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24 Haziran 2024
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Women and Girls With Autism: How Autistic Traits May Differ

 

Autism spectrum disorder (ASD) is a developmental disability that is usually diagnosed at or before the age of 3. While people of any sex and gender can be autistic, it is common for people assigned female at birth to be diagnosed with ASD later in life. Many autistic women and nonbinary people are not diagnosed until they reach adulthood.1

According to the Centers for Disease Control and Prevention (CDC), the prevalence of ASD in the United States in 2020 was 3.8 higher for boys than girls—or about 4% of boys and 1% of girls aged 8 years old.2

Autistic women might be diagnosed later in life for a few reasons, including because the set of autistic traits listed by the American Psychiatric Association most accurately reflect the realities of autistic boys and men. Girls and women with ASD are also socialized to be better at masking, or hiding their autistic traits.

Sex and Gender

People assigned female at birth are not all girls/women. Women, nonbinary people, and trans men all face certain challenges in getting an autism diagnosis compared to cisgender men. 

While this article is focused on the challenges faced by women and girls, it should be noted that people who are nonbinary or gender non-conforming face similar challenges with autism diagnosis. 

This article will go over how autism might be different along gender lines, and what some of the challenges are in diagnosing autism in girls and women. 

Common Traits of Autism

People of all sexes, genders, races, ethnicities, and backgrounds can be autistic. Just like autism is a spectrum, autistic people are a varied group. The mix of traits that each autistic person displays, how they experience and interact with the world, as well as how much support they need, will vary.

There is also evidence that the traits of autism can look different in women than it does in men, which may partly explain why there is a gap in early diagnosis for autistic girls.3

The most common signs of autism include:

  • Social and communication differences
  • Repetitive behaviors
  • Highly specific interests
  • Sensory sensitivity to light, sound, or touch

The criteria for diagnosing autism have changed over time. In 2013, several categories of autism—including Asperger syndrome and pervasive developmental disorder not otherwise specified—were removed from the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition” (DSM-5).4

To make a formal diagnosis of autism according to the DSM-5, the traits must have been present before the age of 3—even if the diagnosis is not made until much later in a person’s life.

First-Person Language

Many people diagnosed with autism spectrum disorder prefer using identity-first language rather than person-first language. For example, they may prefer saying “an autistic person” rather than “a person who has autism.”5

Communication Differences

To be diagnosed with autism, a person will have differences concerning communication. There is some evidence that autistic girls and women might be better at “studying” their peers to learn about neurotypical socializing and can imitate these behaviors, or mask, to try to fit in.3

Some of the most common speech-related differences autistic people have include:

  • Repetitive use of language (e.g., repeating phrases from TV or the internet, using the same words in the same way over and over again, etc.)
  • Flat prosody (e.g., vocalization without tone changes)
  • Difficulty with picking up speech patterns and body language signifying humor, sarcasm, etc
  • Being non-verbal some or all of the time (e.g., communicating primarily with sign language or an augmentative and alternative communication (AAC) device)

Autistic Speech Patterns

In addition to differences with speech and body language, autistic people have challenges with social communication:

  • Inability to distinguish between platonic and romantic conversation
  • Difficulty discussing anything except a favored topic (e.g., will only talk about a favorite TV show)
  • Difficulty determining when it is or is not appropriate to speak, ask questions, or participate in a social group
  • Speaking quickly, loudly, and frequently in partnered or group settings

Communications Challenges for Autistic People

Behavioral Differences

Autistic behaviors are not always easy to spot, depending on their frequency and intensity. There is also evidence that autistic girls may have more socially acceptable behaviors or are better at hiding these behaviors than boys, which makes diagnosis harder.3

Common autistic behaviors can include:

  • StimmingMovements and sounds autistic people make to self-calm (e.g., rocking, humming, pacing, or repeating phrases). Some autistic people stim by touching certain textures or listening to certain sounds.
  • Meltdowns. These intense emotional and physical reactions generally occur when an autistic person gets overwhelmed and is feeling panicky or stressed.
  • Aggressive or self-harming behavior. Some, but not all, autistic people can display self-injuring behaviors, particularly during meltdowns. They may also do aggressive behaviors like hitting or throwing objects when they are overloaded.
  • Preference for solitude or lack of interest in others’ social overtures. Many autistic people are quite happy on their own and often need solitary time to recharge. Many autistic people who are interested in socializing still find it difficult to form and/or maintain social relationships with neurotypical people.

Sensory Differences

When the criteria for autism changed in 2013, the DSM-5 added a new set of traits to the list that considered sensory differences. The update included an autistic person’s increased sensitivity to or interest in sensory factors in their environment like pain, temperature, sounds, textures, light, and movement.6

Most autistic people have sensory sensitivities—though what they are and how severe they are will vary. Autistic people may find some sounds incredibly overstimulating—even painful. Other people seek out certain textures that they find soothing and enjoyable.

For example, an autistic person might:

  • Not be able to tolerate the feeling of their hair on their neck because it’s overstimulating or find repeatedly playing with their hair to be soothing
  • Be overloaded by the sound of a hair dryer or be calmed by the “white noise” it generates

Some autistic people also experience understimulation, a feeling of boredom, discomfort, and stagnancy that can grow until it becomes painful. Dancing, listening to loud music, watching an interesting video, or playing a game can all help with understimulation.

Autistic people may seek out sensory stimulation and comfort through food or drink. Some autistic people have a specific (and often short) list of foods that they are always comfortable eating. These foods are referred to as “safe foods.” Depending on how restrictive their eating requirements are, it can be difficult for autistic people to get all their necessary nutrients and calories.

Eating disorders such as avoidant-restrictive food intake disorder (ARFID) are conditions that often co-occur with being autistic. While ARFID is not about weight and body image, it can lead to weight loss. On the surface, it can easily look like more well-known eating disorders like anorexia or bulimia nervosa.

Sometimes, autistic girls and women are mistakenly diagnosed with anorexia nervosa (AN) because of their restrictive eating patterns. However, it’s also possible for autistic people to have eating disorders other than ARFID, including AN.7

Autism and Self-Care

Autistic people often have difficulty with motor skills and planning actions (executive function), which can make self-care tasks challenging.8

While it’s true that some autistic girls and women are not interested in nor understand the gendered social expectations attached to activities like putting on makeup and shaving body hair, other autistic people may want to partake but struggle because of the complex planning and motor skills needed to do them. Autistic people of all genders may also find it difficult to brush and shower daily. When you add sensory sensitivities to the mix, an autistic person may have a very hard time doing something as “simple” as washing their hair in the shower.

Autistic people who menstruate may also find managing their periods extremely difficult, since there are many changes involved that can be overstimulating (e.g., painful cramps, new smells, the sight of blood, the discomfort of wearing a pad, tampon, or cup), including having to change their routines (e.g., needing to change pads/tampons, having to avoid certain activities or certain safe foods).9

Sensory Overload in Autism

Understanding Autism in Women

Some researchers have asserted that autism is a manifestation of the “extreme male brain (EMB).”10 The foundation of the EMB autism theory is that lack of empathy is essential to being autistic and that testosterone impairs cognitive empathy, but both theories have been proven false. While there does seem to be a difference in the number of women and girls diagnosed as autistic compared to the number of males, the so-called “female protective effect” is still being explored by researchers.

Many autistic people are over-empathetic to people, animals, and non-living objects, especially autistic women and nonbinary people who are socialized as such. Autistic people often just do not express, feel, or display empathy in ways that allistic (non-autistic) people are used to recognizing. 

In recent years, it has become clear that autism is underdiagnosed in people who aren’t cisgender men.3 The possible reasons for the disparity include:

  • Children who identify as girls are more likely to internalize anxiety related to autism than children who identify as boys. Instead of behaving aggressively, they are more likely to become depressed or anti-social.
  • Many cultures make it acceptable for girls to be “shy” whereas shyness is less acceptable in boys.
  • When autistic girls focus exclusively on a particular interest, they are more likely than boys to choose a “socially acceptable” fascination such as unicorns or dolls.

Researchers are still trying to understand how autism is different for girls and women. However, the lack of gender diversity in diagnosed autistic people is a hindrance for scientists, as is the widespread delegitimization of thoughtful self-diagnosis.

Autistic women, nonbinary people, and all people of color are less likely to have professional diagnoses due to discrimination, being underinsured, or not possessing the hundreds to thousands of dollars a professional diagnosis costs. Until things change, there will continue to be a lack of gender diversity in studies on, and knowledge about, autistic people. 

Masking/Camouflaging

Some research has suggested that autistic girls might be more likely than boys to intentionally or unintentionally hide or cover up their traits. This is called camouflaging or, more commonly, masking.3

For example, autistic girls might be better at:

  • Mimicking their peers’ facial expressions, vocal tones, and other behaviors, which can make it harder for providers and caregivers to spot the signs of autism
  • Using resources like TV, social media, and their observations of others to learn about social rules and practice them
  • Forcing themselves to make eye contact and suppress autistic behaviors such as hand-flapping

While girls on the spectrum might be better than boys at masking, doing so takes considerable effort to maintain, and autistic girls often have trouble forming and maintaining peer relationships with allistic (non-autistic) people. Finding community with other autistic and neurodivergent people can be a homecoming experience for many people.

It is very important that everyone, especially marginalized people, have people around them who they can relate with and who understand them. Many adults coming into their autistic identity are discovering such community online and in person.

Long term masking is dangerous as it will always lead to autistic burnout. Autistic burnout is an intense, chronic experience of physical, mental, and emotional exhaustion that is often accompanied by a loss of skills and a lower tolerance to sensory stimuli. Autistic women and nonbinary people are most at risk for burnout as well as the co-occurring depression, anxiety, and suicidal ideation.

Suicide Prevention Hotline

If you or someone you know are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. For more mental health resources, see our National Helpline Database.

Co-occuring Conditions

Co-occuring conditions are diagnoses that are commonly given in addition to a main diagnosis. Research suggests that co-occurring conditions are more common with autistic girls than boys.11 Co-occurring conditions are also more likely when a person is diagnosed with autism at a later age, as they most likely have not received the care, understanding, and support they’ve needed their whole lives.

Some common co-occurring conditions in autistic girls and women include:

  • Depression
  • Attention deficit hyperactivity disorder (ADHD)
  • Anxiety
  • Anorexia nervosa, ARFID and other eating disorders
  • Obsessive-compulsive disorder (OCD)
  • Tic disorders
  • Sleep disorders

Causes

There is no proven cause of autism, though being autistic tends to run in families. Thankfully, it is not necessary to discover why people are autistic. As autistic self-advocacy has become more prominent, autistic advocates have begun pushing back against the idea that autism is a disease or syndrome that needs a cure or research done concerning its origin.

Autistic advocates point to the ongoing field of eugenics that shows that when marginalized traits have their causes known, they are systematically eradicated via infanticide or genetic selection. We see this phenomenon happening today with the population of people with Down Syndrome being nearly zero due to medical intervention in multiple European countries.12

Finding the origin of autism will not better the lives of autistic people and actually endangers them. The search for the “cause” of autism is inextricably linked to the search for a cure, and both manifest in deadly ways for autistic people, as seen with the many parents who have fed their autistic children bleach in order to cure them.13

It is more important for loved ones of autistic people to seek to learn about autistic people and to learn from autistic adults, advocates, and communities about what is best for them.

For people wanting to support autistic populations at large, housing instability and homelessness, economic insecurity, and lack of access to medical, dental, and mental health care are some of the prevailing issues autistic people face that need more focus. Research and funding needs to be directed at these disparities as well as organizations and systems aiming to rectify them.

Diagnosis

There is no single medical test for autism spectrum disorder. The diagnosis is based on observations and specific screening tools.1

A child’s caregivers will usually fill out a variety of questionnaires about their child’s infancy and toddlerhood and respond to questions about their child’s development, behavior, and skills. Healthcare professionals may ask this of adults seeking diagnoses as well. Providers can also use hands-on and observational tools to see if a person meets the criteria for autism and whether they have any co-occurring conditions.

According to the Centers for Disease Control and Prevention (CDC), about 1 in 54 American children are autistic—and only about 1 in 4 autistic children are girls.14 While the 1-to-4 ratio is considered accurate, researchers have found that the ratio might actually be closer to 1-to-3.15

The difference comes in part from the “gold standard” diagnostic tools that primarily reflect the autistic experiences of men and boys. Autistic adults are often diagnosed by psychologists and psychiatrists with strong expertise in autism. 

Self-Diagnosis

Getting professionally diagnosed with autism as an adult can be a time-consuming and costly process. For marginalized communities, including women, self-diagnosis is the only option when placed against the cost of a professional diagnosis. Due to growing awareness of this disparity, self-diagnosis is becoming more accepted within the autistic community. 

Autism Diagnosis in Children

Support and Treatment

There is no cure for autism but there are therapies and resources available to help autistic people.11 While some them need to be prescribed by a provider, others are behavioral and/or developmental and can be provided by a therapist, caregiver, or even something an autistic person can undertake on their own. 

There is no “best” treatment for autism. Some possible treatments for autism include:16

Applied Behavioral Analysis (ABA) is endorsed by scientific organizations as the premier therapy for autistic people, but autistic people and self-advocates say otherwise. Opposition to ABA is grounded in the fact that the therapy aims to make autistic people behave like allistic people, and in that autistic people who undergo ABA develop post-traumatic stress symptoms correlating with the treatment.

People who are diagnosed with autism as adults often have low support needs (what used to be called “high functioning”) but that does not mean they would not benefit from having support. These people are also likely to have been masking for years or decades and might need more support when they stop masking or reach burnout.

Autistic adults often seek support on their own, like talk therapy. Some people find social skills coaching, sensory integration therapy, and support groups with other autistic adults helpful. 

Summary

Autism in women and girls is underdiagnosed and/or diagnosed at a later age. There are some possible reasons for the disparity. 

The basis for diagnosing autism is often skewed toward behaviors that are more common in boys. Some evidence suggests that girls might be better at masking, hiding autistic behaviors, or are more likely to have “socially acceptable” special interests.

It’s not uncommon for women to only find out they are autistic as adults; however, the process of getting a formal diagnosis as an adult can be timely and costly. Autistic women are also more likely to have other mental health conditions including anxiety, an eating disorder, and obsessive-compulsive disorder.

Getting support can make a positive difference at any age for autistic people, though earlier intervention is ideal.

çeviri reyyan sabır

https://www.verywellhealth.com/autism-in-women-5209272

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