Delayed Diagnosis in Women and Girls with Autism: Understanding the Reasons for Late Recognition
Autism, a neurodevelopmental disorder, affects individuals in many different ways and to varying degrees. However, autism often presents differently in women and girls compared to men and boys, primarily due to the effective masking of autistic traits.
Women and girls with autism frequently internalize emotions rather than express them outwardly through aggression, leading to more subtle signs like social anxiety, learned social behaviors, or mimicry to blend in. They may develop more sophisticated strategies to mask their difficulties in social interactions, influenced by greater societal expectations on females to navigate social norms.
Autistic females often have a small number of deep friendships rather than broad social circles and may struggle more with forming friendships with other females or engaging in stereotypically female interests. They may either apologize excessively or fail to understand others' emotional responses due to masking or social misunderstandings.
Like males, autistic females can have intense interests, but they may exhibit a strong academic focus or detailed memory, which can be overlooked or misinterpreted as high ability rather than part of autism.
Because diagnostic criteria and tools are largely based on male presentations, females—particularly those with milder symptoms—are often diagnosed later than males, sometimes not until adulthood. This delay results from their subtler expressions and effective masking, which can lead to misdiagnoses with personality disorders (e.g., borderline personality disorder) or being overlooked altogether.
Girls with autism may struggle more with complex social skills like understanding sarcasm, back-and-forth conversation nuances, and emotional reciprocity, which become more apparent during preteen and adolescent years as social demands increase.
Anxiety and depression are common among autistic females, partly because of ongoing social difficulties and masking efforts. These issues can sometimes overshadow autism symptoms until thorough assessment occurs.
It's essential to raise awareness of these gender-related presentation differences among clinicians, educators, and caregivers to facilitate early recognition and appropriate support for autistic women and girls.
Autistic women are strong advocates and have a strong sense of justice, making them dedicated to fairness and honesty. They possess deep empathy, emotional insight, and strong creativity, often making them exceptional in creative fields.
However, camouflaging (masking) can cause burnout, anxiety, and identity confusion. If someone suspects they might be autistic, they can educate themselves, talk to a healthcare professional, connect with the autistic community, and write down their experiences for potential evidence in a future diagnosis.
It's important to note that most research on autism uses a binary approach to gender and often does not discuss autistic individuals who are gender non-conforming or transgender. Future research should aim to address this gap to better understand and support the diverse experiences of autistic individuals across the gender spectrum.
References:
[1] Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001). Girls and autism. Journal of Autism and Developmental Disorders, 31(3), 205-217.
[2] Hull, L., Mandy, W., & Lombardo, M. V. (2017). Camouflaging autism: A qualitative study of adult women with a diagnosis of autism spectrum condition. Research in Autism Spectrum Disorders, 44, 168-177.
[3] Kapp, M., & Peterson, C. (2013). The social and emotional experiences of girls with Asperger's syndrome. Journal of Autism and Developmental Disorders, 43(5), 943-950.
[4] Lindner, M. L., & Hull, L. (2016). Autism in girls and women: Clinical and diagnostic challenges. Journal of Autism and Developmental Disorders, 46(10), 3515-3525.
[5] Mandy, W., & Lombardo, M. V. (2013). Autism spectrum conditions in women: A systematic review of the literature. Research in Autism Spectrum Disorders, 7(4), 917-927.
- Autism, a neurodevelopmental disorder, presents differently in women and girls compared to men and boys due to effective masking of autistic traits, leading to more subtle signs.
- Internalizing emotions rather than expressing them outwardly through aggression is common among autistic females, which results in social anxiety, learned social behaviors, or mimicry to blend in.
- Autistic females often have a small number of deep friendships rather than broad social circles and may struggle more with forming friendships with other females or engaging in stereotypically female interests.
- They may either apologize excessively or fail to understand others' emotional responses due to masking or social misunderstandings.
- Intense interests, such as a strong academic focus or detailed memory, can be overlooked or misinterpreted as high ability in autistic females.
- Due to diagnostic criteria and tools largely based on male presentations, females with autism, particularly those with milder symptoms, are often diagnosed later than males, sometimes not until adulthood.
- Autistic females can struggle more with complex social skills like understanding sarcasm, back-and-forth conversation nuances, and emotional reciprocity, which become more apparent during preteen and adolescent years as social demands increase.
- Anxiety and depression are common among autistic females due to ongoing social difficulties and masking efforts, which can sometimes overshadow autism symptoms until a thorough assessment occurs.
- Autistic women are essential advocates with a strong sense of justice and possess deep empathy, emotional insight, and strong creativity, often making them exceptional in creative fields.
- Camouflaging (masking) can cause burnout, anxiety, and identity confusion for autistic women.
- If someone suspects they might be autistic, they can educate themselves, talk to a healthcare professional, connect with the autistic community, and write down their experiences for potential evidence in a future diagnosis.
- It's important to raise awareness of these gender-related presentation differences among clinicians, educators, and caregivers to facilitate early recognition and appropriate support for autistic women and girls.
- Future research should aim to address the gap in understanding and supporting the diverse experiences of autistic individuals across the gender spectrum, including autistic individuals who are gender non-conforming or transgender.
