Gender Differences in Neurodiversity Diagnoses

Ahead of International Women’s Day on 8th March, it seemed fitting to talk about one of the biggest topics in Neurodiversity: varying rates of diagnoses between genders.

Surely the stats are what they are?

With ratios for many neurodivergent conditions showing greater prevalence in males than females, that would be an easy conclusion to come to; the idea that the data is reflective of reality. But we have to look at the wider context. Male:female dyslexia ratios have decreased from 9:2 in 1970 to 3:2 in 1998. The estimate of gender ratio in autism ranges from 1.3:1 to 16:1. The story is similar for other neurodivergent conditions.

Better understanding of Neurodiversity

As academics have started to question gender ratios in neurodivergent conditions, more research has been commissioned on this topic, like this piece showing that gender variation in dyscalculia diagnoses actually depends which diagnostic criteria are used. Research is showing more equal distribution between the genders, and this is turn is helping us to understand that our diagnostic criteria – and subsequently our interpretations of the diagnostic criteria – are gender biased. This piece from the Dyspraxia Foundation says that primary school teachers of dyspraxic girls were less aware of their symptoms than teachers of dyspraxic boys, and it’s easy to see why:

Boy tapping his foot = annoying

Girl tapping her foot = send her to ballet class

Boy lines up his cars = non-imaginative play

Girl lines up dolls = fashion show

Boy knows detailed train times = “Special Interest”

Girl knows Take That’s international tour schedule = Superfan

In addition to these inherent differences in how we view similar behaviours, girls seem to be better at what is called “masking”. Masking means putting extra effort in to make it look like you’re not struggling. It can involve mimicking friends or repeating lines from films or TV shows to hide the fact that your brain just can’t think of what to say next in a conversation. It could be asking someone to read something for you with a made up excuse so they don’t realise you’re dyslexic. Or saying “No, here’s fine” when your friend picks the table in a draughty spot in a restaurant. Under the speaker system. And a fluorescent light.

What impact does this have?

Missed diagnosis and misdiagnosis can have a devastating effect on girls and women. Imagine going to the doctor with a broken arm and the doctor saying “Yes, there’s definitely something wrong with your arm, let’s give you steroids to increase your muscle mass and see how we go.” This is happening to women who are being medicated for conditions they don’t have because the clinicians don’t recognise their presentation of a neurodivergent condition.

For even more women, Neurodiversity has an impact on mental well-being. Yes, our brains might have a minority wiring, but we feel isolated and “different”. When we don’t have a rationale for that difference and we can’t see it mirrored in the people around us that can really take it’s toll. This piece in The Times is from a lady in her 70s asking if it’s too late to get an autism diagnosis. Why get a diagnosis in that stage of your life? Because it’s confirmation that actually, you’re not weird or lazy or a failure, you’re just autistic, and there are other people out there just like you.

Next Steps

What to do if you think you are neurodivergent

Some people might signpost to a psychologist in this scenario, but I advocate for connecting with other neurodivergent people as a first step.

Why? Because a visit to a psychologist could result in a lengthy or expensive diagnosis process, and this isn’t about having a piece of paper in your hand at the end of the day. Neurodiversity isn’t something to frame and put on the wall. It’s about working out what works for you.

Self-diagnosis is valid among the neurodiverse community, so meet other neurodivergent people (online is a great place to start), and see if what they’re saying resonates with you. You will likely pick up some tactics for making your life a little easier too.

What to do if you think your child is neurodivergent

Again, it is worth connecting with other parents of neurodivergent children and also with neurodivergent adults, but you might also want to look at diagnostic criteria – adjusted for girls if you are looking for your daughter. There will likely be some signs to look out for that you weren’t necessarily expecting, such as:

For dyslexia: perfectionism, inconsistency and/or hyper-organisation

For ADHD: anxiety, low self esteem, day dreaming

For autism: anxiety, shyness, black and white thinking

If you think a friend is neurodivergent

Someone once said to me, “No one needs unsolicited feedback.” And while I do agree – the realisation you are neurodivergent can be life shattering and tear down the identity you have been building your whole life – I do understand that you want to help.

My suggestion is to start by helping with the things that appear to pose a challenge. For example, picking a table in a cafe away from the counter if your friend struggles with too much going on around them. Or introducing them to someone if they have no one else to talk to at a party. Calculating how to split the bill if they struggle with numbers. Sending a link in advance to the restaurant’s online menu if they are dyslexic or struggle with too much choice.

These sorts of accommodations will be far more valuable to your friend and will really have a positive impact for them.

Most importantly, keep reading about Neurodiversity because the more we understand ourselves the more we realise that there are other people out there just like us.

Hannah

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