As a mental health professional, it is essential to continually stay up-to-date with new research and information that may contradict formerly accepted ideas. One of these ideas is that men develop autism far more than women do. Research has proven that this is not true after all. In fact, women are severely underdiagnosed with autism or are diagnosed later in life.
One of the biggest reasons autism is underdiagnosed in women is that many women learn how to perform camouflaging. Camouflaging allows them to mimic certain social behaviors in public situations, including at doctor's offices and in therapy. This leads to mental health professionals missing the signs of autism in women and underdiagnosing them.
While boys may outwardly show more signs, including hyperactivity, a lack of eye contact, intense interests, and more, girls have taken social cues to hide these behaviors to be accepted by peers, authority figures, and parents. These camouflaging behaviors can begin in childhood and persist late into adulthood, resulting in women being diagnosed much later in life than boys. Although many girls learn to mask their signs and symptoms, traits of autism may continue to persist throughout their lives, making social situations difficult without the individual understanding why.
Boys often show the commonly accepted signs of autism, including:
Not being interested in playing with others
Social and verbal development delays
Becoming extremely interested in something particular
Preferring to be alone
Missing or misunderstanding social cues
These signs and symptoms are relatively obvious and easy to catch, making it easy for mental health professionals to diagnose autism in boys. For girls, on the other hand, the task of diagnosing autism can be a little more complicated. Even at a young age, camouflaging behaviors may have already begun.
According to a study published by the Journal of Autism and Developmental Disorders, there are several signs of autism in girls that are commonly dismissed. The study found that these signs include:
An obsession that is socially accepted: Girls with autism may latch onto obsessions that are more commonly accepted by society. The study provides examples like “books, celebrities, and animals" as specific interests that are seen as typical.
Social impairment is overlooked: Compared to boys, girls with autism may be more concerned with not fitting in and having an extreme desire to be liked by those around them. This can be chalked up to “typical girl behavior” and not taken seriously as a potential sign of autism.
Participating in play and sharing behaviors: Unlike boys with autism, girls with autism may have a desire to participate in play with others, mimic facial expressions, and share. Because boys with autism often do not participate in these behaviors, it is often assumed erroneously that girls with autism would not either. The research shows that that is not true.
Overall, it may seem that learning how to diagnose autism in women can be extremely difficult and nuanced. You may feel great concern over missing potential signs simply because the research for how autism presents in girls still needs to catch up to what we currently know about how it shows up in boys.
If you have started to suspect that one of your clients is engaging in camouflaging behaviors and may have undiagnosed autism, it can be challenging to know how to navigate telling them. Many women have spent years or even decades of their lives living with autism and not knowing it. They may feel strange, different, or like they have never fit in no matter what they try. Approaching their feelings with compassion and understanding can help them feel safe and validated.
When you provide an autism diagnosis for a client, she may react with shock or acceptance. A diagnosis might explain to her why she has faced specific challenges, or she might be angry that she was not diagnosed earlier. Providing your client with a safe space to explore these feelings without judgment can help them process their new diagnosis.
For women who are diagnosed with autism later in life, this new diagnosis can feel isolating and overwhelming to understand. As a mental health professional, you can provide tools and resources to help them cope as they learn to view the world and themselves in a new way through their diagnosis.
Some tools and resources that may help include:
Helping them create a stable routine
Introducing them to organizations that provide support for those with autism
Dispelling common stereotypes and myths about autism
Providing low-sensory situations for overwhelming times
Teaching them how to stop masking behaviors that result in emotional pain
Practicing how to set boundaries in social situations
Beyond these, one of the most important things you can do as a mental health professional is to accept your client for who they are and help them do the same.
For many mental health professionals, diagnosing autism in boys is significantly more straightforward due to the abundance of research surrounding the signs and symptoms of autism in men. On the other hand, autism is significantly underdiagnosed in girls due to a lack of research on how autism presents in girls. Another common reason girls are frequently underdiagnosed is that girls learn from a very young age to camouflage behaviors that will socially exclude them. Understanding how women may mask their autism can help you spot the signs and symptoms in girls and women. At SokyaHealth, we understand that each client has their own unique background and behaviors. Our licensed, compassionate therapists are trained to provide holistic care that treats the whole person and not just their symptoms. We can help you better understand how autism affects your life and navigate the often complicated feelings surrounding a late diagnosis. Call us at (877) 840-6956 for more information.