Gender bias continues to pervade psychology as girls and women with autism
spectrum disorder remain disproportionately underdiagnosed.
By Anna Tsou
Most of my life has been spent relentlessly striving to hide my autistic traits. And it was
done not knowing I was autistic.
Growing up, I quickly picked up the unshakable habit of imitating others. It is not
uncommon for kids, teens, and adults alike to create a persona out of the desire to leave
a good impression, to be accepted by and fit in with peers. But for many autistic people,
such as myself, it is a means of anxiously yearning to stitch together the parts that have
been made to make us feel broken and lesser.
Masking(1) is the suppression of autistic traits and behaviors to camouflage as
neurotypical. This often is grounded in hours upon hours of careful observation of
every human being and interaction that crosses our field of vision. Conversations are
not just social exchanges, but they become grounds for field research. Refining
hypotheses and collecting data and analyzing results become a round-the-clock job that
your brain never knows how to clock off from.
If the data gathered deem to be statistically significant, then the implications soon
become evident in the countless, calculated tweaks to one’s own way of being:
mimicking behaviors and mannerisms of others (e.g., hand gestures, facial expressions,
eye contact); suppressing intense emotions, interests, sensory issues, and behaviors such
as stimming; and scripting conversations.
More and more research shows that masking is more common in autistic girls, and this
may be a significant reason why so many girls struggle to get identified and correctly
diagnosed. But why is it that so many girls mask their autism, unknowing that they are
autistic in the first place?
Many autistic girls mask in response to autism-related stigma as well as gender
expectations and norms. Being socialized female often comes with the expectations of
having strong social and emotional skills. Many autistic girls can convey typical verbal
and non-verbal behaviors, hold conversations, and make friends. However, this is only
a superficial appearance, as the mask begins to slip when maintaining friendships
becomes more nuanced and difficult to keep up with.
Being socialized female also frequently comes with the expectation of being
well-behaved and non-disruptive. And because externalizing behaviors such as
hyperactivity and disruption are signs of developmental disorders such as autism,
teachers and parents are more likely to notice the kids who are disruptive than those
who are not.
But receiving a late diagnosis causes grave consequences. Not receiving a timely
diagnosis means amplified struggles, as a result of missing out on resources, services,
and accommodations crucial to the thriving of autistic individuals. It can also mean
greater mental health issues down the road. One study showed that women diagnosed
in adulthood were significantly more likely to develop psychiatric conditions such as
depression, anxiety, and personality and eating disorders.
For every girl that meets the criteria for ASD, 3 boys meet the same criteria. Many of
these girls can possess a stronger severity of autistic traits. The problem is that those
who are critical to the process of identifying autistic girls in childhood still don’t know
how autism may present in children other than males. Some still even resist believing
that girls can be autistic.
The single-minded profile of the predominantly male presentation of autism is harmful.
Not only to young girls but to anyone who doesn’t fit in that box—which leaves a
significant portion of the community dismissed all too easily.
We need more meaningful representations of autistic people; not just the white, male
ones. Black children are less likely to be diagnosed, or experience a more delayed timing
of diagnosis with ASD than white children, and Hispanic children are even less likely
than either group. We must also consider the experiences of gender-diverse autistic
individuals. One large-scale study showed that transgender and gender-diverse
participants were 3-6x more likely to be autistic than cisgender participants.
We must lessen the stigma that continues to permeate our society. Education is
necessary to create a world that is inclusive and accessible for all. That includes creating
space and accessibility for autistic people to be integral to the conversation, and to have
simply the opportunity to get our needs met. We must foster a greater common
knowledge of what autism actually is, and better yet, accept the vast scope of diverse
autistic individuals who do exist.
Only after finding out I was autistic was I able to know that everything I spent my life
trying to smother and erase has a name for it; that it does not mean you are irreparably
broken; that you do not need to shrink your space in shame of being too much, or not
enough, or nothing at all. Only then could I finally be authentic, autistic me.
Works Cited
1. Attwood, Tony. “The Diagnosis.” The Complete Guide to Asperger’s Syndrome,
Jessica Kingsley, London, 2008, p. 58.
Hiller, Rachel M., et al. “Sex Differences in Autism Spectrum Disorder Based on
DSM-5 Criteria: Evidence from Clinician and Teacher Reporting.” Journal of
Abnormal Child Psychology, vol. 42, no. 8, 2014, pp. 1381–1393.,
https://doi.org/10.1007/s10802-014-9881-x.
Loomes, Rachel, et al. “What Is the Male-to-Female Ratio in Autism Spectrum
Disorder? A Systematic Review and Meta-Analysis.” Journal of the American
Academy of Child & Adolescent Psychiatry, vol. 56, no. 6, 4 Apr. 2017, pp. 466–474.,
https://www.jaacap.org/article/S0890-8567(17)30152-1/fulltext.
Ratto, Allison B., et al. “What about the Girls? Sex-Based Differences in Autistic
Traits and Adaptive Skills.” Journal of Autism and Developmental Disorders, vol. 48,
no. 5, 4 Dec. 2017, pp. 1698–1711., https://doi.org/10.1007/s10803-017-3413-9.
“Spotlight on: Racial and Ethnic Differences in Children Identified with Autism
Spectrum Disorder (ASD).” Centers for Disease Control and Prevention, Centers for
Disease Control and Prevention, 27 Aug. 2019,
https://www.cdc.gov/ncbddd/autism/addm-community-report/differences-in-c
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Warrier, Varun, et al. “Elevated Rates of Autism, Other Neurodevelopmental and
Psychiatric Diagnoses, and Autistic Traits in Transgender and Gender-Diverse
Individuals.” Nature Communications, vol. 11, no. 1, 2020,
https://doi.org/10.1038/s41467-020-17794-1.