High-Functioning Female Autism

What is high-functioning autism?

High-functioning autism (HFA) refers to a pattern of behaviors and traits that are consistent with autism, while still allowing a person to function independently in society. Individuals with HFA tend to possess strong language and cognitive skills and can function effectively in both professional and social settings with suitable support. Though not an official diagnosis, high-functioning autism refers to those individuals who require less support, previously known as Asperger’s syndrome.

Signs and symptoms of high-functioning autism

The symptoms of high-functioning autism can include a wide range. In general, they tend to be highly devoted to routine, structure, and order in their daily lives. They may exhibit repetitive bodily movements or restrictive habits that appear unusual to onlookers. Other symptoms may include some of the following:

Difficulty making eye contact
Sensitivity to sensory input (i.e., smell, sound, textures)
Difficulty engaging in a two-way conversation
Frequently perceived as being rude or blunt
Usually takes things literally
Trouble making decisions
High anxiety in social settings

How high-functioning female autism differs from males

According to the American Psychiatric Association, men are diagnosed four times more often than women with autism. For decades, it was believed that autism spectrum disorder (ASD) was primarily a condition affecting males. But with further research, it is now widely accepted that ASD, including high-functioning autism, presents differently in females, often causing difficulties in trying to diagnose and treat it.

Women are more likely to mimic neurotypical behaviors, use scripted social responses, and develop “acceptable” special interests such as pop culture or crafting, making it more difficult to detect. They also tend to have a stronger social motivation to fit in and often appear more socially skilled at first glance. Yet, trying to achieve this frequently comes at the cost of tremendous mental and emotional energy, particularly in unfamiliar or overwhelming situations.

Challenges in diagnosing high-functioning female autism

The effort to diagnose high-functioning autism in women presents several challenges, including the following.

The use of camouflaging or masking strategies to hide autistic traits

One of the biggest barriers to diagnosing high-functioning female autism is the tendency to engage in what is known as masking in autism, also referred to as camouflaging. This means consciously hiding or suppressing autistic traits to fit in, often by mimicking the social behaviors of others, or suppressing specific autistic characteristics.

Gender Bias and Societal Expectations

Traditional diagnostic criteria for autism have almost always been based on observations of males. As a result, the nuances of how autism manifests in women are often overlooked by diagnosticians. This can lead to delayed or missed autism diagnoses, ultimately impacting the timing and effectiveness of therapeutic interventions.

Internalizing feelings

Many high-functioning women with autism can spend years feeling “different” without understanding why. As a result, they begin to internalize their difference as a personal failing, which can lead to a series of other issues, including low self-esteem or chronic self-doubt.

The risk of mental health issues when autism goes undiagnosed in autistic women

When autism in females goes undiagnosed, it can lead to a range of serious mental health challenges, including depression, anxiety, chronic stress, eating disorders, and a very fragmented sense of self. Having spent years masking their symptoms and mimicking others to fit in, they’ve wound up blaming themselves for their feelings of inadequacy, emotional overwhelm, and social struggles without ever understanding the real reason. In cases of misdiagnosed autism, this prolonged uncertainty can erode self-esteem, adding to their feelings of burnout and isolation. That’s why an early and accurate diagnosis is critical, not only to confirm their lifelong experiences but also to provide access to a set of customized interventions that support their needs.

How ABA therapy relates to diagnosing high-functioning women with autism

Though it’s not directly used to diagnose autism, ABA therapy, or Applied Behavior Analysis, is one of the most widely used types of interventions to support individuals on the spectrum, including high-functioning women with autism.

The gift of ABA therapy in autism is that it can provide tremendous insight into how high-functioning female autism manifests, particularly since their symptoms are often more subtle or masked compared to those of men, for example.

Identifying relations between behaviors and the environment

To diagnose high-functioning autism in women, it’s critical to look beyond the surface-level symptoms and examine how their behaviors relate to environmental factors. Understanding what is ABA therapy means recognizing one of its fundamental principles: that behavior never occurs in a vacuum. Instead, every behavior serves a purpose and is influenced by its context. For women with high-functioning autism who often present subtler or nuanced symptoms, the link between environment and behavior is crucial for obtaining a more accurate diagnosis.

Social Communication

As mentioned, many women emulate typical social behaviors to blend in, which enables them to conceal deeper struggles. Yet, in stressful situations or unfamiliar settings, it’s the differences in eye contact, the flow of a conversation, or body language that make it obvious they may be struggling.

Repetitive Behaviors

The same can be said for repetitive behaviors. From quiet stimming to obsessive thoughts and rigid routines, all of these behaviors might go unnoticed because they seem harmless. But when tracked and understood when they happen, such as during sensory overload or emotional stress, this can underline important coping mechanisms.

Adaptive Behaviors

While some with high-functioning female autism might excel in structured environments, they may struggle to deal with change, multitasking, or unexpected situations. Observing how they handle these scenarios can reveal challenges that a standard autism checklist may overlook.

ABA therapy provides an individualized and functional approach

One of the gifts of ABA therapy is its emphasis on individualized observable behavior. This is particularly helpful when identifying high-functioning autism in women, whose symptoms don’t fit the traditionally male-centered criteria, which are often used in diagnosis. ABA examines how someone communicates, functions day-to-day, or responds to change, even if those behaviors are subtle or different.

By focusing on what a person does and in what context, ABA offers a more accurate and personalized view. As a result, this helps to reveal autistic symptoms that might otherwise be overlooked, allowing for the development of support strategies that will genuinely meet the woman’s needs.

The collaboration between ABA therapists and diagnosing practitioners

Yes, ABA therapists focus on observing everyday behaviors, but they also regularly work closely with psychologists, pediatricians, and psychiatrists who have the training to make a formal diagnosis of autism. This collaborative environment is especially critical for identifying high-functioning autism in women, where symptoms may be subtle or masked.

While ABA therapists provide everyday insights, diagnosing professionals bring the clinical expertise. Together, they help paint a more accurate picture, leading to a diagnosis and more personalized support.

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Frequently Asked Questions on High-Functioning Autism

How can high-functioning autism impact daily life and mental health for women?

From chronic stress and anxiety to burnout, there is a range of symptoms that can come from masking symptoms and trying to meet social expectations. In addition, many women suffer from low self-esteem, isolation, and are at a greater risk for depression or other mental health illnesses.

What types of therapies are effective for high-functioning autism in women?

The most widely used therapy is ABA, but others include cognitive behavioral therapy (CBT), social skills training, and personalized support plans. Regardless of the type of therapy used, all of them can be customized to the unique autism symptoms a woman is experiencing.

How can workplaces better support high-functioning autism in women?

By providing sensory-friendly spaces, clear communication, flexible work environments, and fostering a culture that embraces neurodiversity, workplaces can better support women with high-functioning autism.

Why is an early and accurate diagnosis important for high-functioning female autism?

An early diagnosis can improve the long-term outcomes by addressing challenges before they become overwhelming. Not only does an accurate diagnosis validate a woman’s lifelong experiences, but it enables customized support, thereby reducing the risk of mental health problems.