As with many medical diagnosis, symptoms of certain ailments present differently between men and women. For example with a heart attack: while women experience chest pain like men do, they also experience other symptoms like nausea/vomiting and back or jaw pain. This is no different when diagnosing autism because women often display different symptoms than men, which may lead to an incorrect diagnosis.
Most studies conducted on autism have used male volunteers, so there’s often less understanding of women with ASD. The most up-to-date consensus is that more males are currently diagnosed with autism than females, at a ratio of 3:1 (up to 5:1 or as low as 2:1 depending on who you ask). Here are some subtle signs of women with autism spectrum disorder (ASD), although a proper diagnosis can only be given by a certified professional:
Obsession with a band/person/celebrity or animals
One of the signs of autism is an intense focus on “things,” or for lack of better word, being a nerd. For guys, it’s like being obsessed about inanimate objects like trains, for example. Women with ASD also display intense obsessions but it’s not always about objects – they’re also likely to be on people and animals.
So they may be obsessed with a band, celebrity or person to the extent of needing to know every single fact about them. While it’s easier to see an obsessive girlfriend as possessing a trait of ASD, it’s less obvious when women are rabid fans of celebrities or bands – for example, Kpop or Korean actor stans. Not all fans have ASD, of course, but it does contribute to their diagnosis.
Anxiety, depression, and anorexia
Doctors may misdiagnose women with ASD as having other issues like anxiety and depression which can come from the act of “social masking,” or artificially performing social behaviours that seems “normal.”
Clinical experience suggest that autistic boys sometimes don’t care whether they have friends or not, while autistic girls tend to show a much greater desire to connect. Also, autistic females tend to use their words carefully – their words have purpose, so they’re less likely use small talk or make meaningless comments.
A research in the mid 2000s at King’s College London explored the idea that anorexia might be one way that autism manifests itself in females, because people with autism and those with anorexia tend to be rigid, detail-oriented, and distressed by change. No one is suggesting that the majority of women with anorexia also have autism – this merely suggests is that some of the “missing girls” on the spectrum may be getting eating disorder diagnoses instead.
All of these reasons can explain why most women are only diagnosed later in life, if at all.
Hypersensitivity to uncomfortable clothes (and other things)
Adult women with ASD may have hyper-sensory issues with things like fabrics, tags, and textures. The American Psychiatric Association added sensory sensitivities to the symptoms that help diagnose autism in 2013. This boils down to being hyper-sensitive to things like bright lights or certain sounds, smells, and tastes.
While many among us will probably choose comfortable clothes over style, women with ASD may react more negatively towards wearing uncomfortable clothes or fabrics like wool or nylon.
Difficulty maintaining eye contact
“Lack of eye contact” is a well-known symptom of autism. Even adult women with ASD may have difficulty in making eye contact. A common misunderstanding is that lack of eye contact indicates a lack of empathy or connection, but a study published in Scientific Reports reveals that people with autism spectrum disorder avoid eye contact because it causes anxiety, and not as an unintentional demonstration of lack of empathy.
May be more masculine
Gender dysphoria is common among autistic people. Multiple studies, including one done by the University of Cambridge, found that autistic people are more likely than neurotypical people to be gender diverse, and gender-diverse people are more likely to have autism than are cisgender people. It may be that people with autism are less affected by societal pressures to conform to gender “norms”.
A small study by Jane McGillivray at Australia’s Deakin University in 2014 compared 25 autistic boys and 25 autistic girls with a similar number of typically developing children of the same age. It showed that autistic girls scored as high as typically developing boys when it came to friendship quality and empathy, but lower than typically developing girls.
Autism may also shape the brains of women differently to those of men. A study by Simon Baron-Cohen at the Autism Research Centre in Cambridge previously found that autism may be caused by an extreme male brain, or EMB. The condition seems to cause female, but not male, brains to look more masculine, and advocates of the EMB hypothesis propose that people with ASD have an extreme male cognitive style of systemising over empathising. However, this hypothesis is still being tested.
The theory of EMB stems from studies that show embryos with exposed to higher than normal levels of testosterone before birth impairs cognitive empathy. A large Swedish study found that in women with polycystic ovary syndrome (an disorder involving elevated levels of male hormones), there’s a 59% increased risk of giving birth to a child with autism.
Have fewer friends
Particularly in their teenage years, autistic girls often have fewer friends than other girls in their peer group. This is linked to the difficulty they experience with communication and interaction – it’s also common for them to misunderstand social hierarchy. This can cause anxiety or hostility, particularly when they’re also struggling to understand their sexuality, relationships, and puberty.
Many have vivid fantasy worlds
Autistic females often have better imagination, and much like an autistic boy with strong, specialist interests, an autistic girl may develop a vivid imaginary world. Evidence suggests that girls have better imagination (Knickmeyer et al, 2008) and tend to create very rich and elaborate fantasy worlds where they escape into fiction.
The trouble with diagnosing women with ASD
Girls with ASD may display less obvious and severe symptoms than boys – partly it’s because they have a stronger desire to blend in with the crowd by repressing certain ASD behaviours. Girls with ASD also have a tendency to be shy, passive, or quiet, which is socially acceptable (or “normal”).
Because their autistic cues aren’t as obvious, many women go through life without a diagnosis. Hopefully, the more we understand women’s presentation of ASD, more women and girls will receive the correct diagnosis.