Are autistic females rare?

The research is pointing to the fact that autistic females are not rare. What was thought to be a 4:1 male to female prevalence of autism is now predicted to be more likely 2:1 (male to female).

Autism overlooked

Speaking as an autistic female, I can tell you that I didn’t get diagnosed until my mid-40s despite seeing therapists since I was 5 years old. The reason for the therapy visits was that I had suffered significant developmental trauma (abuse) and as a result had anxiety, depression, and repetitive behaviours. It was only when my autistic symptoms manifested more dramatically in my 40s after a significantly traumatic experience that I was diagnosed correctly.

I started spending most of my time alone, withdrew from family and friends, and was quite happy in my own little world, but the change was so drastic that a number of people became very concerned. My reaction to the trauma was unusual; I did not seem concerned with it, but inside what had happened was the world had become an unsafe place for me, although I did not know this. What I felt was that I just did not want to pretend anymore. I did not want to pretend that I liked social situations or talking on the phone or any number of things that I had hidden for many years. I just wanted to be left alone and do my research. If you met me you would not know that I was autistic—after all, no doctor or therapist or psychiatrist did until I showed my symptoms.

Camouflaging

The reason why my autism alluded me and others is that I learned to mimic, as I wanted to be liked and accepted. So I got REALLY good at mimicking. When I was told by a person that I stared too much into their eyes, I practiced changing the behaviour. When my parents got called into school when I was 7 years old because a teacher was concerned that I was colouring everything—the Sun, the grass, people—magenta, it was assumed that the trauma was at the root of it. Also, my obsessions were socially revered; I liked to do lots of reading and research. My focus was joked about; my family said that when I had a baby I would bring the groceries home and leave the baby, but I often left the groceries as my son was my focus. Behaviour after behaviour I modified until I became socially adept.

I love being an autistic female. We are known to be deeply compassionate, caring, and kind individuals. We are known to be intelligent and have lateral thinking brains. We think of things that other people don’t consider. We can lie, but prefer not to lie.

The downside

The downside is that the statistics show a propensity to suicide and depression; 71% of autistic females struggle with suicidal ideation. I have had to learn to live with the fact that these thoughts come into my head, and that they are a symptom of my autism; not (objective) reality.

Here is a part of a diary edition that I wrote shortly prior to my diagnosis:

It is never pleasant when the depression creeps in like a cold fog and surrounds my heart. And my heart begins to hurt. It feels as though I shall collapse inward—into myself, which is different than when my heart hurts with joy. There the ache like a bright sun pushes away the fog. Mostly this happens when I step through the ‘wardrobe’ into my own land. Freedom. It is only here that I can breathe. And who is to say what my reality needs to be? On this Earth people are unpredictable and I feel like a small scared squirrel. Nervous. Here on Earth I feel mostly unloved and I feel unliked by so many—always having to hide who I am.

Also, I have a tendency to give people more information about myself than intended, and so I have to use a rule of thumb in my head to remember to not keep talking. Get me onto a subject I am passionate about and in the past, you had better have prepared for a long one-sided conversation. Now I know that after one minute of conversation, I need to let the other person talk.

Sex differences

Autistic males are found to show more externalizing behavior problems than females, such as aggressive behavior, hyperactivity, reduced prosocial behavior, and increased repetitive/restricted behaviors and interests and thus are more easily identified and diagnosed

Autistic females show greater internalizing symptoms than boys, including anxiety, depression, and other emotional symptoms as reported by parents. Parents also more frequently endorse the item “avoids demands”. Autistic females tend to only get diagnosed if they have a low IQ and/or significant support needs.

The observed sex differences raise the possibility that male-typical externalizing behaviors are more disruptive in the home or school setting than female-typical internalizing behaviors—preferentially prompting evaluation and diagnosis for boys, especially as compared to girls with higher IQs and adaptive skills. For girls then, low IQ may be more likely the secondary issue prompting evaluation and diagnosis.

This scenario further implies that some proportion of the sex difference in autism prevalence is attributable to biases inherent in the diagnostic process. Girls without diagnoses showed increased communication difficulties, but reduced social impairments as compared to non-diagnosed boys. Thus, it may be that relatively higher levels of social ability in females preclude them from getting an autism diagnosis.

Here is an excellent video on autism in females: