Autism Spectrum Disorder

“Could I Be Autistic, Too?” Signs of Autism in Women with ADHD

Autism in women is misunderstood — and commonly misdiagnosed or missed altogether in the presence of an existing condition like ADHD. Here’s an overview of what autism can look like in women with ADHD, along with diagnostic considerations and strategies for fighting through the misinformation of society and the medical establishment.

ADHD is traditionally thought of as a little boy’s disorder, and doctors are less likely to pick up on inattentive-type symptoms that don’t overtly disrupt a classroom or home. For these reasons and many more, it can be challenging to receive an accurate ADHD diagnosis as a female.

It’s equally challenging for an autistic woman to be officially diagnosed with autism spectrum disorder (ASD).

Why? The reasons are similar: Women are socialized to mask their autistic traits, and even when they don’t succeed in hiding the signs, autism is perceived by many as an exclusively male condition. The older an autistic woman gets without a formal diagnosis, the more likely clinicians are to be skeptical when she seeks an autism evaluation. These women often hear, as I once did, that they seem “too normal” or have had too much success to be autistic.

These sentiments are borne out of misinformation, which can affect the most qualified psychologists and scientists when it comes to women on the spectrum. The presentation of autism in adult women varies greatly from that of the young boys clinicians typically see. And since the current DSM-5 diagnostic criteria are based on studies of mostly boys and men, it is common for women with the same neurological variations to slip through the cracks.

Autism and ADHD in Women: Overview

ADHD vs. Autism: Similarities and Differences

Autistic women and women with ADHD can share the following traits:

[Take This Self-Test: Autism in Adults]

ADHD is diagnosed when a patient has symptoms of inattentiveness, hyperactivity, and/or impulsivity. For an ASD diagnosis, however, the patient must have clinically significant difficulty with social interaction or communication, and unusually restricted or repetitive patterns of behavior or interests. In fact, many autistic people have a “special interest” — a topic or subject that they are heavily invested in and are more knowledgeable about than most.

Autistic individuals are also more likely to have sensory processing disorder, discomfort making/maintaining eye contact, and hyper-logical methods of thinking, with a tendency to be extremely literal.

How Do I Know if I’m Autistic?

If you are an adult female and suspect you may be on the autism spectrum, you are not alone. it’s important to evaluate your behaviors in light of your other diagnoses. For example, if you already have an ADHD diagnosis, your executive functioning difficulties can be attributed to that diagnosis. Thus, determining whether you could be autistic as well requires a closer look at behaviors related to social communication, need for routine, sensory differences, and logical/literal thinking.

Autism traits may also be masked to some degree by your gender socialization, as many women typically learn to hide autistic traits that would otherwise prompt a diagnostic evaluation.

[Read: What Does Autism Spectrum Disorder Look Like in Adults?]

Take social camouflaging – or when someone on the spectrum intentionally or unintentionally mimics other people’s social behaviors to cover up their autism traits. Autistic people often use this coping strategy after experiencing negative social interactions (making the camouflage a reaction, not an instinct). Social camouflage is distinct from the traditional development of social skills because the individual has no intuitive understanding of why the social norm exists.

Autism in Women: Diagnostic Considerations

If you are seeking a diagnosis, prepare yourself to face skepticism — possibly even from your clinician. Unfortunately, anyone without a nuanced understanding of the spectrum may be doubtful of a seemingly “normal” adult female requesting an evaluation.

That’s why it is essential to work with clinicians who have experience diagnosing autism in adults. It is especially helpful if they have knowledge of any existing diagnoses, like ADHD, and have previously evaluated or counseled other women. While the research on autism in women is sparse, first-hand experience can equip these clinicians to accurately assess the possibility of autism.

The good news is that experienced, knowledgeable psychologists and psychiatrists do exist, and one of those individuals will take your concerns and questions seriously. The clinician will likely evaluate you using a combination of diagnostic surveys and interviews with you and someone who knew you as a child. Generally, this is a parent, but it could be any person who observed you consistently before age four or five. After your doctor gathers this information, it will inform your diagnosis.

You can decide to be evaluated at any point in your life. Receiving my diagnosis, at age 19, improved my relationships with family and friends. I didn’t become a different person, but afterward I could articulate my ways of thinking and perception.

Autism in Women: Accommodations and Treatment

There is no universally prescribed medication for people on the autism spectrum. Prescription treatments more often address a comorbid condition, such as anxiety, mood disorders, ADHD, or seizures.

However, almost all autistic people are encouraged to try cognitive behavioral therapy (CBT). This talk-based counseling can help autistic adults identify and process the ways they experience the world differently. A therapist can help an autistic patient develop an understanding of social rules or learn how to advocate for themselves in a work setting.

It is important to note that an adult with autism can determine which new skills they want to learn and which personal differences they want to keep or change. By contrast, many young children placed in Applied Behavior Analysis (ABA) therapy are trained to behave “less autistic” while still too young to parse out how being on the spectrum affects their sense of self.

Accommodations for people with autism include creating sensory-friendly spaces, establishing clearly defined social rules, and holding neurodiversity-based autism education in the community. In a work-place, there might be the provision of a job mentor or the flexibility to work from home.

Autism in Women: Dispelling Myths

The medical establishment has been slow to develop an accurate profile of autism in women with low support needs. (Instead of calling an autistic person “high-functioning” or “low-functioning,” it is more accurate and respectful to describe them as having high, medium, or low support needs. Someone with high support needs likely requires very frequent assistance completing everyday tasks and is unlikely to be able to live independently. Someone with low support needs — what was once called Asperger’s syndrome — likely requires fewer accommodations.)

Though our knowledge of autism, especially in women, is increasing, it has been slow to make its way into the mainstream. It’s why common myths like the following persist, and why we must work to raise awareness:

1. Is ADHD on the autism spectrum? No. there is a clear distinction between the two. ADHD and autism are separate neurological differences that can both exist in the same person. Scientists have suggested that the two conditions have a biological connection, which causes a high rate of comorbidity.

2. Autistic people feel little or no empathy. This is categorically untrue. Some autistic people report feeling their emotions more intensely than most. This stereotype seems more connected to the social nuance used to convey emotion/empathy than to the actual experience of it.

3. You can immediately tell if someone is autistic. There is no way to know whether someone is autistic just by looking at — or talking to — them. Still, many people can’t accept the fact that someone who isn’t obviously disabled could be on the spectrum. In fact, I often hear people say to me, “You don’t look autistic!”

4. People who are extroverted can’t be on the autism spectrum. It’s easy to see why this myth has arisen, but it isn’t true! Someone can have difficulty with social communication and still enjoy interacting with other people. Being naturally extroverted does not preclude autism.

Even though we have a long way to go toward neurodiversity empowerment, I encourage potentially autistic women to explore the possibility. As our ranks grow, perhaps the world’s understanding of us will grow as well.

Autism in Women with ADHD: Next Steps

Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.