In this post, you’re going to find out what does autism look like in women and girls and discover autism in women symptoms that are often missed/overlooked.
There’s a misconception that autism is predominantly a male condition.
The classic pattern of behavior in autism can be clear in girls and women who were intellectually disabled.
But those who were more verbal and intellectually able would often go undiagnosed.
It is only in recent years that the female presentation of behaviors in autism has begun to receive recognition. (*)
- What is Autism Spectrum Disorder (ASD)?
- Do Women Get Autism?
- Autism In Women Symptoms That Are Often Overlooked
- 1. Childhood
- 2. Childhood Relationships
- 3. Adolescence
- 4. Education
- 5. Adulthood
- 6. Adult Relationships
- 7. Gender Identity
- 8. Personal Relationships
- 9. Pregnancy and Parenting
- 10. Employment
- 11. Health and Well-being
- 12. Ageing with Autism
- Autism In Women TED Talks
What is Autism Spectrum Disorder (ASD)?
Autism is a spectrum disorder characterized by challenges with social skills, repetitive behaviors, and issues with verbal and nonverbal communication.
Autism is often accompanied by other medical issues, or “comorbidities”, such as seizures, sleep issues, ADHD, and other cognitive disorders.
As a spectrum disorder, there is a broad range of symptoms that fall under the definition of autism.
Every single case of autism is unique and individual with the disorder exhibits different symptoms. This makes diagnosing Autism Spectrum Disorder (ASD) can be a difficult task.
This also means that treatment options will differ from one individual to another on the spectrum.
Although some cases of autism can be diagnosed as early as age 18 months, most cases of autism take many years to arrive at a diagnosis.
Treatment options include behavioral analysis and therapy, medications, and adapting the patient’s environment to better accommodate their individual challenges and needs.
Do Women Get Autism?
Females are significantly less likely to receive an autism spectrum diagnosis than males, even when their symptoms are equally severe.
This is partly due to stereotyping by parents and professionals and gender expectations.
Another factor that had an impact on public perception is the “extreme male brain theory” of autism developed by Professor Simon Baron-Cohen, which relates to levels of testosterone, androgen, and other neurobiologically occurring chemicals.
According to this theory, autism is partly caused by elevated foetal testosterone levels. Excess testosterone is correlated with a number of autistic characteristics, such as eye contact, vocabulary, and social relationships.
Further research confirmed that women with autism had higher testosterone levels than control samples and that these women displayed more masculinized characteristics.
Autism In Women
Bölte et al. (2011) found that girls with autism scored higher in executive function, and boys with autism scored higher in attention to detail.
This supports the idea that women with autism are more active in life in general. Rather than the typical “extreme autistic aloneness”, girls were more ‘clinging” to others, trying to imitate their speech and movement, but without a deeper understanding of the non-verbal social interactions.
In comparing boys and girls with autism, Lai et al. (2011) found that both were ‘equally autistic’ as children, but as adults, the females showed fewer social communication difficulties, which suggests that they may have learned compensatory strategies in order to appear more ‘socially typical’ and fit in.
Although this front can make them appear capable, it cannot be maintained beyond certain limits. (*)
Getting A Diagnosis
Due to the learned strategies, girls may adopt and the gender expectations, boys are more likely to receive an autism diagnosis than girls despite both sexes displaying signs clinically associated with autism.
Nichols et al. (2009) suggest the following signs can facilitate the diagnosis of autism spectrum in women:
* Previous diagnosis of another disorder or several disorders, such as Attention Deficit Hyperactivity Disorder (ADHD), anxiety, depression, obsessive-compulsive disorder, eating disorder.
* A diagnosis of social anxiety or general difficulty in social situations.
* Adult women having a previous diagnosis of schizophrenia or psychotic disorder.
* A family member having an ASD diagnosis.
* Apparent deterioration of capacity to cope as adolescence approaches, where social relationships become more nuanced and complex.
* In adolescence, girls may not demonstrate typically ‘female’ social interests, such as fashion and relationships.
The benefits of getting a diagnosis extend beyond the ‘medical’ explanation.
A positive, timely diagnosis of autism can be the beginning of a new journey of understanding, acceptance and appropriate support.
Autism In Women Symptoms That Are Often Overlooked
Autism Spectrum Disorder (ASD) diagnosis may happen as early as two years of age, but often the conclusive diagnosis of ASD is reserved until an older age to ensure that the assessment is consistent over time and natural development.
However, parents whose daughters didn’t receive a diagnosis until later in life, on a hindsight, would often say that they ‘knew’ something was different about their child, even before any current formal indicators of diagnosis could possibly be used.
The following is a list of typical early childhood indicators of ASD that might be present:
* The parent feeling a sense of detachment from the child as if she was ‘in their own world’.
* Atypical eye contact (unusually limited or staring).
* A lack of attention, interest, or response specifically to people and faces (smiling, voices) compared to their interest in objects.
* Limited response to social facial expressions and social cues (smiling, pointing).
* Very silent and peaceful babies, or very anxious, distressed and clingy babies.
* Sensory preferences and intolerances:
- small temperature tolerance range, which can cause febrile convulsions
- clothing – texture and touch
- physical touch – distressed by being cuddled
- specific strong food preferences and dislikes, and other intolerances and allergies.
Despite displaying many of these signs, it may not be until the child joins a playgroup that the parent realizes that their daughter is really different from her peers, as she struggles with the more frequent and numerous social interactions.
The following list presents typical ASD features that girls with ASD might struggle with:
#1. Non-Verbal Communication
Reading And Expressing Facial Expressions
Girls with ASD don’t just struggle with reading non-verbal signals, they also struggle with expressing them in order to enable other people to ‘read’ them.
Thus, a girl that makes few facial expressions, or ones that appear slightly out of context in the situation, might be a candidate for autism assessment in the same way as a girl who does not actively respond to cues.
Eye contact in girls with autism can be noticeably different in infancy, ranging from little or no eye contact through to staring.
The difference resides in not having the intuitive understanding of eye contact as a means of reciprocal communication, or difficulty in focusing on more than one sensory input at once, or simply experiencing an intense discomfort at the intensity of looking into another person’s eyes.
Lack of eye contact doesn’t mean that the person isn’t listening or isn’t understating. The autistic girl or woman can be entirely present and use her other senses more effectively without having to loot at the unfathomable movements of a face at the same time.
As an adult, the autistic woman learns that eye contact is a social norm and teaches herself to replicate this.
#2. Verbal Communication
When it comes to language ability, individuals with autism present a varied profile, both in speech and language comprehension.
Some individuals are non-verbal throughout their lives but have good intellect. Others had early speech and advanced vocabulary.
In fact, their verbal ability, an indication of intelligence and social skills, is one of the main reasons why girls with autism go undiagnosed.
Despite their verbosity, these girls have social difficulties in understanding subtle social cues, such as idiom, sarcasm, tone of voice, etc.
Individuals with autism are often described as ‘literal’ and brutally honest. They speak their minds and may say inappropriate things as a result.
But these girls will learn that sometimes honesty is not the best policy, and quickly learn verbal and non-verbal subtlety, which along with empathy, allows for more gentle interactions.
Girls and women with autism aren’t just literal in their own speech, they’re also literal in interpreting that of other people.
The difficulty of seeing beyond the actual meaning of someone’s speech can be a source of anxiety for the autistic individual because it generally involves other people and a potential for confusion and failure.
#3. Dealing with Unpredictability
Unexpected situations and occurrences can be met with a fight response (for example, a meltdown) or flight response (for example, avoiding it at all costs and remaining alone at home) from the autistic girl
Parents need to be alert to potential triggers by slowly changing routines and giving their daughter a good explanation.
#4. Activity Choice and Interests
Research into sex differences in children with autism found that girls with autism do not have the same stereotypical interests as boys with autism have.
Although the choice of interest varies, repetitive and restricted behaviors were the norm for these girls. These behaviors may include watching the same TV/video/DVD program, reading the same book, collecting, coloring, etc.
But unlike repetitive behavior observed in boys with autism, the girls’ activities generally involve people, rather than objects.
Their interest quality not being unusual for the ‘typical girl’ is yet another reason why these girls can go undiagnosed.
Despite their interest not being unusual for a typical girl, the narrowness of the topic and the intensity of the interest can be an indicator of autism.
Girls with ASD generally have extensive knowledge of their interests and might think or speak about them for an extended period of time, without necessarily having a desire to live it out.
For instance, a girl who speaks of nothing but cats may not actually want one and simply enjoys talking about it.
Having such intense interests may be a way to find predictability and have an escape from the chaotic real world.
Most girls with autism have a preference for toys designed for ‘doing’, (such as Cars, Lego®, construction, etc.) rather than imagining or pretending. Other girls may prefer being outside and active rather than playing with toys.
Even when a girl with autism has soft, cuddly toys, the play involved more organizing and collecting rather than imaginative play with these items.
Even when a girl with autism talks to herself out loud, she’s probably not creating imaginary characters but may simply be repeating a TV show or a conversation she overheard.
This is why it’s important to consider the content of the play rather than take the observation at face value when assessing autism.
Many girls with ASD have a strong interest in reading and were described as voracious readers, whether information-related or fiction.
In fact, reading not only offer a solo escape, but also help them replace their confusion by providing knowledge and data that help them manage their world more effectively.
Encouraging these interests is a great way to support a girl with ASD.
These girls’ isolation and lack of social interaction may be concerning to their parents, but it may be their way to replenish their energy so they can cope with the overwhelming demands of school and family life.
Without having quality time, these girls may shutdown, have a meltdown, or experience increased anxiety.
The girl with ASD would generally play solo. When she seeks out the company of others, it usually doesn’t take long before she either offends the other children or becomes upset with the notion of shared play.
When playing with other children, girls with ASD either take a domineering role and demand that all activities be on their terms, or they take a more passive role where they let others ‘mother’ them.
#5. Sensory Tolerance
Objects and Sensations
Sensory differences for girls with ASD can be observed early on. they are likely to be made known by the child through refusal, screaming, and general extreme distress when encountering certain objects or sensations, such as noise or bright light, or tactile textures.
These girls would also actively seek out stimulus that soothes and calm them.
The differences in food preferences involve specific criteria and rules regarding color, texture, type, times, smells, and tastes.
Food preferences also represent control and preference for predictability. Girls with ASD might avoid new and unknown experiences when it comes to their food, which may result in feeling afraid of trying new foods at school and not eating any lunch.
This behavior might be hard to distinguish from the typical child phases, which is another reason why a girl with ASD can go undiagnosed until much later.
There is a strong preference among many girls with ASD for clothing that is comfortable, soft, and stretchy.
Some girls would even dislike clothes they consider ‘girly’, which include colors and type of clothing (skirts, dresses, etc) typically associated with girls.
#7. Toileting and Personal Hygiene
A high number of girls with ASD have difficulties in becoming independent when it comes to toileting and personal hygiene, mainly due to the social rules, sensory issues, and unpredictability involved in toileting.
Anxiety and Irritable Bowel Syndrome are well-documented features among many girls with ASD, which can add to their toileting difficulties.
Hygiene behavior is assumed to be intuitive and understood and therefore is not taught to girls with ASD.
Some of the most common difficulties girls with ASD encounter include recognizing the physical signals that indicate a need to use the bathroom, as well as anxiety when using toilet facilities outside their homes.
Sleep for girls with ASD can bring rest after a stressful day, but can also bring more confusion and dear for others.
Sleep problems for girls with autism might be caused by being left to fall asleep alone, night-time waking, ruminating thoughts, anxiety, and sensory difficulties (temperature, textiles)
2. Childhood Relationships
#9. Social Interactions
Too Sociable/Loner Feature
While being a loner is part of the autism profile, this might not be always the case for girls with ASD.
In fact, their proactive sociability can be a clue that these girls might have autism.
With few boundaries and little understanding of the feelings and intentions of others, it is possible for girls with ASD to be too sociable.
Under the age of four years old, intuitive empathy and social skills aren’t developed yet and so not engaging at all socially or not knowing when not to engage and when to stop, can’t be indicative of potential autism in the girl under this age.
The expectation for girls is that they are naturally good at subtle, nuanced, and intuitive non-verbal cues.
This is not the case for females with autism, resulting in assuming that they’re behaving in an intentional way and being reprimanded more severely than a boy not recognizing these cues.
Despite their desire to interact with people, girls with ASD find it difficult, as they learn that they have to process each experience consciously rather than intuitively before deciding what to do.
The huge amount of early awareness and cognitive processing required can be exhausting and baffling for the young child with ASD, especially as they see that everyone else seems to just ‘get it’.
Eventually, many girls start actively avoiding interactions. Some would prefer the company of their imaginary friends.
Despite not being forthcoming in seeking interactions, their behavior is often attributed to shyness or even high intelligence for some girls, resulting in delaying their ASD diagnosis.
Preference for Adults
Many girls on the autism spectrum seek adult interaction (especially mothers and grandparents), rather than peer interaction.
Adults might seem to the girl with ASD, less complicated than her peers to engage and communicate with.
Many girls with autism would describe their friendships as being on their terms with little perception or regard for the feelings of others.
Another group falls into the shy category as they are considered unusually quiet.
In general, girls with ASD would make fewer, more socially clumsy attempts at connecting with their peers than would be usually expected from a typically developing child.
Some of the girls with ASD might feel merely tolerated by their peers, rather than actively liked, which further affects their withdrawal and self-esteem.
Being less socially intuitive than their peers, make girls with ASD an easy target for getting bullied, especially for those who are more outspoken, and come out as aggressive or dictatorial.
For other girls with ASD, their ‘shyness’ and quiet demeanor might protect them from getting bullied to a certain degree.
The girl with autism might have one friend that so she won’t appear to be a ‘loner’ and she will gain access into the social arena.
However, that friend might become a subject of focus and fascination and cause the girl with autism an enormous distress when the friend wants to play with other children.
Girls with ASD might also seek large groups of friends so they can hide on the peripheries and have few requirements to participate.
Other common friends for girls with ASD include those who are very similar to them in finding the social requirements difficult for various reasons.
Or they might befriend those who are very different from them – super-sociable girls.
Another friend choice for girls with ASD is boys, as they are less complex and nuanced in their social skills than girls.
#11. Social Behaviors
Girls with autism learn how to behave socially by observing and copying behaviors of other people. They might practice these learned behaviors further with their toys, re-enacting scenarios and conversations they have had or overheard.
The common interest of reading (fiction during childhood and psychology or self-help books later in life), observed in many girls with ASD, is another valuable tool in learning how to behave socially.
The notion of sharing is generally developed at around four to six years of age for most children.
However, girls with ASD might not develop this skill until much later and sometimes not to the same degree as their peers.
Because of not having the concept of the needs of others properly developed, girls with ASD might appear self-focused, which is a trait that is not easily tolerated in girls, as they’re expected to have more intuition regarding the needs of others.
Sharing can be difficult for girls with ASD because it usually involves:
- Change of plan and having to adapt to the new situation.
- Other people that the girl doesn’t know what they might want.
- Non-verbal communication that might prevent them from detecting others’ intentions.
- Unpredictability regarding whether or not the girl will get back the item, or when her turn will be to have the item.
- Verbal negotiation and the pressure of having to come up with on-the-spot, socially acceptable response.
- Having to anticipate the behavior of another person.
- Loss of control and safety.
This is why most girls with ASD at a young age prefer playing solo, especially when the consequences or the benefits are not being explained.
Adolescence in itself is usually a difficult time for all young women, and it’s even more difficult when combined with autism.
The changes the teenager encounters, such as the body changes, feelings changes, expectation changes, etc. can be a lot to handle for someone who takes a while to get used to changes.
It’s even harder to navigate through this period when the teenager didn’t get a diagnosis of autism.
Other factors such as not finding like-minded friends, or kind, accepting peers, might impact the teenager’s adolescence.
#12. Social Interactions Complexities
Although girls with autism find less difficulty with social behaviors than body with autism at a young age, in adolescence, girls encounter more difficulties.
This is mainly due to gender expectations that make girls and women more socially dependent, compared with boys whose interactions remain activity- or topic-based, which means less verbal and non-verbal requirements.
Another difficulty comes from the autistic young woman’s tendency to focus and seek exclusivity with one friend, which may leave her confused as to why that friend would want to spend time with other people.
Another issue young women with ASD seem to struggle with is their feelings of both, contempt for the superficial content of the interactions of their peers, and needing to be accepted by these peers.
Later in life, adults feel a sense of relief that they no longer have to fit in with their peers and that they have the choice to opt-out.
The Internet may offer, for young women with ASD, a space for developing friendships based on interests and not requiring the complexities of face-to-face interactions.
#13. Mental Health Difficulties
The additional expectations and requirements that come along with adolescence regarding social ability, education, independence, etc may lead to more mental health difficulties.
Young women with autism may develop visible signs of anxiety, eating disorders, and even self-harm. These issues might be incorrectly attributed to puberty without addressing the underlying stress involved in living with ASD.
Young women with ASD are more likely to suffer in silence and their shy profile might contribute to the fact that these difficulties often go unnoticed.
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#14. Communication And Social Understanding
The typical diagnostic characteristics of ASD can become less obvious in adolescent women, especially when it comes to communication and social understanding.
As they reach adolescence, young women become more intellectually able and self-aware, which helps them learn what is deemed unacceptable and what is required in social interactions.
In an attempt to receive social approval and fit in, young women with ASD would study the behaviors of others. As a result, they become better at predicting more accurately what others will do and imitating these behaviors themselves.
Intense interests continue throughout the lifetime of women with ASD. Reading is one of the most common interests along with drawing, writing, collecting, and video-gaming for some young women with autism.
These interests are usually solitary pursuits and not shared with peers, except for video gaming, which involved remote interaction rather than being with someone in the same room.
The solitary nature of these interests might lead to the assumption of isolation, shyness, or social anxiety, which can further mask underlying autism.
#16. Coping With Change
Most women with autism report life-long difficulties with changes to plans and routines, including during adolescence.
As teenagers, these changes often lead to outburst and having an anxious need for details or reassurance. However, these young women tend to internalize the anxiety and stress they feel around change, as to not draw attention to their inability to cope with change.
Repression of these emotions and putting themselves under chronic stress can cause long-term mental health issues.
#17. Independent Skills
Young women with autism are extremely capable and independent. They usually behave well and do as they’re told.
This makes others make the assumption that they’re mature and sensible, and further mask the difficulties they’re facing living with autism.
Other young women with ASD found the expectation impossible to meet and worked hard to hide these difficulties by finding new ways to cope.
For instance, a young woman might find it extremely stressful to use public transportation and would prefer walking than having to go through the compulsory interaction with the bus driver and my peers on the bus.
#18. Periods and Puberty
The main struggle for young women with autism regarding puberty is lack of understanding and knowledge.
This is mainly due to generally having a limited peer group, which is typically the main source of such information.
Without a comprehensive guide and an opportunity to ask questions around this issue, young women with ASD might experience anxiety and fear as they witness their body changes.
Furthermore, keeping clean and changing sanitary protection are skills that may need to be taught to these young women.
Other issues, such as when to wear a bra might need support from parents or carers, especially when the young woman has sensory sensitivity to touch.
#19. The School Experience
Children and young women spend a lot of time at school. This means that they will spend a large portion of their waking hours surrounded by people, who are generally different and not very accepting.
This makes school a place of great anxiety and stress, and sometimes not a safe place as many young women with autism get bullied.
But school is also a place of knowledge and structure, and so the extent to which the experience is positive or negative depends largely on the understanding of the young woman’s ASD and the support she gets.
Although many children and young women with autism have high levels of intelligence, this doesn’t necessarily lead to conventionally successful outcome.
The nature of the learning environment and social requirements present, mean that the girl and young woman with autism have to work doubly hard to meet the social and academic requirements.
#20. Physical Environment
Going to school for the first time might be distressing for girls and young women with autism.
This is mainly due to spending significant time with people other than her family in an unfamiliar environment.
Other issues like sharing space and materials and being exposed to sensory environment in terms of noise and light, can be equally distressing, and may lead to increased anxiety.
Small adjustments can make a huge difference for these girls, such as:
- a quiet space with headphones,
- being permitted to hold a teacher’s clothes rather than her hand,
- wearing rubber gloves while playing in the sand pit,
- a favorite toy,
Such strategies could reduce the child’s anxiety and help her feel less overwhelmed.
#21. Communication And Structure
The child with ASD might experience anxiety due to not knowing what is going to happen unless explicitly told, or having their parents leaving them without being informed that the parent would return.
Having some level of predictability can significantly reduce the child’s anxiety and help her cope with the new changes.
It’s helpful to explicitly reassure the child and let her know what to expect each day and when it will start and end, in the form of a schedule pinned to the wall.
When the child is reluctant to attend an activity, using her interests to encourage her can help her feel look forward to these activities.
For instance, if the girl with autism loves cats, telling her that she will be able to draw cats during the drawing activity, can motivate her to attend and look forward to the activity.
Social motivators, such as persuading a girl with autism to go to playgroup in order to ‘play with her friends’, might not work and reduce her to panic.
This is why it’s important to identify the motivators that are most meaningful to the girl with autism (interests, favorite carer, favorite toy, chocolate on the journey home, etc).
#22. Breaktimes And Social Interaction
Breaktimes can be the most stressful part of the school day for girls with autism.
Breaktimes usually include social interactions and requirements to understand relationships complexities and negotiations and rules of play.
All of this is more likely to make the girl with autism more exhausted than she was when she left the classroom, which negatively affects her behavior, performance and general well-being at school.
Moving into adolescence, friendships change from toy-based and pretence games, to personality-based relationships.
These relationships involve subtle and nuanced communication that further increases the young woman’s struggles.
The typically expected ‘male’ ASD subjects usually involve maths and IT.
However, for many young women with autism, English and art top the list of favorite subjects at school, which might contribute to masking ASD diagnosis.
Girls with autism might also show unusual learning profiles with extreme subject area peaks and troughs.
This is mainly due to:
- the cognitive profile of autism itself
- the nature of the subject being taught and the level of interest and motivation the girl has in that subject
- the girl’s natural processing style and ability
- the teaching style.
Changes in teaching approaches or explaining the purpose of the topic can help these girls perform better in certain subjects.
Even though being bullied is likely to decrease as people get older, it can be replaced with feeling invisible, which might reinforce feelings of being rejected.
College can also mean starting over again with the need to form new relationships that involve more complexities and nuances than the previous ones.
Some women with autism find college easier than school as they have more freedom of movement, autonomy and control, fewer classes per day and being able to choose the subjects that they excel at and enjoy.
#25. Looking ‘Normal’
By the time the woman with autism entered adulthood, she has spent her childhood and teenage years learning how to mask her difficulties and fit in.
To other people, she might not look autistic, but that doesn’t mean that she can be severely autistic.
All of the diagnostic criteria for autism remain, albeit presented differently as an adult.
Unfortunately their efforts to hide their difficulties might come at a price. Mental health issues and exhaustion are commonly reported by these women.
#26. Communication Skills
Features such as being direct, straightforward and blunt in their communication style continue for adult women with ASD. This is mainly due to difficulties picking up the subtleties of non-verbal cues.
When it comes to social interactions, adult women with autism don’t like it or ‘get it’ any more than they did when they were teenagers.
As a result, they often misunderstand the words of others and find themselves being misunderstood too.
Their tendency to take things literally along with not being able to understand sarcasm, and sometimes jokes can cause more confusion, anxiety, and sometimes self-censorship making them think twice before uttering every single thought, as to not offend anyone.
Related: How To Communicate More Effectively
Girls with autism have difficulties with the concept of sharing, and for some women this issue doesn’t go away.
Even when they can learn that sharing is a requirement, it still doesn’t come easily.
Sharing or lending an item implies loss of control and feelings of uncertainty as to whether or not she’ll get it back, along with dislike of change. All of these elements add to their stress around sharing.
Sharing space, when co-habiting, can be equally distressing. Living with other people means that things are constantly moved, which adds to the stress around not having what they need or having to look for it.
Related: How To Give Up Being Selfish? (8 Ways To Be A Little Less Selfish Every Day)
#28. Sensory Behaviors
Most women with autism who don’t have an intellectual disability have certain movements and behaviors that they find either enjoyable or increasing at times of stress, such as finger picking, or plucking hairs.
Individuals with autism find solace and relaxation in repetitive movements and can manage them so that they do not cause any physical harm. Therefore it should not be mistaken for Obsessive Compulsive Disorder.
In order to stop any of these behaviors, it’s important to understand the function of the behavior and meet that core need.
Some women with autism experience difficulties due to specific sensory sensitivities, such as crowded places and overwhelming situations.
#29. Coping With Change And Uncertainty
Difficulties around change of plans and breaks to routines remain as the woman with ASD goes through adulthood.
However, women with autism tend to hide their discomfort and take the stress on themselves and do what is required, but may engage in self-destructive behaviors once at home.
They find it hard to admit their limitations, vulnerability and asking for concessions or help since this would equate to failure for many women with autism.
#30. Fantasy Worlds And Imaginary Friends
The fantasy worlds observed in the childhood remain for a number of adult women.
The escape these fantasies offer is needed just as much in adult life. They also offer a sense predictability and help women with autism in coping with life.
Many girls with autism tend to choose their clothing for function rather than fashion. For many women, this remains the case unless fashion is a specific interest or passion.
Some women have an androgynous preference around clothing, and others would have strong preferences for certain colors, textures or styles.
During adulthood, intense interests and all-encompassing pursuit of passions might get side-lined by the need of family and profession obligations.
But for many women with autism they still exist. These interests might include reading and gathering knowledge about special interests, cooking, travel, TV shows, science fiction, and video-gaming.
Their focus continues to be in people in TV shows or books, for example, rather than the story being told.
Although these interests appear to be fairly common, the depth of knowledge and the diligence put into pursuing these interests is too excessive to be considered a ‘hobby’.
The racing thoughts experienced by girls seem to persist for some older women with autism.
They would have a need to process the day and to anticipate the next, which might cause difficulty in getting to sleep.
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#34. Independent Skills
Being used to hide difficulties from the gaze of the outside world, many women with autism manage to appear capable on the surface.
As a result, they may appear extremely ordered at work but live in complete chaos at home, as they feel totally overwhelmed with the nature of tasks at home that tends to have no schedule or accountability unless they impose one on themselves.
6. Adult Relationships
People interactions continue to be a complex issue and a major source of effort and anxiety for adult women with ASD for the following reasons:
* The need to identify who might become a potential friend and to know when they have become one,
* The actual social effort required to physically spend time in their presence,
* The fact that friendships need to be maintained (through contact) in-between meetings,
The years of childhood and adolescence feelings of difference can also take their toll and add to these women’s anxiety.
#35. Social interactions
Many women with autism are too self-centric and focused on their own projects and plans that they find it hard to invite a friend to do something together. They would rather do it alone.
Some would even feel that seeing other people ‘gets in the way’ of them doing their own preferred activities.
For others, their social interactions need to have some purpose or function rather than for the purpose of simply meeting others to establish a mutual, empathic and emotional bond
As a result, the frequency of interactions and number of people in these women’s lives tend to be typically small. For some women, their family members are the only people they needed, as they provide them with what most women with autism are looking for: acceptance without judgment.
#36. Online Friends
Internet remains a source of great support for women as they go through adulthood. It can also offer friendships from the stress-free environment of their own home.
Animals can be great potential friends for women with autism.
They are easy to read (limited facial expressions), non-judgemental, loyal, and have limited and easy-to-meet demands (food, stroke, walk, sleep).
#38. Enjoying Aloneness
Many women with autism are quite happy being alone pursuing their interests and keeping their schedules and routines.
For some, leaving home can feel like an effort. However, these women risk getting ‘stuck’ in their safe place and might need some encouragement to take a chance on the world beyond her walls.
7. Gender Identity
#39. Gender Identity
Throughout their lives, many women struggle to fit in with their female peers.
Having a more typically masculinised and straightforward communication style, it’s no surprise that some women with ASD have issues regarding sexual and gender identity.
Many women with ASD prefer broader gender labels, such as ‘genderfluid’ or ‘third sex’.
This is mainly due to the sense of not feeling either male or female, but androgynous (i.e., non-gender-specific), hence the identification with a ‘third sex’.
8. Personal Relationships
Personal relationships present a number of difficulties for women with autism:
1. Along with confusion and uncertainty involved in social interactions, personal relationships also include emotional involvement, intimate physical contact and sharing one’s time, space and possessions for an extended period of time.
2. Societal gender expectations lead us to believe that nurturing and caring come naturally and intuitively to women. And so not being good at these things might lead the woman with autism to feel somehow cold and damaged.
3. Having a close personal relationship means that these women will have to drop their masks and reveal their real selves to a partner. And this in itself can be terrifying.
4. Many women with autism are not great judge of character and oftentimes end up making a poor choice of partner, perhaps even feeling grateful that someone considered her as girlfriend/wife material.
All these factors lead the women with autism to believe that they’re not ideal companions.
However, the majority of women with ASD seem to want to be with a partner, and only a few choose to remain happily single.
#40. Potential Partner As Intense Interest
Some women with ASD become infatuated with their partner, thinking about them constantly, wanting to know everything about them, what they did and where they were, etc.
This is partly due to their intense interest in people rather than objects, whether in pursuing passions or in relationships.
This is why these women need support to understand their strong feelings for someone, learn how to put them in perspective, and learn what socially acceptable behavior is and what may be considered scary and weird.
#41. Reading Signals
The autistic women’s struggle with reading non-verbal cues adds to their struggle to perceive how the other person is feeling, and whether they’re attracted to them or not.
Personal relationships involve much subtlety and flirtation.
This can lead not only to obsessive stalking, but may also make these women vulnerability to abuse. Without being able to read people’s desires and intentions, things may become dangerous.
#42. Selecting Partners
When selecting a partner, women with autism have a lot to consider including needs to be met and presence to be tolerated.
Sharing interests and lifestyle can be important considerations.
For some women with autism they describe their partner choices as ‘random’, which mainly explained by their difficulties in reading people, ‘connecting’ and understanding one’s own emotions and those of others.
#43. Staying Single
For some women with autism, they remain single, whether by choice, or for various reasons that prevented them from having a relationship, such as not feeling strong attraction to anyone, or missing signs of attraction.
One of the main issues for these women is feeling like a failure that they had not managed to achieve what other people had when it comes to relationships, especially when the autistic woman wants to fit in, be accepted and be invisible.
#44. First Sexual Encounters
First sexual encounters may occur as early as 14 years of age and may also involve alcohol and some regret.
Desperately wanting to fit in and feel ‘normal’, these girls may have sexual encounters that are less than positive.
Many of these girls believe that if someone wanted to have sex with them then it meant that they liked them, not considering that for many young men, their selection process doesn’t involve liking the girl. Other young girls might feel like they can’t say ‘no’ because they aren’t allowed to, or that people won’t like her if she said ‘no’.
#45. Vulnerability to Sexual Assault
Vulnerability to sexual assault is a well documented issue for girls and women with autism.
This is mainly due to their struggle with misreading cues, naivety and taking what others say and do at face value. They assume that other people have good intent because they themselves do.
This can result in serious danger when it comes to sexual situations.
Many of the women with autism reported multiple occasions where they had been abused, attacked and/or raped.
This has nothing to do with intelligence, but everything to do with social understanding. Many feel like they’re left with two choices: trust everyone or trust no-one.
Other women learned to protect themselves by listing certain requirements for potential partners.
9. Pregnancy and Parenting
Being neither socially intuitive nor flexible can make parenting a hard task for women with autism. Babies are unpredictable and demanding.
This is why these women need support throughout their journey.
#46. Wanting Children
Some women with autism have absolutely no desire to have children. Others have been obsessed by the idea from an early age.
In general, research suggests that women with autism have a lower interest in marriage and children than neurotypical (NT) women.
Pregnancy can be an intense experience for women with autism.
A lot is happening; feeling out of control of their body and seeing it change almost by the day, the appointments, new people, physical contact from strangers, whether it was for examination or random strangers touching a pregnant woman’s belly.
Typically, many women with ASD take on pregnancy as a special interest and read as much as they can on the subject.
It’s important for women with autism to have access to clear information about the process and an opportunity to ask question. When making a birth plan, sensory issues like physical touch and pain thresholds, and communication approaches need to be taken into consideration.
Women with autism need support if she wishes to breastfeed.
Breastfeeding shouldn’t be assumed to be implicitly or intuitively known.
For those who choose not to breastfeed, they shouldn’t feel judged or guilty. The well-being of the mother usually best supports the well-being of the child.
#49. Being A Mother With Autism
Mothering for an autistic woman presents a number of challenges.
There are requirements for socializing her child, planning birthday parties, attending school meetings, etc.
These expectations might make the autistic mother compare herself to other mothers and feel inadequate.
Other mothers felt that their autism helped bring a positive sense of rightness to their abilities as a parent, and felt a sense of pride and determination.
Mothers with autism, in general, do not project their own needs and wants on their children, and simply accept and value them for who they are.
Work can present a number of challenges for the autistic woman due to the long-term nature of the social relationships, including having to see the same people every day and having to be somewhere surrounded by people.
#50. Challenges at Work
Some women with autism have a hard time coping with injustice, feeling unliked, inability to tolerate certain people in authority, not seeing the point from doing certain jobs or even certain tasks in a job, being inflexible to ways of doing things other than their own, etc.
As a result, many women with autism end up working in jobs below their ability in order to reduce stress or work part time and therefore reducing their income.
In other words, being smart isn’t enough.
Other women choose to work on their strengths, such as repetitive routine tasks e.g., filing, categorizing, routine correspondence, setting up systems, proofreading.
#51. Gender Expectations
There are certain roles in some workplaces where women are generally expected to take on, such as being able to multitask, gift-buying for colleagues’ new babies and general gossip.
Women with autism might reject these roles in a direct manner that makes others see her as ‘difficult’.
Disclosing a disability, should result in making adjustments to accommodate that condition.
However, many women choose not to disclose their autism to employers for fear of discrimination.
For instance, some adjustments that could help women with autism at wok might involve writing instructions down or trying to make them easier to understand, not having to go to conferences or do public speaking, etc.
11. Health and Well-being
#53. Physical health
Many women with autism reported experiencing different health issues, such as aches, pains, intolerances and sensitivities that affect their everyday life.
Health issues and conditions vary between individuals, but some of the common issues reported by women with autism include: migraines, Irritable Bowel Syndrome, specific and generalized anxiety disorders, Chronic Fatigue Syndrome (CFS, also known as ME) and fibromyalgia.
Most of these conditions are mainly caused by stress, as a result of living in a world that is unknown, unpredictable and unsafe, both socially and physically.
Being detail-focused and hyper-aware, these women may notice more acutely when something doesn’t feel right. They are often experts in their own conditions and their opinion should be considered in decisions relating to any treatment process.
#54. Allergies, Intolerances And Sensitivities
It is widely recognized that individuals with autism experience differences in tolerance for various stimuli, including light, sound, smell, and a wider range of substances, such as chemicals, medication, caffeine, fabric, air fresheners, air conditioning, etc.
These women’s reaction may appear hypochondriacs, but the sensitivity is very real.
Mears–Irlens Syndrome, also known as Scotopic Sensitivity, affects visual perception and light and contrast sensitivity. Specialist opticians may provide individually tailored colored lenses in glasses that can relieve many of the symptoms.
Ingudomnukul et al. found that women with autism experienced irregular menstrual cycles, dysmenorrhoea and Polycystic Ovary Syndrome (PCOS) more than other women.
They found that almost twice as many women with autism experience PMS than non-autistic controls.
#56. Eating Disorders
It has been suggested that up to 20 per cent of individuals with anorexia may also have an ASD.
One of main reasons is the fact that women with autism can be strongly affected by the media’s portrayal of seemingly successful females and seek to emulate their body size in order to achieve social acceptance.
Feeling different and excluded while having no means to fix things, can cause depression for many women with autism.
Some of these women describe themselves as having been ‘depressed forever’ due to their limited social acceptance and daily challenges.
Some women found that medication helped to lift their mood, but most had learned strategies to cope with their low moods.
Many people on the autism spectrum consider anxiety as a normal part of their lives.
Living in a world that is endlessly confusing, illogical and frustrating, and full of inconsistencies can lead to feelings of anxiety and a general sense of worry that can be triggered at any moment.
Behaviors, such as skin-picking, scratching, rubbing and plucking hairs are common for many women with autism.
However, these behaviors are often considered by most of these women as calming ones rather than a form of self-harm.
Others would self-harm as a means of feeling something real (pain) or reconnecting with themselves in times of overwhelming emotion.
Diagnosis of ASD along with meditation and self-awareness can help these women understand why they feel the way they do and find a healthier way to cope with their struggles.
#60. Suicidal Ideation
One study found that 66 per cent of adults with autism had had thoughts about ending their lives.
Women can be very susceptible to suicidal thinking for multiple reasons:
- chronic high levels of anxiety,
- tendency to get stuck on negative thoughts,
- replaying over and over again negative statements that others have said to us,
- low self-esteem,
- inability to have significant relationships with others,
- lack of a solid self-identity,
- difficulty with expressing self to others and not feeling understood
These women need to be supported, have their self-worth affirmed, and have their struggles recognized and validated.
#61. Treatments And Strategies
Medication can be helpful in relieving migraines, anxiety, and depression symptoms.
Therapy that is directive and support the learning of social understanding can also be helpful.
Some women learn how to develop practical strategies for themselves to help them cope with their challenges, such as pursuing interests, exercising to relieve stress and tension, reaching out for understanding company, journaling, etc.
12. Ageing with Autism
For some women with autism, living with autism can become more difficult as they get older.
However, a positive outlook and some good choices can make a huge difference in the quality of autistic women’s lives.
#62. Diagnosis of Older People
A diagnosis, even later in life, can bring a huge sense of relief and acceptance.
However, diagnosis might be more difficult for older people because they may not have living parents to provide additional information relating to the childhood impact of autistic characteristics, and the individuals themselves may have difficulty remembering significant details of childhood events.
#63. Accessing Health And Social Care
Because of their differences in the way that they experience and report pain, women with autism may not alert professionals when they are unwell for considerable periods of time.
It’s important to ensure that older people with autism are sufficiently monitored, particularly if they live alone.
#64. Physical and Mental Effects
Tiredness and fatigue are common issues older women deal with.
But along with the general physical tiredness, many women with autism report a tiredness of pretending to be someone else and masking their autism. They simple can’t do it anymore
Other physical limitations that could be experienced involve memory and a feeling of reduced brain-processing ability and speed.
Other issues include eyesight and hearing problems, which can greatly increase anxiety of not being able to recognize visual cues and make the individual reluctant to leave the house and maintain an active life.
#65. Social Impact
Most women with autism maintain a small circle of friends, with some reporting that their main friends are their families.
Moreover, women with autism may have less interest in marriage and/or children, which means that more women with autism may age without families.
These factors may lead to greater isolation than is experienced by non-autistic older people.
Autism is not an excuse for limiting aspirations. Girls and young women need to be encouraged to achieve what they want.
Women need to be validated and supported in their daily struggles.
Autism In Women TED Talks
- Portions of this article were adapted from the book Women and Girls with Autism Spectrum Disorder, © 2015 by Sarah Hendrickx. All rights reserved.
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