Autism has historically been conceptualised as primarily affecting boys and men and continues to be most frequently diagnosed in male than female individuals. Some researchers suggest that this may not be due to a true difference in prevalence, but rather due to underdiagnosis of autistic girls and women. For those autistic girls and women who are diagnosed, on average they receive their diagnoses later in life than their male peers which has implications for their quality of life.
Timely diagnosis is important because it facilitates access to therapy and support services, as well as educational and/or workplace accommodations, all of which may improve the person’s functioning, coping skills, and mental health. Additionally, diagnosis may help autistic people to better understand themselves. An autism diagnosis might explain why they feel different to other people around them and/or why they have struggled in certain areas of life. In my experience as a clinician, it can be beneficial for self-esteem and mental health to reframe these struggles as not reflecting a lack of effort, but instead resulting from a brain which is wired differently. In keeping with this, autistic adolescents who are diagnosed earlier in life experience lower levels of depression and self-harm behaviours than those diagnosed later in life, perhaps due to better understanding of self. So why are girls and women being diagnosed late, or not diagnosed at all?
One possible reason for missed or late autism diagnosis of females is that the way we have historically conceptualised autism may be biased towards its typical male presentation. For example, autistic people are often stereotyped as not desiring friendships or social contact, preferring to keep to themselves. While male autistics are more likely to meet this expectation, many females with autism desire and enjoy social contact and friendships. Some autistic girls and women may have just as many friendships as their neurotypical peers. However, their social communication difficulties can impede their ability to maintain these friendships over time, and they may struggle with conflict resolution within them.
Additionally, while both male and females on the autism spectrum often have a very strong interest in a specific topic (often referred to as a special interest), the special interests of females with autism may tend to be deemed more socially acceptable and therefore draw less concern from family and teachers. For example, autistic boys may more often have strong interests in trains, maps or pipelines, while autistic girls may more often have strong interests in animals, celebrities or music.
Furthermore, despite stereotypes that suggest autistic people lack imagination and creativity, many autistic females are highly imaginative. As children, they often have elaborate make-believe worlds. Many are drawn to creative hobbies and careers, such as visual art, music or creative writing.
Another factor which may contribute to underdiagnosis is that evidence suggests girls and women have a greater propensity for camouflaging or “masking” their autistic traits than their male peers. Of those who are diagnosed with autism, there are fewer female than male patients of above average intelligence. Some authors have interpreted this to mean that autistic females are more likely to have an intellectual disability, however, an alternative explanation is that girls and women without intellectual disability may be more skilled at camouflaging and therefore be going undiagnosed.
While camouflaging behaviours can be helpful in that they may allow the individual to better fit in socially, they also have a cost. Though it may look the same as neurotypical behaviour on the outside, camouflaging is hard work. A helpful analogy is that when a neurotypic...
