What do you think of when you think about Autism?
I give you permission to be a bit stereotypical. In fact, I want you to be a bit, well, judgy for a moment. When I previously thought about Autism, I would picture the stereotypical white male child.
Studies suggest that at least three males will receive an autistic diagnosis for every one female. It seems as though there are more autistic boys than there are girls. Here are three reasons why Autism might be misrepresented:
Misrepresentation may have to do with how well Autism is portrayed in the media. There is not a whole lot of representation for girls, especially in persons of color. Look up “autistic characters on tv” in Google: Dr. Shaun Murphy, Max Braverman, Sheldon Cooper, Jerry Espenson, and Spencer Reid can be found. I’d like to assume women and persons of color as underrepresented as they have been for centuries.
It is possible girls go undiagnosed for ASD due to the fact that the current diagnostic criteria do not meet the expression of Autism (or traits) in girls. The diagnostic criteria for Autism are fundamentally based on research performed in boys with Autism rather than girls. The criteria for the diagnosis of Autism are based on pre-existing concepts of what Autism may “look like,” which poses a huge problem for behavioral maskers. As a result, many gals are not diagnosed until later in life, typically in their teen years.
It’s difficult to diagnose girls
Diagnostic criteria call for individuals who lack the capacity to communicate and interact socially. As a result, many girls are being left undiagnosed with Autism and are diagnosed with other mental health disorders, like manic bipolar disorder or depression.
According to Autism in Girls, “The main issue with the current diagnostic criteria is that behavioral maskers that are used as criteria for diagnosing autism are based on pre-existing conceptions of what autism “looks like.” As suggested, the research took samples for their research based on predominantly male populations to diagnose Autism-It’s common for girls to be able to “mask” their autistic traits, and the behavior maskers used as diagnosis criteria are therefore not so transparent, but what can this mean for girls?
Many women find themselves questioning if they are Autistic (or on the spectrum) later in life. This especially happens in teenagers and in their twenties when the need for complex social interaction capacity has heightened. Girls are not being diagnosed properly and miss out on early intervention up into age three. When these girls do receive early intervention, the results show better health outcomes. However, no matter what the reason for the underrepresentation of girls with Autism, the facts are girls are being misdiagnosed and not taken as seriously as males.
Challenges for Autistic Girls
Keep in mind that Autism is a spectrum and presents differently from person to person. The spectrum includes different types of Autism, from severe or low functioning to high functioning. It’s easier to diagnose low-functioning because the signs and symptoms are more prevalent. However, this list can help offer some insight into some common difficulties girls with autism deal with:
Communication and social skills
A classic symptom of Autism is difficulty involving social interactions. This is much easier to spot in males because females tend to adapt to social situations more naturally than males.
When socially interacting, girls with Autism may find it difficult to maintain eye contact (to a point where it’s been described as “hurting” to attempt to do so). Some girls find it hard to concentrate on the interaction at hand and will escape difficult situations through mental processing or daydreaming.
Other social and communicable examples:
- Take things literally; struggle to understand sarcasm.
- Find it challenging to form an intimate bond or interact intimately.
- May have lower levels of verbal cognitive ability.
- Language and communication issues
- It needs more time to process to engage and interact.
- Conversations seem “scripted.”
Girls with Autism tend to have sensory processing issues, which include struggling to process intense sound, lighting, or touch.
For someone with Autism Spectrum Disorder, there are sensory inputs that increase the desire or need for self-regulation. Some ways include having meltdowns, stimming, or in more extreme situations, self-harming behaviors. Some examples of stimming may include biting nails, waving hands, or tapping.
Headbanging is a common example for children to self-soothe themselves and helps communicate their needs as a result of severe anxiety. The desire to self-soothe can come from an individual being in physical pain, seeking attention, sensory issues, or attempting to communicate.
Sometimes, we find it hard to communicate. Sometimes described as: “When we know what we WANT to say in our head, but it doesn’t come out of our mouths properly, it becomes frustrating.” And sometimes, it creates aggressive feelings.
Girls with Autism can sometimes become aggressive or act out due to these feelings of difficulty communicating. Additionally, sometimes the aggression is put on due to an issue with trying to regulate over-stimulation. For example, if there is a constant tick-tock of a clock that is over-stimulating occurring at the same time an intense conversation is happening, aggression may occur.
Physiological or health relative problems may be related to these behavior issues. It’s essential to remember everyone is different.
Instead of thinking in language, people with ASD tend to think more in pictures. To process information, they see things in their mind or need to see them physically to better understand.
For some, it means having the ability to solve complex problems or conceptualize patterns in their mind. According to The Place for Children with Autism, “Additionally, once the images are associated with a specific train of thought, the words and images become associated and banked as memory.” Visual thinkers might have photographic or near photographic memories. In addition, linear thought processes do not come hand-in-hand with visual thinking.
It’s interesting enough! Neurotypicals can become quickly confused by visual thinkers, like people with ADS, because they might recall an image that’s tied to memory and associate it with something completely off-topic and unrelated but can make perfect sense in their mind! Add another struggle to the “communication and social skill” box – why don’t you?
Obsessions and special interests: A Classic Stereotype
Boy, will you see the light in their eyes when speaking about their special interests or obsessions! Girls on the spectrum tend to limit interests and often narrow down what they enjoy.
One of the reasons girls are misdiagnosed may be that their special interests are more socially acceptable than boys with ASD. For example, a female teen may obsess over celebrities or boys. These girls may do so because they have a strong desire to “fit in” with their friends by “masking” their autistic traits.
How do girls on the spectrum mask?
Girls with autism spectrum disorder are rock-star ninjas, basically. They know how to blend in and hide, known as camouflaging or masking – a real diagnostic issue!
Masking happens due to cultural pressure to act normal. However, it comes naturally for girls to mimic the behavior of others. They spend a great deal of energy to hide their autistic “quirks,” almost as if they’re in a play.
Some examples of mimicking include forcing eye contact (regardless of the internal discomfort or anxiety may induce) and mimicking facial expressions. Based on current studies and clinical experiences, other signs of Masking might include suppressing “quirks” or stimming behaviors such as “Flappy Happy Hands” or giving scripted responses.
They learn to adapt to their environment by utilizing these strategies to avoid standing out or to “fit in” with their given situation. Masking is learned through observing or mimicking. Girls with Autism might learn this ability by watching television or movies, from neurotypical peers, or from day-to-day observation.
Why Masking has Consequences?
Masking might seem like a super-power, but it has its consequences. It’s exhausting! One study suggests Masking can cause detrimental effects such as an emotional, physical, and mental drain. This occurs because Masking means constantly monitoring what is or what is not deemed as socially acceptable. Additionally, Masking is related to feeling like an outcast and a higher rate of depression.
What are the psychological impacts of being diagnosed late in girls?
Autistic girls don’t often “get it,” so they strive to do what other people are doing, and it wears them out. Oftentimes, girls with Autism start wondering what is “wrong” with them. In some social situations, they’ll start to obsess over every little detail of the past conversation.
Examples of obsessive thoughts that may occur are:
- Why did I say something so stupid?
- Did they think I was funny or inappropriate?
- What did I do wrong?
- How can I make this better?
- How can I be better next time?
Constantly questioning yourself and monitoring your behavior is exhausting and can take a toll on mental illness
In fact, girls with less severe cases of Autism will often first be flagged because of depression or social issues. Girls come into the doctor’s office for something like anxiety, depression, or school performance. It’s not until later that physicians may discover social communication issues and restricted interests.
As mentioned previously, another impact of a diagnosis going overlooked is missing out on early intervention and support for skill-building. For example, It’s hard to focus on subjects that do not spark interest for individuals with ADHD, but especially with Autism. Academically, this can be detrimental when proper support is not available—resulting in poor performance and frustration (for the whole family).
Earlier diagnosis means getting the proper resources and access to therapies earlier in life. It means a girl and her family have more time to learn how to manage the diagnosis properly. Early intervention is crucial to development, but a later in life diagnosis is better than none at all.
Playing catch-up on learning proper social skills and coping mechanisms often happens in those who become diagnosed later in life. However, after a proper adjustment period, most females find comfort in their diagnosis. In fact, Netflix Comedian Hannah Gadsby explains her diagnosis as being handed the “key to her own city,” as while growing up, she always felt different.
After diagnosis, an individual with Autism can start to meet with autism experts, psychiatrists, or occupational therapists, or other trained professionals. They can help with answering questions and help give guidance or support in ways to build a better quality of life.
Whether the reasoning is difficult during diagnosing or not, ask for a second opinion by a practitioner. We highly recommend connecting with someone reputable within Williamson County for more questions. It’s time to open up a conversation about Autism in girls and women as early as possible.
Find Support in Williamson County, TX:
Revolutionary Wellness, PLLC (Georgetown, TX)
High School Social Skills Group (Austin, TX)
ABA Connect: Wise Owls Social Group (South Austin, TX)
Autism Society: Improving the Lives of All Affected by Autism
Texas Autism Research & Resource Center:
Support Groups Near Williamson County, TX:
Autism Support Groups near Round Rock, TX:
Autism Parenting Magazine: