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Autism in Women

Symptoms

The symptoms of autism spectrum disorder present in drastically different ways in girls than in boys. In terms of comorbid and co-occurring conditions, both boys and girls with autism experience anxiety at a high rate. However, girls have a higher probability of experiencing the following comorbid or co-occurring conditions: eating disorders and self-harm. In the area of repetitive or restrictive interests, girls exhibit less restrictive interests and repetitive behaviors than boys. Boys exhibit aggressive behaviors far more than girls. Autistic girls experience more internalization of their symptoms and emotions than autistic boys.

The most notable differences occur in language and social development. Autistic girls have increased language development and communication abilities compared to autistic boys. Autistic girls are very often more verbal and communicative than their male autistic counterparts. In the area of social skills, boys experience more social deficits and gravitate toward solitude whereas girls gravitate toward social behaviors. Boys are also more likely to be socially rejected by their peers than girls. 

Autistic girls adapt their behavior to fit societal expectations of their gender, therefore presenting their autistic traits differently than boys. Girls in Western society, such as in the United States, are expected to be the more social and communicative gender. They are expected to conform to social norms, have a high level of empathy, be caregivers to those around them, and act in a socially appropriate manner. Because of the enormous pressure for girls to be social and communicative, girls with autism frequently learn how to camouflage, or mask, their autistic traits in order to fit in with their peers and meet the societal expectations of their gender. Thanks to this, girls are less likely to present with overt autistic symptoms.

Diagnosis

Autism is diagnosed more frequently in boys than in girls by a large margin. Presently, most studies report a male-female ratio of 4:1 in relation to diagnosis. As such, autism has historically been viewed as a male condition.

The first step in a child receiving a diagnosis of autism is getting a referral for an evaluation. As discussed in the symptoms section, girls learn early on to mask, or camouflage, their symptoms due to the societal expectations of girls. If a girl is successfully able to mask her symptoms or her symptoms are very covert, the adults in her life won’t have a reason to suspect she may be autistic.

Even if an autistic girl is correctly referred for an evaluation, another roadblock stands in her way. Most diagnostic tools and tests have been created and tested using only men. Unfortunately, so few autistic girls have been studied, that diagnostic tools and tests may not be as valid and/or reliable for them. Because of this, it’s common for autistic girls to receive their diagnosis of autism as an adolescent or adult. 

During evaluations, girls will continue to mask their symptoms. Their typically high verbal abilities, social strengths, caretaking nature, social motivation, lack of aggressive behavior, amicability, and intelligence can easily mask autistic traits. Autistic women generally have very high verbal and communicative abilities. Due to one of the main symptoms of autism being decreased communication and language abilities, girls who defy this stereotype face even greater difficulties in receiving a diagnosis.  

In addition to not receiving any diagnosis whatsoever, girls are more likely to be misdiagnosed than boys after undergoing an evaluation. As discussed, the societal expectations placed on girls directly lead to a lack of proper diagnosis. Misdiagnosis is a large problem faced by autistic girls and women. Many girls grow up autistic but don’t know it, having received diagnoses for other conditions. 

It is crucially important that autistic individuals receive a proper and timely diagnosis. Women who did not receive a diagnosis until adulthood report struggling academically, feeling misunderstood, struggling with self-identity, and experiencing anxiety and depression as a result of social isolation. They also have difficulty making and maintaining friendships, poor emotional regulation, confusion about why they felt different from others, and low self-esteem. The power of a timely and correct diagnosis cannot be underestimated.

Experience

The female autistic experience differs greatly from the male autistic experience. Autistic women experience bullying, social ostracization, dismissal of their opinions or issues, and accusations of faking their autism from their social peers in greater numbers than autistic men. Autistic women also have a greater likelihood of experiencing struggles with mental health, psychiatric conditions such as anxiety and depression, a history of abuse, and an unstable sense of self. 

Autistic women also have a higher likelihood of experiencing sexual assault than both autistic men and non-autistic women. Because many autistic women struggle to understand social cues and read social situations but have learned to do as they’re told as part of their attempts to mask their autism, they have an elevated risk factor. They may be easily convinced to go along with what someone is saying, as this is part of how they masked for many years. They may struggle to understand social interactions such as flirting, sexual advances, and times they could be in potential danger.

While both autistic men and women have common foundational experiences as a result of their disorder, women’s experience on the spectrum still differs from men’s likely because of the less overt ways their symptoms present.