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Please note: In this post I use the term “female” to reference and respect the inclusion of individuals socialized or identifying as girls/women regardless of their assigned gender at birth.
Gender biases in autism diagnosis
Autism is a developmental disorder that is marked by two kinds of behaviors: deficits in communication and social skills, and restricted or repetitive behaviors. Children with autism also often have sensory processing issues. However, gender stereotypes may get in the way of recognizing patterns of behaviors that fit the diagnosis. For example, boys may focus on sports statistics or equipment. Meanwhile, girls might have excessive interest in horses or unicorns, which is more gender-conforming for them. An untrained eye may miss or fail to diagnose base on the level of interest.
An important subjective dimension may also be missing in the diagnostic process. This refers to the lived experiences of our clients that informs how they are to be treated. Professionals have realized that many “higher functioning” autistic girls are overlooked or diagnosed late because they don’t fit the stereotypes. More, their symptoms are misinterpreted as something else. In fact, according to a 2005 study at Stanford University, autistic girls exhibit less repetitive and restricted behavior than boys do. The study also found brain differences between autistic boys and girls can help explain this discrepancy.
Is it a hobby or is it a restricted interest?
These interests are qualitatively different from a hobby in several ways. First, restricted interests may be used to make sense of the social world more than hobbies. One can learn about real-life social interactions through repeatedly watching a specific TV show and studying the characters and how they behave with each other. In other words, restricted interests and hobbies can have a significant difference in purpose. There can also be significant difficulty disengaging or transitioning away from these preferred interests, compared to hobbies.
Sometimes coping skills get in the way.
Many autistic people, especially females, learn to cope with their neurology. This is another reason why diagnosis can be difficult. Autistic females appear to be more socially able and more socially motivated than autistic males. They tend to study and copy social interactions, learn how to fit in, and camouflage more typically autistic behaviors in many situations. Faking neurotypicality, however, can be very draining and lead to feelings of anxiousness and depression.
The role of “theory of mind” in diagnosis
The concept of “theory of mind” (i.e., understanding that others can have different perspectives than one’s own) and the role that it plays in diagnosis has evolved. Autistic children do have theory of mind as shown in newer research. However, they may not recognize that they need to use information they have about someone’s perspective. Or, the perspective-taking skill may develop later in life. Because autistic females are socially motivated, they tend to have very good perspective-taking skills. They may actually overcompensate, have a superior theory of mind, and develop intuition to protect themselves from repeated social rejection.
The potential for misdiagnoses
Autistic individuals can demonstrate periods of extreme moodiness. These are caused by the impact of the mental juggling and related academic and social difficulties. The “all or nothing” or “black and white” thinking, which is a characteristic of Autism, often plays out in the social relationships of females. They can range between intense interest and focus to social withdrawal.
Autistic women are often misdiagnosed with Bipolar Disorder or Borderline Personality Disorder, partly because of the intensity of the mood changes. The desire for routines and sameness can then be misdiagnosed as Obsessive Compulsive Disorder (OCD). In addition, autistic people may have significant difficulty with executive functioning and avoiding non-preferred topics or tasks. Children often get a preliminary diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) only. Several of these diagnoses can co-occur with an Autism diagnosis or they can be distinct conditions. Accurate identification can be the game-changer from feeling “defective” to viewing themselves as quirky and sensitive people.
Missed opportunities for intervention
Depression, anxiety, and loss of self-esteem are just a few of the heavy costs of a late or missed diagnosis. Early efforts at skill-building or behavior therapy is another loss, along with missed opportunities during peak periods of brain development. These are essential to get academic, functional, and social support in school.
Do these points resonate with you or someone in your life? Dr. Menon is experienced in the nuances of gender identity and autism across the lifespan and is ready to support you with a comprehensive evaluation and therapy. Schedule a free consultation call with her: https://mythrivecollective.com/contact/ or learn more about her: https://mythrivecollective.com/meet-dr-vinita-menon/
