Research on Autism and ADHD in Women and Girls
The Gendered Exclusion of Neurodivergent Women and Girls
Historically, autism and ADHD have been viewed as predominantly male conditions, with diagnoses being four times more likely for males than females. This gender bias has led to the systematic exclusion and misunderstanding of neurodivergent women and girls, who often struggle to obtain accurate diagnoses and access appropriate support.
The recent surge in women becoming aware of, diagnosed with, and seeking a diagnosis for conditions like ADHD and autism has been met with a mixed response from the media. While some attempts have been made to raise awareness, such as the recent BBC documentary “Unmasking My Autism,” women continue to face significant barriers. These include long waiting lists, a lack of pre- and post-diagnosis support, sex biases in diagnostic criteria, and the trauma of a lifetime of misdiagnoses, poor mental health, and the internalisation of negative societal messages about their character.
Theoretical Tensions and the Lived Experiences of AuDHD
The neurodiversity movement has asserted that neurological differences are a naturally occurring feature of humanity, and that all individuals are equal, although they may not be treated as such, everyone is human and this needs to be the starting point. This paradigm shift challenges the traditional deficit-based model that positions neurodivergent individuals as “abnormal” in contrast to the “neurotypical” norm.
However, the separate treatment of autism and ADHD, both theoretically and in terms of assessments and services, fails to account for the high likelihood of their co-occurrence. It is estimated that 30-80% of individuals with ADHD are also autistic. This lack of a holistic understanding can leave AuDHDers feeling like they don’t fully belong or “fit” anywhere.
The diagnostic criteria for these conditions have also been criticized for their narrow focus on deficits, their basis in male presentations, and their limited applicability to the full-lived experiences of neurodivergent individuals. Key features, such as sensory experiences and Rejection Sensitivity Dysphoria, are often overlooked, particularly in the case of women and girls who tend to experience these conditions more internally and mask their symptoms more efficiently due to gendered expectations.
Centering Neurodivergent Voices in Research and Support
To fully achieve the neurodiversity movement’s vision of recognizing difference as naturally occurring and all neurotypes as equal, a radical overhaul of society, institutions, and behaviours is necessary. This requires addressing the oppressive structures that disable and disadvantage neurodivergent individuals, while also recognizing the impact of intersecting axes of oppression, gendered norms, roles, and institutions.
Qualitative, participatory research conducted with and by neurodivergent individuals, particularly those whose voices have been historically marginalized, is crucial. This can provide valuable insights into the lived experiences of AuDHD women and girls, and inform the development of more inclusive and trauma-informed diagnostic processes and support services.
However, challenges remain in a research landscape that prioritizes and funds research that does not reflect the needs of those who are researched. The majority of autism research funding goes toward aetiology studies, while qualitative research that captures the richness and diversity of neurodivergent experiences often holds less policy sway.
The Need for Holistic Assessments and Personalised Support
To truly support AuDHD women and girls, we need to move beyond the compartmentalization of lived experiences into separate “autistic” and “ADHD” boxes. Holistic neurodiversity assessments that are female-centered and trauma-informed, coupled with personalized pre- and post-diagnosis support, must become the norm.
While the counterargument often centres on resource constraints, the long-term costs of multiple waiting lists, assessment processes, mental health treatments, and the human toll of suffering far outweigh the investment required. It is high time that we stop ignoring, silencing, and hurting AuDHD women and girls. Their voices must be heard, and their needs must be addressed with compassion and urgency.
References:
Craddock, E. (2024). Raising the voices of AuDHD women and girls: exploring the co-occurring conditions of autism and ADHD. Disability & Society, 1–5. https://doi.org/10.1080/09687599.2023.2299342
Lau-Zhu, A., Fritz, A., & McLoughlin, G. (2019). Overlaps and distinctions between attention deficit/hyperactivity disorder and autism spectrum disorder in young adulthood: Systematic review and guiding framework for EEG-imaging research. Neuroscience and Biobehavioral Reviews, 96, 93-115. https://doi.org/10.1016/j.neubiorev.2018.10.009
