A brief history of autism and why women are often overlooked

by Dr. Lisandra Mendoza

The understanding and treatment of autism have undergone significant changes since the term was first coined in the early 20th century. This evolution is not just a testament to scientific progress but also reflects a growing societal awareness and acceptance of neurodiversity. Today, Neurodivergent-Affirming Therapy is an approach that recognizes and respects the unique experiences of autistic individuals.

History of autism timeline

The early days: From misunderstanding to recognition

Autism has a history of being misunderstood and misdiagnosed. In the early 20th century, it was frequently conflated with other conditions, such as childhood schizophrenia, leading to a range of inappropriate treatments. The prevailing view was that autism was a form of mental illness, and many treatments focused on addressing perceived deficiencies rather than understanding the unique ways autistic individuals experience the world.

Psychiatrist Eugen Bleuler first coined the term “autism” in 1911. Still, it was the Austrian-American psychiatrist Leo Kanner who concluded it was a neurodevelopmental condition that needed further attention and research. In 1943, Kanner published a paper describing eleven children who displayed unique characteristics of autism, such as “happiest when left alone” and with “an anxiously obsessive desire for the maintenance of sameness.” He also noted that these children “have come of highly intelligent parents,” and their “relation to people was altogether different.” 

Dr. Kanner’s research proved to be very important for the field and the study of autism, as it distinguished autism from schizophrenia and other mental health conditions that were frequently mistaken for one another or incorrectly grouped together. His emphasis on “infantile autism” established the groundwork for future studies, and he was well-known as an advocate for autistic children.

Shifting paradigms: From deficits to differences

The latter half of the 20th century saw a dramatic shift in how autism was perceived. In the 1960s and 1970s, researchers began to dispel the notion that autism was solely a psychological disorder. Studies in neurobiology and genetics suggested that autism had a significant biological basis, paving the way for a more nuanced understanding of the condition.

This period also saw the development of behavioral therapies, most notably Applied Behavior Analysis (ABA). While ABA has been effective in teaching specific skills, it has also been criticized for its focus on compliance and normalization, sometimes at the expense of respecting the autistic person’s autonomy and preferences.

Autism diagnosis: Gender disparities and high-masking autism

According to the Centers for Disease Control and Prevention (CDC), autism spectrum disorder (ASD) affects 1 in 36 children in the United States. According to the Child Mind Institute, “girls with autism might not have as many repetitive behaviors as boys, or they might be quieter about them.” Having an intense interest in something specific is also common in people with autism. If that interest is something considered “girly,” like horses, a doctor might dismiss it as normal.”

Because girls who meet the criteria for autism are less likely to receive a clinical diagnosis, they’re also less likely to get the support they need. Girls may become exhausted from masking, trying to fit in, and mimicking socially acceptable behaviors, contributing to anxiety, depression, or low self-esteem. There is a risk of misdiagnosing ADHD and social anxiety, which may receive less clinical attention and be mistaken for “shyness.”

Girls who go undiagnosed turn into undiagnosed women. You could be undiagnosed because you were overlooked in the past or because you didn’t meet the full criteria in the DSM-V. I like the term “spectrum” because it encompasses the diversity of clinical comorbidities that come along with autism and also acknowledges the wide range of individual differences among autistic people. There is no one way to “look” or “be” autistic. 

Along the way, you may have learned to mask. Women with high-masking autism have learned to imitate the behaviors of neurotypical individuals to avoid bullying, feel safe, code-switch, and survive in a world that is not always kind to neurodiverse individuals. 

High-masking autism can include adopting behaviors like creating predetermined responses or “scripts” to navigate social interactions more smoothly, using social camouflaging to blend in so you’re perceived by other people a certain way, or hiding sensory sensitivities and suppressing stims. 

High-masking autistic women may become exhausted, burned out, stressed, and depressed. You may feel like you’ve lost yourself by hiding core pieces of your identity. But you may also not be ready to express yourself fully and openly show your autistic traits. 

The rise of the neurodiversity movement

The 1990s brought a transformative wave with the rise of the neurodiversity movement, which advocates for viewing autism and other neurological differences as natural variations of the human experience. This perspective emphasizes the strengths and contributions of neurodivergent individuals, advocating for societal changes to accommodate and celebrate neurodiversity.

The neurodiversity movement includes the experiences of autistic people, but also those with ADHD, dyslexia, dyspraxia, and other conditions. Girls and women are often underdiagnosed with these conditions, so it’s important to be inclusive in our understanding of neurodiversity.

Neurodivergent-Affirming Therapy emerged from this movement, focusing on understanding and supporting the unique needs of autistic individuals. Rather than attempting to “fix” or change autistic behaviors, this approach encourages psychologists and therapists to work with their patients to develop strategies that enhance their quality of life while respecting their neurodivergent identity.

Key principles of Neurodivergent-Affirming Therapy

If you identify with the autism experience and you are seeking reassurance through a diagnosis (or you have previously been diagnosed as “unspecified”) — you don’t have to walk this journey alone! There is hope. At Avatar Cognitive and Behavioral Center, we offer Neurodivergent-Affirming Therapy so you can show up exactly as you are. You don’t have to mask or hide your true self when you’re working with our highly trained psychologists and therapists. 

Neurodivergent-Affirming Therapy offers:

Respect for the autistic identity

Psychologists and therapists acknowledge and respect the autistic person’s identity, understanding that their neurodivergence is an integral part of who they are. Neurodivergent-Affirming Therapy is an approach that recognizes and respects the unique experiences of autistic individuals, promoting their well-being without trying to “normalize” them.

Strengths-based approach

Rather than focusing solely on challenges, psychologists and therapists recognize and build on the individual’s strengths and interests, fostering a sense of competence and self-worth. This approach helps autistic individuals build confidence in their abilities and see themselves as capable individuals.

Collaborative goal setting

Therapy goals are set collaboratively, ensuring they align with the autistic person’s values and aspirations, rather than imposed external standards of what society deems as “normal.” This empowers autistic individuals to take ownership of their therapy and work towards goals that are important to them.

Sensory and communication accommodations

Psychologists and therapists are attentive to sensory sensitivities and communication preferences, creating an environment where autistic individuals can thrive. This may involve creating a quieter space for therapy sessions or using visuals aids to support communication.

Advocacy and empowerment

Neurodivergent-Affirming Therapy empowers autistic individuals to advocate for their needs and rights, fostering self-advocacy and autonomy. Psychologists and therapists can help autistic individuals develop communication skills and strategies for self-advocacy.

Do you ever feel like you don’t quite fit in? You’re not alone

At Avatar Cognitive and Behavioral Center, we specialize in helping autistic women (especially high-masking autistic women) understand themselves better and live more fulfilling lives

We provide online Neuropsychological and Psychological Evaluations and Therapy tailored specifically for Women in Florida

Our experienced bilingual psychologists and therapists fluent in English and Spanish can help you improve your social skills, manage anxiety and stress, and create a life you love 

You deserve to feel understood and supported

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When was ADHD first diagnosed? And what are ADHD symptoms in women today?