Nuanced Considerations for Diagnostic Diversity Within Autism Spectrum Disorder (ASD)
At Elevated Insights Assessment, our psychologists bring over a decade of expertise in comprehensive psychological evaluation services, specializing in the diversity within autism. Our team of testing psychologists have advanced training on mild and nuanced presentations of autism which are frequently missed, particularly in females.
Research confirms that unique challenges exist for females in obtaining an accurate diagnoses, emphasizing the role of symptom presentation, diagnostic awareness, and potential misdiagnosis.1 This study also revealed that females were more likely to be misdiagnosed, with the majority of these misdiagnoses involving personality disorders, especially borderline personality disorder.
Did you know that on average, females are diagnosed with autism an average ten years later than males? Specifically, females often present less overtly with the “hallmark” characteristics of autism. They tend to be internalizers, or prone to processing emotions internally.
Females may also show intense interests in subjects/themes that are “socially expected” which tend to blend in. Research also shows that females are much more likely to be socialized to present in stereotypical favored ways that lead them to blend in among their neurotypical peers.
Blending In: Masking or Camouflaging
Unfortunately, these behaviors which are commonly referred to as masking or camouflaging not only delay recognition of autism, but typically lead to significant exhaustion, fatigue, and burnout.
- Masking or Camouflaging are terms used to describe a (conscious or unconscious) strategy used to hide, suppress, or control certain characteristics to assimilate within social situations. They can also include mimicking, imitating, and learning certain social behaviors to use within social settings.
It’s important to recognize however, that across all genders and ages, many autistic individuals tend to mask depending on situations and environments. This can show up as suppressing behaviors that are much needed to regulate themselves.
Autistic Burnout
Autistics can end up overcompensating by masking and camouflaging leaving them emotionally and physically drained.
- Autistic Burnout is a term used to refer to a state of emotional, physical, and mental exhaustion which impacts functioning to a significant degree.
Autistic burnout can occur from substantial overwhelm and distress related to navigating a world typically designed for neurotypicals and can last from several days to several months. It can include increased differences in sensory processing, challenges with concentration and focus, difficulties completing tasks of everyday life (such as working, driving, paying bills, hygiene, eating, sleeping, etc.), withdrawal, and meltdowns. Extreme fatigue and exhaustion are common, and individuals often see an increase in symptoms of anxiety and depression along with chronic pain or illness.
Fortunately, strategies exist to mitigate autistic burnout. Immediate recovery from autistic burnout includes the minimization of external demands coupled with patience, persistence, and self-grace and love. This will look different from person to person, as there is much diversity within autism spectrum disorder, and should include increasing rest and relaxation, which may include withdrawing socially.
Identifying what external demands can be minimized, outsourced, or delayed is essential. Reengaging in passions and enjoyable sensory experiences can help autistic brains reenergize and recharge. Oftentimes, individuals greatly benefit from participating in mental health interventions with licensed neuroaffirming providers who have expertise in neurodivergence.
Supporting Diversity Within Autism
Accommodation, interventions, and systems of support are essential. For school– aged children, public schools are able to implement formal learning plans (504 Plan or IEP- individual education program). Certain institutes for higher learning exist and are able to set up accommodations to increase accessibility for individuals.
For an autistic adult, workplace accommodations are also available. Unfortunately, initiating and accessing the required accommodations is often another uphill battle that requires increased effort and energy. Working alongside a system of support such as family/friends, licensed healthcare providers, academic/workplace supervisors, and connecting with the autistic community can all promote self-advocacy. There are many resources that exist to empower autistic individuals to learn more about available supports.
At Elevated Insights Assessment, our team of neuroaffirming clinicians are specially trained to identify nuanced presentations of, and the diversity within autism, through comprehensive psychological assessments. Our clinical expertise requires ongoing training and research that allows us to partner with you to identify the hidden characteristics of autism that have been missed- misdiagnosed, misunderstood, and masked. We seek to empower and uncover one’s unique brain style within a safe and inclusive space to identify areas of strength and vulnerabilities that can inform accommodations, interventions, understanding, awareness, and advocacy.
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by: Jennifer Paz Ryan