What Is the Female Autism Phenotype?

Why do so many autistic girls and women fall through the diagnostic cracks?

Many autistic girls and women are not being properly diagnosed — some do not receive an autism diagnosis until their 30s, 40s, 50s, or even older.

Born with autism, a genetic neurodevelopmental condition associated with various social, neurological, and sensory difficulties, these girls and women are able to hide the signs and characteristics of autism from themselves and others, even evading the concern of the most highly-trained healthcare professionals.

More commonly and devastatingly, they are misdiagnosed with conditions like borderline personality disorder, obsessive-compulsive disorder, social anxiety, bipolar disorder, and so on.

These conditions — including eating disorders like anorexia — can be highly comorbid (often appearing alongside autism), but without that key autism diagnosis, a girl or woman’s understanding of herself will be limited — sometimes with devastating consequences. She will unlikely get the support and help that she needs.

But why are so many autistic girls and women never diagnosed or not diagnosed until late in life?

Females or afabs (assigned female at birth) that do get diagnosed as autistic at a young age often present with more male-like or “classical” autistic characteristics. Some might say that they present with more “obvious” or expected autistic traits. While those who get diagnosed early in life are NOT more autistic, their characteristics do tend to be more in line with stereotypical ideas of autism, on which the DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria are based.

The earliest autism research focused on men and boys, and autism research today continues to be focused on men and boys. For this reason, several experts have concluded that the current autism diagnostic criteria and assessment tools require significant changes and revisions to ensure reliable autism diagnosis in all genders.

Something indeed needs to be done so that the healthcare system — and society in general — stops failing autistic females.

Another reason that some autistic females or afabs were diagnosed early is that they received an autism assessment by a therapist, psychologist, or other healthcare professional who was knowledgeable about the variety of ways that autism presents differently in females.

Key ways that autism presents differently in females (aka the female autism phenotype):

  1. Autistic girls and women are very good at camouflaging or masking their autistic traits and difficulties in order to fit in, make friends, and be considered acceptable to others. Unless they know about their autism, they are likely to camouflage or mask unconsciously or assume that everyone does the same.
  2. Autistic girls and women are typically more socially-inclined and socially-capable than autistic boys and men. While they typically have fewer (yet often more intense) friendships than non-autistic females and spend more time alone to rest and recharge, they are less likely to be seen as different or abnormal by those around them.
  3. The behavioural or emotional problems of undiagnosed autistic girls are often blamed on shyness, being “highly sensitive,” early trauma, family problems, or other issues. The mental or emotional problems of undiagnosed autistic female teens and women are often diagnosed as post-traumatic stress disorder, obsessive-compulsive disorder, social anxiety, depression, bipolar disorder, or borderline personality disorder.
  4. The emotional highs and lows and intense emotional lives of many autistic individuals can lead several healthcare professionals to assume that they are dealing with a personality disorder (borderline personality disorder is one of the top misdiagnoses received by autistic women). This is likely due to the fact that the training received by healthcare professionals is lacking in updated and comprehensive content on autism.
  5. Autistic girls and women tend to have fewer repetitive behaviours like hand-flapping or rocking back and forth, or they are more likely to be very self-conscious and hide these behaviours in public. Additionally, several autistic females have repetitive behaviours that are considered girly or “cute”, like hair twirling or even humming.
  6. The special interests of autistic girls and women tend to be more varied and “socially acceptable” than those of their male or amab (assigned male at birth) counterparts. Autistic females are more likely to have special interests involving fine art, literature, pop culture, makeup, and so on. These types of interests are often not seen as abnormal by others, yet the depth of knowledge about their favoured topics will be greater than is typical. Additionally, the special interests of autistic women, girls, and afabs are more likely to change or cycle over time, while the special interests of men, boys, and amabs are more likely to stay the same or have less variation over time.

“Some people with autism try to hide aspects of their autism or develop ways to cope with it. This is known as camouflaging. Camouflaging involves finding ways around things that an autistic person finds difficult, hiding aspects of their autism, and trying to fit in with others. Overall, camouflaging might help some people to make friends, but it can be very exhausting and might even cause people harm.” –Laura Hull & Will Mandy, “Camouflaging in autism

Please share this article with someone who could benefit from knowing more about the female autism phenotype. And leave a comment if you have a question or would like to see additional coverage about a particular topic — related to autism, psychology, or health and wellness. I’d love to hear from you.

North Dakota-born science writer in British Columbia. Research communications specialist. Founder of The Other Autism: https://other-autism.com/

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