Autistic Women and Masking: The Road to Closing the Gender-Based Gap in Autism Spectrum Disorder Diagnoses

Abstract

The current state of autism spectrum disorder diagnoses reflects a skew toward men which is due to a bias in the diagnostic criteria. The diagnostic criteria in the DSM-5 fail to properly assess for alternative-to-male expressions of the disorder; one specific factor that is not adequately addressed is masking. Masking pertains to an individual’s ability to hide and adapt their autistic traits to appear more neuro-typical. Though any autistic person may have the ability to mask their autistic traits, recent research shows that more women than men possess this ability, and to a higher degree. Masking is not exclusive to adults; it is seen in autistic girls from a very young age. The diagnostic criteria need to be amended to account for an expression of autism under the cover of masking. If we do not change the way we diagnose autism, and we keep the insensitive and biased current criteria, we will continue denying diagnosis to so many autistic women who deserve support and acknowledgement. The first step in this process is to gain a better understanding of masking, and the best way to do this is to ask autistic women themselves for their expertise, experience, and guidance. Self-report is necessary in this exploration. I recruited five autistic women through Instagram and then I conducted five semi-structured interviews with each of those women, separately. During the interviews I used an interview guide that consisted of 27 open-ended questions, all of which were aimed at gaining knowledge about the experience of autism and masking for each of these women. I found four themes in common across the interviews: gradual realizations, routine yet forced masking, burnout and comfort-seeking, and advocacy for self.