Autism in Women

Autism is a neurotype that can present in many different ways depending on the individual person. Often, autism is seen to create differences in communication, behavior, and social interactions. Historically, it has been viewed through a male-centric lens, leading to a significant gender bias in diagnosis and understanding. In fact, it has only been in relatively recent years that professionals have realized that autistic females exist! Recent research highlights that autism can present differently in women, those assigned female at birth (AFAB), and genderqueer individuals, often leading to late or missed diagnoses. It is important to note that there are autistic AFAB people who do present in a more “traditional” manner, but, due to the aforementioned gender bias, they might still experience missed or late diagnoses. This article discusses some of the different ways autism can present in these groups, emphasizing the roles of masking, late diagnosis, and common distinctive traits such as hyperlexia, hyper-verbal abilities, high empathy, and sensitivity.
 

The Masking Phenomenon

One of the most significant reasons autistic women are often underdiagnosed is due to the phenomenon of masking. Masking refers to the conscious or unconscious suppression of autistic traits to fit in with societal norms. Women and AFAB individuals can be particularly adept at this, often mimicking the social behaviors of their neurotypical peers. People who mask sometimes don’t even realize that they’re masking; it’s something that subconsciously develops over the course of their lives by observing people’s reactions to others’ or their own behaviors. Additionally, for those who have been masking for long periods of time, it can be difficult to learn how to unmask or display their autistic traits. 
 

The Costs of Masking

While masking can help individuals navigate social situations, it can come at a considerable cost. The constant effort to appear neurotypical can lead to severe mental health issues, including anxiety, depression, and burnout. Many women report feeling exhausted by the need to constantly monitor and adjust their behavior, leading to a sense of alienation and identity loss. This is yet another reason why women can be misdiagnosed. They may be experiencing mental health issues, sometimes even as severe as suicidal ideation and attempts, self harm, and eating disorders, but mental health professionals may not realize that the underlying reason for these symptoms is due to masking autistic traits. Because it may be difficult for the person to unmask, their autism may go undetected for many years.
 

Late Diagnosis

Due to the subtlety of some autistic traits and the ability to mask them, many autistic women are diagnosed much later in life than their male counterparts. Additionally, it can be challenging to find providers that are well-versed in diagnosing autism in women, as there are many professionals who are not up-to-date on autism across different genders. Because it causes autistic women to go many years of their lives not knowing that they are autistic, late diagnosis can have profound implications for their mental health and well-being. 
 

Misdiagnosis and Co-occurring Conditions

Autistic women are often misdiagnosed with other conditions such as borderline personality disorder, obsessive-compulsive disorder, panic disorder, or generalized anxiety disorder. These misdiagnoses can lead to inappropriate treatments and a lack of support for the correct diagnosis of autism. For example, some autistic women are put on pharmaceutical medications that are not accurate or helpful for them, which can cause side effects, further mental health issues, and health complications. Moreover, many autistic women are also ADHDers, which is another diagnosis that is frequently missed in women and can further complicate the diagnostic process. Women who are both autistic and ADHD, frequently referred to as AuDHD, are often even more likely to fly under the radar of professionals due to the somewhat conflicting traits that autism and ADHD create. 
 

Common Presentations in Women

Autistic women and AFAB individuals frequently have different presentations and traits than the “stereotypical” presentation of autism, which can obscure recognition and diagnosis. Understanding these common traits in autistic women and AFAB people is crucial for identification and support.
 

Hyperlexia and Hyper-Verbal Abilities

Hyperlexia, the ability to read at an advanced level beyond one’s age, is a common but often overlooked trait in autistic women. These individuals may have an extensive vocabulary and a love for reading and language from an early age. However, despite their advanced reading skills, they may struggle with comprehension and using language in social contexts. They might decode written words with great skill but find it challenging to grasp the nuances and implied meanings in texts. This discrepancy can lead to frustration and a sense of inadequacy, especially in academic settings where reading comprehension is essential.

Similarly, hyper-verbal abilities, characterized by a penchant for talking extensively about specific interests, are often seen in autistic women. They may come across as articulate and knowledgeable but can struggle with the give-and-take of typical conversations, leading to misunderstandings. These individuals might dominate conversations, not out of self-centeredness but due to an intense focus on their topics of interest. This can sometimes alienate peers who may not share the same level of enthusiasm, making social interactions challenging. Additionally, some autistic women can use rich and complex vocabulary, which can be perceived as showing off or being overly formal, further complicating social dynamics.
 

High Levels of Empathy

Contrary to the stereotype that autistic individuals lack empathy, many autistic women report experiencing overwhelming empathy. This can manifest as heightened sensitivity to the emotions of others, often to the point of personal distress. This intense empathy can make social interactions exhausting and may contribute to the need for masking. Autistic women might absorb the emotional states of those around them, leading to heightened anxiety and emotional exhaustion. They often find themselves deeply affected by the suffering of others, whether in real life or through media, which can lead to a tendency to avoid situations where negative emotions are prevalent.

Their empathy also drives a strong sense of justice and a desire to help, which can be both a strength and a source of stress. They might go to great lengths to support friends and family, sometimes at the expense of their own well-being. This intense empathy can also make it difficult to set boundaries, leading to situations where they feel overwhelmed or taken advantage of.
 

Emotional Sensitivity

Emotional sensitivity is another common trait in autistic women, AFAB, and genderqueer individuals. This sensitivity can make them more attuned to their own emotions as well as the emotions of those around them. Autistic women often experience emotions more intensely than their neurotypical peers, making it difficult to regulate these feelings. This heightened emotional sensitivity can be both a gift and a challenge, contributing to deep connections with others but also leading to emotional overwhelm.
 

Intensity of Emotions

Autistic women frequently report feeling emotions more intensely than their neurotypical counterparts. Joy, sorrow, anger, and excitement can all be experienced with greater depth and urgency. This intensity can be a double-edged sword: while it can enhance experiences and relationships, it can also make emotional regulation more difficult. Autistic women who experience intense emotions may find themselves quickly overwhelmed, leading to frequent meltdowns or shutdowns when they are unable to cope.
 

Empathetic Overload

Autistic women may also experience empathetic overload, where the intense emotions of others can become overwhelming. They might absorb and mirror the feelings of those around them, leading to heightened anxiety and stress. This can be particularly challenging in emotionally charged environments, such as during conflicts or in situations where someone is in distress. The need to manage both their own emotions and the emotions of others can be exhausting and may contribute to social withdrawal.
 

Need for Emotional Boundaries

Due to their heightened emotional sensitivity, autistic women may need to establish strong emotional boundaries to protect themselves from becoming overwhelmed. This can include setting limits on social interactions, avoiding emotionally intense situations, and practicing self-care to manage stress. However, setting these boundaries can be challenging, as the desire to help and support others often conflicts with the need for self-preservation.
 

Autism in Genderqueer Individuals

The experiences of autistic AFAB, trans, or otherwise genderqueer individuals add another layer of complexity to the discussion. Gender identity can intersect with autistic traits in unique ways, influencing how these individuals perceive and express their autistic traits.
 

Gender Dysphoria and Autism

There is a noted overlap between autism and gender dysphoria, with many genderqueer individuals reporting experiences of both. The rigidity in thinking and the strong sense of identity that are often associated with autism can lead to an early recognition of gender incongruence. However, the co-occurrence of autism and gender dysphoria can complicate both diagnoses, as professionals may not always recognize the interplay between the two.
 

Unique Challenges

Autistic genderqueer individuals face unique challenges, including increased rates of discrimination and misunderstanding from both the neurotypical and LGBTQ+ communities. These individuals may struggle with finding spaces where they feel accepted and understood, leading to increased isolation and mental health challenges. More neuro-affirming and LGBTQ-affirming resources are needed to support those who hold intersectional identities.
 

Recognizing the Signs

Understanding the signs of autism in women, AFAB, and genderqueer individuals is essential for promoting earlier diagnosis and better support. Here are some key signs to look for:
 

Social Communication Differences

• Difficulty understanding social cues and norms

• Preference for one-on-one interactions or small groups over large social gatherings

• Challenges in initiating and maintaining conversations

• Literal interpretation of language and difficulty understanding sarcasm or jokes
   

Repetitive Behaviors and Special Interests

• Deep, intense interests in specific topics, which can sometimes seem unusual for their age

• Repetitive behaviors or rituals, such as needing to follow a specific routine

• Preference for familiar environments and aversion to change
   

Sensory Sensitivities

• Overwhelming reactions to sensory stimuli, such as loud noises, bright lights, or strong smells

• Preference for certain textures and aversion to others

• Need for sensory accommodations, such as noise-canceling headphones or weighted blankets
   

Emotional and Behavioral Differences

• High levels of empathy, often leading to personal distress when others are upset

• Sensitivity to criticism and perceived rejection

• Difficulty regulating emotions, leading to frequent meltdowns or shutdowns
   

Masking Behaviors

• Mimicking the social behaviors of others to fit in

• Developing scripts for social interactions

• Exhaustion and burnout from the effort of masking
   

The Importance of Recognition and Support

Recognition and support are crucial for autistic women, AFAB, and genderqueer individuals. Understanding the oftentimes unique presentations of autism in these groups can lead to more accurate diagnoses and better-tailored accommodations and supports.
 

Educational and Occupational Support

Providing appropriate educational and occupational support is essential for helping autistic individuals thrive. This may include:
 

• Tailored learning strategies that accommodate sensory sensitivities and social communication differences

• Support for transitioning from school to work, including job coaching and workplace accommodations

• Promoting understanding and acceptance in educational and professional environments
   

Mental Health Support

Addressing the mental health needs of autistic women, AFAB, and genderqueer individuals is also vital. This can involve:
 

• Providing access to therapy that recognizes and accommodates autistic traits in a neuroaffirming way

• Offering support groups where autistic individuals can connect with others who share similar experiences

• Educating mental health professionals about the challenges and experiences of these groups utilizing neurodiversity affirming perspectives
   

Community and Peer Support

Building a supportive community is crucial for the well-being of all autistic individuals, but can be especially difficult to find for autistic women. This can include:
 

• Creating safe spaces where autistic women can connect and share experiences

• Promoting acceptance and understanding within the broader community

• Encouraging peer support networks that provide emotional and practical support
   

Conclusion

Autism in women, AFAB, and genderqueer individuals is often misunderstood and underdiagnosed due to differences in presentation and the phenomenon of masking. Recognizing the signs and challenges faced by these groups is essential for promoting earlier diagnosis and better support. By promoting understanding and acceptance, autistic women can create healthier and happier lives for themselves. Understanding the commonly misunderstood ways autism manifests in different genders and supporting those autistic people is not just a clinical necessity but a social imperative. With better recognition and tailored support, autistic women, AFAB, and genderqueer individuals can lead fulfilling lives with a lessened burden of masking.