Autism Spectrum Disorder (ASD) has been diagnosed around four times more often in boys than in girls (Whiteley, et al., 2010). Researchers in the past 5-10 years have only started to question whether ASD may in fact be more common amongst females than has previously been thought (Zwaigenbaum, et al., 2012). Misdiagnosis of females with an ASD may be because diagnostic criteria, concepts and practices have historically been predisposed towards the conventional (a.k.a. male) presentation of ASD (Dworzynski et al., 2012). Also, importantly, females may be better able to adapt to, or compensate for, aspects of ASD symptomatology than males, sometimes referred to as the ‘camouflage hypothesis’ (Gould & Ashton-Smith, 2011). Because of how they camouflage their ASD traits, females are never referred for diagnosis. They are then accordingly missed from the statistics even if they have the exact some profile as their male counterparts. Even people who have ‘classic autism’ are still are given the run around from clinicians because autism is apparently “a boy thing”.
My PhD project intends to explore whether the ‘camouflage hypothesis’ is related to the conditioning of femininity in girls. The conditioning of femininity is accomplished through an active process of interacting with others in a particular social context. How the performance of femininity impacts on the diagnosis of females on the autistic spectrum will therefore be examined.
I’m sure I’m preaching to the choir but yes, masculinity and femininity are learned.
Here is a quote from Meghan Murphy’s blog Feminist Current to help illuminate the above point:
“There are many other things women are taught in our culture – they are taught to be polite, to be passive, to take up as little space as possible. They are taught that they will be treated better if they do a good job of performing femininity. They are taught that they will be successful at ‘womanly’ things like husband-getting and that they will be rewarded for being physically attractive above all else.” (Murphy, 2011)
To apply these ideas to women on the spectrum, autistic author Zosia Zaks says this:
“Whenever a girl acts in a sensitive manner towards the people around her and her community, she is praised and her behaviour is reinforced. This served as another chance social lesson: People liked me when I was kind, when I did a favour, when I volunteered, when I helped, when I asked if there was something that I could do. So I build more successful experiences on the last. I discovered early that I could “win” people over and that they would assume I was a good girl with no problems – if I did nice things.” (Zaks, 2006: 297)
Obviously, these do not match (heavily contested) stereotypes of being either abrupt and abrasive or insular and indifferent.
Another constructive adaptation in performing successful femininity is females will camouflage through imitation and imagination (Attwood in Holliday Willey, 2010). Females will observe someone who is “socially successful and popular”, either from her peers or a character in television and novels. They will then “adopt that person’s persona in mimicking speech patterns, phrases, body language and even clothing and interests using a social script. She becomes someone else, someone who would be accepted and not recognised as different.” (Attwood in Holliday Willey, 2010: 13). However, this camouflaging of Asperger traits causes many women and girls to “slip through the diagnostic net” and this had led to more problems (Attwood in Holliday Willey, 2010: 14).
To specify what kind of problems that autistic females experience without a diagnosis, Dale Yaull-Smith says this:
“The fact that girls with undiagnosed autism are painstakingly copying some behaviour is not picked up and therefore any social and communication problems they may be having are also overlooked. This sort of mimicking and repressing their autistic behaviour is exhausting, perhaps resulting in the high statistics of women with mental health problems.” (Yaull-Smith, 2008)
Professor Attwood is adamant that clinicians need a “paradigm shift” in assessing the female presentation of autism. The performance of femininity needs to be considered in how it has caused them to slip through the “diagnostic net”.
Further reading on the autistic female experience:
Safety Skills for the Asperger Woman by Liane Holliday Willey
Aspergirls by Rudy Simone Life and Love: Positive Strategies for Autistic Adults
Coombs, E., Brosnan, M., Bryant-Waugh, R., & Skevington, S. M. (2011). An investigation into the relationship between eating disorder psychopathology and autistic symptomatology in a non-clinical sample. British Journal of Clinical Psychology, 50(3), 326-338.
Dworzynsky, K., Ronald, A., Bolton, P., & Happe, F. (2012). How different are girls and boys above and below the diagnostic threshold for autism spectrum disorders? Journal of the American Academy of Child and Adolescent Psychiatry, 51(8), 788-797.
Gould, J., & Ashton-Smith, J. (2011). Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum. Good Autism Practice, 12(1), 34-41.
Hambrook, D., Tchanturia, K., Schmidt, U., Russell, T., & Treasure, J. (2008). Empathy, systemizing, and autistic traits in anorexia nervosa: A pilot study. British Journal of Clinical Psychology, 47(3), 335-339.
Holliday Willey, L. (2010) Safety Skills for the Asperger Woman: How to Save a Perfectly Good Female Life. Jessica Kingsley Publishers: London
Murphy, M. (2011) “My performance of femininity and why it isn’t all about me.”, Feminist Current, viewed 20/08/2014,http://feministcurrent.com/3011/my-performance-of-femininity-and-why-it-isnt-all-about-me/
Whiteley, P., Todd, L., Carr, K., & Shattock, P. (2010). Gender ratios in autism, Asperger syndrome and autism spectrum disorder. Autism Insights, 2, 17-24.
Yaull-Smith, D (2008). ‘Girls on the spectrum’, Communication, Spring 2008. 30-31.
Zaks, Z. (2006) Life and Love: Positive Strategies for Autistic Adults.Autism Asperger Publishing Co: Shawnee Mission
Zwaigenbaum, L., Bryson, S., Szatmari, P., Brian, J., Smith, I., Roberts, W., et al. (2012). Sex differences in children with autism spectrum disorder identified in a high-risk infant cohort. Journal of Autism and Developmental Disorders, 42(12), 2585-2596.