Neurodiversity, Psychiatry & Stigma

Research into autism continues to focus on men and, in the case of neuroimaging research, there is an ascertainment bias (meaning that males are specifically selected in favour of females as research subjects) of up to 15:1.4

The fact that girls with autism tend to have a more pronounced drive to be sociable suggests that it stems from the inherent differences between boys and girls in terms of their need for social relationships.

Based on surface appearances, then, girls and women with autism appear to be more socially adept than their male counterparts. This difference is one of the main reasons for the misdiagnosis, and underdiagnosis, of female autism. Autistic women have to work really hard at being sociable, but they can become so skilled at it that other people can’t see the difficulties they’re having.

In my own experience, when I first approached my GP about a diagnosis, he dismissed me as being “too normal.” My client, Sandra, experienced a similar reaction. “My GP told me that I smiled, made eye contact, and that because I was married with kids and a job which involved a high degree of social interaction, there was no way I could have autism.”

Part of the diagnostic criteria for autism in the DSM-5 is “restricted, repetitive patterns of behaviour, interests or activities”10—and in this area, girls and women often have different types of interests from men with autism. Boys may be extremely interested in collecting items and gathering information about objects or categories of things—which fits into how we typically think of autism. But while girls may display the same intense level of interest as boys, their interests tend to appear more “normal.”

Girls with autism are often interested in similar things as other girls of their age, such as celebrities, bands, or ponies. Thus, the fact that they are more interested, sometimes to the point of obsession, often goes unnoticed by parents.

Some girls develop a special interest in the workings of the brain and social interactions and some become obsessive about a “crush” or romantic partner, again displaying the intensity of interest but towards things which can be considered “normal."

Given that girls and women experience the drive to be more sociable than men and boys with autism, it makes sense that they also tend to use more, and different, camouflaging tactics than men. "Camouflaging" is a technique used by both men and women with autism—as well as many neurotypical people—to pass as “normal” in a given situation. Women with autism use techniques such as developing a script for conversations, forcing themselves to make eye contact, or avoiding talking about subjects that interest them.

Many women with autism become particularly skilled at camouflaging, to a far greater degree than other people (including autistic men). But camouflaging is linked to mental health issues—including depression, anxiety, and suicidality—and the degree to which women camouflage is closely linked to their mental health.

Because women still tend to take on a greater share of domestic responsibilities, many women with autism find it hard to manage their own autistic needs while still fulfilling their expected roles of daughter, mother, or wife. Much as they would like to pursue their special interests, carve out alone time, and lead a life that meets their needs, many women feel pressured to fulfill gendered expectations.