Autism (or Autism Spectrum Disorder) is a lifelong developmental disability which affects the way in which a person communicates, and how they experience the world around them. It is considered a spectrum condition but it is not linear from low to high severity, it varies similarly to how the condition itself can vary from person to person.
You cannot tell if someone is autistic just by looking at them, meaning that it is regarded as a hidden or invisible disability. Instead, there are four main characteristic areas that are key identifiers of whether an individual has autism; social interactions, social imagination, social communication, and sensory differences. If these indicators are so clear and it is a disability that can affect anyone regardless of gender, then why is it commonly cited that autism is four times more prevalent among boys than in girls? The answer is simple.
Autistic females are hiding in plain sight.
The manifestation of autism in females is often described as “quiet” or “silent”, due to the way in which it greatly differs from the manifestation of the condition in males. Regarding the social characteristic areas of autism, boys and men tend to struggle more when compared to girls and women. Whilst male social communication issues may become increasingly difficult from a young age, females tend to better manage the social demands and societal expectations in early childhood but begin to face difficulties as they enter early adolescence.
One reason for this may be because they are “taken under the wings” of other girls who like to act as mentors for their peers, helping autistic girls to ‘mask’ as socially competent individuals at face value. However, as these ‘mentors’ disappear as they grow up, the problems autistic girls have socially become more evident. This is not as typical an occurrence amongst boys with autism, which is why their difficulties show at an earlier stage.
Alongside this, ASD males are less likely to be able to respond to non-verbal communication such as gestures (e.g. pointing) or gaze following in comparison to ASD females. They are also comparatively less focused and more prone to distractions during social interactions, and in general.
Girls and women with autism are also less likely to engage in aggressive behaviours, and appear to be more passive and withdrawn in comparison to autistic boys and men. However, when engaging in disruptive behaviours it is found that the motivation for the female autistic tendency to engage in these behaviours is to gain attention, whilst autistic males will do so to obtain objects. The societal view of female hysteria, and the assumption that females lash out for attention, is particularly damaging to autistic females as engaging in this behaviour can lead to them being labelled as “attention seeking” rather than raising suspicions of the potential presence of ASD.
Although both ASD males and females have perseverative (obsessive/compulsive) interests, the females are more likely to choose more societally common interests such as celebrities and TV/Movies. Whereas, males are more likely to choose more niche perseverative interests such as schedules, statistics, or transportation. This makes it increasingly difficult for females to receive an ASD diagnosis in their adolescent and teenage years, as their perseverative interests may display as typical behaviour expected of a pre-pubescent and pubescent girl rather than clear displays of autistic tendencies. However, this is not to say that all autistic females have common interests and many in that regard align closer with that of autistic males, but that is not the case for the majority of them.
Whilst investigating the skew in gender ratio for autism diagnoses, scientists have uncovered social and personal factors which assist in females “masking” or compensating for the symptoms of autism better than that of males. A 2012 study carried out by King’s College London cognitive neuroscientist, Francesca Happ, compared the occurrence of formal diagnoses from a sample of 15,000+ twins. It was found that if boys and girls had a similar level of autistic traits, in order to be diagnosed the girls had to display an increased behavioral problems or significant intellectual disability, or both. This greatly suggests that females on the less disabling end of the spectrum are missing out entirely on an autism diagnosis.
A key issue in the lack of identification of females with autism is deep-rooted in the issue that studies include so few girls and women, so their results are “not stratified by sex or gender and male-based conclusions are reported as universally applicable”. For too long, it has been assumed that autism is a male-dominated condition, as research and initial reports of autism were primarily boys and men. Surprisingly, within the last two decades it was thought that the diagnosis ratio was 4:1. Due to the unbalanced results of these studies, which are used in tandem with the four autistic characteristic areas, women and girls with autism are often misdiagnosed or receive additional diagnoses of other disorders such as bipolar disorder, ADHD, depression and anxiety – which in turn delays their autism diagnosis or they may never receive a diagnosis at all. This creates a separate problem in itself, as many studies specifically exclude those with additional disorders and then, inadvertently, exclude females that are on the spectrum.
My younger sister did not receive her autism diagnosis until May 2021, when she was 15 years old. Her diagnosis was completely accidental as she was, at the time, being assessed for her ADHD diagnosis when the psychiatrist identified several severe traits of autism. Going so long without a proper diagnosis was detrimental for her, as the lack of suitable treatment caused her to develop severe OCD, anxiety, and she became virtually agoraphobic. Her treatments and therapies at the time were tailored to suppressing her obsessive and compulsive behaviours, which unfortunately greatly assisted in giving her an improved ability at unintentionally masking her autistic traits. She was constantly under distress and cried all the time, as she couldn’t grasp why she felt the way she did or why she was so different to her peers which led to her becoming severely anxious and depressed. At this point she was failing all her classes, and her school didn’t think she would make it through her GCSE’s.
Now, almost two years on from her initial diagnosis, she has become an entirely different person. She no longer cries all the time and, with the help and guidance of her newfound support network, is more comfortable leaving the house and communicating with others and has joined a support group for other autistic teens to improve her social skills. She achieved multiple A* and A grades in her GCSE’s and is predicted to achieve the same results in her AS and A Levels.
An autistic diagnosis is not the be-all and end-all for a person, but for some it can be. However, receiving a diagnosis can greatly improve your life, as you can gain a greater understanding of yourself and your emotions and can develop more appropriate coping methods. In my sister’s case, her diagnosis saved her life. Linked below are checklists of female and male autistic traits, if you feel you have any of these traits I urge you to seek advice from a GP.
Male Autism Checklist (Adults)
This webpage from The Spectrum may also assist you in offering sound advice on how to obtain an Autism assessment.
Featured Image Credit: OSF HealthCare
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