Autism in Women: Why it’s Different and What to Look Out For

Blog Articles

Apr 4

Introduction

In many areas of life, and particularly healthcare, men are seen as the standard and women suffer as a result as it is assumed female bodies function in the same way. We know that heart attacks and strokes, for example, present differently in women than they do men and this gap in knowledge can have devastating consequences for women.[1]Autism or Autism Spectrum Disorder (ASD) is similar in that many studies have shown that autism presents differently in women (by “women” we’re referring to anyone born female) than it does men.

Sadly, as with many women’s issues, there is a stark lack of scientific research in this area. However, we think it is important to outline what we do know about autism in females so that you’re better able to spot signs of autism either in yourself or others. This is an extremely nuanced and complex topic and we encourage further research on everything we will briefly mention in this article.

First, let’s run through some common signs of autism in adults:

Finding it hard to understand what others are thinking or feeling
Getting very anxious about social situations
Finding it hard to make friends or preferring to be on your own
Seeming blunt, rude or not interested in others without meaning to
Finding it hard to say how you feel
Taking things very literally – for example, you may not understand sarcasm or phrases like "break a leg"
Having the same routine every day and getting very anxious if it changes.[2]

What do we know about autism in females?

Numbers vary, but overall it is widely accepted that autism is more commonly diagnosed in men than in women.[3] Current estimates suggest that around three men receive an autism diagnosis for every one woman.[4]However, there may be several reasons for this.

Taken altogether, research suggests that it is unlikely that ASD is equally common amongst men and women, yet, growing evidence suggests that current diagnostic procedures may fail to capture how ASD manifests in women and thus exaggerates the already existing difference in prevalence rates.[5]Women have also been found to be diagnosed with ASD at significantly later ages and to experience greater delays in the time from an initial evaluation to receiving a clinical ASD diagnosis and so this may also impact numbers and statistics.[6]

How does ASD present in women?

While every girl and woman with ASD is unique, many share certain experiences. According to the Asperger/Autism network, a female with ASD may:

Know that she is different, noticing that her interests veer away from those of her peers.
Prefer having only one or two friends, or to play in solitude, having an appreciation of and focus on specific interests.
Demonstrate an aversion to what is popular, what is feminine, or what is fashionable.
Be sensitive to textures, she might prefer to wear comfortable, practical clothing.
Appear naive or immature, as she is out of sync with the trends or the social norms.
Work very hard to “camouflage” her social confusion and/or anxiety through strategic imitation, by escaping into nature or fantasy, or by staying on the periphery of social activity.
Show different sides of her personality in different settings.
Be more prone to releasing her bottled up emotions at home through meltdowns.
Be exhausted from the work of deciphering social rules or of imitating those around her to hide her differences.
Be anxious in settings where she is asked to perform in social situations. This could lead to mutism, escapism, or a focus on routines and rituals.[7]

Issues when diagnosing ASD in women

As there are no reliable biomarkers of autism, the condition is diagnosed behaviourally i.e. based on observation and description of the core characteristics impacting everyday functioning to a ‘clinically significant’ degree.[8]A fundamental issue with the current diagnostic procedure is that behavioural markers used as diagnostic criteria are established based on pre-existing conceptions of what autistic behaviours look like.

These criteria have been developed based on the predominantly male populations previously identified as autistic.[9]Evidence would suggest that it is under-diagnosed in women because women express their autism in ways which do not meet these current diagnostic criteria, although further examination of the characteristics and their impact across all genders and ages is needed.[10]Female Autism Phenotype (FAP) and the component of camouflaging (compensating for and masking autistic characteristics), in particular, often come up when discussing this issue.[11]

Masking

Differences in the manifestation of autistic traits have lent support to the theory of camouflaging in autistic women, which suggests that women are able to mask ‘socio-communicative impairments’ due to increased sensitivity to social pressure to fit in, gendered expectations for social behaviour, and strengths in some social-communication skills.[12] This is particularly common among females at the high-functioning end of the autism spectrum.[13]Common forms of camouflaging include:

Forcing yourself to make eye contact during conversations
Preparing jokes or phrases ahead of time to use in conversation
Mimicking the social behaviour of others
Imitating expressions and gestures.[14]

While both males and females with autism can camouflage their symptoms, it appears to be more common among women and girls. This could explain why women are less likely to be diagnosed with autism!

Famous women on the autistic spectrum

Dr. Temple Grandin is an American academic 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 an amazing TED talk titled ‘the world needs all kinds of minds’. In 2010, Claire Danes played Temple Grandin in a superb biopic of the scientist, which we definitely recommend watching!

Courtney Love singer of Hole, was diagnosed as “mildly autistic” when she was a young girl. Though she was unusually intelligent, she struggled with school and with social interactions.

Daryl Hannah American actress who starred in the Splash and Kill Bill who said her autism has made her incredibly shy and fearful of large events. However, she hasn't let this stop her from work as an environmental activist.

Maisie Hill author of Period Power, recently shared her diagnosis of autism on Instagram, stating:“As I researched, I realised that a lot of it rang true for me and I’ve spent the last year wondering if I’m autistic. Last week I received a formal diagnosis and it has allowed me to make so much sense of my life.”

Anne Hegerty is an English television quiz personality and most people will recognise her for her sharp wit as one of the "Chasers" on the ITV game show The Chase. She was also a contestant in the 2018 ITV reality show I'm a Celebrity...Get Me Out of Here.

Susan Boyle Scottish singer, who rose to fame after appearing as a contestant on the third series of Britain's Got Talent.

Charl Davies 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.

Greta Thunberg, the famous environmental activist, has been open about sharing that she has autism and selective mutism. Rather than seeing her autism as a disability, Greta says she considers it to be a "superpower".

Final Thoughts

As so much is unknown or speculative, many more large, long-term studies are needed to draw any firm conclusions about autism in women.However, we strongly believe it is helpful to open up these discussions surrounding broader issues such as how women are treated in healthcare and the knock-on effects this can have.

This conversation really highlights the fact that so many conditions and health issues are different between men and women, and shows us the potential impact society and our environment can have. While there have been many advances in the field of Autism Spectrum Disorder, adult women who think they may have autism still face challenges getting a diagnosis and finding treatment.