Women & Autism

As the field of neuroscience continues to develop, there is an ever-increasing consensus among researchers that Aspie women are dramatically undercounted. Well-intentioned, parents, teachers, and counselors often miss the opportunity to identify women on the spectrum. There are two major reasons for this unfortunate situation:

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Reason 1:  Girls Masking in Childhood

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Even though girls may share many core traits of Asperger’s with boys, they often react externally to it in dramatically different ways. One difference in how boys and girls react is the degree to which they mask their autistic traits.

 

Masking is when a person puts on a “mask” to look the way others expect rather than show up in the world in a way that is natural and genuine. You can think of masking as camouflage. In other words, wearing something on the surface so you will not be noticed, yet fearing that you will be discovered. 

 

As compared to boys, girls are more capable of “masking” their social deficits. One theory that explains this superior female masking capability is that girls on the spectrum have innate “social mimicry skills” which enable the girls to more easily "fake it". Unfortunately, the mimicry usually operates at a superficial level, causing the girls to still miss the deeper emotional understanding. Also, social masking is harder for girls to pull off than boys since neurotypical girls often have more nuanced social and emotional dynamics than boys.  

Furthermore, girls are often more motivated to mask than boys. There usually is less parental and peer pressure for boys than girls to make social connections so the boys put less effort into it. The expectation for social connection can be intense for girls so they may put all their energy into “fitting in”, even though doing so may feel completely unnatural and leave the girls exhausted.

In summary, girls on the spectrum may look different than boys in the following ways:
 

• Higher levels of pretend play
   

• More mimicking of role models (without understanding the real social meaning)
   

• Suppressing natural tendencies (such as special interests) to fit in
   

• Acting quiet or shy at school (to fit in) but melting down at home (due to the emotional stress of masking during the day)
   

• Special interests for girls may be focused on imaginary animals (unicorns), real animals, crafts, environment, appearance and celebrities as opposed to computers, video games and transportation for boys (although these commonly crossover)
   

• Suffer from emotional bullying as opposed to boys who experience physical bullying (again, these cross over)
   

• Girls are more likely to internalize anxiety leading to depression while boys tend to behave more aggressively or have meltdowns
   

• For a more exhaustive list, see Tania Marshall’s blog.
   

This masking behavior can come at great cost, creating a constant worry of “Am doing it right?” and “Will I be discovered to be a fraud?”; thus, leaving many Aspie girls feeling highly anxious and emotionally exhausted.

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Reason 2:   Male-centric Clinical & Research Focus

There is a second reason that girls/women are overlooked for ASD diagnosis. Since the early days of recognition of Asperger’s (now ASD), the research was largely conducted by male researchers on male patients. The fundamental assumption was that Asperger's was primarily a condition that belonged to males. Accordingly, the criteria for diagnosing Asperger’s and the methodologies for assessment became biased to identify male clients.

This framework leaves many women outside of or on the borderline of the parameters for a clear ASD diagnosis so they end up without a diagnosis and little hope for a healing path forward. Even worse, they may be misdiagnosed as having ADHD, Major Depressive Disorder, General Anxiety Disorder, or Obsessive Compulsive Disorder. As expected, a misdiagnosis may lead to suboptimal treatment and extreme frustration and disappointment.