Autistic traits in women

When boys and girls have similar autistic traits, males get diagnosed, but females often do not. Females tend to get diagnosed only when their autistic traits are significantly and visibly debilitating. Clinicians are missing many girls who are on the less disabling end of the autism spectrum, which was previously designated Asperger’s syndrome (and is still listed in the ICD-10).^[1]ICD-10-CM Code F84.5 | ICD.Codes

Lack of diagnosis

Current estimates of the male:female ratio of autism is 4:1, however, Simon Baron-Cohen suggests that once autism in females is diagnosed effectively, the numbers will change to 2:1.

The latest reports indicate 1 out of 59 children in the US has autism (1 out of 38 boys and 1 out of 152 girls),^[2]Data & Statistics on Autism Spectrum Disorder | CDC^[3]Autism prevalence slightly higher in CDC’s ADDM Network | CDC but the latter figure might thus be 1 out of 76 girls being autistic.

It should also be noted that the diagnostic criteria developed specifically around autistic males. It is only now that autistic females are starting to get noticed/diagnosed.

Alternate diagnoses

Besides being clinically overlooked as autistic, females tend to be diagnosed with other disorders.

• 23% of women who are diagnosed with eating disorders have autism symptoms^[4]Statistics: How many people have eating disorders? | ANRED—a percentage much higher than in the general public (1.68%).^[5]Data & Statistics on Autism Spectrum Disorder | CDC Their Autism is often overlooked, but eating disorders often stem from or are linked to autism symptomatology.
• Autism and ADHD tend to co-occur, resulting in many females who are easily distracted, and are consequently diagnosed with ADHD alone/instead.
• Due to one of the diagnostic triad being repetitive and restricted behaviour, OCD can look a lot like autism, and so some autistic females are diagnosed with OCD instead.
• On account of emotional dysregulation, some women with BPD are misdiagnosed as autistic, or vice versa.
• A significant number of autistic people get misdiagnosed with bipolar disorder, before arriving at their autism diagnosis.

Different neurology

The brains of autistic women are markedly different from non-autistic women.

• Behavioral and preliminary neuroimaging findings suggest autism manifests differently in girls. Notably, autistic females may be closer to typically developing males in their social abilities than typical girls or autistic boys.
• Autistic girls are indeed different from other girls in how their brain analyzes social information. But they are not like autistic boys. Each girl’s brain instead looks like that of a typical boy of the same age, with reduced activity in regions normally associated with socializing. Their social functioning is still reduced relative to typically developing girls, however.
• On a measure of friendship quality and empathy, autistic girls scored as high as typically developing boys the same age—but lower than typically developing girls.

Masking autism

Autistic women compensate more for their social deficits, though they struggle just like autistic men.

• Autistic girls without intellectual disability tend to camouflage or mask their autistic proclivities more effectively. This is believed to be due to greater social pressures for girls to camouflage.^[6]“Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions (Hull et al., 2017)
• Social life does not come naturally to many autistic females, but they use their high intelligence to mimic and become excellent actresses when necessary. This often results in identity crises, suicidal ideation, and exhaustion.
• Females study people the way other people study, say, math—learning the rules via observation, reading novels, and applying these rules to social situations.
• Autistic girls exhibit less repetitive behaviour than the boys do.
• Autistic females have socially acceptable obsessions such as research.
• The pastimes and preferences of female autistics are similar to those of other girls.
• Autism is often marked by an absence of pretend play, research finds that this is less true for girls.^[7]Autism—It’s Different in Girls | Scientific American

For more information on camouflaging/masking, have a look at the post below:

Autism & camouflaging

Empathy

A ground-breaking theory called the Intense World Theory suggests people with Asperger’s do not lack empathy—rather, they feel others’ emotions too intensely to cope.^[8]The Intense World Theory – a unifying theory of the neurobiology of autism (Markram & Markram, 2010)

Paul Bloom details a level 6 empath:^[9]Against Empathy | Boston Review

Hannah is a psychotherapist who has a natural gift for tuning into how others are feeling. As soon as you walk into her living room, she is already reading your face, your gait, your posture. The first thing she asks you is ‘How are you?’ but this is no perfunctory platitude. Her intonation—even before you have taken off your coat—suggests an invitation to confide, to disclose, to share. Even if you just answer with a short phrase, your tone of voice reveals to her your inner emotional state, and she quickly follows up your answer with ‘You sound a bit sad. What’s happened to upset you?’ Before you know it, you are opening up to this wonderful listener, who interjects only to offer sounds of comfort and concern, to mirror how you feel, occasionally offering soothing words to boost you and make you feel valued. Hannah is not doing this because it is her job to do so. She is like this with her clients, her friends, and even people she has only just met. Hannah’s friends feel cared for by her, and her friendships are built around sharing confidences and offering mutual support. She has an unstoppable drive to empathize.

But consider what it must be like to be her. Hannah’s concern for other people doesn’t derive from particular appreciation or respect for them; her concern is indiscriminate and applies to strangers as well as friends. She also does not endorse a guiding principle based on compassion and kindness. Rather, Hannah is compelled by hyperarousal—her drive is unstoppable. Her experience is the opposite of selfishness but just as extreme. A selfish person might go through life indifferent to the pleasure and pain of others—ninety-nine for him and one for everyone else—while in Hannah’s case, the feelings of others are always in her head—ninety-nine for everyone else and one for her.

Studies have found that when people are overwhelmed by empathetic feelings, they tend to pull back. When someone else’s pain affects you deeply, it can be hard to reach out rather than turning away. For autistic people, these empathetic feelings might be so intense that they withdraw in a way that appears cold or uncaring.

Sexual exploitation

Autistic women are also more vulnerable to sexual exploitation.

• The autistic tendency to be direct and take things literally can make affected girls and women easy prey for sexual exploitation. Furthermore, the desire to fit in makes them feel “the only way to have a relationship with a man is to enter into a relationship sexually”. But Professor Barry Carpenter said that safeguarding autistic girls could be challenging because a “black-and-white thinker” who was “desperate for friends” might believe that engaging in risky behaviour was better than the apparent alternative—being “excluded” and “isolated”.^[10]Your school has at least one girl on the autistic spectrum | Barry Carpenter Education
• The problem with sexual exploitation is “endemic” among women on the spectrum, particularly because so many are acutely aware of their social isolation. “When you feel you’re too difficult to love, you’ll love for crumbs.”^[11]Your school has at least one girl on the autistic spectrum | Barry Carpenter Education

Loneliness

• Autistic females who want to connect obsess about what they are missing, and are thus often tormented by their loneliness.
• 66% of autistic adults report being suicidal. The rate is 71% among autistic women.^[12]Autism—It’s Different in Girls | Scientific American

See also:

Why female autism is questioned