Why the Signs of Autism in Females Are Often Missed

I may only have been diagnosed with having Asperger’s syndrome last year, but the signs have always been there.

The trouble is that teachers and health professionals are often better equipped to spot autism in males, and perhaps the signs are more obviously there for them to make an assessment. Autism in females often presents differently, so it makes it harder to spot and often isn’t even considered as a possibility, leading to misdiagnoses of anxiety and depression.

My own doctor apologized to me for not having recognized the signs, but herein lies another problem which can make diagnosis even harder. Women work really hard at covering up their perceived shortcomings; it’s called masking and I am adept at it. Masking is a way of presenting yourself to the world as if you’re OK and in control, when underneath you feel anything but.

I spent years wondering why I would feel so bad in so many situations.  I had never considered that I could be autistic (isn’t it just boys who are affected?) I wondered if I was “crazy,” and there was no way I was going to disclose my concerns to the outside world, especially not to my doctor.  But the signs were there, masking or not, and when you add them up it presents a clearer picture of what autism can looks like in females.

Selective mutism

I can remember being at nursery (aged 4) and just being completely overwhelmed by the number of kids and the noise.  If a teacher spoke to me I would turn and run away and start doing something else.  When I started school a year later, this tactic was no longer acceptable. I was sent to a speech therapist to identify what the problem was; my parents were baffled, as at home I was chatty and at ease. Eventually the conclusion must have been that I was simply shy, as by Primary 2 I no longer had to go and it was all forgotten about.

Over-compliance

While autistic boys may be identified in class as unruly, autistic girls may be the opposite.  I never put a foot wrong at school. I was quiet; I followed the rules; I never misbehaved. In fact the only time I got into trouble at school was for the telling the truth, which the teacher took offense to and I was made to do 50 lines of “I must not be cheeky to my teacher.” It still feels unjust to this day!

Food dislikes and selective eating

I have always been known as a “fussy eater” and to be honest I have never grown out of it.  I don’t like eating in public and never once took a school meal in the lunch hall. I would go home and eat and then return to school. I have a very limited diet, and I don’t like foods that are mushy, strongly flavored or mixed together. Everything has to be separate and not touching on the plate.  Bribery or punishment would not change my mind, as I would simply not eat if I didn’t like the look of it.

Sensory overload

My mum recently told me that in the early years of school, I would come home and fall asleep before dinner and continue right on through to the next morning. I was simply exhausted by having to go through school every day.  Learning was never the issue; I was bright and often top of my class. But I remember feeling like there was a constant wall of sound and voices that I would have to block out while focusing on my work.

Friends

Autistic girls and women often do need and want to have friends, but they may make very intense relationships with one person in particular and do not need a gang of girls around them. I always found someone I really liked, and had a best friend with whom I could be myself and not feel like I was trying to be someone else. This has continued into adult life; I have very strong and lasting friendships, and I prefer seeing friends one on one.  I resist being part of a group because I simply do not need to be in one, and honestly don’t want to be.

Resistance to change

This has had a devastating impact on me all my life. I do not want to move on to the next phase as it is so overwhelming and scary.  The first time this really affected me was in Primary 7 as I realized I was going to have to move on to high school.  The thought of it was truly terrifying, and there was no getting out of it. I became so anxious that it started to affect me physically; I felt sick and stopped eating. It was the first time I learned how long a night is, as I couldn’t sleep and would be up all night reading or trying to sleep with the light on without disturbing my parents. I could not articulate what was wrong with me (I don’t think I even knew the word to describe it was anxious) so I defaulted into saying “I feel sick.”  I could see that my parents were worried about about me, so about this time I started to cover up how bad I was feeling and tried to present an appearance of being OK.

This pattern of resisting change has continued into adult life, be it starting college, a new job or starting a family. Enforced change such as a relationship breakup, redundancy or a death in the family are very hard, as I simply don’t see it coming and am not prepared.

Social anxiety

Masking really comes into effect when autistic females are in a social arena. We’re not naturally chatty, usually steer away from groups and there is a definite feeling of “us and them.”  The “them” are the women who are so naturally at ease with themselves, make conversation easily and bond together over gymnastics, babies or yoga. “They” collect friends — the more the better and like nothing better than planning the next big night out together. Autistic women know we have to make an attempt to fit in, so we learn to say the right things at the right time and in the right way; it does not come naturally. When I was younger, I would force myself to go on the nights out or the drinks after work, but would often slip away early as soon as was decent.  Social occasions are always exhausting. If I have to go to something I will, and I will perform to the best of my ability. But I’d much rather be at home with my family doing what I actually want to do.

These are some of the signs that autism has always been part of my life. If you recognize them, I would encourage you to come clean, be brave and seek a diagnosis so you can get the help you need. Stop beating yourself up that you’re not “normal.” You may just be autistic.