A doctor has shared a reason as to why women with autism are more likely to experience 'masking' as a psychologist reveals three early signs of the disorder.
While autism is more common in boys than in girls, with some research suggesting this may be due to biological factors, experts have put forward the idea that women may be under-diagnosed.
Now, there are a number of reasons why autism can often go unnoticed in girls and women with autism as such individuals may end up 'masking', learning to hide their symptoms to fit in socially.
What is masking?
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"Masking or camouflaging can be described as hiding, disguising, or suppressing parts of yourself to try and fit in with people around you," explains Dr Selina Warlow of The Nook Clinic (a neurodevelopmental clinic).
"It can be a common trait in spectrum conditions, and it is a trait which we will often see in women and girls with autism. However, men with autism may also mask."
Dr Warlow adds that masking is a more common trait in people with autism 'who may mask to avoid prejudice, stigma, bullying and discrimination to blend into a neurotypical world'.
Are women more likely to mask than men?
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The short answer is, often yes.
"Girls and women with autism often mask their traits more than men due to societal pressures, stronger social mimicry skills, and differences in how autism presents itself in females," Dr Warlow explains.
The expert adds that women and girls are often socialised to prioritise relationships and conformity.
This, in turn, can mean that more subtle social struggles or socially acceptable special interests are less easily recognised.
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"Diagnostic tools based on male presentations often miss female traits, reinforcing the need for masking. Greater awareness of these gender differences can improve support and reduce the need to camouflage," Dr Warlow notes.
What are the signs of masking?
According to Dr Warlow, masking in autistic individuals can include' rehearsing responses in your head, or suppressing self-soothing actions like stimming [repeated movements or vocalisations, like hair-twirling or flapping the hands]'.
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"They may force eye contact despite discomfort or endure overwhelming sensory environments to avoid standing out," she continued.
The expert also notes how masking can take a toll on a person's mental health and energy levels, adding: "These efforts are often exhausting and can lead to feelings of fatigue and low mood.
"In some children, they may experience 'meltdowns' when they get home. Some individuals with autism can also describe feeling like they feel disconnected from reality or feeling like they don’t know who they really are."
What can help with masking?
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"We would encourage neurodiverse individuals not to feel that they need to mask," says Dr Warlow.
"It may be helpful for them to advocate for their needs instead, for example, to explain that they experience social or sensory overwhelm and need to leave the room for five minutes, or not to attend certain events if they feel overwhelmed – rather than feel they need to tolerate this and then feel overwhelmed afterwards."
Dr Mikki Lee Elembaby Psy.D, a New York-based psychologist from Clarity Therapy NYC specialises in autism assessment and diagnosis and has shared three signs of autism in young girls rather than adult women which may be missed.
They may struggle socially but be great at imaginative play
'Imaginative' or 'pretend' play is largely based on a child’s imagination, although some think children with autism struggle with this form of play the most. This type of play is considered sophisticated because it involves cognitive abilities such as abstract and creative thinking.
"Many autistic girls love storytelling and pretend play, but struggle with the unspoken rules of socialising," Elembaby told the Huffington Post. "Research suggests they develop coping strategies to 'blend in', making their autism harder to spot."
Finding friends may feel exhausting
Girls often do find friendships overwhelming and stressful, with Elembaby explaining: "Boys often show obvious social difficulties, [but] autistic girls may have close friendships but feel exhausted by them.
"Their social struggles are more internal, making them less noticeable."
Repetitive behaviours that seem ‘normal’
Elembaby previously said men with autism might fixate on numbers, trains or mechanics which are all associated with autism.
However girls with autism might fixate on other topics, such as: "Collecting dolls, memorising TV scripts, or obsessing over fictional characters might not raise red flags - unlike lining up toys or fixating on numbers, which are more associated with autism in boys."
If you think your child has autism, the NHS says you can speak with a GP, a health visitor for children under five, any other health professional your child has contact with, or a special educational needs (SENCO) staff member at your child’s school.
Rhiannon Ingle