We are failing to diagnose girls and women on the autism spectrum at such an incredible rate that some scientists think there is not a large gap between the number of males and females with Asperger syndrome – we just need to start diagnosing more competently. And this is urgent, because all people with Aspergers have a high rate of suicide, but it’s really high for women. I am a woman who was relieved to discover I have Aspergers, so I’m on a mission to help.
The best way to figure out if a woman or girl has Aspergers is to think in terms of categorizing people on a spectrum. On one end of the spectrum are super-social cheerleader fun-fun types whose emotional intelligence is super high. On the other end of the spectrum are the Albert Einstein types with very low emotional intelligence. Next to Albert Einstein types are typical males and next to typical males are typical females and then come the cheerleaders.
In this spectrum, Albert Einstein has Aspergers. And generally, when we wonder if someone has Aspergers, we compare that person to Einstein. (Or Sheldon on Big Bang theory or whoever your benchmark is.) Everyone else is somewhere on the spectrum either one, two, or three steps removed from the terrible emotional intelligence of someone with Aspergers.
But that picture only works for diagnosing men or boys with Aspergers. Women don’t function like men who have Aspergers. Women with Aspergers function like typical men. A way to think about this is that Aspergers shifts you down the spectrum one spot, to the next group. (This is called the extreme male brain theory of autism it is widely accepted.)
Standing out from the other girls. “The only girl to…” is a common refrain. Or taking classes with all boys. Being an outlier for gender is a risk factor for Aspergers. Do not judge a girl by how similar she is to boys with Aspergers. Look at how similar she is to other girls. The conflict between autism spectrum conditions and traditional feminine identity is the biggest clue we have when it comes to diagnosis. For example, I have vivid grade-school memories of being the only girl to play kickball at recess. Every day.
Good at math. This means good at math compared to other girls. The president of Harvard said the outstanding mathematicians are usually men. He is not wrong. Math and autism go together. So it makes sense that girls with Aspergers will be as good at math as math-smart neurotypical boys. And the boys with Aspergers will be the math gods.
Anxiety disorder. Unlike boys, girls with Aspergers can camouflage when they are younger. And people are likely to say their daughter is “a little different but totally fine”. But we need to redefine what it “totally fine,” because camouflage gets increasingly difficult as girls age: first it becomes exhausting, and then it becomes an anxiety disorder. My life is 100 times more manageable because I take medicine for anxiety, and this is true of most women with Aspergers.
Eating disorder. Most eating disorders emerge as an extension of a sensory processing disorder and/or OCD. Both these disorders are common for people on the autistic spectrum. But eating disorders are especially prevalent in girls with Aspergers. Even as we are under diagnosing girls with Aspergers, we know 20% of girls with eating disorders have Aspergers.
ADD or ADHD. Girls with Aspergers don’t look like they have ADD because they look like neurotypical boys. Even the teachers miss it. But look at attention levels compared to other girls. Most girls have longer attention spans than boys do. It’s not until puberty that boys catch up. Girls who look like they are “just being kids” are not okay. Girls need to look like they are “just being girls”.
Hyperlexia. Most girls with Aspergers love to read. Learning to read at age 2 or 3 is often a sign of hyperlexia. It’s related to Aspergers and it comes from a fascination with letters and puzzles rather than a love of stories. My son was in a classroom of autistic 3 year olds who could all read, and the classroom did not have any books with words because at that age the brain needs to develop social-skills patterning instead.
Dyslexia. Re-reading books, and reading series books are ways girls with Aspergers deal with dyslexia. Dyslexia, often means you can read but comprehension is low, and girls with Aspergers mask that with a high IQ at school and easy books at home. I was in honors classes but I read children’s picture books throughout high school.
Gender dysphoria. Studies show a high occurrence of gender disorder in autistic populations. For girls with Aspergers this issue is especially prevalent because thinking like neurotypical boys is already happening via Aspergers.
Refusal to cross the midline. This is walking before you crawl. In an older kid it looks like being clumsy. Or maybe impressively clumsy which we mistakenly label ambidextrous. Or it looks like having perfect posture, which looks awkward in a boy, but almost ballerina-like in a girl so people overlook it.
Sexually abused as a child or teen. Girls with Aspergers do not read danger signs as well as neurotypical girls, which makes girls with Aspergers much more likely to get into a situation that is bad for them. While the girl with Aspergers will think she’s acting within the realm of normal, a predator looking for a target will see the abnormality as an inviting sign.
Work in the sex industry. Understanding sexual norms is a social skill. Feeling embarrassment is also a social skill. So the sex industry doesn’t feel as emotional risky to women who have Aspergers. Also, its easier to get the unofficial list of social rules in the sex industry than it is in a typical workplace. In my first book I wrote about how I tried to be a sex worker, and now I understand that I couldn’t get someone to hire me because I never looked like I understood the rules.
Having a mother or paternal grandmother with these traits. Or having a mother who is white, college educated and raising children alone – that is, did not remarry after the loss of a partner. (Only 2% of white, college-educated women get divorced, but pretty much all moms except those with Aspergers find a new partner after a divorce.)
Having a weird laugh. Women laugh more than men. And for women laughter is a way to identify themselves as good partners. It’s a social skill. Women with Aspergers have a hard time figuring out how to use a laugh; often they choose not to laugh or they laugh in a stilted or uncomfortable way.
Which makes me wonder if you thought the ribbons in the photo up top are funny and appropriate for this post, or if you thought they were offensive. I wanted to buy them to hang on my wall. But I worried that neurotypical people would not like them, so I hung them in a post about Aspergers instead. Which is, perhaps, an example of me doing camouflage as an adult.
Since writing this post, I have received hundreds of emails from women who have Aspergers, and others who thought they might have Aspergers. I am hosting a free live video event on April 15th where I will answer all of your questions live. Sign up here to reserve your spot.