Autism in Women

Autism in Women

Historically, autism has been predominantly studied and diagnosed in males, leading to a gender bias in understanding and identifying the condition. However, recent studies have depicted the unique characteristics, challenges, and experiences of autistic women and girls. Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder characterized by pervasive deficits in communication and social interaction and patterns of repetitive, restrictive interests and/or stereotyped behaviors.

Most diagnostic assessments and tools are based on research with autistic males and underestimate symptoms or are not sensitive enough to autistic female presentation, contributing to sex/gender bias. Common pathways for women receiving diagnosis may include having a family member or partner receiving an autism diagnosis and then identifying signs in themselves, recognising personal traits in accounts by autistic women, or exploring the possibility of autism when they experience employment difficulties or burnout. Females may therefore be more negatively affected by the time they reach adolescence and adulthood, through experiencing mental strain from encountering difficulties, without the knowledge these may be related to autism (Jamison et al., 2017; Zener, 2019).

Women appear to have a tendency to camouflage. This is a relatively common part of the everyday experiences of autistic individuals without intellectual disability. Autistic individuals may camouflage their autistic characteristics during clinical assessments, consciously or not, which may lead to missed diagnosis or lack of appropriate support. Some of the challenges of being a female with ASD do not come directly from the individual’s autistic difficulties; instead, how these difficulties express themselves within a culture that has specific expectations for “women”. Some females feel a conflict between their desire to accept their autistic selves, and perceived pressures to fulfill traditional gender roles. Females with autism are less likely to be diagnosed or are identified much later than their male counterparts. Achieving a late-in-life diagnosis is very valuable for adults and can improve self-awareness and access to limited support. In addition to assessing the maintenance of social relationships, research into autistic females compared to autistic males, females may appear to have fewer social difficulties overall, but may struggle with other aspects of socializing, especially in comparison to non-autistic females. Like, autistic females may find it harder to maintain long-term friendships or relationships than autistic males, despite having similar levels of motivation for social relationships as non-autistic females.

Furthermore, most diagnostic tools used to identify and diagnose ASD are developed over studies done on populations that have higher numbers of men compared to women in ratios. Therefore, the initial diagnosis formulated may be incorrect, and misdiagnosis may be due to shared features between autism and mental health conditions. Many autistic women are first perceived as having Borderline Personality Disorder (BPD), due to overlap in areas such as verbalizing emotions, intense relationships, superficial friendships and impairments in social functioning (Dell’Osso et al., 2018). Similarities have also been noted between autism and anorexia nervosa (Baron-Cohen et al., 2013; Zucker et al., 2007), with overlapping symptom domains including executive functioning issues, emotional recognition and regulation, lack of interest in social contact, difficulties within relationships and social leisure activities (Tchanturia et al., 2013). Furthermore, autism may be misdiagnosed as Obsessive Compulsive Disorder (OCD) due to shared features of compulsive repetitive behaviors and obsessive thoughts (Zener, 2019).

Hence, Autistic women and girls are more likely to have co-occurring conditions such as anxiety, depression, eating disorders, and ADHD. Beyond a male-centric perspective, promoting accurate diagnosis, and developing tailored interventions and support services that address the unique needs of autistic females across their lifespan can help with co-occurring conditions such as eating disorders, self-injury, and autoimmune disorders that can be addressed while providing comprehensive care and support.