Autism In Adult Women: Neurodiversity, Masking, And Support Options

Autism is a lifelong condition without a cure, meaning that this neurodevelopmental disorder continues to impact people throughout adulthood, although symptoms can shift over time. Millions of women worldwide live with autism spectrum disorder. However, due to disparities in the field of mental healthcare and the relative newness of autism spectrum disorder (ASD) as a diagnosis, women have often been overlooked when considering the various symptom presentations associated with autism. 

For this reason, many women are not diagnosed until adulthood, and some go undiagnosed their entire lives. Understanding how autism can differ between women and men can help you understand yourself and others, as well as find effective support options. In addition, parents of Autistic girls may benefit from knowing what to expect as their children age. 

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What is autism spectrum disorder (ASD), and what are the signs of autism? 

Autism spectrum disorder is a lifelong neurodevelopmental condition whose symptoms arise in early childhood. This condition impacts behavior, personality, social function, and sensory experiences. Many Autistic individuals are diagnosed in early childhood, usually before the age of four. Because autism is one of several developmental disorders, it can delay typical developmental milestones, such as walking, talking, and interacting with others. Autistic children may struggle to communicate verbally in a way that others understand, and they may not interact with their environment as much as neurotypical children. 

Signs of autism: The autism leveling system and diagnostic criteria 

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), autism spectrum disorder is classified as a spectrum with three different levels of support needs. Although all Autistic individuals must meet the main criteria of the disorder to receive a diagnosis, the level system describes how much support an individual requires and whether they are able to live independently based on the impacts of their Autistic traits. The main criteria of the condition are as follows: 

• Persistent deficits in three areas of social communication and interaction
• Two to four types of restricted, repetitive behaviors 

Social challenges can involve social-emotional reciprocity challenges, difficulty perceiving or showing nonverbal cues, deficits in understanding relationships, and challenges with understanding peers. Persistent, repetitive behaviors can involve intense interests, repetitive movements (stimming), insistence on rigid patterns, and hyper-focus on sensory aspects of one’s environment, often causing distress. 

The autism levels are as follows: 

• Level one: Requires support
• Level two: Requires substantial support
• Level three: Requires very substantial support 

People with level one autism may have previously been referred to as having “high-functioning autism” or “Asperger’s syndrome.” However, these terms are no longer used in a clinical setting and may be considered harmful or controversial by some people. 

Autism in adults: How it can differ from childhood autism, anxiety, depression, and other mental health conditions

Signs of autism arise in early childhood, but some people might not be diagnosed until adulthood. In addition, adult symptoms may differ from a person’s childhood experience of autism. Because adults often face different pressures and responsibilities, some Autistic adults develop behaviors like “masking” to hide certain symptoms. This can enable them to “fit in” socially and professionally. In addition, many adults find ways to accommodate themselves, such as wearing headphones to block out sound in public spaces, seeking out jobs that don’t require much interaction with others, or residing in an assisted-living facility.

Understanding the disparity in adult vs. childhood diagnoses 

Autism was initially added to the 1980 edition of the DSM (the DSM-III) as “infantile autism.” In 1987, the disorder’s name was changed to “autistic disorder” in the DSM-III-R. In the DSM-IV, published in 1994, autism was viewed as a spectrum with multiple subcategories: autistic disorder, Asperger’s disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS). Rett’s disorder and childhood disintegrative disorder (CDD) also fell under the category of pervasive developmental disorders alongside autism.

In 2013, the spectrum was revised to add the three levels of support needs to further classify the spectrum of symptoms, and the subcategories of autism were condensed into one diagnosis: autism spectrum disorder. Autism, as a diagnosis, is still considered relatively new. Early studies on autism only involved children, as autism is a developmental disorder. Because adults were overlooked in the initial discussion, especially women, people of color, and other minority groups, children were diagnosed more frequently than adults, and adults often had (and still have) difficulty getting diagnosed.

Autism in women and girls: The female autism phenotype and gender differences 

Many women and girls have autism but may not receive diagnoses due to gender disparities, a lack of understanding of autism symptom presentation in females, and difficulty being taken seriously by healthcare providers.

The symptoms experienced by Autistic women or girls might not be seen as “typical” autism by providers, which may lead to misdiagnosis and a lack of support. According to additional research, women tend to be more likely to be misdiagnosed with depression, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and borderline personality disorder (BPD) when they actually have autism spectrum disorder. 

How does autism affect adult women?

Adult women may be impacted by autism in different ways than men. In addition, because they are adults, they may have learned to fit in with society in ways that hide or “mask” their autism symptoms. Below are further explanations of these differences. 

Masking symptoms of autism spectrum disorder or signs of autism 

Masking is a strategy used by some individuals with autism to hide certain behaviors that might be considered “socially unacceptable.” By masking these behaviors, people with autism may be better able to fit into society and lead independent lives. Autistic women may mask autism symptoms to build friendships, earn respect at work, and avoid social ostracization. Since women are often expected to be highly social, women who struggle with socializing or seem “different” in some way may be at a higher risk of experiencing bullying and peer violence. In these cases, masking might protect someone from being outcast by their peers.

However, masking can be harmful, and studies have found it often leads to a higher risk of anxiety and depression. Unlearning masking behaviors can mean allowing yourself to stim openly, accommodating your needs, and telling other people you’re Autistic to help them understand you better. If you’re not sure how to unmask, talking to a therapist may be helpful. 

Gender-based societal expectations

Outside of the autism community, women, in general, are frequently expected to act in certain ways. In some cultures, women are pressured to be homemakers, have children, and serve men and religious communities. In the US, women (especially BIPOC women) often make significantly less than men at work and are less likely to be promoted to corporate positions. 

Autistic adults may have a strong sense of justice, refusing to fit a certain mold. Autistic women may be more likely to speak up when they witness injustice, open up about their emotions, and reject harmful authority. Because these women don’t always assign themselves a submissive role in society, people may label them “dramatic,” “mean,” or “rude,” even if they’re just trying to advocate for fairness. 

Research on autism in women and girls 

More recently, autism research on women and girls has increased. However, in the past, women were not studied at all. For this reason, Autistic females may showcase symptoms that doctors aren’t familiar with from reading studies on Autistic males. In addition, women are generally less likely to have been diagnosed with autism in childhood, leading to more adults seeking diagnoses later in life.

Other differences in the mental health of Autistic women: Anxiety, depression, and more 

A 2019 study examined the differences in autism between women and men. They found that women were more likely to camouflage their symptoms (mask) and that women had higher autism spectrum quotient (AQ) scores overall in the population of Autistic people studied. In addition, women were found to have less repetitive and restrictive behaviors in childhood, and even young girls, including toddlers, were more likely to mask symptoms than boys. 

This research suggests looking further into how masking plays a role in diagnostic gender discrepancies. Women with autism may also be more likely to experience co-occurring mental health conditions, such as depression, anxiety, and ADHD. 

Special interests in adult women 

Women with autism may have different “special interests” than men. Special interests generally refer to obsessive or hyper-focused interests that a person with autism spends a lot of time and energy engaging in or talking about. Men and boys are often thought to enjoy trains, dinosaurs, science, and mathematics as special interests, although they can enjoy other topics as well. Women, however, have been found to enjoy the following subjects more often: 

• Celebrities
• Animals (horses, cats, and dogs, in particular) 
• Psychology
• Languages 
• Autism and the concept of masking 
• Crime and investigation 
• Music
• Plants and gardening
• Their careers
• Astrology and spirituality 

How can Autistic women find support? 

Autistic adult females may have trouble finding support from a provider who can diagnose autism, as many resources are designed for young children and their families. However, some providers work specifically to diagnose and treat adults with autism. Look for one in your area or search for a professional who provides services online. 

When looking for an autism assessment, ask the provider about their experience diagnosing adult women and what they look for differently between genders. If they don’t have much experience in diagnosing people like you, consider looking for another provider who does. Finding the right provider can be important in getting an accurate diagnosis, as adult women with autism are often misdiagnosed with personality disorders or bipolar disorder.

Mental health support options for Autistic women 

If you’re seeking therapy with a provider informed in treating Autistic adults or people with undiagnosed autism, you’re not alone. Finding providers with this type of experience in your area can be tricky, as specialists often work in bigger cities and have long waitlists. In these cases, you might try seeking an autism therapist online through a platform like BetterHelp. 

With an online therapy platform, you can specify that you’re looking for a therapist who has experience treating people with autism. In addition, you can choose between phone, video, and live chat sessions, giving you more control over how and when you receive help. Studies have found that online therapy can be an effective option for adults with autism, especially in chat format.