Females in Neurodiversity

Image courtesy of psdgraphics.com. Female symbol.

Female (noun) – is the sex of an organism, or a part of an organism, that produces non-mobile ova (egg cells). Most female mammals, including female humans, have two X chromosomes.[1]

Okay, done with the definition. Last time, I discussed why males are more likely to have a neurodiverse condition. It’s their single X chromosome and sex hormones that makes them more susceptible to developing neurodiversity. But that doesn’t necessarily mean females are exempted in neurodiversity.

Oh?

Males may more likely to be identified and diagnosed with neurodiverse conditions, but sadly, females are more likely to be missed when diagnosing learning disabilities and developmental disorders.

Image courtesy of keepcalm-o-matic.co.uk. Wait, this proverb doesn’t mean girls are exempted from having developmental differences.

But why are females are harder to diagnose than males in neurodiversity?

One reason may be the differences in behaviors between boys and girls. We know that boys in general tend to draw more negative attention in schools. One report showed that boys represent around 85 percent of all discipline referrals. Another showed that 22 percent of boys had been formally disciplined, versus 8 percent of girls.[2] Let’s use ADHD as always as a classic example: boys with ADHD tend to show more hyperactivity, impulsivity and physical aggression than girls with ADHD. That behavior makes them stand out from the other boys. Meanwhile, girls with ADHD are more likely to show a different set of symptoms and side effects. These include anxiety, depression, constant talking, daydreaming and low self-esteem. But their behavior appears more typical of how other girls behave.[2]

In short, males and females in neurodiversity present different symptoms.

(C) Cartoon Network. Er, not the Powerpuff Girls. But basically, sugar, spice, and everything nice don’t make girls immune from neurodiversity.

Another thing that makes it difficult to diagnose females in neurodiversity is this: the female sex itself. In my previous post, one study showed that the double X chromosome seems to be a protective barrier for females against genetic, chromosomal, or environmental hazards. For example when having chromosomal defects, females are almost always unaffected, thanks to their double X chromosome. While one X chromosome is defective, the other X chromosome is usually normal, and that saves the female from developing chromosomal defects.

“When you look at the X chromosome, there are 1,500 genes and 5 percent are important to brain development…imagine you’re a male, any mutation that even makes the protein produced a little weaker or less efficient, now you’re stuck with that,” researcher Evan Eichler, a professor of genome sciences at the University of Washington School of Medicine, said. “The female, because she has two X chromosomes, chances are if she has a defective mutation on one of those genes, she can compensate because she has one from the other parent.”[3]

“The female, because she has two X chromosomes, chances are if she has a defective mutation on one of those genes, she can compensate because she has one from the other parent.”

It’s like “the heir and the spare” sort of thing.

Another study also confirmed that females at better in overcoming effects of genetic mutations that makes them less likely to manifest symptoms of neurodiversity. The researchers in Switzerland theorized that women are better able to overcome genetic mutations, compared to men. Despite the fact that females had more mutations – and larger mutations – they were less likely to develop diagnosable neurodevelopmental problems.[3]

“Girls tolerate neurodevelopmental mutations more than boys do. This is really what the study shows,” said study author Sebastien Jacquemont, an assistant professor of genetic medicine at the University Hospital of Lausanne, in Switzerland.[4]

Image courtesy of imgarcade.com. Wait, girls, don’t celebrate yet. More mutations are needed for girls to develop learning disabilities and developmental disorders.

This so-called female protective model lessens girls to have neurodivergent conditions, but more genetic mutations are needed for a female to develop such conditions.

Reason: anatomical. It is based on brain-imaging studies which suggest differences between the patterns of internal connection in male and female brains. Male brains have stronger local connections, and weaker long-range ones, than do female brains. That is similar to a difference seen between the brains of autistic people and of those who are not. The suggestion here is that the male-type connection pattern is somehow more vulnerable to disruption by the factors which trigger autism and other cognitive problems.[5]

Let’s see how male brains differ from female brains:

Image courtesy of clearmirrorhealing.wordpress.com. No, not that sort of brain… although this is true ^_^

Image courtesy of The Guardian. Male brain neural map.

The male brain pattern. Now, let’s look at the female brain.

Image courtesy of The Guardian. Female brain neural map.

Ah, it’s complicated. But more connections are there in females’ brains.

Another reason: females’ compensation to hide neurodiverse symptoms. For example, in autism spectrum disorder (ASD), while young males are “obvious” in their symptoms, young females “mask” their symptoms by compensating their behavior. Because ASD causes “social blindness,” kids with ASD don’t know how to interact with other people. While boys are reluctant to this, girls are more aware of their difference. To compensate for their difference, girls “shapeshift” in order to be similar to neurotypical girls to have interaction.

Shapeshift?

Shapeshifting is a term coined by The Curly Hair Project.[6] It is the ability of an ASD female to copy the social graces of a neurotypical in order to bond with other people.[6] The process goes like this:

Observe –> analyze –> understand –> react[6]

First, the ASD female observes how neurotypical girls bond (making eye contact, grooming, updates about fashion, romcoms, and boys, observing facial expression, body language, gesture, tone of voice, etc.). Then, the ASD female analyzes these observations and then understands why such gesture is done, i.e. flirting is done to see whether a man is interested to her or not, why empathizing a friend is helpful, etc. From there, the ASD female shift into that what the other person needs us to be[6] to interact with other people.

In summary, shapeshifting in ASD is one way of females compensating for their neurodiversity, comparable to an actress rehearsing her script.

(C) The Curly Hair Project. The Shapeshifting Process in ASD.

(C) The Curly Hair Project.
The Shapeshifting Process in ASD.

To better illustrate shapeshifting in ASD females, let’s use the little mermaid as an example. Mermaid/nymph tales (The Little Mermaid, Undine, Rusalka (Dvorak’s opera), Selkie, etc.) involve mermaids falling in love with human princes and desiring to be human as well. To be human, they exchange their voice (communication) for legs, which makes them human, but mute. Unfortunately, these tales have a sad ending. Except for the Disney version of Little Mermaid where Ariel lives happily ever after with Prince Eric, most mermaids fail to win the prince’s love and end up either dead or damned.

In fact, one article in Patheos described how mermaids are similar to ASD females: …these tales—three faces of one story—involve water creatures shape shifting into human form, rather than humans transforming into animal form. What a curious emotional stunting we see on the part of humans—in these stories, we do not return love, we do not recognize love, we betray love, we mistake coercion for love. In the little mermaid’s case, there is an inability to communicate…the symbolic loss of her tongue could equally describe the inability of the prince to understand or register her voice.[7]
Much like the ASD female’s shapeshifting effort. Though she is successful into morphing into a neurotypical girl, her true self is lost like the mermaid’s loss of tail and voice just to be liked by other people, regardless whether people will actually like her or not, and this is double whammy when people don’t like the ASD female despite her shapeshifting (I’m totally related to this experience, though…)
And the author concluded: “These stories of the waterfolk who occasionally rise to the surface and mingle with us remind me to stay alert for the variety of intelligences that nudge and stretch our concept of what it is to be human, to be normal. What would it be if we reframed mental difference, psychological outliers, as filled with potential? Gifted, rather than different, strange, wrong, needing to be fixed?”

(C) Disney. The little mermaid is autistic? Shapeshifting in ASD females are already illustrated by mermaid tales when falling in love with humans.

“These stories of the waterfolk who occasionally rise to the surface and mingle with us remind me to stay alert for the variety of intelligences that nudge and stretch our concept of what it is to be human, to be normal. What would it be if we reframed mental difference, psychological outliers, as filled with potential? Gifted, rather than different, strange, wrong, needing to be fixed?”

The flip side: compensating for neurodiversity is mentally exhausting. Unlike neurotypical girls who interact intuitively, neurodivergent females use their conscious effort to compensate for their symptoms. This result in mental drain and can cause anxiety, depression, obsessive-compulsive disorder, eating disorders, and phobias. Not good because psychiatrists usually first detect these mood disorders instead of the developmental/learning disability itself.

What it is like for a female in neurodiversity?

While most neurodiverse conditions’ symptoms mainly apply to males, females present different symptoms aside from showing different behavior, having double X chromosomes, and conscious masking behaviors. And the worse part is that female neurodiverse symptoms are considered ideal in society thanks to the sugar, spice, and everything nice thing, which makes it harder for specialists to diagnose females.

(C) Wikipedia. Mary Pickford portraying an ingenue, which has the ideal behavior of girls and women in society ( which makes females in neurodiversity very ideal, ignoring their true symptoms).

Except for hyperactive or tomboyish females in neurodiversity, most of them fit into the “ingenue” (an innocent or unsophisticated young woman) category. Very ideal in society, but ignoring their true symptoms.

Image courtesy of Slideshare. Females in neurodiversity can be considered females with hidden disabilities.

Now, the bottom line: This make females in neurodiversity at more risk of all the hazards she can face thanks to her hidden disability. Risks include development of mood and eating disorders, educational underachievement (or overachievement, which is bad either as it results in more stress), unemployment or underemployment, social isolation, and/or relationship difficulties and becoming domestic violence or rape victims, and these are more common to females with undiagnosed ADHD and/or autism.

This is no joke. While girls’ niceness can seem lovely to the eyes of the authorities, they outgrow these when reaching puberty. And after puberty, the fall into the slippery slope of misery, wondering why they are weird or something and/or disorganized, making neurodiverse symptoms worse and damaging to their well-being.

An article from the Atlantic describes how females with ADHD suffer: Further, while a decrease in symptoms at puberty is common for boys, the opposite is true for girls, whose symptoms intensify as estrogen increases in their system, thus complicating the general perception that ADHD is resolved by puberty. One of the criteria for ADHD long held by the Diagnostic and Statistical Manual, published by the American Psychiatric Association, is that symptoms appear by age 7. While this age is expected to change to 12 in the new DSM-V, symptoms may not emerge until college for many girls, when the organizing structure of home life—parents, rules, chores, and daily, mandatory school—is eliminated, and as estrogen levels increase.[8]

In “The Secret Lives of Girls with ADHD,” published in the December 2012 issue of Attention, Dr. Littman investigates the emotional cost of high-IQ girls with ADHD, particularly for those undiagnosed. Confused and ashamed by their struggles, girls will internalize their inability to meet social expectations. Sari Solden, a therapist and author of Women and Attention Deficit Disorder, says, “For a long time, these girls see their trouble prioritizing, organizing, coordinating, and paying attention as character flaws. No one told them it’s neurobiological.”[8]

As for females with ASD, they experience the same difficulties ADHD females, not being socially attuned, having psychological problems due to their neurobiology plus combining with common problems neurotypical females face.

According to SEN Magazine in their article about autism in girls: It is not until puberty that girls’ social difficulties become more obvious, particularly as they enter secondary school when they can become the subject of bullying or can be generally marginalised and perceived as strange. Unlike boys, they become withdrawn, depressed and quiet, rather than aggressive.

Profound anxieties may be demonstrated in altered behaviours, lower grades at school, poor sleep patterns, low mood/depression and obsessive behaviour.

Research from 2011 found that many women who were later diagnosed as being on the autistic spectrum initially were thought to have learning difficulties, personality disorders, obsessive compulsive disorder or eating disorders (Rivet and Matson, 2011). This differential diagnosis could be related to lack of awareness of how ASD present in females.[9]

In the book ‘Asperger’s Syndrome for Dummies’ (Gomez de la Cuesta & Mason 2010), the authors touch on this issue and describe different ‘types’ of women on the autism spectrum. At work, women experience ‘a glass ceiling that is double glazed’ according to the authors. Women experience the same difficulties as other women, plus the difficulties experienced by women on the autism spectrum.[10]

Undiagnosed learning disabilities (LDs) can be a slap on the face too. Girls with LDs tend to overcompensate their difficulty, which may or may not yield good results, making them at risk for verbal and emotional discrimination, i.e. teachers/professors and employers may call her stupid/dumb or irresponsible, making her prone to unemployment.

Image courtesy of dual diagnosis.org. Depression is usually the common feature of women in neurodiversity.

Final note: While LDs, ADHD, and ASD are now beginning to be recognized by the commonfolk, their presentation to the female population must not be ignored and awareness of these must be continued or pushed further. Remember, females in neurodiversity are still females and humans with the same needs as the rest of us: understanding and acceptance.

Reference

  1. http://en.wikipedia.org/wiki/Female
  2. https://www.understood.org/en/learning-attention-issues/getting-started/what-you-need-to-know/do-boys-have-learning-and-attention-issues-more-often-than-girls
  3. http://www.foxnews.com/health/2014/02/27/study-reveals-why-autism-is-more-common-in-males
  4. http://consumer.healthday.com/cognitive-health-information-26/autism-news-51/gene-study-offers-clues-to-why-autism-strikes-more-males-685295.html
  5. http://www.economist.com/news/science-and-technology/21597877-women-have-fewer-cognitive-disorders-men-do-because-their-bodies-are-better
  6. http://thegirlwiththecurlyhair.co.uk/blog/2014/05/17/asd-females-shapeshifting/
  7. http://www.patheos.com/blogs/sermonsfromthemound/2014/07/shapeshifting-autism-and-the-little-mermaid/#sthash.524lMZc7.dpuf
  8. http://www.theatlantic.com/health/archive/2013/04/adhd-is-different-for-women/381158/
  9. https://www.senmagazine.co.uk/articles/articles/senarticles/is-autism-different-for-girls
  10. http://www.autism.org.uk/about-autism/autism-an-introduction/gender-and-autism/women-and-girls-on-the-autism-spectrum.aspx

Further Reading:

  1. http://www.theguardian.com/society/2015/feb/10/victims-domestic-violence-abuse-women-learning-disabilities
  2. http://www.theatlantic.com/health/archive/2013/04/adhd-is-different-for-women/381158/
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