Young children gradually learn to adapt their behaviour and language to suit different situations. They will behave in one way in the playground and another way in the classroom. They will use different language when talking to a grandparent and when talking to a friend.
Children on the ASD spectrum find these adaptations to behaviour and language almost impossible to navigate. They have to be constantly alert in order to avoid committing social blunders, always watching their peers to work out what is acceptable and what is not. This continual social manoeuvring is made even more challenging because of the children’s poor understanding of the rules governing social interaction. If you laugh for too long or too loudly at a joke, you will be considered weird. If you don’t laugh at all, you will be accused of not having a sense of humour.
ASD children will mask their natural responses and emotions in order to fit in, and negotiating such tricky interactions all day, every day will leave the children exhausted.
Social communication difficulties are common in both boys and girls on the autistic spectrum. However, as a result of their early socialisation, girls tend to be compliant, sociable, considerate and more likely than boys to try to blend in with their peers. This behaviour will come at a high cost when the girls mask their real feelings in order to be the same as everyone else. The need for good social skills accelerates in secondary school, and this is the time when many children experience a dramatic decline in their confidence; feeling isolated and mis-understood.
Traditional assessments for autism were designed with boys in mind, therefore boys’ behaviour is more likely to match the diagnostic criteria. The implications for women and girls of research that involves only male subjects, is just beginning to be acknowledged. Characteristics displayed by autistic females will not always fit the accepted ASD profile. For example, one recognised autistic trait is that of having all-consuming interests. Such interests have traditionally included: transport systems, mechanics, science fiction, numbers, computers or gaming. Girls’ special interests are more likely to be socially acceptable, for example: pop stars and bands, horses or collecting soft toys.
As a result of the lack of awareness about the presentation of ASD females, misdiagnosis is common: 42 % of women and girls receive at least one mis-diagnosis before securing an appropriate one. Common mis-diagnoses include: anxiety disorders, mood disorders, depression, borderline personality disorder, eating disorders and even schizophrenia. Women and girls are likely to experience isolation, loneliness, fatigue, anger and poor self-esteem as a result of such mis-diagnoses; but then be seen by professionals in relation to these secondary conditions, and prescribed unnecessary drugs or given ineffective treatment.
The present government launched a consultation in the summer of 2021 to explore gender inequality within the UK health system and to recommend the improvements that need to be made.
Following this consultation, the government will publish a ‘Women’s Health Strategy’ in the Spring of 2022. The need for research trials to reflect all members of society will be part of this strategy.
It’s been a long time coming, let’s hope it’s worth the wait.