mental health

The women who are autistic but don’t know it

If getting a diagnosis of autism is already tricky for men, it is even more difficult for women.

Let us call her Sophie. The description we will give could be that of any woman who is on the autistic spectrum without knowing it. Because they are intelligent and used to compensating for communication impediments they may not be consciously aware of, these women slip through the cracks of our still-too-inefficient diagnostic procedures.

Studies reveal one woman for every nine men is diagnosed with so-called “high-functioning” autism, that is, autism without intellectual disability. If we compare this to the one woman for every four men diagnosed with the more readily identified “low-functioning” autism, we can easily imagine many autistic women are left undiagnosed.

Today, Sophie, who lives in France, has a job interview. If you could see her nervously twisting her hair, you might think she is anxious, like anyone would be in the circumstances. You would be wrong. Sophie is actually on the verge of a panic attack. At 27, she just lost her job as a salesperson due to repeated cash-register mistakes – and it is the eighth time in the last three years. She loved maths at university and is deeply ashamed. She hopes the person hiring will not bring up the subject – she has no justification for her professional failures and knows that she is incapable of making one up.

Learning accounting by herself

Sophie’s wish is granted: the interviewer asks her instead about her time at university. Relieved, she happily launches into an explanation of her masters thesis on meteorological modeling, but he cuts her off abruptly, clearly irritated. He wants to know why she is applying for a temporary job as an accounting assistant when she has no experience or training. Although her heart is racing wildly, Sophie manages to keep her composure, explaining that she taught herself accounting at home in the evenings. She describes the excellent MOOC (online course) she found on the website of the French Conservatoire National des Arts et Métiers, and tells him how one of the questions she asked the teacher on the forum led to a fascinating debate on the concept of depreciation expenses.

Sophie is not good at guessing what people are thinking, but she understands from the way the man is staring at her that he believes she is lying. Overwhelmed, she feels weaker by the minute. She watches his lips move but does not understand what he’s saying. Ten minutes later she is in the street, with no memory of how the interview ended. She is shaking and holding back tears. She curses herself, wondering how anyone could be so stupid and pathetic.

She climbs into a crowded bus, swaying under the heavy odours of perfumes worn by those pressed up around her. When the bus brakes suddenly, she loses her balance and bumps into a fellow passenger. She apologises profusely and hurriedly gets off. In her rush, she trips again and falls to the pavement. “I must get up, everyone is looking,” she thinks, but her body refuses to obey. She can no longer see properly and does not even realise her own tears are blinding her. Someone calls an ambulance. Sophie wakes up in a psychiatric facility. She will be misdiagnosed with a psychological disorder and given medication that will solve none her problems.

A unique way of thinking

Sophie’s story is typical of the chaotic lives led by women whose autism remains undiagnosed because they are on that part of the spectrum where the signs are less obvious. In spite of her impressive cognitive capacities – like the ability to teach herself a totally new field of knowledge – Sophie has no idea of her own talents, and neither do those around her, or only rarely. Trapped in a social environment highly critical of what makes her unique, such as her unusual way of thinking, taste for solitude, and the intensity of her passions, Sophie is acutely aware that these are seen as shortcomings.

If Sophie could be given the correct diagnosis of high-functioning autism, she would at last understand the way her mind works. She could meet other autistic adults and learn from their experience to help her overcome her own difficulties.

Autism is characterised by social and communicative difficulties, specific interests that people with autism are capable of speaking about for hours (like meteorological modelling, in Sophie’s case), and stereotyped behaviours. There are also differences in perception, such as hypersensitivity to smells or sounds, or, conversely, reduced sensitivity to pain. Autism is thought to affect around one in one hundred people.

Seventy percent of people with autism have either normal or superior intelligence. This form of autism is generally referred to as high-functioning autism, as per the latest version of the “bible” of psychiatric disorders, the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders). In this version, all reference to older categories has been removed, including Asperger syndrome. The term Asperger’s is still used today in some countries, however, even though all types of autism are now grouped under a single spectrum and classified according to the severity of symptoms.

Support throughout schooling

Ideally, Sophie would have been diagnosed as a child. She could have benefited from specialised support throughout her schooling, as is legally required in France and other countries. This support would have made her less vulnerable, giving her the tools to defend herself from bullying in the schoolyard and helping her learn with teaching methods adapted to her way of thinking. Upon leaving school, her diagnosis would have opened up access to labour rights, such as disabled worker status, which would have helped her find an adapted employment. Sophie’s life would have been simpler and she would be more at peace with herself.

But Sophie’s problems are twofold. Not only is she autistic, but she is also a woman. If getting a diagnosis is already tricky for men, it is even more difficult for women. Originally, autism was thought to only rarely affect women. This erroneous idea, which emerged from a 1943 study conducted by Léo Kanner (the first psychiatrist to describe the syndrome), has been reinforced by the long-dominant psychoanalytical approach. The criteria defining autistic symptoms were based on observations in boys.

Later, when science replaced psychoanalysis as the dominant model, studies were largely conducted on male children, thus reducing the chances of recognising autism as it is manifested in females. This phenomenon, also present in other areas of science and medicine, has far-reaching implications today.

Similar test results for boys and girls

To diagnose autism spectrum disorder, doctors and psychologists evaluate quantitative criteria using tests and questionnaires, but also qualitative criteria, like interests, stereotyped movements, difficulties with eye contact and language and isolation. But while autistic girls show similar test results to autistic boys, the clinical manifestation of their condition differs, at least in cases where language has been acquired.

With social-imitation strategies, for example, autistic girls have fewer troubles making friends than autistic boys ; they have seemingly more ordinary interests than boys (for example horses, rather than maps of the subway); while less restless than boys, they are more vulnerable to less-visible anxiety disorders, and more adept at camouflaging their stereotyped and soothing ritual behaviors. In other words, their autism is less obtrusive, which means their symptoms are less obvious to their families, teachers and doctors.

Play

Biology and environment explain these differences, and in this case it is impossible to separate nature from nurture. On the nature side of the argument, some hypothesise that girls are better equipped for social cognition and more apt at caring roles. This would explain why they appear to be more interested in the animate (cats, celebrities, flowers) than the inanimate (cars, robots, rail networks).

When it comes to nurture, girls and boys are not brought up in the same way. Socially acceptable behaviours differ according to sex. Although autistic children are more resistant to this phenomenon, the pressure to conform is so strong it still ends up influencing their behaviour, as illustrated by the case of Gunilla Gerland. As a girl, this Swedish woman did not want to wear rings or bracelets because she hated the way metal felt on her skin. Observing that adults could not fathom that a little girl might not like these things, she resigned herself to getting gifts of jewellery, and even learned to thank the giver, before stashing the object away in a box at the earliest opportunity.

The art of camouflage

As autistic girls grow up, the gap between how their condition and that of boys manifests widens. As adults, some autistic women can become highly skilled in the art of camouflage, which explains the use of the term “invisible disability” to describe certain types of high-functioning autism. Incidentally, this is the meaning of the title of Julie Dachez’s 2016 graphic novel, The Invisible Difference.

A page from ‘The Invisible Difference’ (Delcourt), by Julie Dachez.  Delcourt/Mirages
A page from ‘The Invisible Difference’ (Delcourt), by Julie Dachez. Delcourt/Mirages

More and more women are discovering their condition later in life and sharing their experience. Since September 2016, the Francophone Association of Autistic Women (Association francophone des femmes autistes, or AFFA) has been fighting for recognition of the specific ways autism manifests in women. A learned society on autism in women is also being created in France, bringing together the general and scientific communities, with the goal of promoting dialogue between researchers and autistic women.

A specific questionnaire for girls

Historically, major figures in autism research believed there was significant prevalence in women. The Austrian Hans Asperger (for whom the syndrome is named) put forward the idea as early as 1944, as did British psychiatrist Lorna Wing, as early as 1981. But it is only in recent years the scientific community has really started examining the evidence.

Some researchers aim to better understand the specific characteristics of autism in women. Since the beginning of this year, volunteers are invited to participate in a study on “autism in women” conducted by Laurent Mottron, a professor in the department of psychiatry at the University of Montreal, Canada, and Pauline Duret, a doctoral student in neuroscience, in collaboration with myself and Adeline Lacroix, working at the École des Hautes Études en Sciences Sociales in Paris, France. Adeline Lacroix is a master’s student in psychology and has herself been diagnosed with autism.

Other studies are attempting to adapt diagnostic tools for use with female subjects. A team made up of Australian scientists Sarah Ormond, Charlotte Brownlow, Michelle Garnett, and Tony Attwood, and Polish scientist Agnieszka Rynkiewicz, is currently perfecting a specific questionnaire for young girls, the Q-ASC (“Questionnaire for autism spectrum conditions”). They presented their work in May 2017 at a conference in San Francisco.

While there has been an initial trove of interesting results, current research into the specific characteristics of autism in women is raising more questions than it answers. However, the confusion could be considered a necessary step toward the acquisition of knowledge, provided the women affected can contribute to the research and share their point of view on the direction the work should take.

Ordinary citizens can also work towards ensuring autistic girls have the same rights as their male counterparts. By gaining a better understanding of the different forms of autism, everyone can contribute to a world in which children and adults with autism can find their place, and help fight exclusion by creating an inclusive society.

This article was first published on The Conversation.

Translated from the French by Alice Heathwood for Fast for Word.

This article was co-written by Adeline Lacroix, who works with Fabienne Cazalis and was recently diagnosed with Asperger syndrome. A second year master’s student in psychology, she is working on a scientific literature review about the characteristics of high-functioning autistic women.

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Top picks, best deals and all that you need to know for the Amazon Great Indian Festival

We’ve done the hard work so you can get right to what you want amongst the 40,000+ offers across 4 days.

The Great Indian Festival (21st-24th September) by Amazon is back and it’s more tempting than ever. This edition will cater to everyone, with offers on a range of products from electronics, home appliances, apparel for men and women, personal care, toys, pet products, gourmet foods, gardening accessories and more. With such overwhelming choice of products and a dozen types of offers, it’s not the easiest to find the best deals in time to buy before your find gets sold out. You need a strategy to make sure you avail the best deals. Here’s your guide on how to make the most out of the Great Indian Festival:

Make use of the Amazon trio – Amazon Prime, Amazon Pay and Amazon app

Though the festival officially starts on 21st, Amazon Prime members will have early access starting at 12 noon on 20th September itself, enabling them to grab the best deals first. Sign up for an Amazon Prime account to not miss out on exclusive deals and products. Throughout the festival, Prime members will 30-minute early access to top deals before non-Prime members. At Rs 499/- a year, the Prime membership also brings unlimited Amazon Prime video streaming and quick delivery benefits.

Load your Amazon pay wallet; there’s assured 10% cashback (up to Rs 500). Amazon will also offer incremental cashbacks over and above bank cashbacks on select brands as a part of its Amazon Pay Offers. Shopping from the app would bring to you a whole world of benefits not available to non-app shoppers. App-only deals include flat Rs 1,250 off on hotels on shopping for more than Rs 500, and flat Rs 1,000 off on flights on a roundtrip booking of Rs 5,000 booking from Yatra. Ten lucky shoppers can also win one year of free travel worth Rs 1.5 lakhs.

Plan your shopping

The Great Indian Sale has a wide range of products, offers, flash sales and lightning deals. To make sure you don’t miss out on the best deals, or lose your mind, plan first. Make a list of things you really need or have been putting off buying. If you plan to buy electronics or appliances, do your research on the specs and shortlist the models or features you prefer. Even better, add them to your wishlist so you’re better able to track your preferred products.

Track the deals

There will be lightning deals and golden hour deals throughout the festival period. Keep track to avail the best of them. Golden-hour deals will be active on the Amazon app from 9.00pm-12.00am, while Prime users will have access to exclusive lightning deals. For example, Prime-only flash sales for Redmi 4 will start at 2.00pm and Redmi 4A at 6.00pm on 20th, while Nokia 6 will be available at Rs 1,000 off. There will be BOGO Offers (Buy One Get One free) and Bundle Offers (helping customers convert their TVs to Smart TVs at a fraction of the cost by using Fire TV Stick). Expect exclusive product launches from brands like Xiaomi (Mi Band 2 HRX 32 GB), HP (HP Sprocket Printer) and other launches from Samsung and Apple. The Half-Price Electronics Store (minimum 50% off) and stores offering minimum Rs 15,000 off will allow deal seekers to discover the top discounts.

Big discounts and top picks

The Great Indian Festival is especially a bonanza for those looking to buy electronics and home appliances. Consumers can enjoy a minimum of 25% off on washing machines, 20% off on refrigerators and 20% off on microwaves, besides deals on other appliances. Expect up to 40% off on TVs, along with No-Cost EMI and up to Rs 20,000 off on exchange.

Home Appliances

Our top picks for washing machines are Haier 5.8 Kg Fully Automatic Top Loading at 32% off, and Bosch Fully Automatic Front Loading 6 Kg and 7 Kg, both available at 27% discount. Morphy Richards 20 L Microwave Oven will be available at a discount of 38%.

Our favorite pick on refrigerators is the large-sized Samsung 545 L at 26% off so you can save Rs 22,710.

There are big savings to be made on UV water purifiers as well (up to 35% off), while several 5-star ACs from big brands will be available at greater than 30% discount. Our top pick is the Carrier 1.5 Ton 5-star split AC at 32% off.

Also those looking to upgrade their TV to a smart one can get Rs. 20,000 off by exchanging it for the Sony Bravia 108cm Android TV.

Personal Electronics

There’s good news for Apple fans. The Apple MacBook Air 13.3-inch Laptop 2017 will be available at Rs 55,990, while the iPad will be available at 20% off. Laptops from Lenovo, Dell and HP will be available in the discount range of 20% to 26%. Top deals are Lenovo Tab3 and Yoga Tab at 41% to 38% off. Apple fans wishing to upgrade to the latest in wearable technology can enjoy Rs 8,000 off on the Apple Watch series 2 smartwatch.

If you’re looking for mobile phones, our top deal pick is the LG V20 at Rs 24,999, more than Rs 5000 off from its pre-sale price.

Power banks always come in handy. Check out the Lenovo 13000 mAh power bank at 30% off.

Home printers are a good investment for frequent flyers and those with kids at home. The discounted prices of home printers at the festival means you will never worry about boarding passes and ID documents again. The HP Deskjet basic printer will be available for Rs 1,579 at 40% off and multi-function (printer/ scanner/ Wi-Fi enabled) printers from HP Deskjet and Canon will also available at 33% off.

The sale is a great time to buy Amazon’s native products. Kindle E-readers and Fire TV Stick will be on sale with offers worth Rs 5,000 and Rs 1,000 respectively.

The Amazon Fire Stick
The Amazon Fire Stick

For those of you who have a bottomless collection of movies, music and photos, there is up to 60% off on hard drives and other storage devices. Our top picks are Rs 15,000 and Rs 12,000 off on Seagate Slim 5TB and 4TB hard drives respectively, available from 8.00am to 4.00pm on 21st September.

The sale will see great discounts of up to 60% off on headphones and speakers from the top brands. The 40% off on Bose QC 25 Headphones is our favourite. Top deals are on Logitech speakers with Logitech Z506 Surround Sound 5.1 multimedia Speakers at 60% off and the super compact JBL Go Portable Speaker at 56% off!

Other noteworthy deals

Cameras (up to 55% off) and camera accessories such as tripods, flash lights etc. are available at a good discount. Home surveillance cameras too will be cheaper. These include bullet cameras, dome cameras, simulated cameras, spy cameras and trail and game cameras.

For home medical supplies and equipment, keep an eye on the grooming and personal care section. Weighing scales, blood pressure monitors, glucometers, body fat monitors etc. will be available at a cheaper price.

The sale is also a good time to invest in home and kitchen supplies. Mixer-grinders and juicers could see lightning deals. Don’t ignore essentials like floor mops with wheels, rotating mop replacements, utensils, crockery etc. Tupperware sets, for example, will be more affordable. There are attractive discounts on bags, especially laptop bags, backpacks, diaper bags and luggage carriers.

Interesting finds

While Amazon is extremely convenient for need-based shopping and daily essentials, it is also full of hidden treasures. During the festival, you can find deals on telescopes, polaroid cameras, smoothie makers, gym equipment, gaming consoles and more. So you’ll be able to allow yourself some indulgences!

Small shopping

If you have children, the festival is good time to stock up on gifts for Diwali, Christmas, return gifts etc. On offer are gaming gadgets such as Xbox, dough sets, Touching Tom Cat, Barbies, classic board games such as Life and more. There are also some products that you don’t really need, but kind of do too, such as smartphone and tablet holders, magnetic car mounts for smartphones and mobile charging station wall stands. If you’re looking for enhanced functionality in daily life, do take a look at the Amazon Basics page. On it you’ll find USB cables, kitchen shears, HDMI cables, notebooks, travel cases and other useful things you don’t realise you need.

Check-out process and payment options

Amazon is also offering an entire ecosystem to make shopping more convenient and hassle-free. For the festival duration, Amazon is offering No-Cost EMIs (zero interest EMIs) on consumer durables, appliances and smartphones, plus exchange schemes and easy installation services in 65 cities. HDFC card holders can avail additional 10% cashback on HDFC credit and debit cards. Customers will also get to “Buy Now and Pay in 2018” with HDFC Credit Cards, as the bank offers a 3 Month EMI Holiday during the days of the sale. Use Amazon Pay balance for fast and easy checkouts, quicker refunds and a secured shopping experience.

Sales are fun and with The Great Indian Festival offering big deals on big brands, it definitely calls for at least window shopping. There’s so much more than the above categories, like minimum 50% off on American Tourister luggage! To start the treasure hunt, click here.

This article was produced by the Scroll marketing team on behalf of Amazon.in and not by the Scroll editorial team.