By Katie Munday (they / them)
Historically, being Autistic was considered a male childhood experience, with boys more readily diagnosed than girls. This trend is still prevalent in many areas of autism research but thankfully the gap between male and female diagnosis and realisation is slowly closing. As is the access to diagnosis and realisation for transgender, non-binary and gender divergent individuals.
There have been many reasons why many girls and women have been overlooked for diagnosis including (but not limited to); systemic misogyny and transphobia, autism research which favours ‘male’ traits and cultural gender stereotypes.
Systemic misogyny and transphobia
Misogyny across medical systems, which upholds ideas of female ‘hysteria’ and over-emotionality, means women are more likely to be disbelieved or wrongly diagnosed with personality differences and mental health issues. These diagnosis can then cause access issues to Autistic identification.
Professionals are not seeing the very real connection between what would be considered ‘disorders’ (what I prefer to call embodied self-preservation) and Autistic experience, which often includes consistent trauma. So, even when females are diagnosed with personality differences they are often overlooked for also being Autistic.
Access to diagnosis is also difficult for transgender and gender divergent individuals who wish to transition medically. Often these people are left to choose between being supported with their Autistic diagnosis or gender affirmation, but very rarely are they given the opportunity for help with both. Unfortunately, Autistic people are still seen as children who do not understand gender and therefore are not ‘really’ transgender. This infantilsation denies Autistic people gender affirming healthcare and many forgo an autism diagnosis so they can get help with the more immediate need of living their authentic gender.
Many people turn up to gender identity health clinics because they are confused by their gender and need help untangling it all, some of us live in gender flux and fluidity and this confusion should never mean punishment. All gender experiences are relevant, and all people should have access to gender affirming and diagnostic healthcare, this means creating more support for people of colour, queer people, physically Disabled people and all other marginalised groups.
Autism research which favours ‘male’ traits
Across 70 years of autism research the most researched group of people have been young white males. This means that all criteria for diagnosis, and the supposed ‘support’ which comes with it, is based on ‘male’ behaviours. Anyone who does not present these traits are not considered Autistic and may be misdiagnosed with another form of neurological difference.
The very few Autistic people who fit the stereotype of Rain Main and Sheldon Cooper have the privilege of far fewer barriers to diagnosis. However, girls and women, transgender and non-binary folk and males who do not show these traits are often overlooked as we do not live up to the standard of male stereotyped Autistic traits.
This is further complicated for those of us who are people of colour, physically Disabled, Queer and trans because our social ‘difficulties’ are often understood as a common ‘impairment’ of our other marginalised identities. This is a glowing indictment of the racism, ableism and queerphobia within medical systems but also within places of education, work and anywhere else we are seen as being ‘problematic’ or ‘too much.’
These male stereotypes are based around white western ideals of behaviours; giving eye contact, staying still, keeping quiet, but ideas of ‘appropriate’ behaviour vary across different cultures. There are many indigenous cultures, for example, which deem eye contact as incredibly rude, but this is not accounted for in white western medicine.
Autism research has focused on male stereotypes for so long that the idea of a ‘female autism phenotype’ has arisen. Not only does this create even more barriers for those of us outside the binary but it also continues to other female Autists, favouring males as the ‘real’ Autistics. (I could, and probably will, write a piece on the ‘female phenotype’ but I lack the spoons to write about that particularly misogynistic, racist and transphobic idea at the moment).
Cultural gender stereotypes
Criteria for diagnosis, which favours males and is steeped in misogyny, are based on the undeniable inequality that all of us who aren’t cisgender male face.
Girls and women are often overlooked as Autistic as they often (strangely!) fit western female stereotypes. Many of them are either quiet: “she’s so shy!” or very talkative: “they’re quite the chatter box!” These vast differences in communication, confidence and the need to talk are both seen as inherently female: potential non-speaking or hyper-verbal traits are often considered as just a ‘girl thing’ and therefore often overlooked.
In many Western cultures, girls are kept young, virtuous and innocent for as long as possible. This can run parallel with the interests of Autistic people who often stay loyal to their hobbies for longer than their neurotypical peers. This is often misunderstood and pathologised as developmental regression but it is just the lack of fear we have about enjoying what we enjoy loudly and proudly!
Heteronormativity also plays a big part in gender stereotypes; girls are to grow into women who have children with a man and keep the household. Girls are explicitly and implicitly told that they are to grow up to be the main caregiver of children, do all the housework and most times squeeze in a full or part time job. Due to this many women are exhausted beyond measure; this is considered a cultural norm and does not consider neurological differences.
As we know, burnout between neurotypical people and Autistic people are vastly different, add in the overwhelming responsibilities placed upon women and we are sure to suffer poor mental health. Unfortunately, these cultural norms feed into misogynistic medical systems, which suggest that mums simply need to ‘rest more’ or pop a few Xanax and carry on exactly as they are. There never seems to be any understanding that this burnout is due to being Autistic, as well as living in a garbage heteronormative world. Less still can it be seen for what it often is: an Autistic person raising other Autistic young people in a world that is simply not made to support or enrich us at all.
So how can we de-centre the ‘male’ Autistic experience?
Firstly, challenging oppression benefits us all and this is in no way a fight against men and boys who also deserve diagnosis, support and acceptance. I want to create a world in which we can all reach understanding and support earlier in our lives.
Unfortunately, systemic misogyny and transphobia, focusing on ‘male’ traits and cultural gender stereotypes are all reciprocally determinant, they reinforce each other and are a difficult cycle to break.
Difficult, but not impossible.
Change won’t come overnight. It comes from the writings of brilliant Autistic academics and those of us who continue to put pressure on politicians and policy makers, the advocates and activists who show up every damn day to fight our oppression.
No contributions from any of us who stand up to oppression is small – we are all part of a bigger movement to change systemic ableism, racism, transphobia and bigotry. We can change things through our anger, through our writing, for showing up for one another, through social media, protests, pride events, Autistic run conferences, supporting Autistic artists, activists and writers.
These acts can and will invoke change so that the Autistic kids of tomorrow have more of a chance at Autistic joy, pride and acceptance.