How I Identify Autism in Undiagnosed Women
A year into my art therapy private practice, I refined my niche to highly intelligent women with overwhelming emotions and thoughts. What I didn’t realize was that this niche would attract a higher than normal amount of undiagnosed autistic women.
Why is that?
First, most undiagnosed adult women are typically highly intelligent. It is their intelligence that enabled them to go unnoticed in school. They excelled in their classes and were heavily praised. They did so well that people did not need to stop and take a closer look.
High intelligence also helped these individuals to learn masking and camouflaging skills that hide how they would actually like to behave or how they truly feel. They have the lived interior experience of autism, but it does not show externally.
In contrast, autistic boys display far more external autistic characteristics or coping behaviors that alert people to the possibility they might be autistic, such as overt stimming and outbursts.
Autistic girls, whether by nurture or nature, care far more about blending in socially and typically learn to mask these behaviors. They may have a desire to rock side to side or hum to themselves, but they do not because they are aware it makes them socially different. This leads many autistic girls to hold more inside, often leading to the development of depression and anxiety at an early age.
Undiagnosed autistic women often report feelings of anxiety and depression as children. They also report feeling intensely different or weird as children.
They also note difficulty making or keeping friends. They were typically socially awkward or found social events overwhelming.
I want to be clear that I do not think autism directly causes social problems; it’s actually a result of differences in perceiving the world. Autistic individuals have brains that perceive, function, and learn differently that others. It is believed that neural pathways fire more frequently and in conjunction with other pathways, resulting in a greeting intensity in senses, emotions, and thoughts.
For example, an autistic person may be able to hear better than a neurotypical. This makes them more sensitive to loud noises, so large parties and crowded places are overwhelming.
Many autistics need alone time to recover from overstimulation. Furthermore, many autistic deeply enjoy solitude, as it provides time for their special interests.
When I talk with someone who suspects they might be autistic, I talk with them about all of the above things. We also systematically examine six key areas of their life where autism characteristics present: senses, body, learning/thoughts, emotions, interests/passions, and social. We dig deep and explore all the various autism characteristics in each category. These deep discussions make it indelibly clear that someone is autistic, as well as what their unique autistic profile looks like.
However, many times clients come to me and do not suspect they might be autistic. As I mentioned, my niche of “highly intelligent women with overwhelming thoughts and emotions” attracted many undiagnosed women.
So how do I recognize autism in someone who has been masking and camouflaging their whole life?
I watch for some of the following key signs
Expressions of sensory sensitivity. For example, someone noting they can’t stand certain sounds or they have a strong preference or aversion to certain textures
Signs of exhaustion from daily activities and life. For example, someone explaining they hate going to parties or always so tired from socializing
Extreme self-awareness of differences, but can’t seem to change those differences. For example, I had one client who would continually go on tangents. She would then apologize profusely, but was unable to stop going on tangents.
Hyper attunement with me. For example, a client might apologize to me saying, “I’m sorry I’m moving so much.” This is a clue because it shows high self-observation, as well as hyper awareness of the impact on others.
Beloved subjects or hobbies they get very excited about.
Bursts of enthusiasm about specific topics. For example, a rather neutral client may suddenly light up with excitement about a specific topic and suddenly change their tone, facial expressions, and more.
Shifting eye contact or overly intense eye contact. Most masking autistics can make excellent eye contact when listening (which can feel overly intense), but struggle to make eye contact when talking.
This may sound like an odd list of signs and that anyone could exhibit one of these traits - and that’s true.
What I’m doing as a therapist is sitting back to take in the whole picture. These casual signs alert me to ask more pertinent questions related to the six key categories of autism (sensory, body, thoughts, emotions, and socializing).
Another key component is that for autistic people, their autistic characteristics have been present their entire lives.
As a therapist, I’m also listening for root causes of their feelings, thoughts, and behaviors. For example, I wrote an essay about how autism and CPTSD can look very similar, but their cause is different.
Once I strongly suspect someone is autistic, I begin to share about autism and how it presents in women. Usually, something clicks for them. When an undiagnosed autistic finally has an explanation for why they feel so different, they often deep dive into learning as much as they can about autism.
As we continue to dive into autism in therapy and they research on their own, a person typically becomes more and more sure of their autistic identity. Some clients choose to stick with self-identification, and some choose to go for formal diagnosis with a psychologist (you can read more about deciding whether to pursue diagnosis here).
Either way, it is an exciting experience to be a part of their autistic journey.
Thank you for reading. If you’d like to read more, sign up for my FUNletter. If you would like to explore your autistic identity with an autistic therapist, you can learn more about my therapy services here.