Autism and Women
Author: Mark Palmer | 5 minute read
Almost unbelievably, there are still people that think that only boys and men can be Autistic. Only this week I saw an online exchange where a mother mentioned that her child was Autistic, and the first response was to ask how old her son was. In fact, she had an Autistic daughter.
Sadly, it is true that there is not a level playing field for having Autism recognised and support put in place between men and women. Women are likely to face more of a struggle to have their neurodivergence diagnosed and adjustments made. How has this disparity arisen, and what can we do to address it?
Do Autistic traits present differently in women?
The first thing to say is that Autistic traits present differently in every individual. There is no single trait that is present in every Autistic person. There are traits that are shared by many Autistic people, but even then, they will present and combine with other traits in a way unique to that individual.
It is also worth remembering that the scientific understanding of Autism is still in the early stages of development. One study published in Scientific American, however, has found significant differences in the brain activity of Autistic boys and girls in relation to socialising. A key finding is that while Autistic girls’ brains show reduced activity when socialising compared to neurotypical girls, their brain activity in these situations is similar to neurotypical boys. In other words, Autistic girls are different from neurotypical girls, but like neurotypical boys in this respect.
The same study also points out the key role that hormones play in the development of the brain. Given the vastly different chemical cocktails in adolescent boys and girls, it seems almost inevitable that Autism will have a different impact on the two genders. There is much still to learn in this area, but it seems clear that there are indeed major differences in Autistic traits between men and women seen from a scientific perspective.
There are also differences in how common Autistic traits are perceived in girls and boys against the gender biases of society. A girl who prefers to play by herself rather than in a group is less likely to be seen as “unusual” than a boy with this preference. Similarly, the special interests of Autistic boys, such as very detailed knowledge of a technical subject like engines, may seem more unusual than those of Autistic girls, such as dolls or a particular celebrity. This perhaps illustrates the impact of gender bias in our society more than anything else, but it is also a barrier to the recognition and diagnosis of Autism in girls.
Masking and Autistic women
Another key factor in the underdiagnosis of Autism in women is the masking effect. Masking is when Autistic people suppress their natural behaviours and instead copy those of neurotypical people around them, effectively playing a part for some or all of their lives rather than being their true selves. This can be driven by a desire to fit in, particularly in a situation like school or work, or as a result of being bullied or mistreated for being different in the past. Masking is a problem as it is exhausting and can have major negative impacts on mental health. Everyone should be free and accepted as they truly are, not forced to pretend to be somebody else.
Put simply, Autistic women are more likely to mask than Autistic men, and they are also better at doing so. Some Autistic women may be so good at masking that they do not even realise that they are doing it, which can eventually cause problems when the mental toll becomes too much to bear. Masking inevitably has an impact on diagnosis and recognition of Autism.
It’s important to remember that masking isn’t always a conscious decision. Often, people will mask, because they don’t feel safe to be their true selves. This can be because of discrimination, ableism, and more.
The diagnosis gender gap
Historically, the criteria used for a medical diagnosis of Autism were based on the traits likely to occur in men rather than women. Combined with the factors discussed above, it is no surprise that women are less likely to be diagnosed as Autistic than men, but the rate at which this is taking place is horrifying.
A study by the Centre for Disease Control in the USA found that Autism was four times as common in men than women, and it is interesting to see that this is presented as a fact showing how Autism occurs rather than how frequently it is diagnosed in men and women.
The National Autistic Society in the UK summarises research as showing the ratio of Autistic men to Autistic women of anywhere between 2:1 and 16:1 with 3:1 the most likely situation.
The diagnosis gender gap is closing, but there is still much more to do.
When are Autistic women diagnosed?
Research by Swansea University has shown the average age of diagnosis for Autistic girls to be between 10 and 12, compared to between 4 and 6 for boys. This huge disparity further illustrates the problems faced by Autistic women and girls in having their neurostatus recognised.
Many more women are also seeking a diagnosis as adults, having had their Autism misdiagnosed or missed altogether when a child. The Independent newspaper reports that 150,000 women took an online test for Autism in 2021 compared with 49,000 in 2020. As awareness grows, this trend is likely to continue.
The journey continues
It was not so long ago that anyone suggesting that a girl or woman may be Autistic would probably have been dismissed out of hand by many medical professionals. Thankfully, that situation has now passed, but we are still a long way from equality in recognising and supporting Autistic women to be their true selves. This is important, because when the right support is in place, Autism can bring huge strengths and benefits, not just problems navigating a world designed by brains that work a different way.
We all have a role to play, and education is key. By being well informed and sharing that knowledge with others when we can, the pace of change will only increase.
