Autism in Girls and Women

Have you ever noticed that the typical image of autism often focuses on boys? Historically, autism has been more readily identified in boys, leading to a significant under-recognition and misdiagnosis of autism in girls and women. This article will explore the specific ways autism can present in girls and women, the reasons behind this oversight, and why a gender-sensitive understanding is crucial for timely support.

A Different Presentation

So, how might autism look different in girls and women? While core autistic traits are the same across genders, their expression can vary considerably. Autistic girls and women often develop different ways of coping and interacting that can obscure their autistic characteristics.

Masking and Camouflaging

Do autistic girls and women seem to "fit in" more easily in social situations? Many autistic girls and women become highly skilled at "masking" or "camouflaging" their social difficulties. This involves consciously or unconsciously learning and imitating neurotypical social behaviours, communication styles, and mannerisms to blend in and avoid negative attention. For instance, an autistic girl might spend a lot of time observing how other girls interact and then mimic those behaviours, even if they don't feel natural to her. This constant effort to perform a neurotypical persona can be incredibly draining.

Socially Acceptable Interests with Autistic Intensity

Are their interests always seen as "unusual" like those often associated with autistic boys? Autistic girls and women may have intense, focused interests, similar to autistic boys, but their chosen interests might be more "socially acceptable" or less obviously atypical. For example, instead of a deep fascination with train timetables or specific scientific facts, an autistic girl might have an intense interest in pop music, animals, fictional characters, or reading. While these interests might appear typical for their age or gender, the intensity and depth of knowledge pursued are characteristic of autistic special interests. This can lead to these interests being overlooked as a sign of autism.

Reasons for Under-recognition and Misdiagnosis

Why are so many autistic girls and women missed or misdiagnosed? Several factors contribute to this significant gap in diagnosis:

• Different Trait Presentation

  The way autistic traits manifest in girls can be more subtle or internalised compared to the more outwardly evident presentations often seen in boys. This makes it harder for parents, educators, and even professionals to recognise the signs.

• Masking Abilities

  The highly developed masking skills in girls mean that their struggles might be hidden from others. Teachers or family members might not see the immense effort and distress happening internally because the person appears to be coping socially.

• Diagnostic Criteria Bias

  For many years, diagnostic criteria were largely based on studies of autistic boys. This led to a "male-centric" understanding of autism, meaning the diagnostic tools and professional training were not sensitive enough to capture the nuances of female autistic profiles.

• Misdiagnosis

  When autistic girls and women do seek help for their difficulties, they are often misdiagnosed with other conditions. Have you heard of autistic women being misdiagnosed with Borderline Personality Disorder? It happens more than you might think. Some other common misdiagnoses include anxiety disorders, depression, and eating disorders - because the underlying autism is simply not recognised.

Internal Experiences

What is it truly like to be an autistic girl or woman who is constantly masking? The internal experience of unrecognised or undiagnosed autism can be profoundly challenging.

• High Anxiety

  The constant effort to navigate a neurotypical world and suppress natural autistic behaviours leads to pervasive and often debilitating anxiety. Imagine constantly worrying about saying or doing the "wrong" thing in social situations.

• Exhaustion from Masking

  Masking is mentally and physically exhausting. This continuous performance can lead to chronic fatigue, burnout, and emotional dysregulation once the person is in a safe space where they can unmask.

• Intense Emotions

  Autistic people often experience emotions very intensely. This, coupled with difficulties in understanding and expressing emotions in neurotypical ways, can lead to significant emotional distress.

• Loss of Authentic Identity

  Spending years masking can result in a profound disconnect from one's true self. Autistic women may struggle to understand who they are "beneath the mask" and feel a sense of confusion or loss of identity.

Gender Differences in Diagnosis Rates

Do boys and girls really get diagnosed at the same rate? Statistics consistently show that boys are diagnosed with autism significantly more often than girls. While exact figures vary, this disparity has led to a common belief that there are far more autistic boys than girls. However, many professionals and autistic self-advocates argue that the split is much more likely to be 50/50, and that a lot of women and girls are simply being missed in the diagnostic process.

One autistic advocate noted that before their own diagnosis, all the examples of autism they encountered were boys under the age of 10 who were non-verbal and interested in trains and computers. This highlights a prevailing stereotype that does not encompass the diverse presentations of autism, particularly in girls and women.

Differences in Support and Understanding

How does this under-recognition impact the support and understanding autistic girls and women receive? The disparity in diagnosis often translates into differences in the level and type of support offered - for example:

• Delayed Support

  Because autism in girls and women is often missed, they may not receive appropriate support and understanding until much later in life, if at all. This can lead to years of struggling in silence, experiencing mental health issues, and feeling misunderstood.

• Misinterpretations of Behaviour

  Without a diagnosis, behaviours that are actually autistic traits (like anxiety-driven demand avoidance or repetitive self-soothing actions) might be misinterpreted as character flaws, mental health problems, or even deliberate "acting out". This can lead to inappropriate interventions and further emotional distress.

• Lack of Tailored Educational Support

  In educational settings, autistic girls who are masking well might not be identified as needing additional support. This means they may struggle academically or socially without the necessary accommodations that could help them thrive.

• Limited Understanding from Others

  When friends, family, or colleagues are unaware of an autistic person's diagnosis, they may lack the empathy and understanding needed to adapt their communication or provide necessary adjustments. For example, an autistic person might find flashing Christmas lights distressing, but a friend might not understand why they would want them turned off if they don't know about their sensory sensitivities.

• Increased Pressure to Mask

  The ongoing lack of societal understanding of how autism presents in girls and women perpetuates the pressure to mask. This continuous masking, as discussed, leads to significant mental and physical health tolls, including burnout and depression.

Gender-Sensitive Understanding and Support

What can we do to ensure autistic girls and women receive the understanding and support they need? Raising awareness and adopting gender-sensitive approaches are critical. Here are some of the things we can do to make a practical difference:

• Updated Diagnostic Criteria

  Healthcare professionals need to use diagnostic criteria and assessment approaches that are sensitive to the varied presentations of autism in girls and women. This includes looking beyond traditional male-centric stereotypes and considering the nuances of masking and internalised struggles.

• Increased Awareness

  Educators, parents, and the general public need to be educated about the diverse ways autism can present in girls and women. This helps to recognise signs that might otherwise be overlooked.

• Early Intervention

  Timely diagnosis and support can prevent years of misunderstanding, anxiety, and the negative impacts of masking.

• Strengths-Based Approach

  Focus on and celebrate the unique strengths that autistic girls and women possess, such as loyalty, honesty, creativity, and deep passions.

• Tailored Support

  Provide support that is tailored to individual needs and preferences, acknowledging the specific challenges faced by autistic girls and women in navigating social situations and sensory environments.

By fostering a more gender-sensitive understanding of autism, we can ensure that autistic girls and women are seen, understood, and supported throughout their lives, enabling them to thrive and contribute their talents to the world.