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Passing the Test: Girls, Autism, and Stereotypes

November 23rd, 2020     by Lucinda Thee     Comments

Illustration by Mallory CK Taylor

Niamh McCann is a teenage girl who’s passionate about ballet, the plays of William Shakespeare, the environment and public speaking. In a TED talk she presented in 2018, McCann tells a story about her younger brother: he was diagnosed with autism when he was three and a half years old. Not many may expect that McCann, like her brother, is also autistic but, unlike her brother, was not diagnosed until the age of 14.

Getting a diagnosis wasn’t smooth sailing for McCann. The test was the exact same one her brother took, involving a bag of feathers, thumbtacks, and a book about flying frogs. And her score? A perfect zero. According to that test, Niamh was not autistic.

Unfortunately, this is not an uncommon occurrence among autistic girls. Many of them receive a late diagnosis, and some may not even be diagnosed at all. Autistic girls are on average diagnosed 1.5 years later than boys, according to a recent study published in the journal, Autism Research.

I myself was diagnosed with autism when I was four. Looking at the report for the test I took, I am surprised at the amount of emphasis on eye contact and play, omitting other factors such as sensory issues and masking, and putting less emphasis on stimming and special interests; these topics that were only given a tiny paragraph on the test.

I was only diagnosed because I displayed symptoms the test was looking for, rather than symptoms most autistic girls and women actually display. This is the reason why McCann and other autistic girls and women are taking to prominent platforms like TED talks: most autism tests are tailored to boys, which results in misdiagnosis in girls. Through sharing their stories, McCann and others hope to raise awareness of the specific issues that autistic girls and women face: misdiagnosis, stereotypes, and discrimination.

Gender discrimination begins at diagnosis. Most people can instantly recognize the stereotypical symptoms of autism — language delays, “meltdowns” (an intense reaction to an overwhelming situation, often mistaken for a tantrum), and aversion to eye contact. However, few may recognize the symptoms of autism that females are more likely to have. These symptoms include:

  • Stims, or self-stimulatory behaviour: constant repetition of physical movements, sounds, words or moving objects, such as chewing hair, tapping fingers, and heel raising
  • Masking: When an individual changes or “masks” their natural personality to blend in to societal norms. This may result in different people seeing vastly different sides of a person, which could be mistaken for borderline personality disorder.
  • Problems with executive functioning: Lack of attention span, difficulty organizing things, procrastination, lack of motivation to do a task
  • Special interests: These can be disguised as passions, hobbies or pastimes, such as literature, cooking or fashion.
  • Sensory issues: Highly sensitive to bright lights, loud noises and other strong sensations but may not outwardly express discomfort
  • Difficulty in understanding figurative language: Unable to understand idioms, irony and sarcasm
  • Other disabilities: Many autistic females are identified with mental health conditions like anxiety, depression, and borderline personality disorder, before they are diagnosed with autism.

Many girls are not diagnosed early because the people around them fail to recognize these little-known symptoms, many of which could be dismissed as “typical” for girls. For example, an autistic boy’s head-banging or arm flapping would raise more flags than an autistic girl’s nail biting.

In addition, tests to diagnose autism often miss out on these symptoms in favour of traditional ideas about the “extreme male brain.” This theory is based on the assumption that male brains are better at systemizing than empathizing, and that female brains are the opposite. Autism causes the extreme version of the “male brain” in autistic people. The tests that follow the “extreme male brain” theory primarily focus on facial expressions, basic social interaction, and obscure obsessions such as trains and flying frogs, like the test McCann took. The focus on childlike social interaction becomes even more problematic when the same diagnosis tests are performed on much older women, who likely do not enjoy playing with toys anymore.

Misdiagnosis is just the beginning. Stereotypes about autism erase autistic girls’ and women’s experiences and perpetuate stigma. Many people picture an autistic person as a young boy who dislikes social interaction and has frequent meltdowns, and think this applies to all autistic people. This stereotype can result in backhanded compliments, like “you don’t look autistic” or “you look really normal,” which erases autistic girls’ and women’s experiences and identity. Further, some people will distance themselves from autistic girls and women, because stereotypes tell them that we are “robots” who cannot feel empathy, let alone understand our own feelings.

The media, such as the movie Rain Man (1988)and the television series The Good Doctor (2017-), have perpetuated another common stereotype: that autistic people are good at mathematics, science, and computer technologies. These are already labelled as “masculine” interests and activities, which helps to “confirm” the assumption that only boys are autistic, and further erase autistic girls’ and women’s experiences.

Thinking about autism as a spectrum can help avoid stereotyping. It’s called a spectrum for a reason: it is difficult to fully differentiate from different levels of severity, and instead, each and every autistic individual has a few symptoms from a wide, diverse list, and every autistic experience is different. As Dr. Stephen Shore, autistic professor of special education at Adelphi University says, “If you’ve met one person with autism, you’ve met one person with autism.”

Beyond misdiagnosis and stereotyping, autistic girls and women can face additional challenges due to economic barriers, racism, and more. Autistic people from low-income families are less likely to be able to afford diagnosis tests or therapy. While applied behaviour analysis (ABA) has earned criticism from the autistic community for being misguided and even cruel, it is the most widely approved and, therefore, the most widely covered by insurance autism therapy in the U.S.. Many other therapies have been developed in recent years, but are not covered by most insurance plans, leaving many families with few options. One insurance company in Singapore offers a policy called SpecialCare (Autisim), but the high cost of this policy offers low coverage, and implies that autistic people are at a higher health risk than smokers. A lack of insurance exacerbates the financial burden on families with autistic family members, and shows the underlying systemic discrimination against autistic people and, to an extent, the disabled community in general.

Other social inequalities also impact autistic girls and women. Because of systemic racism, Black autistic girls are more likely to come from low-income backgrounds and have a lack of access to health services. Plus, when public service providers interact with Black autistic people, subconscious racism and prejudice causes them to be ignored, or worse. Black autistic girls and women may face added pressure to “disguise” their autism due to the common stereotype that Black girls and women are always stronger and tougher than white girls and women. This can cause extreme stress and anxiety, and they may be fearful of disclosing their autism to the people around them for fear of being shunned.

This also applies to other people of colour. Latina or Hispanic autistic girls and women may come from low-income families, too, resulting in a lack of access to health services in countries without affordable healthcare, like the United States. Additionally, Hispanic autistic people are less likely to be properly diagnosed in the U.S. because of language and cultural barriers. In the state of California, which has the highest population of Hispanic children, only 29% of doctors provide diagnosis tests in Spanish.

In Asian communities, autism isn’t a frequently discussed topic. The idea of “saving face”, or avoiding shame, is prominent in most Asian cultures and it is viewed as “disgraceful” to openly discuss disability in public. Many Asian families have high expectations for their daughters and dismiss autism as “bad parenting”, or regard the subject as “taboo”. One Asian-American parent of an autistic child recounted how she was criticized, ridiculed and shunned by other Asian-American parents for candidly bringing up autism. She was surprised that many Asians from Generation X — and even Millennials — knew little about the condition, and had never encountered an Asian autistic child. Even when Asian children are diagnosed, less than one percent of them receive extra help and guidance for their autism.

Misdiagnosis, stereotypes, and discrimination can have negative effects on autistic girls’ and women’s mental health. Due to social anxiety and the frustrating inability to express their feelings accurately, autistic people may find it difficult to confide in anyone. According to researchers from the A.J. Drexel Institute of Autism, about 70% of autistic people have at least one, if not multiple, mental health conditions, such as social anxiety and depression. When these go undiagnosed, they may affect an autistic female’s daily life. Autistic females may isolate themselves, avoid expressing their opinions, self-harm, and have suicidal thoughts — one recent study found that more than half of women with autistic traits reported having suicidal thoughts. Even their physical health may be affected, causing an increase in headaches and stomach upsets.

Autistic girls’ and women’s poor mental and physical health can also be exacerbated by abuse. In a 2018 study, autistic girls were found to be three times more likely to suffer from sexual abuse than neurotypical girls — meaning girls who do not have any neurodevelopmental differences (such as autism and A.D.H.D.). In one blog, an autistic person wrote about living through abuse as a child, and said he had low self-esteem, depression and Post Traumatic Stress Disorder as a result.

It’s important that we spread awareness about these issues faced by autistic girls and women. It is estimated that about one in one hundred people are autistic; you may be autistic, or it’s likely that someone close to you, such as a family member or friend, is autistic. We need to advocate for more accurate diagnosis, combat stereotypes, increase access to resources, and call out racism so that autistic girls and women can shine.

About the Author: Lucinda Thee (she/her) is a young writer in Singapore who is the youngest finalist in New Zealand’s NFFD Youth Competition 2020 and has been published in Overachiever Magazine, BAZOOF! and Skipping Stones. She is also a writer for websites such as Gen Z Writes and Plastic-Lite SG. Being autistic with mild scoliosis, she is passionate about writing about disability hot topics. She is currently addicted to puzzle-solving and website building.

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