Written by Bana Shriky

You might wonder what the common factor is between Anthony Hopkins, Chris Packham and Greta Thunberg. The answer is autism. Recent research from University College London studied the variation in autistic traits according to gender and observed that a process known as ‘camouflaging’ is more prevalent in autistic females. Researcher, Dr Will Mandy, Associate Professor at UCL and co-author of the study, discussed the newly published work on autism at this year’s British Science Festival.

What is autism?

Autism is a lifelong developmental disability that affects how people perceive the world and interact with others. Some autistic people have learning disabilities and mental health issues that make them more vulnerable than the rest of population. Being a spectrum condition means that autistic people need different levels of support according to the severity of their case.

According to the National Autistic Society around 700,000 people are identified as autistic in the UK, an equivalent of more than 1 in 100 people.

Although having autism can create challenges, a lot of autistic individuals regard their syndrome as a neurodiversity that grants them a unique way of viewing the world and unmatched creativity and passion.

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The research: Autism and ‘camouflaging’

According to Dr Mandy, camouflaging refers to strategies and behaviours that are performed consciously or unconsciously to compensate for inherent autistic social differences. For instance, learning how to establish eye contact, control stimming movements or the use of practice ‘scripts’ for regular social interactions to mask the appearance of autism.

The largest study of its kind was published in the journal Autism and compared camouflaging behaviours between autistic and non-autistic males and females.  A total of 781 people participated in the study with an average age of 31 years old. The sample included 306 diagnosed autistic and 475 non-autistic adults. Participants were recruited from the UK, North America and various European countries including Germany and the Netherlands. 

All participants self-reported a 25 item questionnaire to measure their camouflaging strategies. The questions were designed to investigate three traits: compensation, masking and assimilation.

Results showed that autistic females scored higher than males on two out of three camouflaging questionnaire subscales, showing how females are more likely to cover up their disorder than males. No differences were found between non-autistic males and females.

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Implications for future diagnoses

The research findings suggest that clinicians must take camouflaging into account when diagnosing a person, particularly if they are female. Dr Mandy said, “lots of women are flying under the diagnostic radar,” and this needs to be addressed. The study suggests that high social awareness in females may lead them to experience and express their autism in different ways to males, resulting in females to be identified late or misdiagnosed altogether, a phenomenon known as the ‘female autism phenotype.’

Female camouflaging was also connected to internalisation of difficulties which may result in anxiety, stress and exhaustion from constantly ‘trying to act normal’. These prolonged masking behaviours were found to be associated with eating disorders, depression and suicide.

Autism is more common in boys than in girls. This has resulted in the majority of diagnosis models being developed and validated with male samples. Moreover, the male-to-female childhood diagnosis ratio is four-to-one. This means only 1 in every 5 individuals that are diagnosed with autism are women. However, the difference in gender diagnosis ratio is reduced to three-to-one upon reaching adulthood.  Dr Mandy and colleagues expect the difference to shrink further to two-to-one if diagnostic tools are adjusted to account for female camouflaging.

The general lack of knowledge of the female autism phenotype means that parents, caregivers, and healthcare providers may be less likely to look for symptoms of autism in girls.

Hannah Hayward, a research worker from King’s College London, explained that most of the newly diagnosed adults suffered from wrong diagnosis throughout their lives and were denied the support they needed. Their cases sometimes were concealed due to good coping mechanisms, otherwise known as camouflaging. For others, however, a diagnosis of autism was the missing key to knowing and finding peace with themselves.