Updated: Aug 2
Attitudes towards autism and gender are changing, although we still have a long way to go. Many autistic women and girls are still struggling to get the support they need. Women with autism tend to present differently than men, a fact which has often led to misdiagnosis and under-diagnosis. As a result, women who have autism and don’t receive a diagnosis tend to judge themselves harshly for finding life difficult and this can lead to many secondary mental health difficulties. Here, we'll evaluate the differences and difficulties regarding women/girls and autism.
Various studies have suggested that the ratio of autistic males to females is anywhere between 3:1 to 16:1 - though the most widely accepted statistic is 3:1 as of 2022. We know that early diagnosis can significantly help and improve the life of the individual, allowing them to understand their thoughts and behaviours more clearly and also receive extra support where needed, i.e. in school. It is thought that, on average, boys receive a diagnosis up to 2 years earlier than girls - so why is there such disparity in diagnosis recognition?
"I feel autistic women are more likely to be described as ‘anxious’ and an autism diagnosis overlooked, since it can challenge gender stereotypes." - Dr Camilla Pang, scientist & author
Research and knowledge about autism changes constantly, but the diagnosis of autism is predominantly based on behaviour observation and to what extent these behaviours/thoughts impact significantly on day-to-day functioning. However, a fundamental flaw of this method is that it relies on clinicians looking for 'typically autistic behaviours' that were developed from observations of predominantly autistic male populations. This leads to the notion that autism is under-diagnosed in women and girls because they express their autism in different ways and do not necessarily show the 'typical' signs of autism that is more present in boys and men.
Other theories around the differences in diagnosis rates include;
a range of biological and environmental factors may mean that autism is just more prevalent in boys and men
autism traits are under-reported by significant people in the child's life, or they are downplayed as the child being 'different' or 'weird'
girls and women are typically better at camouflaging and masking
Camouflaging and Masking
Camouflaging and masking are behavioural changes that people with autism can make in order to, in my boyfriends words, "appear less autistic". It actually goes far deeper than that. As humans, we all have a deep rooted desire to want to fit in, achieve social and professional success and to socially connect with those around us and therefore we typically want to display behaviours that promote that. Some typical autistic behaviours, such as difficulty maintaining eye contact, difficulties in social communication and additional sensory needs, can make it challenging for autistic people to feel connected, and therefore they can try to push down, or mask, these behaviours. Examples of masking behaviours include;
forcing eye contact (though also being conscious not to do this too much to the point where it is socially uncomfortable)
mimicking social behaviours of others
practicing jokes or phrases ahead of time to use in conversations
imitating gestures, expressions or even accents
Whilst masking and camouflaging behaviour can be exhibited by all autistic people, it has been noted that it is far more prevalent in women and girls. It is important to remember that masking does not turn off the autism, they are suppressing the symptoms so that it could be undetectable by others but this is extremely taxing and draining to do.
Imagine having a conversation with a colleague. You have to be aware of body language, posture, tone of voice, turn-taking etiquette, topic of conversation, future implications of the conversation...it's a lot of things! Autistic people will be highly conscious of all these components and will have to work harder than neurotypical people to behave "normally" for all of these areas.
From my own personal experience, I see my boyfriend masking a lot, especially when we're in social situations with a lot of people (which is often when we're a family of 10!). I then often see that he needs a lot of alone time to recuperate and just have some calm time. I can imagine this is the same, if not more, for women and girls so if you see them needing more space away from others, it may be that they are just mentally exhausted. This constant need to feel like they need to mask and fit in can lead to secondary mental health needs.
Mental Health Needs
Several studies have linked camouflaging and masking with increased cases of mental health needs in autistic women and girls. Mental health difficulties such as depression, anxiety, eating disorders, low self-esteem and even suicidality have been linked to the degree to which an autistic woman masks vs the autistic traits themselves.
“I learned to mask early on. My mother reminded me daily how weird I was and I learned to hide myself. The biggest impact of that for me was the constant worry that I’d done something wrong—that I’d revealed too much of myself by mistake. I’d ruminate for hours about whether I’d let the mask slip.”
Analyses from a recent study into mental health and camouflaging showed that camouflaging was associated with feeling distressed (depressed, anxious, and/or stressed). For women who reported above-average levels of camouflaging, camouflaging was also associated with having thoughts about suicide and struggling to function in everyday life. Trying to camouflage autistic traits was associated with mental health challenges, regardless of whether those traits were very mild or more severe.
Many women with autism become so skilled at masking they don’t know they’re doing it. One study showed that it may not be until later in life that women’s social difficulties become too great for them to manage with their usual camouflaging strategies. Dropping the mask isn’t always easy for women with autism, as wearing it has become a part of them. But if there’s a way to safely and gradually reduce their camouflaging, they may well experience an improvement in their mental health—along with a huge sense of relief.
Famous Women on the Autism Spectrum
Dr. Temple Grandin
Dr. Grandin a top scientist in the human livestock handling industry best known for giving the world a unique insight into how the autistic mind works. Her books have helped tear down the stigma around autism by helping others to better understand how people with autism see the world. She has given many amazing TED talks and discusses why the world needs many types of minds.
For anyone based in the UK, you may know Anne as "The Governess" from ITV's The Chase. Anne has Asperger's Syndrome and it took her a couple of years to get an autism spectrum disorder diagnosis. When it came, Anne reported it was a relief. “It kind of helped me just reframe everything,”
Charl is a Welsh Tattoo artist who gained widespread fame appearing on the British MTV series Just Tattoo of Us. Char speaks openly about her autism and endometriosis and you can follow her on Instagram.