Embracing the Diversity of Neurodivergent Females
This Part 1 of a series, “Hiding in Plain Sight”
5 min read
What You'll Learn
How does autism manifest differently in females?
What symptoms can co-exist with autism and ADHD?
The need for updated tools
The landscape of psychological assessments for autism is undergoing a crucial transformation, in both child and adult autism evaluations. As specialists in psychology here in Charlotte, NC, we are advocating for a more nuanced approach. It is critical that we recognize the unique ways autism and related forms of neurodivergent manifests in females.
Internalized Complexities
Autistic females often internalize their social challenges, which can manifest with co-occurring conditions such as anxiety, depression, and ADHD. This internalization is a coping mechanism that can result in the under-diagnosis of autism in females, as their behaviors might align with societal norms, including engaging in "typical" special interests.
Autistic females may develop intense interests in specific topics, characters, or media franchises. For example, they might immerse themselves in the intricate details of a particular book series, movie saga, or television show, often demonstrating impressive knowledge and enthusiasm. Some autistic females may have special interests in creative endeavors such as drawing, painting, writing, or music. They may spend countless hours honing their skills, exploring different techniques, and expressing themselves through their chosen artistic medium. Another common special interest among autistic females is animals. They may have a deep fascination with certain types of animals, such as horses, cats, or marine life, and eagerly acquire knowledge about their behavior, habitats, and care.
The tendency for autistic females to camouflage their symptoms further complicates the diagnostic process, making it imperative for psychological evaluations to be gender-informed and strengths-based. Autistic females may engage in social mimicry or imitation to blend in with their peers and conceal their differences. They might observe and mimic neurotypical behaviors, such as maintaining eye contact, using appropriate body language, or mirroring social cues, in an effort to socially tune in to others. Some autistic females may suppress or mask their emotional responses to avoid drawing attention to themselves or appearing overly sensitive. They might internalize their emotions, adopt a stoic demeanor, or mimic the emotional expressions of others, even if they don't fully understand or experience the same feelings.
“My autism isn’t what makes me stand out, it’s what makes me unique.”
Overlapping ADHD and Autism
The intersection of adult autism and ADHD presents additional diagnostic challenges. Symptoms of ADHD can sometimes overlap with or even conceal the characteristics of autism. Autism and ADHD share some common symptoms, such as difficulties with attention, executive functioning, and social interaction. This overlap can make it challenging to differentiate between the two conditions, particularly in adults who may have developed coping mechanisms or camouflaging strategies to mask their difficulties. Both autism and ADHD are spectrum disorders, meaning that they can manifest differently in each individual. Therefore, ADHD testing and autism psychological services must be comprehensive, considering cognitive abilities, language skills, adaptive behaviors, social-emotional functioning, and executive functioning skills.
Several studies have indicated higher rates of ADHD symptoms or diagnoses among autistic individuals compared to the general population. Approximately 30% of autistic children and adolescents also meet criteria for ADHD. Regarding autistic females specifically, research on the co-occurrence of ADHD in this population is limited compared to studies focusing on males or mixed-gender samples. Some research suggests that ADHD may be underdiagnosed in females with autism due to differences in how symptoms manifest and diagnostic biases that may favor males. However, more studies are needed to better understand the prevalence and characteristics of ADHD in autistic females.
Providers in our area, Charlotte, NC, and beyond are called to skillfully use updated tools for assessment, to detect the often-subtle signs of autism in females. By embracing a neuro-affirming perspective, practitioners can ensure that autistic females are no longer "hiding in plain sight," providing them with the accurate diagnoses and tailored support they need to thrive.
References
"ADHD Symptoms in Children with Autism Spectrum Disorders: A Systematic Review and Meta-analysis" by Josephine Barbaro and Cheryl Dissanayake, Journal of Autism and Developmental Disorders, March 2014
"Prevalence of ADHD Symptoms in Children with Autism Spectrum Disorders" by Rebecca A. Lehman, Laura A. Cochran, Julie M. Byrd, and Terry F. Maski, Journal of Autism and Developmental Disorders, April 2013
"Prevalence of Co-occurring Mental Health Diagnoses in the Autism Population: A Systematic Review and Meta-analysis" by L. V. Fortuna, L. C. Porche, and E. G. A. Padilla, JAMA Pediatrics, August 2015
“Being different doesn’t mean being less. It just means being you.”
ABOUT THE EXPERT
Dr. Gray Gray — Psychologist & Expert Evaluator
Dr. Gray has 25 years of experience with adults and children. She enjoys connecting people to resources and was a founder of the Charlotte Autism Consortium with the hopes of raising awareness of autistic strengths. Having started her career under the mentorship of Dr. Gary Mesibov at UNC within the Department of Psychiatry, she recognized early on the important need for coordinated care and collaboration with providers across various disciplines. Dr. Mesibov, co-founder of Division TEACCH and internationally recognized leader in autism research and practice, underscored the importance of embracing all of the unique strengths autistic people bring to the world. As a result, Dr. Gray has been inspired to utilize a strengths-based and therapeutic approach to assessment and intervention. She fosters the development of self-compassion and shared understanding through her clinical work and advocacy.
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