Autistic Spectrum Disorder in females - (ASD) – Do you know the signs of this lifelong disability!

By Melanie Mahjenta. Ph.D.

Until recently autism seemed rare, but these days the healthcare system is more adept at identifying it. However, female presentation of Autism Spectrum Disorder (ASD) can be more challenging to recognise.

My daughter has an ASD and raising her has opened my eyes to the difficulties all young women with these conditions face in this world. If after reading this article you suspect that a young woman in your life may have an ASD, I would urge you to talk to her about it and consider seeking a diagnosis.

The ASD female may be a chameleon blending masterfully in, actively concealing her difficulties. She may wave her hands instead of flapping them. She’s more likely to internalize dysregulation, saving her meltdowns for her nearest and dearest when she gets home and it feels safe to vent. She may develop speech later than expected and be unable to process much verbal information, even though her hearing is good. She’s super smart but can’t decipher body language or facial expressions yet is visually talented and excellent at copying behaviour.

She’s the child who will wander in the night and gleefully run towards water and open spaces in the day. She’s very busy and needs physical boundaries, not just to keep her safe but just so you dare to take your eyes off her for a nano-second. She is the child with no danger awareness, gladly cuddling into total strangers and continually scaring you.

She’ll be running the taps and flicking at light switches nonstop in her sensory seeking. She will take longer to learn things, including the word NO! She will often wear a blank expression, or a veneer of haughtiness and she may struggle with eye contact. ASD individuals do sometimes make eye contact so it’s a myth that they can’t or won’t. An unusual use of, or the complete lack of eye contact is an appropriate definition to go by.

You may ask, "Why do we need to get her an ASD diagnosis? Most people turned out just fine without help!"

Did they really turn out just fine though? Possibly not. Today, there are adults among us with ASD who aren’t diagnosed. They are often struggling with major issues that are much more manageable, even avoidable, when other people understand and the appropriate interventions are applied. It can just be a relief for herself, to know and understand why they feels like an alien, speaking another language and living on the wrong planet!

The issues I speak of include ultra-high anxiety levels, affecting the nervous system, which can manifest in physical and mental health difficulties. She can socially isolate herself unable to sustain stable relationships or manage employment. She may be traumatised through social naivety and harbouring unreported cases of abuse, sexual assault and exploitation. Then we have her time management issues, eating disorders, and her meltdowns caused by her inability to identify stressors and effectively manage them, and so the list goes on.

These unrecognised stresses mean that suicide can be a last resort for those who are unable to fit intuitively into the social world. So those who went without a diagnosis years ago, were not necessarily better off. Her prior experiences and what she continues to experience today would alter drastically with the understanding of a diagnosis.

I am certain that years ago, many children with ASD were just considered naughty. It wasn’t then within our understanding that there were underlying auditory processing, cognitive, communication and sensory differences causing her behaviour as she just ‘looked normal’! Many girls with ASD are seen as smart, extremely polite, and well behaved. This is typically how an ASD female presents herself to the outside world. The meltdowns and challenging behaviours can often be an at home phenomenon where she feels safe!

It's important to get her assessed and diagnosed because she needs extra safeguarding measures in place at school and at home. She has special needs and so requires you to be her advocate. She masquerades, copying those around her without any real understanding, and as she gets older when she can no longer get away without social comprehension. Other children see her as a copycat and perceive that her social skills lack timing and quality in expression. She may be bullied and suffer constant rejection but doesn’t know what to do about it. Depression from not fitting in literally eats away at her soul.

School is her worst nightmare. The dinner hall is too loud and overwhelming where she may sadly or gladly sit alone. Often, girls with ASD do go on to college, despite struggling at school. Some do well whilst others cannot cope and drop out through the exhaustion of processing social and educational information, which can be debilitating without the reasonable adjustments and visual aids that having a diagnosis can give.

Research carried out by the National Autistic Society (NAS) recognized that Only 16% of individuals with an ASD manage to hold down a full-time job. It is also known that around 40% of ASD individuals have above average intelligence, this is despite possibly having an accompanying learning difficulty. They often are also gifted with a superb ability to hyperfocus so it is important that we support them with their talents and special interests so they can forge an enjoyable career and achieve great things.

As she grows older predatory peers may see her vulnerability and take advantage of her, leading to pregnancy, a ‘bad reputation’, and even STD's. She looks normal, beautiful, and is often viewed as mysteriousso the supportive social circles enjoyed by neuro-typical girls may reject her. She is often misjudged and considered weird, wrongly assumed as untrustworthy or suspicious due to her social awkwardness and the unusual differences she has in making eye contact.

Childlike friendliness and naivety can be mistaken for flirting, so even as an adult she can become victim of unreported workplace violence, gossip, or even sexual harassment. She may marry, yet struggle with the ‘normal’ aspects of a partnership, with in-laws, outside friendships, etc. Unless the woman with ASD finds a partner who respects her differences and her ‘bubble’ it can be a recipe for disaster. She could be susceptible to staying in an unhealthy or abusive relationship if her life is viewed through the lens of a self-esteem shattered by adverse childhood experiences. To her the abuse just seems normal.

Almost half of ASD adults have been abused by someone they thought was a friend.

37% of autistic individuals had been manipulated into doing something they didn’t want to do.

Over a quarter had money or possessions stolen by someone they regarded as a friend.

44% stayed at home as they feared harassment or abuse and over a third didn’t leave the house most days.

41% said they often feel lonely (compared to 11% of the general population) and two-thirds said they felt depressed due to loneliness.

To my view, none of these struggles constitute turning out “just fine”. Nobody should have to experience life this way. An ASD female can be happy, but the journey is mired in complications due to this disability. A diagnosis helps prevent females struggling through life unknowingly, and enables them to receive support and interventions to help cope in the world. We do often need to teach what may seem obvious to a neuro-typical person, as ASD individuals need to learn through their intellect that which others intuitively already know.

It's also really important for everyone to be aware and accepting of ASDs, which are highly heritable conditions and an alternative or neuro-diverse brain wiring. We all must be willing to respect other people's differences, and this comes from education and awareness. So please do not be afraid of an ASD diagnosis as this is the gateway to helping your loved one live the full life she deserves. Understanding herself is one key to happiness and internal peace.

If you suspect your child has an ASD you can see your GP and self-refer at https://childrenandfamilyhealthdevon.nhs.uk/autistic-spectrum-disorder/

The national autistic society also have a lot of information at https://www.autism.org.uk/