Stimming is the autistic way of dealing with stress. Even a
few minutes here and there in the bathroom could be of help.
[.] (WP9)
Sometimes I think, if I didn’t have my interests to keep me
going. I would give up and lose control completely (WP41)
During a period of burnout, exhaustion limited the autistic
individuals’ ability to manage stressors, and social support
played an important role in recovery, as illustrated by this
participant:
[.], I needed solitude and I needed to remove as much
sensory stimuli as possible. It was not possible for me to talk to
people or to have them around. The only exception was my
brother because [.] he spoke to me [.] very quietly and
calmly and slowly and directly so that I could clearly under-
stand what he was saying and I did not have to spend energy
interpreting or trying to understand his words [.] (WP93)
Subtheme 6.1: ‘‘you need enough balloons to manage the
weight of the rocks’’. This subtheme described the deliber-
ate use of strategies for managing demands and energy to
avoid overload that could lead to autistic burnout over time.
60
Users commonly described the benefits of rest and social and
sensory avoidance to offset demands, which helped preven-
tion and recovery.
I was told for years that avoiding things will only make
everything worse. And while that is commonly true for my
#anxiety it absolutely isn’t true for my #autism related prob-
lems. Exposure there makes it WORSE because it causes
overload, then burnout. Avoidance HELPS this. (T98)
Theme 7: masking: damned if you do, damned
if you don’t
Masking was a complex and multifaceted theme. Many of
the adults identified masking as a leading risk factor for au-
tistic burnout and described it as a ‘‘no win’’ situation. Al-
though masking facilitated access to job opportunities and
social inclusion, it was consistently described as exhausting.
Long-term masking negatively impacted individuals’ mental
health and well-being and ultimately led to burnout. For
many, masking led to identity confusion and contributed to
support needs being unrecognized or disbelieved.
Masking is a skill but can feel like a curse. We need to
remind ourselves to unmask, otherwise we risk burning out.
And we deserve better. [.] (T19)
Many participants described ‘‘taking the mask off,’’ either
reluctantly (e.g., unable to keep masking) or by choice (e.g.,
through self-acceptance). However, unmasking was com-
plex; while it facilitated self-acceptance and reduced cogni-
tive load, the consequences of being openly autistic included
ostracism and bullying, which contributed to burnout.
I know that the breakdown and following burnout is be-
cause I was simply unable to keep masking my autism, and
there’s no putting the lid on again (nor would I want to), but
it’s still a complex set of relations that underpin this change.
(T262)
The autistic adults also described the harmful impact of
masking on social relationships. After unmasking, some were
accused of faking autistic traits, whereas others were criti-
cized for pretending not to be autistic. Some were advised to
continue masking.
[.] I have encountered some people who either will not
believe my diagnosis or who take the attitude that if I could
conceal my traits before, then there is no reason why I
shouldn’t continue to [.] (WP106)
Many users tried to strike a balance between masking,
living authentically, exhaustion, and discrimination. They
retained masking behaviors to achieve goals, avoid stigma,
and attain resources, but dropped the mask with trusted
friends and family to try and reduce their risk of autistic
burnout.
Theme 8: ask the experts
This theme described the adults’ significant insight and
knowledge about autistic burnout. They clearly described
various characteristics of their burnout experiences, includ-
ing causes and symptoms, its impact on their lives, and
MANTZALAS ET AL.
strategies for prevention and recovery. Most decried the lack
of knowledge and understanding about autistic burnout out-
side the autistic community, and many shared links to per-
sonal blogs, videos, infographics, and other resources to
educate others and bridge the knowledge gap.
Like so much else about autism, I’ve learnt everything I
know about autistic burnout from the insightful descriptions
and selfless honesty of autistic people (T191)
Non-autistic Twitter users were encouraged to use the
#AskingAutistics hashtag to utilize the expertise of the au-
tistic community to support autistic family members and
friends. Some individuals were professional autism advo-
cates, but, ironically, the demands of autism advocacy
sometimes contributed to burnout.
Subtheme 8.1: stronger together. This subtheme cap-
tured how sharing burnout experiences online fostered em-
pathy, connection, and belonging among the adults. Users
across both platforms sought and offered support and advice
from fellow members. The Twitter hashtag, #Actually-
Autistic, was widely used to claim an autistic identity, express
autistic pride, and bring groups of autistic people together.
For many, the compassion and understanding demonstrated
by other online users were often an invaluable source of
comfort and hope, especially for those who lacked support
offline.
As an #ActuallyAutistic woman who did not get diagnosed
until age 41. this thread made me cry multiple times because
of how SEEN I felt. Particularly the section about Autism
Burnout. I lived my whole life that way. I’m so grateful I don’t
ever have to go through that again [.] (T477)
Discussion
We explored the lived experience of autistic burnout in a
large cohort of autistic adults to garner a comprehensive
understanding of how burnout begins and recurs, and ways to
support prevention and recovery. Our findings confirm
Raymaker et al.’s9 definition of autistic burnout as a syn-
drome characterized by long-term exhaustion, reduced abil-
ity to function, and increased sensory sensitivity caused by
masking and life stressors that negatively impact mental
health and quality of life. Their suggested strategies for re-
ducing burnout, including acceptance and peer support, un-
masking, social withdrawal, recognizing symptoms of
burnout onset, and the benefits of early autism diagnosis were
also supported. As our research was conducted independently
and commenced before the publication of Raymaker et al.’s9
seminal work, the similarities between findings strengthen
and validate our understanding of autistic burnout. Our
findings also extend what is currently known.
We found that while autistic burnout is a consequence of
chronic life stress,9 it could itself be a chronic condition.
Many adults described numerous burnout episodes, with
onset usually in adolescence, and a recurring cycle that in-
terfered with personal progress and achievement. The World
Health Organization characterizes chronic conditions as
persistent and often co-occurring with other health problems
caused by multiple, complex, social and economic factors
that can impact quality of life and independence, create
WHAT IS AUTISTIC BURNOUT?
restrictions and disability, contribute to loss of education and
marginalization, and lower life expectancy.38 Some chronic
conditions (e.g., insomnia) may manifest as one long episode
or as shorter episodes that recur.39 Indeed, research on
workplace burnout shows it often follows a chronic and stable
pattern.40,41 Collectively, these criteria reflect the character-
izations of autistic burnout reported here. Recognition of
autistic burnout as a chronic health condition is a first step to
raising awareness and improving detection, especially among
families and health professionals.
Our findings offer a new perspective on why autistic
people report lower educational attainment and higher un-
employment than adults in the general population.42–44 The
direct impact of burnout on physical and mental health was
evident, including overwhelming exhaustion, speech diffi-
culties, loss of skills, and impaired executive functioning.
The indirect impact was also significant through its influence
on educational achievement in adolescence and early adult-
hood. The adults described a ripple effect that included
fewer employment opportunities later in life and difficul-
ties achieving financial independence. Recovery often took
months or years, with many not regaining their preburnout
capabilities. Longitudinal studies of burnout among health
care professionals show that burnout levels can remain stable
2 to 8 years later.45 Thus, lengthy study or career breaks due
to autistic burnout could partly explain lower educational and
employment achievement among autistic adults.
Notably, some adults described positive consequences of
burnout, especially if it preceded an autism diagnosis, the
benefits of which have been reported previously.19,46,47 Late
diagnosis helped the adults in our study find the autistic
community, form a positive autistic identity, implement
positive career and lifestyle changes, improve self-esteem,
and increase confidence to self-advocate for accommoda-
tions. This finding highlights the importance of early diag-
nosis and teaching autistic children effective coping
mechanisms (especially during key transition stages) to cir-
cumvent the burnout cycle before it begins. The positive
outcomes of early diagnosis and intervention in childhood are
well established.48,49
The benefits of stimming and special interests for regu-
lating emotions, stress management, sensory stimula-
tion,50–55 and avoiding burnout9 have been previously
reported; however, our findings suggest that each may have a
unique role. Stimming provides accessible and immediate
relief against emotional and sensory stressors, which could
protect against autistic burnout in the short term. Many adults
described masking stims to avoid discrimination and bullying
and fit in with peers, which contributed to stress and overload,
especially as they got older. Research shows that stimming is
more socially acceptable during childhood but is deemed
inappropriate in secondary school.50 Notably, many adults
first experienced burnout during adolescence, suggesting that
restricting stimming during a developmental period of sig-
nificant change and heightened demands may be particularly
harmful. A societal shift from the pathologizing/stigmatizing
view of stimming could empower autistic adults to use these
protective strategies more openly.
The current findings also suggest that special interests may
play a background, maintenance function that contributes to
well-being over the longer term. While special interests can
improve coping and well-being in autistic adults,52 exhaus-
61
tion during autistic burnout prevented some adults in our
study from engaging with them. Conversely, others indicated
that focusing on their interests too intensely contributed to
autistic burnout. Previous research shows that hyperfocus can
sometimes outweigh the benefits of special interests.52 Thus,
the protective qualities of special interests for autistic burnout
may depend on finding a balance between being pleasurable
and overtaxing. Learning to regulate hyperfocus to avoid
exhaustion could also protect against autistic burnout.
Many adults managed their energy strategically, applying
a cost/benefit rationale to cognitive, social, and physical
tasks. A popular method was ‘‘Spoon Theory,’’56 which en-
tailed allocating metaphorical spoons representing finite
physical and mental energy to activities of daily living, in-
cluding work, personal hygiene, and food preparation.
Spoons are replenished with rest, reduced sensory input, and
time with favorite activities, suggesting that using energy
management techniques from an early age may be a practical
and flexible strategy for preventing autistic burnout.
We identified that alexithymia might be a unique risk
factor for autistic burnout. The adults with good self-
awareness of their physical and emotional states described
signs of looming burnout, including clusters of meltdowns
and/or shutdowns and extreme fatigue. It has been estimated
that up to 50% of autistic adults experience difficulties
identifying, verbalizing, and analyzing emotions associated
with bodily sensations.57–59 Alexithymia can affect mental
health and emotion regulation and contribute to impaired
interoception,60 which is the ability to perceive internal states
such as hunger, muscle tension, and heart rate, and is often
atypical in autism.61 Indeed, many adults in our study failed
to recognize burnout symptoms until it was too late, sug-
gesting that improving cognitive and emotional self-
awareness may protect against the onset of autistic burnout.
Our findings suggest that coping strategies used by adults
during autistic burnout may differ from adults in the general
population. ‘‘Avoidant’’ coping strategies are generally used
to distract from stressors and deny their impact on psycho-
logical or physical health, whereas ‘‘attention’’ strategies are
viewed as adaptive coping as they directly address sources of
stress.62 However, in our study, social and sensory avoidance
were primarily used to restore energy and recover from au-
tistic burnout. This finding suggests that avoidant behaviors
may represent adaptive attention strategies that offset
stressors (e.g., too much social contact, overwhelming sen-
sory stimuli) and promote well-being. Coping research
among nonautistic adults shows that withdrawal and avoid-
ance may be positive in the short term but are harmful over
time.63 Longitudinal studies are needed to evaluate the long-
term efficacy of avoidance as a protective strategy for autistic
burnout.
The overarching theme identified herein was that the onset
and recurrence of autistic burnout were underpinned by
stigma and a lack of awareness and acceptance regarding the
diversity of autism among autistic individuals within the
health care, education, employment, and social systems.
Autism advocates have highlighted the importance of autism
acceptance and the meaningful inclusion of autistic people in
the society.64 The narrative surrounding mental illness and
disabilities is usually controlled by those who do not share the
lived experiences of people with these conditions.65 There-
fore, amplifying the voices of autistic people and dispelling
62
harmful autism stereotypes are essential to achieve a positive
and lasting change.66
The importance of acceptance was evident through the
prevalent use of masking, which most adults identified as key
to the onset and recurrence of autistic burnout. Echoing
previous findings,15,17 masking was used to pass as ‘‘normal’’
and prevent bullying, social exclusion, and discrimination
resulting from negative autism stereotypes and stigma. Some
adults reported internalized stigma, reported in previous re-
search,29 including feelings of being a burden and unworthy
of accommodations. Many attributed recurrent experiences
of burnout to the failure of their parents, health care pro-
viders, and teachers to recognize their autistic characteristics
in childhood, leading to missed or misdiagnosis and inade-
quate supports. Missed and late diagnoses have been identi-
fied as risk factors for mental health difficulties and lack of
achievement and independence among autistic adults.67
Promoting autism acceptance may alleviate the motivations
for masking and lessen the burden on autistic people.
The consequences of burnout were dire for some adults in
our study, including homelessness and institutionalization.
Their experiences were similar to a case study of two pre-
viously homeless autistic men who described homelessness
as a ‘‘domino effect’’ of multiple factors, including dis-
crimination and societal stigma, stressful life events, and
employment difficulties,68 highlighting the urgent need for
autism acceptance and adequate supports to prevent adverse
outcomes.
Like Raymaker et al.,9 we identified a possible link be-
tween autistic burnout and suicidality, especially when adults
had other mental health conditions (e.g., depression), sug-
gesting that co-occurring conditions may be a unique risk
factor for autistic burnout, possibly contributing to suicidality
if they coincide. As mental health conditions are common
in autistic adults,10 the relationship between co-occurring
conditions, autistic burnout, and suicidality merits further
investigation.
A strong sense of community and celebration of autistic
strengths were evident in the posts, through reclamation of
the autism label, widespread use of identity-first language,69
and the #ActuallyAutistic hashtag. The adults demonstrated
empathy, offered mutual support and advice, and proactively
shared information to educate others about burnout,
strengthening previous research that autistic adults are ex-
perts about their lived experiences.66 Online media raises
awareness, evident in the 2018 Twitter campaign, ‘‘#Ta-
keTheMaskOff,’’ which highlighted the association between
masking and autistic burnout and exponentially increased
discussion on this topic. Our findings support research about
the benefits of online communities for autistic adults, in-
cluding belonging, shared identity, and positive attach-
ment.19,70 Online communities may also provide vital
support during recovery from burnout.
Interestingly, many users actively participated online
during self-reported episodes of autistic burnout. Given that
burnout has been characterized by overwhelming exhaustion,
impaired speech processing, and poorer executive function-
ing,9 this noteworthy result supports previous findings of the
benefits of internet-mediated communication for autistic
people.70,71 Online communication alleviates some pressure
associated with face-to-face communication, including eye
contact and immediacy of response.70,71 This insight could
MANTZALAS ET AL.
inform creative avenues for supporting autistic adults through
recovery from burnout when they may be unable to tolerate
face-to-face appointments with health care providers.
Strengths and limitations
A major study strength was direct access to the lived ex-
perience of autistic burnout via online communication of a
large sample of adults that spanned 12 years. The data pro-
vided a rich and nuanced insight into this little-studied phe-
nomenon. Descriptions of burnout were consistent over time
and platform and were constructed organically, without
prompting or direction from researchers. Risk and protective
factors were identified to inform future research into autistic
burnout.
Nevertheless, the data were retrospective which prevented
follow-up questioning about context and outcomes. As min-
imal demographic data were available, the sociodemographic
characteristics and diversity of the sample remain unknown.
Hence, it was not possible to examine the influence of gen-
der and age on autistic burnout or investigate burnout from
the perspective of individuals with additional marginal-
ized identities (e.g., LGBTQI; female; Black). The adults had
access to online platforms and could communicate in writ-
ing, however, the lived experiences of non-English-speaking
autistic adults who do not use online platforms or have higher
communication support needs remain unknown. Finally,
despite investigating an issue of high priority for autistic
adults, the study was not codesigned with autistic people.
Conclusion
Typical descriptions of autistic burnout onset during ado-
lescence and its recurrence during transitional stages under-
score the importance of educating families and health care
practitioners to recognize early symptoms of autism and
burnout. Our findings suggest that autism acceptance could
reduce the need for effortful masking and have implications
for how the education and employment sectors can support
the participation of autistic people to improve their long-term
well-being and quality of life. At the individual level,
learning effective coping, energy management, and self-
awareness skills may protect autistic adults from burnout.
The adults could communicate online during periods of
burnout, which has practical implications for delivering
support to autistic people during burnout. Future studies
should investigate risk and protective factors for autistic
burnout to understand why some individuals may be more
vulnerable. Finally, more research is needed to assess the
prevalence of autistic burnout, develop effective screening
tools, and to explore the relationship between burnout and
suicidality.
Authorship Confirmation Statement
J.M., A.L.R., and C.D. contributed to the study design.
A.A. extracted the data. J.M. conducted the data analysis and
wrote the article. A.L.R., C.D., and J.L. contributed to data
analysis and provided critical feedback. All coauthors have
reviewed and approved this article before submission. This
article has been submitted solely to this journal and is not
published, in press, or submitted elsewhere.
WHAT IS AUTISTIC BURNOUT?
Acknowledgments
We are grateful to all our research participants, especially
those who allowed us to include extracts from their posts. We
thank our autistic colleague, Katherine Gore, for her in-
sightful and valuable feedback.
Author Disclosure Statement
No competing financial interests exist.
Funding Information
The authors did not receive any funding for this study.
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Address correspondence to:
Amanda L. Richdale, PhD
Olga Tennison Autism Research Centre
School of Psychology and Public Health
La Trobe University
Bundoora
Melbourne, Vic 3086
Australia
Email: a.richdale@latrobe.edu.au