Recently, I have come across a lot of information about women and autism. And it has me questioning things regarding women and mental health diagnoses. As I reviewed the literature and anecdotal stories, I realized that as clinician's we may often miss the mark when it comes to women.
We are often told to leave bias and other barriers to meeting the client where they are at the door, but I know this is very hard because we are all human. The more I read the research the more realized that we need to dig deeper when it comes to treating all clients; especially women who may be on the spectrum. Often when women struggle in social settings, they are given a diagnosis of anything from social anxiety to generalized anxiety all the way to borderline personality disorder. But research suggests that due to the way women are socialized, especially in the Western world, they are more adept at masking and fitting in socially because, for people assigned female at birth, being pleasant, sociable, friendly, and pleasing is something we are modeled and taught at very young ages. If a woman is struggling socially, she may have learned at a young age how to blend in in order to meet expectations. This becomes even more complicated when we consider different cultures of color and socialization. Most BIPOC people living in the Western world have learned many ways to adapt to the environment as a minority. This confounds getting an accurate diagnosis for both BIPOC men and women. This brings me to the question that I began to reflect on, is it a spectrum issue or socialization?
As someone who was assigned female at birth and is a member of the BIPOC community this question is almost a conundrum.
Staying aware of the fact that autism presents differently for those assigned male and female at birth is important to keep in mind. This understanding brings home the fact that becoming more aware of ourselves has the ability to help improve quality of life, relationships, communication and mental health overall.
In the Psychology Today article 10 Key Signs of Autism in Women by Dr. Claire Jack, some of the key differences that women on the spectrum present with are:
Social difficulties: Women with autism often find it difficult to read and respond to social cues. Many women navigate this difficulty by creating a social “checklist” and learning how to respond to people in socially appropriate ways. They often feel socially anxious, ruminate on their social interactions, and may end up feeling left out and lonely—despite their best efforts to be sociable. While autistic women may interact well in one-to-one situations, they often find it very hard to be in groups and may feel exhausted after too much social interaction. These feelings can often lead to symptoms of anxiety and depression, hence why women, especially BIPOC women, may receive these diagnoses more often.
Camouflaging/Masking: Autistic women tend to have a greater desire to be sociable than autistic men and spend a considerable amount of time and energy in masking, or camouflaging, their differences in order to pass as “normal.” Although neurotypicals of both genders and autistic men also camouflage, women with autism tend to do so to a far higher degree. Masking may look like a woman simply mirroring or mimicking behaviors, for example, laughing at a joke other people are laughing at although they either don’t think it's funny, don’t get the joke, or a combination of both.
It is harder to notice these behaviors in women due to the way females are socialized in western society. What makes diagnosing even more difficult is when it comes to camouflaging\masking. BIPOC people, especially BIPOC women, not only deal with higher expectations to be sociable, but also cultural implications to assimilate not only to the majority culture but often to their very own cultural expectations.
BIPOC women, especially black women, have the double whammy of the typical expectations of females in the Western world AND the cultural expectations of the oh so dreaded stereotype of the “strong, black woman” as well. Black women are supposed to be able to cope with almost anything and keep going, right?? These types of assumptions and expectations makes masking/camouflaging a draining, disappointing, and defeating daily activity for black women who are not on the spectrum. Imagine how it must feel for those that are ON the spectrum??
So, how can we as therapists, friends, families, allies, or concerned members of the public discern if a female, especially a BIPOC female is on the spectrum or managing, struggling with cultural expectations? Consider using the CATINA method. The CATINA method is a way for mental health professionals to provide person-centered, knowledgeable, and more effective treatment when working with a female and/or BIPOC clients who may be on the spectrum.
CATINA stands for:
Test your EQ
Check out the printable PDF for the FULL explanation of the CATINA method and how it is used to help identify and serve female, BIPOC clients.
Along with cultural expectations, spectrum diagnoses are given far less to BIPOC individuals and the studies on BIPOC people on the spectrum are even farther and fewer between. According to the article ‘Autistic while black’: How autism amplifies stereotypes by Catina Burkett “There is a debate in autism research about whether race should be considered in evaluating how well therapies work. In 2016, Jason Travers and his colleagues analyzed 408 peer-reviewed, published studies of evidence-based autism treatments. Only 73 of them, or 17.9 percent, reported the race, ethnicity or nationality of participants. Of the nearly 2,500 participants in the 73 studies, fewer than one in five reported their race — and 63.5 percent of those were white.”
In the end, although there is no “cure “for autism, an accurate autism diagnosis can help raise awareness, give neurodivergence more diversity and, increase understanding about what it means to be on the spectrum. This insight has the potential to raise self-awareness for those on the spectrum and the people who interact with them, which can translate into improved quality of life, mental health, and mental health treatment.
10 Key Signs of Autism in Women. Claire Jack, Ph. D. Psychology Today. April 29, 2021
‘Autistic while black’: How Autism Amplifies Stereotypes. Catina Burkett, LICSW. Spectrum Viewpoints, January 21, 2020.
The CATINA Method. Sean Inderbitzen. Where Autism and Mental Health Meet. August, 2, 2020