By Andie Chilson, LGPC
Autism spectrum disorder (ASD) is (fortunately!) becoming a hot topic in the mental health community and beyond. Now more than ever before, people are recognizing just how broad and encompassing the ‘spectrum’ part of autism spectrum disorder is. What isn’t being talked about enough, however, is the vastly different presentation of ASD between men and women.
The term ASD has been evolving for the better part of a century, and has given millions of people the awareness and vocabulary for a lived experience outside of a neurotypical paradigm. However, ASD is still evolving and expanding to include the intersecting and varied experiences of those who fall outside of the paradigm on which the initial diagnostic criteria were normed. The research informing the diagnostic criteria for ASD have overwhelmingly been conducted on male samples, missing the possibility for divergent presentations of the same condition in women.
It’s not so much that the diagnostic criteria as they stand are inaccurate in assessing for ASD in women, but that they are insufficient. While a woman with ASD may struggle with effective social communication and reciprocity, this can easily be misread (and misdiagnosed) as bossy, aloof, or self-involved. Other signs in the realm of social interaction that point to a possible ASD diagnosis are feeling blindsided when friendships end due to undetected strain, oversharing, or strict adherence to social norms.
Masking in women
Masking is one of the most important factors to consider when conceptualizing ASD in women. A hallmark of autism is studying and learning the social conventions of the ‘in’ group in close proximity to an individual so that they can mimic the behaviors that do not come intuitively to them. Women, more than men, become expert maskers. They are taught from a young age that there are specific and narrow expectations for women and girls, and when they fail to comply with them, the consequences often mean social ostracising and abandonment. Therefore, it is not uncommon for autistic women to find themselves in conventionally socially desirable roles, like cheerleader, sorority member, or class president. Because autistic women have evolved to become expert maskers out of survival, this often results in ASD going undetected in large swaths of women.
Cognitive vs. emotional empathy
Another challenge for women on the spectrum is the ability disparity between cognitive and emotional empathy. Autistic individuals are often touted as emotionless and unfeeling - not far off the mark from clinical psychopaths. This is due to a diminished capacity for cognitive empathy. Cognitive empathy is defined as the ability to correctly identify another person’s mental state. Because autistic individuals struggle with theory of mind (essentially the definition of cognitive empathy), this is often misattributed as being unfeeling. Where women on the spectrum find their strength, however, is with emotional empathy, or the ability to respond to another person’s mental state with an appropriate emotion. While autistic individuals struggle to mentally put themselves in another person’s shoes, the capacity to feel the emotions of another person is perfectly intact. This emotional empathy often spurs individuals towards acts of service and altruism - helping the downtrodden, abandoned, or those who cannot help themselves. This frequently manifests as a deep sensitivity for animals in autistic women.
Comorbid conditions
One of the most important reasons for receiving an accurate ASD diagnosis is the high comorbidity with other dangerous conditions, such as eating disorders, anxiety, depression and process addictions. Eating disorders, in particular, run rampant among women on the spectrum. They afford spectrum women an artificial sense of control and provide rules and routines to put their minds at ease. They also serve as a source of numbing to cope with living as a neurodivergent person in a neurotypical world.
As Maya Angelou said, “when you know better, you do better.” We now know that there are myriad presentations of neurodivergence in the world, and the onus is on us to make the world a place where people with all different types of neurological makeup can not just survive, but flourish.
Here are some additional resources to continue your education on ASD in women:
Books:
Autism in Heels, by Jennifer O’Toole
Women and Girls on the Autism Spectrum, by Sarah Hendrickx
Podcast:
The Neurodivergent Woman, hosted by Michelle Livock and Monique Mitchelson
References:
The Chick-list Checklist, by Jennifer O’Toole
The Psychology of Emotional and Cognitive Empathy, by Lesley University
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