MISIDENTIFYING FEMALES WITH AUTISM DUE TO SOCIETAL MASKING The expectations of how autism presents in females need to be revisited, reframed, and aligned with reality. Moves in that direction can help address the pressing issue of missed identification in this large group of young adult and adult autistics. This problem is at once urgent and multi-faceted: females are not only more likely to have been disregarded in the past (and still even today) in screenings and diagnoses, they are also more likely to have received prior inaccurate diagnoses in attempts to account for their symptoms, symptoms like anxiety and depression. Some women have faced years of therapy or pharmaceutical intervention to address a mental disorder that doesn’t exist, perhaps even being referred to inpatient treatment in institutional settings…to determine only later that autism is what is at the root of their difficulties. When finally identified, those who were misdiagnosed in the past can at last reclaim their lives through self-awareness and can begin to make use of greatly needed appropriate supports and accommodations. And, for the first time, they can accurately assess their needs regarding education, employment, leisure, and social relationships.
Another separate but often ignored reason underdiagnosis of autism in females is of special concern is because of the basic biological and physiological make-up of females. Menstruation, possible pregnancies, and inevitable peri-menopause and menopause each lead to wide hormonal fluctuations that hold formidable sway over the female experience in the course of a lifetime. The well-known phenomena of premenstrual syndrome and the far more impactful premenstrual dysphoric disorder, as well as post-partum or post-natal depression, all cause emotional dysregulation which can be severe.
Fluctuations in hormone levels impact brain chemistry and, due to inherent differences in autistic brains, are likely to affect autistic females differently. Despite these realities, researchers Jan Schlaier and Jacqueline Berko have recently asserted, “The topic of hormonal influences on women with autism has received scant attention from health care workers.” And unbelievably, Rachael Mosley and colleagues even determined as recently as 2022, “Nothing is known about how autistic women handle the menopausal transition.” Nothing?!? That is simply unacceptable.
Research I reviewed reveals a growing reality whereby some females are able to manage, mask, or cope with their autistic characteristics and symptoms all the way until reaching menopause, whereupon the onslaught of hormonal changes leaves them no longer able to do so, finally leading to a diagnosis. Clearly, the influence of hormonal variation on autistic females needs more attention.
As societal awareness grows regarding the many, varied presentations autism can take, progress in these areas needs to be swifter to help a growing population of adult autistics better understand themselves for improved mental, emotional, and physical health.
