Rethinking Support for Autistic Adults: From Coping to Functioning.
A Q&A with Dr. Bijal Chheda
This week, we sat down with one of our referral partners; Dr Bijal Chheda – Chartered Psychologist and neurodiversity specialist – about what genuinely supports autistic adults over the long term. Rather than focusing on surface-level coping or outward presentation, this conversation explores how neuroaffirmative, individualised support can help shape wellbeing, capacity, and sustainability in everyday life.
In your clinical work, what tends to make the biggest difference to whether an autistic adult feels able to function well long term, rather than just get through the day?
“The most significant factor for audism support in adults is individualised, neuroaffirmative support planning. When clinicians take time to understand how autism presents for each person, including masking patterns, sensory profiles, and co-occurring mental health needs, support can be shaped around real functioning rather than short-term coping.
This kind of understanding allows interventions to align with how someone actually experiences the world. Over time, that alignment supports sustainability, autonomy, and wellbeing, rather than constant effort just to keep going.”
What aspects of everyday life are most often underestimated when it comes to their impact on support for autistic adults?
“Everyday demands that are often taken for granted can have a cumulative and significant impact on autistic adults. Navigating unstructured social interactions, managing sensory environments, coping with unexpected changes to routine, and sustaining masking behaviours in public all place ongoing demands on emotional and cognitive resources.
These pressures are not always visible to others, yet over time they can contribute to heightened stress, exhaustion, and burnout. Sensory overload, such as exposure to noise or bright lighting, and the sustained effort involved in masking to meet external expectations are particularly underestimated sources of strain.”
Where do you most often see support fall short, even when people genuinely want to help?
“Autism support for adults often falls short when it is well-intentioned but not grounded in neuroaffirmative practice. This can include offering standard therapeutic approaches or coping strategies without adapting them to autistic communication styles, sensory needs, or ways of processing information.
Another common difficulty is an emphasis on reducing visible “symptoms” rather than supporting functioning, autonomy, and self-understanding. In adults who have learned to mask effectively, this can be particularly problematic. When the subtleties of how autism presents in adulthood are missed, support can unintentionally invalidate lived experience and increase distress, despite good intentions.”
What risks do you see when the wellbeing of autistic adults is judged primarily on how well they appear to be coping?
“When wellbeing is judged primarily by outward coping, internal distress is easily overlooked. Many autistic adults develop effective ways of presenting as functional, even when significant effort or strain is involved. Over time, this can create a misleading picture of wellbeing.
The risks include burnout and exhaustion, as sustained masking and adaptation are rarely sustainable long term. It can also contribute to late or missed diagnoses, particularly when internal difficulties are masked by external competence. Distress may then be misattributed to personality, behaviour, or resilience, rather than to unmet support needs.
From a clinical perspective; not all challenges associated with autism are visible, and autism support for adults needs to account for what is happening beneath the surface, rather than what is observed.”
When autism acceptance is built into care and support, what does that look like in day-to-day practice?
“In day-to-day practice, autism acceptance means starting from the individual’s lived experience rather than from external expectations of behaviour or functioning. This involves listening carefully to how someone experiences their environment, validating that experience, and resisting pressure to enforce neurotypical norms.
Practically, this includes adapting communication styles, pacing, and therapeutic approaches to suit the person, creating predictable and lower-sensory settings where possible, and collaboratively developing strategies for navigating unavoidable stressors. The emphasis shifts towards recognising strengths, supporting capacity, and building understanding, rather than trying to correct or reduce perceived differences.
This multipronged approach to autism support for adults supports wellbeing by enabling the individual to function in ways that are sustainable and authentic, rather than constantly compensatory.
In other words, real acceptance moves beyond tolerance to respecting neurodivergent needs as legitimate and central to planning support, whether in therapy, work, education or daily living.”
