Autism spectrum disorder is a complex neurodevelopmental condition that affects individuals across the globe. Historically, studies and research into ASD have been focused on the male experience of the disorder, however recent research suggests that there is a larger gender disparity than once believed. Male-predominant cohorts in autism research have led to diagnostic criteria that primarily reflects the male presentation of the condition. This has created a substantial gender bias in diagnosis. This article delves into the struggles and realities faced by undiagnosed and diagnosed females with autism, shedding light on their unique challenges and the importance of recognizing their experiences.
The Unique Traits of Silent Female Autism
A common behaviour found in females with autism is the act of masking and camouflaging behaviour. Masking involves concealing autistic traits in social situations, often to fit in or conform to societal norms and to fit in as best as they can with their peers. Masking is a survival strategy that many females with autism adopt from a young age, potentially making their experience with the disorder less apparent to others. Due to masking, research has found that autism is rarely diagnosed in childhood for females, as opposed to males (Milner et al., 2019).
Recent studies suggest that gender disparity in the diagnosis of autism lies in the differing symptoms that individuals with autism experience based on their gender. A study by Bargiela et al. (2016) suggested that compared to males, females were more likely to "camouflage" or "mask," with higher tendencies to mimic others and prioritise fitting in with their cohorts than their male counterparts. Males with autism, on the other hand, have been found to be significantly less socially motivated (Sedgewick et al., 2016), with greater socio-communication difficulties in their experience with the disorder (Milner et al., 2019).
Social challenges are also prevalent with autism, with deficits in social communication and social interaction characteristically present with the disorder (American Psychiatric Association, 2013). Females with autism often struggle to form and maintain friendships, finding it difficult to grasp the intricacies of social interactions. Misinterpreting social cues can lead to feelings of isolation and exclusion.
The DSM-5 details that special interests and restricted interests are another aspect of autism. These interests can provide comfort and a sense of control, serving as a coping mechanism. However, they differ from the more stereotypical interests observed in males with autism. Female hyperfixation interests have generally been found to be focused on topics of interest that are similar to those of their neurotypical peers, such as celebrities, musicians, or artistic crafts; however, the quantity and depth of these interests may be greater (Gould & Ashton-Smith, 2011).
Emotional Effects of Silent Female Autism
The emotional toll of being a female with undiagnosed autism can be profound. The struggle to fit in and mask their true selves often leads to a profound sense of isolation and alienation. Females experiencing the social communication difficulties characterised by autism may subsequently experience social rejection, isolation, or distress, and these undiagnosed symptoms have been found to be one of the most emotionally problematic for females with undiagnosed autism (Kreiser et al., 2014). The sensation of feeling different from peers but not knowing why can take a heavy toll on one's self-esteem and mental health.
Anxiety and depression are common co-occurring conditions among undiagnosed females with autism. The constant effort required to mask autistic traits can exacerbate anxiety, leading to chronic stress. Over time, this can contribute to depression, making daily life even more challenging. As the symptoms presented in females are much more subtle and less obvious than those in their male counterparts, females often experience a delay in diagnosis, remain undiagnosed, or may be misdiagnosed with other conditions.
Many cases have been found where individuals with symptoms of autism have been misdiagnosed with anxiety disorder, emerging personality disorder, or other conditions with similar symptoms (Kreiser et al., 2014). With an accurate diagnosis, females with autism can gain access to treatments, resources, or support services that may be highly beneficial to their everyday lives.
Conclusion
The struggles and realities of undiagnosed female autism highlight the need for a more inclusive approach to understanding and diagnosing autism. It is essential to recognize the unique traits and challenges faced by females with autism and to provide early intervention and support. In the future, both further qualitative and quantitative research is needed to understand the gender disparity in autism symptoms and diagnoses across genders and to further examine the unique symptom manifestation found in females.
By identifying and forming a greater understanding of how this disorder presents across genders, the symptoms and manifestations of autism can be better supported. Raising awareness, advocating for gender-inclusive diagnostic criteria, and supporting individuals with autism are steps toward achieving this goal. By doing so, we can create a world where undiagnosed females with autism are better understood and can reach their full potential.
If you or someone you know is experiencing challenges related to female autism, our team of psychologists, psychotherapists, counsellors and coaches is here to help.
Click the button below to learn more about ADHD and Autism support with psychosexual therapist and registered psychologist, Lia Lawton:
Click the button below to learn more about neurodiversity and relationships with registered psychosexual therapist, Rhiannon Derrig:
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Bargiela, S., Steward, R., & Mandy, W. (2016). The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281–3294. https://doi.org/10.1007/s10803-016-2872-8
Gould, J., & Ashton-Smith, J. (2011). Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum. Good Autism
Practice (GAP), 12(1), 34–41.
Jack, A., Sullivan, C. A. W., Aylward, E., Bookheimer, S. Y., Dapretto, M., Gaab, N., Van Horn, J. D., Eilbott, J., Jacokes, Z., Torgerson, C. M., Bernier, R. A., Geschwind, D. H., McPartland, J. C., Nelson, C. A., Webb, S. J., Pelphrey, K. A., & Gupta, A. R. (2021). A neurogenetic analysis of female autism. Brain (London, England : 1878), 144(6), 1911–1926. https://doi.org/10.1093/brain/awab064
Kreiser, N. L., & White, S. W. (2014). ASD in Females: Are We Overstating the Gender Difference in Diagnosis? Clinical Child and Family Psychology Review, 17(1), 67–84. https://doi.org/10.1007/s10567-013-0148-9
Matthews, L. K., Wall, K. H., Hoffman, Y., Pantale, A., & De Martinis, J. (2019). The Unheard Voices of Transition: The Experiences of Four Female Young Adults with ASD as they Prepare to Graduate. The High School Journal, 102(4), 283–296. https://doi.org/10.1353/hsj.2019.0010
Milner, V., McIntosh, H., Colvert, E., & Happé, F. (2019). A Qualitative Exploration of the Female Experience of Autism Spectrum Disorder (ASD). Journal of Autism and Developmental Disorders, 49(6), 2389–2402. https://doi.org/10.1007/s10803-019-03906-4
Sedgewick, F., Hill, V., Yates, R., Pickering, L., & Pellicano, E. (2016). Gender differences in the social motivation and friendship experiences of autistic and non-autistic adolescents. Journal of Autism and Developmental Disorders, 46(4), 1297–1306.