Studies show that women with Autism Spectrum Disorder are diagnosed less frequently than men and thus less likely to get the help they need. They require more severe symptoms, greater behavioral problems, and more overall evidence of ASD than men, even though the diagnostic criteria for both sexes are the same.
Why is this? It’s possible there are actually two forms of Autism Spectrum Disorder, one specific to men, the other to women. As of yet, however, this hypothesis has not been confirmed. Women are also more motivated to engage socially and have a greater capacity for friendships, both of which are in conflict with the standard notion of ASD. They are less likely to have the typical kinds of behaviors associated with this condition such as hyperactivity, impulsivity, and reduced concern for others. And they more vulnerable to anxiety, depression and eating disorders, conditions that are not considered diagnostic features of Autism Spectrum Disorder.
Themes of Autism Spectrum Disorder in Women
Several themes are common among women who seek a professional evaluation for Autism Spectrum Disorder. Some are told they don’t have it even when the evidence suggests otherwise. Their concerns are minimized or dismissed because of an inherent reluctance among professionals to diagnosis women who have average social skills. Quiet, compliant behavior in women is seen as socially acceptable and thus not within the parameters of ASD.
Many women on the autistic spectrum grow up learning strategies to cope with being seen as “different,” one strategy being an attempt to mask their differences and instead appear normal. They learn to mimic what is successful in social situations, studying people’s behavior and adopting them as their own.
For some women, adopting social gender stereotypes of sociability, such as peer friendships, engagement in face-to-face relationships, passive behavior, sacrificing individual identity for group acceptance, is not desirable. Instead of following common social norms, they define themselves in ways consistent with their personal, individual interests.
The challenges of being a woman with Autism don’t necessarily come from their specific ASD features but from how those features play out in a society that has specific expectations for females. They experience a conflict between their desire to accept who they are as someone with Autism Spectrum Disorder and pressure to fulfil traditional gender roles. For example, some find their desire to live as a woman with ASD incompatible with expectations that they adopt the roles of wife, mother, caretaker, and/or girlfriend. The challenges they face are societal rather than those specific to Autism Spectrum Disorder. Some turn away from identifying with their assigned gender or from a binary gender identity, preferring instead to accept alternative identities more in line with who they see themselves to be.
The Challenges of a Diagnostic Evaluation
Autism Spectrum Disorder in women is more likely to be identified late, misdiagnosed, or not diagnosed at all. Those women who are especially invested in and skilled at masking their ASD are at greater risk of having their condition undetected, even by experienced, skilled professionals.
Women who tend to turn their challenges inward (anxiety, depression) rather than outward (hyperactivity, misbehavior, oppositionality) are also at risk for being misdiagnosed.
Many professionals have a bias, conscious or unconscious, that women can’t have Autism Spectrum Disorder. This is a significant source of diagnostic error. Some diagnosticians see ASD as not encompassing more subtle, female-typical presentations. The same is common among people who are not specialists in Autism but are nevertheless influential in directing women towards obtaining an ASD diagnosis and services.
The overall picture is one where women often do not receive accurate diagnoses and the corresponding help and services they deserve. More attention must be paid to ensuring that both accuracy and care are provided for those deserving of knowing whether or not they have Autism Spectrum Disorder.