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

Intersectionalities with Neurodiversity

Neurodiversity can be a tricky topic sometimes. We can’t see it, so it is easy to forget when addressing diversity in our organisations. And we only know our own experience of the world, so different lived experiences can be difficult to understand.

But the biggest difficulty is that we can’t view different diversities in silos. If we are talking gender diversity, we are also talking racial equality and Neurodiversity, for example. We can’t address these differences in isolation if we really want to make a difference.

Gender

Did you know that for every female diagnosed autistic, 4 males are diagnosed? For ADHD, the ratio is 1:3

It is believed that prevalence is similar in both genders, and that women and girls are better at camouflaging or masking.

This means that when we look at gender diversity in the workplace, for instance, if we don’t consider Neurodiversity in parallel, we risk decreasing the pool of women we are trying to support by 20% (based on 1 in 5 being Neurodivergent), which in turn will impact our success rate.

Race

This short piece from the Open University articulates, far more clearly than I could, some of the issues around varied diagnostic rates between races.

To take one of their points as an example, in some Asian cultures it is considered rude to give eye contact to an adult or someone in authority, and children are discouraged from doing so. And yet lack of eye contact is often considered one of the markers of autism. Unsurprisingly, diagnoses of autism among Asian people in the UK are half that of people classed as white British.

This is another group of people where Neurodiversity can be under recognised, and potentially impact our hiring, retention and job satisfaction.

Mental Health

Ok, you’ve seen where this is going…

This article from Psychology Today pulls together a number of sources, explaining that 3 in 10 children with ADHD also suffer from anxiety, and children with dyspraxia have been show to have higher levels of anxiety than their peers as young as 3-4 years old.

There is also research showing that the risk of suicide in individuals with “mild”* autism is 10 times higher than in the general population. It also found that autistic women are more likely than autistic men to commit suicide, despite suicide being more common in males in general.

The interesting thing here is that we know that conventional mental well-being practices do not work for neurodivergent people. Suggesting someone with ADHD take a meditation or yoga class is like telling a fish to take a long walk. Some might be able to do it, but it’s not the solution for everyone. DBT has been shown to be more effective than CBT for neurodivergent people, for example.

We need to extend our mental well-being offerings to ensure that everyone can benefit.

LGBT+

Possibly a result of being more likely to challenge social “norms”, it has been found that 70% of autistic people identify as non-heterosexual:

In fact, the intersection between autism and LGBT identities has its own Wikipedia entry.

Age

We know that there are higher rates of Neurodiversity diasgnoses in children, and high rates of research on children. But those children grow into adults, and those adults grow old. And yet there is very little research on the impact of Neurodiversity as we age.

This study found that only 0.4% of autism research focussed on older adults. But how does Neurodiversity impact the menopause, with its hormonal changes, sensory issues and emotional impact? What about the significant life change of moving from work to retirement and its impact on our routines, which in many cases keep us grounded? What about the emotional and executive function challenges of juggling work, children and grandchildren?

What can we do to make sure neurominorities are adequately represented?

There are two key things we need to keep in mind to ensure not only that we are driving inclusion for neurodiverse people, but also that we are maximising the impact of other diversity initiatives:

1. We need to treat everyone as an individual. Each person we engage with has a distinct “diversity profile”: everyone has a gender, a race, a sexual orientation, an age, etc. and we must treat each person as a whole rather than as a sum of those parts.

2. We must ensure that Neurodiversity is a strategic priority on our people agendas across organisations. This will help to drive other diversity metrics, plus creating the psychological safety for individuals to feel comfortable to disclose will increase the accuracy of any Neurodiversity metrics in place. Because until there is psychological safety, those metrics will measure rates of disclosure rather than true rates of diversity.

Hannah

*This article uses the term “mild autism”, which has been repeated verbatim here, but we do not subscribe to this idea. It can be harmful to describe autism as “mild” because it plays down the challenges that the person has.

Adult Diagnoses

I went to a secondary school that had the motto “know thyself”. It never struck me as odd – as a teenager I interpreted it as “be true to yourself”. It was only later in life when I realised how little some of us actually do know ourselves.

Our understanding of neurodivergent conditions is increasing, and as a result many adults are facing earth shattering realisations that they have spent their whole lives being neurodivergent. This isn’t like realising you’ve got a cold; it smashes apart everything you thought you knew about yourself for you to pick up the pieces and put them all back with a different lens. Like starting with a Picasso and refitting the pieces into a Rembrandt.

Why is it important to talk about adult diagnosis?

Well, 2 reasons that I’d like to focus on – though there are many more.

Firstly, inclusion only works when it is top down. Senior leaders across all industries including the public sector need to be aware of diversity issues and promote inclusive practices for their staff and their customers. But there is a remarkable lack of senior leaders who are open about their neurodivergence.

In the UK, Vice Admiral Nick Hines, one of the most senior members of the Royal Navy, recently went public about his Autism diagnosis. Nick had been diagnosed at the age of 45, but waited 10 years before coming out, saying that he did so in order to make the Navy a better place to work.

You can read about Nick’s story here.

Adrian Chiles (yes, him off the One Show) also opened up last year about his recent ADD diagnosis, which he talks about here.

And Eastenders actress Luisa Bradshaw White revealed just last week that she is Bipolar, saying, “ [I] am shocked I didn’t get diagnosed earlier as I see patterns of it throughout my whole life”

But these individuals are in the minority. Every person in a position of influence or responsibility who is open about their neurodivergence is demonstrating that success is not reserved for neurotypicals, and is helping to breakdown the stereotypes and stigma associated with Neurodiversity.

An great example of leadership in practice comes from GCHQ. When they realised they needed staff with a skill set that matched the dyslexia profile, it was their Director of Strategy, Policy and Engagement along with two dyslexic employees who fronted the campaign.

Undiagnosed neurodivergent adults

And the second point I want to touch on is, what about all those adults out there who haven’t yet had their Eureka moment? The adults who might seek a diagnosis (or self diagnose) in 5, 10, 20 years time? At the moment, they are in the workplace, or meeting up with us for coffees, perhaps they are family members, and they aren’t any less neurodivergent than they will be when they get that piece of paper to make it official.

This means that our inclusive practices need to be wider that a strategy just aimed at neurodivergent people who have been diagnosed. We need accessible and inclusive practices that allow everyone to flourish, regardless of how and whether we label ourselves.