Today is International Women’s Day 2024. The theme for International Women’s Day this year is “Inspire Inclusion”.
And while in the context of neurodivergent women there are so many interpretations of this that are applicable, the one that is often overlooked is initial inclusion in the neurodivergent community itself.
There is a general consensus amongst the neuroaffirming medical and research communities that girls have been – and still are, to a lesser extent – underdiagnosed with neurodivergencies.
Misdiagnosed
Many people who seek support for neurodivergent traits are misdiagnosed. These misdiagnoses are often other forms of neurodivergence, due to similar traits, however these errors can be the difference between receiving appropriate support / thriving, and struggling further.
For example, some autistic people are initially misdiagnosed as having a form of rapid cycling bipolar disorder. This is often due to the reporting or observation of meltdowns occurring soon after normal, or even happy, mood; and then returning to regulated behaviour again soon after.
This is not entirely unreasonable.
30% of youth 7-17 with bipolar also met the criteria for Autism (Joshi et al., 2013).
47.2% of adults with bipolar showed a clinically significant level of Autistic Traits (Abu-Akel et.al, 2017).
27% of children w/ pervasive developmental disorder also had bipolar (Raja & Azzoni, 2008) (compared to 4% of the general population).
Megan Anna Neff – https://neurodivergentinsights.com/misdiagnosis-monday/bipolar-and-autism
However, there seems to be a leaning towards certain diagnoses, and away from others. Many have expressed concern about how often a medicable condition seems to be selected over those which cannot be cured or treated with medication.
One of the reasons that autism is misdiagnosed is that it is a big picture diagnosis with many neurologic features. Autism […] has multiple features that may overlap with other conditions with a smaller symptom profile.
The DSM-5 manual notes that we should only make a diagnosis if the characteristics “are not better explained by a different diagnosis.” Clinicians should be ruling out autism first, and then considering diagnoses with fewer features (like bipolar, obsessive compulsive disorder, social anxiety, etc).
Dr Theresa Regan – https://www.adultandgeriatricautism.com/post/autism-misdiagnosis-bipolar-disorder
Mislabelled
Due to societal expectations of gender, girls are often “allowed” to exhibit more traits of neurodivergence without being flagged as needing support.
- Girls with inattentive ADHD are considered to be daydreamers, whereas their male counterparts may be accused of being rude, not paying attention, or getting distracted.
- Dyspraxic females are often dismissed as “not very sporty”, whereas this is often a point of concern in boys due to the resultant social exclusion.
- Depressed teenaged girls can be flagged as “possibly anaemic”, “hormonal”, or “dealing with teenage girl dramas at school”.
- Early stages of eating disorders can be ignored as girls are “focusing on their appearance” or “losing the puppy fat”.
There appears to be a dangerous desire by many professionals to “err on the side of caution” rather than confirm neurodivergence, as though neurodivergence is a bad thing. That being helplessly emotional or uncoordinated is better than the self-recognition and acceptance that comes with confirmation of neurodivergence. That being expected to fit in when you can’t, or try harder when you’re trying your hardest, is a better option than knowing who you are.
Harsher Criticism
Also due to these societal norms, women and girls are often more harshly judged for their neurodivergent traits than males in a similar situation.
One of the reasons suggested for the extreme disparity in average ages of confirmation of ADHD in each gender, for example (6-7 years in males, late 30s or early 40s for females) is:
- “Enthusiastic” or “talkative” (ADHD-H) and “daydreaming” and “quiet” (ADHD-I) girls are largely seen as acceptable
- “Hyperactive” and “disruptive” (ADHD-H) and “distracted” and “ignorant” (ADHD-I) boys are perceived as needing reform
- “Eccentric” and “powerful” men who rely on administrative staff for executive function tasks are frequently accepted as leaders with big ideas, whereas:
- “Bossy” women are seen as disorganised if they clearly rely on others for executive function management
Similarly, as Harriet Quiney outlined in her essay about female neurodivergence,
Our culture commonly expects women to fill the caretaker role, but when it’s difficult to organise and plan, taking care of others can feel impossible. Because women with ADHD may not be able to do the things that society expects women to do, like remember birthdays or the names of their colleague’s children, people may think they don’t care. Societal pressure also may increase neurodiverse women’s feelings of inadequacy, leading to low self-esteem and chronic stress.
It is often at this point that women reach out for help, thinking they have a mental illness, or are experiencing perimenopause, only to discover they have been an ADHDer their entire lives.
Similarly, dyspraxic girls can be perceived as unladylike and clumsy. Girls experiencing situational mutism are more likely to be seen as shy or rude than boys. Autistic girls are ostracised for being “weird” due to the degree to which they do successfully mask, or imitate peers; boys are more likely to be authentically autistic, and therefore find genuinely accommodating peers.
Fight for Confirmation and Inclusion
So on this International Women’s Day, to inspire inclusion, I urge all people to consider that understanding neurodivergence in itself is the first step towards inclusion. Second comes receiving the support and recognition required to receive the confirmation your child needs to thrive. And third is the fight for accommodations in school, the workplace, and society.
It begins with including all neurodivergent women in the ND community, rather than trying to pretend it’s something else for the benefit of… who knows?
If you are the parent of a daughter you suspect as being neurodivergent, and you do not feel you are being heard, or receiving adequate support, from medical or education professionals, please reach out to More Than Quirky for help. It’s what we’re here for and, sadly, something we have years of experience dealing with.