Recently, there have been many discussions surrounding the unique experience of Autistic girls when it comes to diagnosis, misdiagnosis or even being undiagnosed. Amongst individuals diagnosed with ASD there is a pronounced gender difference, with the ratio of girls to boys being significantly lower. Most recent statistics of autism prevalence show there are around one in 100 people that are autistic, with the ratio of boys to girls at 3:1. However, it is believed that the true ratio is thought to be much more equal, with the implication that there are several girls whose symptoms are being left undetected therefore undiagnosed.
As a parent of two neurodiverse girls, one diagnosed with ASD who has masked since a young age, the statistical ratio gap between girls and boys with diagnosed ASD has been a topic I have wanted to explore further.
Among the challenges autistic individuals encounter, the concept of masking stands out as a prominent issue. In my studies for the NASENCO qualification, I explored the challenges faced by autistic girls that are sometimes caused by masking or inadvertently cause masking.
There is a stereotypical view of autism and girls are typically not falling under diagnostic criteria possibly somewhat due to masking or hiding their authentic selves. Masking therefore, has a significant impact on diagnosis in women and girls and their misdiagnosis or late diagnosis can lead to poor mental health and emotional wellbeing.
The implication of all this is that we, as practitioners should be better equipped to spot the signs of masking and camouflaging early on so to support individuals with ASD the best that we can in education. I believe that autistic children themselves offer the best insight into how to create an inclusive education where they can thrive and learn. The way we teach and are taught to teach is often not the best way for children to learn.
Masking is hiding, supressing or camouflaging true emotions or traits in order to conform to societal expectations. Sometimes individuals develop elaborate, energy consuming behaviours in order to succeed in interactions with non-autistic people.
The motivation for masking might also come from deep anxiety or rejection sensitivity causing panic and trauma at the hint of getting anything wrong or being found out. This kind of masking is so deep routed and second nature or unconscious, that it becomes almost impossible to recognise any autistic traits meaning these individuals, more commonly girls, go under the radar and are left undiagnosed. Although it may seem these individuals are coping, if left undiagnosed and without support, they can start to unravel during pre-teen years where other children start to develop socially more complex relationships and the autistic child is left floundering.
Mimicking and copying are masking behaviours. When individuals mask this way, they are hiding the challenges and difficulties they have with social interactions which can cause huge problems. It is mentally exhausting to continually supress your natural social reactions.
In my last school, one parent described her daughters’ meltdowns as intense offloading from an overload of overstimulation, anxiety and exhaustion. I have also experienced this behaviour with my own 15-year-old, whilst her school and teachers paint a much more subdued picture of her self-control and demeanour.
Although the general consensus is that masking is ‘hiding’ one’s true self and this is not a positive action, masking can be seen by some as successful. For example, it can be tool to help individuals live in a world they don’t feel is designed for them in order to partake in whatever elements are required and then retract again. Masking is then only negative or destructive when an individual does not truly know themselves.
Most people would argue that authenticity is essential for mental health and well-being. For individuals with ASD, authenticity comes with its own challenges and can highlight their differences apart from their neurotypical peers which for some will feel uncomfortable. This can be alienating and may attract negative attention which can be unforgiving of those who do not conform to their social norms.
Masking should not necessarily be avoided, rather acknowledged or recognised. Individuals should not be told to stop masking, but be encouraged to get to know their authentic selves to help them to explore strategies of managing their exhaustion.
I recently watched a series of short films about ASD illustrating how different autistic minds work and helping individuals connect their loved ones with authenticity. In one of the films, the individual explains the challenges of autistic masking and describes masking as never speaking her native language. She describes feeling that if she didn’t hide her differences people wouldn’t like her. She even use the term for her masking being a ‘mimic’, copying other people. The powerful film ends with the individual deciding to embrace her authentic self, but not without concerns. One of these concerns being that other’s may think she needs fixing.
Whilst embracing authenticity for some, may foster self-acceptance, confidence and a sense of belonging within the autistic community. It should not be forced upon individuals. Girls should, however, be given the opportunity to express themselves authentically free from the pressure to conform to societal norms.
The stereotypical view of autism favours a generalised savant male view such as portrayed in films like Rain Man and Mercury Rising. Thirty years after its release, the film Rain Man still sets the bar for what we understand as autism: boys and men who are extremely good at maths and do not understand other people.
Arguably, these media depictions of Autism have influenced attitudes about and towards Autistic individuals. These stereotypes have quite possibly had a detrimental impact on women and girls with ASD as they have simply slipped under the radar and failed to be noticed or diagnosed.
Many women and girls now diagnosed with ASD have had a long journey of misdiagnosis due to these stereotypes and other reasons. There are a number of reasons that girls are misdiagnosed. Girls with ASD have better social integration skills than their male peers with the same traits and better coping strategies for managing their socio-emotional struggles. Strategies used to combat these struggles include following social stories or learnt scripts, and masking their innate ASC behaviours.
Girls with ASD also do not noticeably have so many repetitive behaviours as their male peers. This leads to misdiagnoses, delayed diagnosis or even lack of diagnosis which leads to a negative outlook for the future.
There are high levels of mental health issues in women with ASD due to not being able to access the right support to regulate or improve their mental health and wellbeing meaning more specialised support services are needed.
Early diagnosis can empower families, practitioners and healthcare professionals to create inclusive environments supporting girls to identify and maybe learn to embrace their authentic selves.
Navigating the challenges of masking versus authenticity is a journey fraught with obstacles for autistic girls.
Everyone deserves to feel accepted and should be given the freedom to be their authentic selves as part of the world, not the non-autistic world.
As practitioners, we must aim to enable this unmasking and create environments that celebrate our differences not segregate them in order to prevent a negative impact on one’s mental and emotional wellbeing.
We need to do more research and be more in tune with the huge variation in characteristics and not have a ridged view of what constitutes ASD.
Although we are making inroads into identifying more girls with ASD, the fact remains that there are still so many women and girls that have gone under the radar and remain undiagnosed
It is therefore imperative that we equip ourselves better to look for signs and symptoms of masking in order to identify individuals appearing neurotypical but who are actually camouflaging their neurodiversity.
