Overlooking autistic and ADHD women has been the norm for generations. Gender bias in this field is a public health concern
I walked into the gym and froze. The kettlebells had been moved. Their colours were in a new order. The cardio equipment had been relocated. Nothing seemed how it was.
I felt uneasy and exclaimed to my personal trainer: “Everything’s wrong! They’re meant to be by the window!”
This wasn’t the first time I had experienced a visceral reaction to changes in my environment. I once became particularly distressed at the sofa being changed in my counsellor’s room. I used to torture myself over why I was like this. Why did I get so upset about things that didn't seem to bother others?
I was intelligent and a high achiever despite leaving my work until the last minute and operating on a constant rollercoaster of highly productive peaks and deeply depressed troughs. Yet the many decisions, steps and multi-tasking involved in cooking a meal could send me over the edge. It didn’t make sense. I was constantly exhausted. People exhausted me. Life exhausted me.
I now know I am dyspraxic, autistic, and ADHD. The depression, anxiety, and panic attacks I struggled with for years were likely burnout and sensory overload.
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Sex bias leads to late diagnosis—and misdiagnosis
Neurodivergent women and girls have been overlooked by the medical profession for decades. Traditionally, ADHD and autism have been perceived as male conditions, contributing to a two- to fourfold higher likelihood of diagnosis in males compared to females. The diagnostic criteria for ADHD and autism exhibit a male bias—partly because researchers historically recruited only boys and men to scientific studies. This has led to clinicians failing to identify women’s presentations of these conditions.
Clinicians, accustomed to recognising autistic features in boys, may also overlook or misdiagnose autism in girls. That’s if they are referred at all. Research shows girls are less likely to be referred for diagnosis despite exhibiting characteristics of both conditions. The chances of recognition are even slimmer if you aren’t white or middle-class. Women also often display less overt inattentive symptoms of ADHD; these differ from the externalised hyperactivity symptoms predominantly observed in males, resulting in an underdiagnosis of ADHD in girls.
Reading Sarah Hendrickx’s Women and Girls with Autism Spectrum Disorder was a lightbulb moment. She was describing me, my childhood, and my unique weirdness.
I couldn’t cope with uncertainty and change, however small. The wrong texture of clothes could drive me to lose my temper. I was an extremely bland and fussy eater. I couldn’t stand when things were ‘wrong’ or unjust. I would get fixated on what others could easily let go of. I spent my whole life trying to figure out what others meant when they spoke because they never said what they meant. I would become obsessed with topics and immerse myself, shutting everything else out.
