8 Signs Of Autism Spectrum Disorder In Women That Are Often Missed
Autism spectrum disorder (ASD) is frequently misunderstood, and that's especially true in the case of women. The stereotypical person many people think of on the autism spectrum may be a Rain Man character who is male, anti-social, and gifted with numbers, but the population is actually very diverse. Many women with autism go their whole lives believing something is wrong with them because people have misunderstood their traits.
While autism has traditionally been pathologized (and continues to be in misguided warnings about vaccines causing autism), many people on the autism spectrum consider it a positive or neutral personality trait. However, much stigma around autism remains, which may be particularly intense for women, since their traits can conflict with society's "ideal" feminine behavior.
In addition, autism is less likely to be identified in women because they don't always match the stereotype and often work hard to conceal their traits. "'She can’t have ASD because she makes eye contact, she has a friend, she is caring'… there are many gender stereotypes that lead women with ASD to not be diagnosed or misdiagnosed," Tasha Oswald, Ph.D., licensed psychologist and founder and director of Open Doors Therapy, tells Bustle.
"Girls often present with milder forms of social troubles than their male peers, due to teachers’ biases and assessments that the girls are more socially adept than boys," Christine Scott-Hudson, MA MFT ATR, licensed psychotherapist and owner of Create Your Life Studio, tells Bustle. "Girls in general are also socialized not to disappoint or offend their teachers or peers, and so girls on the autism spectrum may intentionally keep behaviors, responses, and feelings to themselves in order to remain pleasing."
Here are some signs of autism that may be particularly applicable to women, but can be missed, according to experts.
Note: The signs below refer to just one form of autism — what was previously called "Asperger syndrome, or Asperger’s". Transition to adulthood specialist Cady Stanton, M.S. says that even though the term "Asperger's" no longer exists, it's a term many people are familiar with. According to Autism Speaks, it now falls under the umbrella term Autism Spectrum Disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), as of 2013. Typical to strong verbal language skills and intellectual ability differentiate it from other forms of autism.
1. Difficulty With Social Situations
"Just like males with ASD, women with ASD struggle socially, but like a double-edged sword, that struggle is both worsened and helped by the higher societal expectations placed on women to be socially aware and adhere to etiquette," says Oswald. In other words, it's not that women have different social symptoms than men; they just may be more likely to mask them.
"Difficulty catching on to others’ intentions, reading social cues, and understanding the unwritten rules of our society are core social challenges present in those with ASD," Oswald says.
2. Being a Target of Bullies
Many girls are the target of bullies in school, but this may be particularly harsh for those on the autism spectrum.
"Middle school is a pivotal time for girls with ASD because they struggle to 'keep up' socially," Oswald explains. "Relational bullying among girls peaks during this time, social interactions become more sophisticated, and demands increase for understanding non-literal language (sarcasm, backhanded complements, etc.). Girls with ASD become the target of harsh relational bullying and social rejection."
3. Being Diagnosed With Anxiety Or Depression
Many challenges experienced by women with ASD, such as being the target of bullies, can lead to anxiety and depression. Sometimes, professionals will make this diagnosis but miss the underlying cause.
"It is more culturally acceptable and statistically more common for females to be diagnosed with depression and anxiety than males," says Oswald. "Consequently, the underlying autism spectrum characteristics get overlooked in females."
4. Deliberately Controlling Your Facial Expression Or Body Language
People on the autism spectrum are sometimes described as having an expressionless face, neutral tone of voice, or flat affect because they don't have the same automatic social behavior others do. Therefore, those with autism, particularly women, may deliberately perform certain actions, like smiling and nodding, in order to fit in.
"Women with ASD, compared to their male counterparts, seem to land on better compensatory strategies for veiling their autism traits, such as nodding and smiling when they don’t understand the nuances of a social interaction," says Oswald. "Maybe they develop better compensatory strategies because women are held to a higher standard to be socially aware, and so are given more implicit and explicit social training."
5. Acting Submissive In Social Situations
This is a behavior that women in general are socialized to exhibit, but for those who have trouble figuring out how to behave in social situations, it may actually serve a dual purpose as a compensatory strategy.
"Being shy and averting your eye gaze when someone speaks to you is more acceptable for females than males in our society," says Oswald. "At the end of the day, it’s OK to be shy and polite because you’re a girl, and so the potential autism traits get missed."
6. Choosing School Or Work Over Socializing
Because people with autism often find social situations difficult or stressful, they may come up with excuses to avoid them, like work or studying.
"They may be extra rigid in their scheduling," says Scott-Hudson. "In college dormitories, they often choose to stay in their rooms to avoid having to go to parties or other group activities and may choose to stay into study as a way to avoid social outings. Boys can do it, too, but girls tend to camouflage more of their social avoidance by saying 'Aw, I'd love to go to the party, but I have to study!'"
7. Getting Exhausted By Social Situations
Many people, particularly introverts, find social situations tiring, but women on the autism spectrum may particularly feel this way, since they work so hard to fit in.
"Girls on the autism spectrum often report feeling fatigued by social interactions because they spend a great deal of energy mimicking others to get by and camouflaging their real desires, such as wanting to play video games in their room by themselves, or watching favorite movies alone on repeat," says Scott-Hudson. "Girls on the spectrum internalize their social difficulties, and the camouflaging leaves them exhausted, reporting higher rates of anxiety and depression."
8. It's Hard For You Not To Have A Clear Role
"Many of the women I meet who were diagnosed later in life report that they have had trouble in social settings where they didn’t have a clearly defined role," Stanton says. "As kids, they may have cried and gone home early during sleepovers. As adults, they create a role for themselves during social gatherings, perhaps helping in the kitchen or cleaning up."
"Autism characteristics can be a great source of strengths and talents, such as intense focus or music ability, but can also lead to a great deal of suffering," says Oswald. "Better understanding your own autistic traits can help increase self-compassion for your suffering and the many ways in which you have been misunderstood, as well as help you make sense of your life, enhance self-awareness, and become a more fully integrated and confident woman."
Correction: A previous version of this story mischaracterized Autism Spectrum Disorder. The story and headline have been updated to accurately reflect it.