Bloomwave Practice

Tag: Autism

  • Gender differences in autism

    Gender differences in autism

    If you’ve been on social media lately, you may have come across more and more people talking about autism and how it affects them.

    Autism spectrum disorder is a neurodevelopmental condition (meaning it starts in childhood) that affects how people communicate and socialize with each other and how they perceive and interact with the world around them.

    Traditionally, autism has been defined by:

    • Difficulties in social interaction and sharing emotions (such as missing social cues or trouble relating to peers)
    • Challenges with nonverbal communication (including facial expressions and eye contact)
    • Restricted or repetitive behaviors or interests (the so-called special interests)

    This is what we often think of when we hear the word autism. And if I asked you to imagine an autistic person, how many of you would imagine them to be male?

    Autism exists on a spectrum, meaning it can look very different from one person to another. More severe cases are usually diagnosed early, while those on the milder end of the spectrum might be missed by the healthcare system. What’s more, it can look very different in women than in men, and it is diagnosed about 4 times as often in males then in females.

    However, many researchers believe the disorder is not actually more common in men, it’s just that the its female presentation is different, and therefore under-diagnosed.

    This post aims to explore the reasons behind this, and ends with what you can do if you suspect you might have autism.

    Genuine gender differences

    First, let’s take a look at reasons why autism may actually be less common in women. These reasons are still being studied, but several hypotheses exist:

    1. Biology and genetics – The ‘Female Protective Effect’ theory posits that women may require a higher level of genetic risk for autistic traits to be expressed.
    2. Hormonal differences – Some research links prenatal testosterone levels to autistic traits. This has led to the theory that autism may represent an “extreme” version of certain cognitive patterns more commonly associated with males.
    3. Brain connectivity differences – There is also evidence that differences in brain connectivity patterns may play a role.

    How autism can look different in women

    1. Social motivation: wanting connection

    One key difference is that autistic women often show higher social motivation than autistic men. This is partially due to socialization, as female children are often encouraged to play more with others, and their activities in general tend to be more community-based.

    This means that:

    • They may want friendships and connection
    • They may put significant effort into fitting in
    • They may appear more socially engaged on the surface

    Because of this, their social difficulties can be less obvious to others, even though they are very much present.

    2. Different types of interests

    Autistic traits are often identified through “special interests.” But what counts as noticeable can be biased. Autistic men may have interests in topics like technology, systems, or mechanics, while autistic women often have interests that appear more socially typical, such as:

    • Animals
    • Books or fictional characters
    • Psychology or relationships

    The difference is not in intensity, but in how socially acceptable the interest appears. This can lead to girls being overlooked.

    3. Internalizing vs. externalizing

    Autistic women are more likely to experience internalizing difficulties, such as:

    • Anxiety
    • Depression
    • Eating disorders
    • Self-harm

    These struggles are often less visible than external behaviours (like aggression or hyperactivity), which are more commonly seen in boys and more likely to trigger assessment.

    As a result, many women are first diagnosed with anxiety or depression, while autism remains unrecognized.

    The role of masking

    One of the most important concepts in understanding gender differences in autism is masking. Masking refers to consciously or unconsciously:

    • Copying social behaviors (by observing others, watching movies, etc.)
    • Rehearsing conversations
    • Forcing eye contact
    • Suppressing natural responses (such as stimming or talking about a special interest)

    How to know of you are masking:

    • You feel very tired and drained after social interactions
    • You often find yourself practicing or rehearsing what you’re going to say in advance
    • You frequently copy others’ behaviors, speech patterns, or facial expressions
    • You deliberately stop yourself from stimming or other behaviors that feel natural to you in public settings
    • You feel like you can’t be your true self around others and constantly adjust your behavior to meet social expectations

    Research shows that autistic women are significantly more likely to engage in masking. While this can help them “blend in,” it comes at a cost:

    • Exhaustion and burnout
    • Loss of identity and feeling confused about who you truly are
    • Increased mental health difficulties, such as anxiety, stress, depression or low self-esteem

    Many women report feeling like they are “performing” rather than being themselves.

    Why are women underdiagnosed?

    1. Diagnostic criteria are based on male presentations

    Most autism research has historically focused on boys. As a result:

    • Diagnostic tools, such as the adult autism quotient (AQ) may miss female presentations
    • Clinicians may look for “male-typical” traits

    This creates a systemic bias in assessment, making it more difficult for women to access the understanding, treatment or accommodations they may need.

    2. Social expectations play a role

    From a young age, girls are often socialized to be polite, emotionally aware and focus on social relationships. Because of this, autistic girls may learn to compensate earlier and more effectively.

    They may also be:

    • Seen as shy , quiet or withdrawn (or a pleasure to have in class by teachers)
    • Overlooked as ‘functioning well’ when they withdraw or struggle with internalizing disorders, such as anxiety

    3. Different social experiences

    Research suggests that while autistic boys are more often overtly rejected, autistic girls are more often overlooked or socially excluded in subtle ways that they may not even recognize themselves as rejection.

    Girls tend to have more social contacts, but these relationships can be:

    • Less stable (switching friends or friend groups often)
    • More superficial (casual friendships instead of deep emotional connections)
    • Take more effort to maintain (they may find socializing very exhausting)

    Why this matters

    When autism in women goes unrecognized, it can lead to:

    • Late diagnosis (often in adulthood)
    • Misdiagnosis (e.g., anxiety, borderline personality disorder)
    • Lack of appropriate support or accommodations
    • Long-term mental health struggles
    • A constant feeling that something is off, but being unable to place it

    For many women, receiving an autism diagnosis later in life can be both validating and overwhelming, finally making sense of years of feeling different. This can also be a pathway to increased understanding and coping for both herself and her loved ones, and becoming able to access supports and accommodations at university or work.

    Towards a more inclusive understanding of autism

    Autism is not one single presentation, and understanding gender differences helps us:

    • Recognize more diverse presentations
    • Reduce diagnostic bias
    • Provide better and more tailored support
    • And perhaps most importantly: help people feel seen and understood.

    There is a lot of nuance in this topic, especially since I have not covered intersex, agender, non-binary or transgender people.

    However, if you are a woman, AFAB person, or someone who was raised as a woman, and you feel you have:

    • Difficulties with social interactions – difficulties making friends, superficial relationships, etc.
    • Difficulties with communication – trouble understanding language, jokes or sarcasm, taking things literally, etc.
    • Sensory issues – overstimulation, increased sensitivity to certain sensory inputs, or conversely, sensory seeking (such as spinning around), etc.
    • Emotional overwhelm – emotional meltdowns or shutdowns, overreactions to minor changes, etc.
    • Intense interests and repetitive behaviors or rituals
    • Coping mechanisms that include masking or performing

    It might be useful to investigate this further, and seek help from a professional, such as a psychologist or psychiatrist.

    References

    Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed autistic women

    Baron-Cohen, S. et al. (2015). Prenatal testosterone and autistic traits

    Hull, L. et al. (2017, 2020). Camouflaging in autism

    Lai, M. C. et al. (2015, 2017). Sex/gender differences in autism

    Loomes, R. et al. (2017). Male-to-female ratio in autism

    Robinson, E. B. et al. (2013). Female protective effect

    Sedgewick, F. et al. (2016). Social relationships in autistic girls

  • How to work with your brain (not against it)

    How to work with your brain (not against it)

    “You just need to try harder. Focus better. Be more motivated”.

    Discipline, effort, pushing through, doing whatever it takes. How many of us have constantly been surrounded by these types of messages, and how many of us talk to ourselves that way? With self-improvement culture and the “lock-in” mentality on the rise (especially on social media), it can feel incredibly frustrating when ‘just trying harder’ seems to not bring you any closer to your goals, and definitely nowhere near happiness or satisfaction. This rings especially true for those of us who are neurodivergent (ADHD and/or autism), and/or dealing with mental illness such as depression or anxiety.

    This blog post aims to help you collaborate with your brain to help you reach your goals as sustainably as possible, be it related to work or study, or healthy living. I will explain the mechanisms of the brain, how to take these into account, and touch upon individual differences, and how to optimize to what works for you, not for your neighbor or colleague.

    What you need to know about the brain

    1. It is predictive

    One of the key insights from modern neuroscience is that the brain works primarily as a prediction machine. Rather than waiting for input and then reacting, the brain constantly generates predictions about what will happen next, based on past experience.

    Why this matters:

    • When your brain anticipates danger (e.g., social rejection), you feel anxiety before a real threat is present.
    • If your history tells your brain that a goal is overwhelming, risky, or likely to fail, it will generate resistance, even if you consciously want the outcome.

    How to work with this:

    To change the prediction, generate opportunities for your brain to get instant feedback:

    • Break down big tasks into small, actionable steps
    • Focus on actions that are within your control, not outcomes you can’t influence

    2. The brain favors familiarity and safety

    Brains are wired for efficiency and safety, so your goals compete with existing patterns. Neural pathways that fire often are easier to activate than new ones, even if they lead to distress. This is related to neural plasticity. It works both ways: repeated patterns become stronger with use, new patterns need repeated, consistent practice to form.

    This is why:

    • Change feels uncomfortable, and new habits are hard to adopt.
    • Relapse into old habits (think: smoking, self-criticism, avoidance) is common.
    • We may stay in relationships, careers or other situations even when they are clearly not working for us, or even actively harming us.
    • Negative thinking patterns feel permanent, because they’re well-practiced

    How to work with this:

    Attach new goals to existing routines, the less ‘novel’ a goal feels, the easier it will be to implement:

    • Stack new behaviors onto existing habits (‘habit stacking’). This could mean combining brushing your teeth with flossing, for example.
    • Keep the structure similar even if the content is new – this could mean keeping your general daily routine the same, but changing up the tasks.
    • Remind yourself that it will become easier and easier as you keep at it.

    3. Willpower is a limited resource

    The popular belief that change is all about willpower is at odds with what science tells us about self-regulation. Willpower is finite resource that gets depleted under stress, fatigue, and strong emotions.

    This explains why:

    • Goals that only rely on self-control tend to fail as stress inevitably increases.
    • Motivation is hard to fine if you lack sleep or adequate nutrition.
    • Decisions feel harder after a long day.

    How to work with it:

    Design your environment, systems and routines that reduce the need to make decisions:

    • Reduce friction for habits you want to implement (for example, setting out your workout clothes the night before)
    • Increase friction for habits you want to reduce (for example, by uninstalling apps that impair your focus)
    • Automate reminders and planning where possible

    Individual differences

    What is even more important than following any generalized advice, is figuring out, and implementing, what works best for you. No two brains are exactly the same, and figuring out ways to tweak and customize is going to be a lot more effective than trying to fit some kind of mold.

    When your brain works differently than the ‘default’

    A major way people end up working against their brains is through internalized shame, which is the belief that something is wrong with them because their natural rhythms, needs, or capacities don’t align with what society rewards.

    A clear example of this is chronotype: whether you are naturally a morning person or an evening person.

    Research shows that chronotype is largely biologically determined, influenced by genetics, circadian rhythm regulation, and age. Yet modern society strongly favors early schedules: early workdays, early school start times, productivity culture framed around mornings. As a result, evening-oriented people are often labelled as lazy, undisciplined, or unmotivated, even if they actually just do their best work at different times.

    Neurodivergence – accommodating to the brain you have

    If you have ADHD or autism, ‘working against the brain’ may look like forcing neurotypical standards of productivity, emotion regulation or focus.

    Examples include:

    • Expecting sustained attention without any breaks
    • Ignoring sensory overload or sensitivity
    • Using rigid routines that don’t account for differences in energy levels throughout the day

    How to work with this:

    1. Educate and identify

    The first step is to educate yourself on your own neurodivergence: find resources online, consult with an expert, or take a look at some scientific research.

    Then, try keeping track of your energy and productivity levels. Rather than asking ‘why am I like this’, ask yourself: ‘what conditions do I need to help my brain function better?’

    2. Build routines

    Based on what you learned about yourself, create predictable daily routines, while avoiding rigid templates that can make you feel stuck.

    • Establish consistent schedules and plan either for the day or week ahead. See if you can find a consistent sleep, exercise and nutrition schedule as well.
    • Make use of time blocking techniques – group similar activities, build ‘buffer time’ between tasks, make visual systems.

    Additional tips:

    •  Make use of external supports: reminders, calendars, to-do lists, timers, body doubling, etc.
    • Allow yourself to move around or stim as needed
    • Reduce sensory overload by using noise cancelling headphones, going to a quieter environment, etc.

    3. Focus on lifestyle habits

    When your body gets what it needs, it becomes much easier to work towards your goals.

    Get enough sleep, and work with your natural circadian rhythm, where possible. Try to go to bed and wake up at the same time every day.

    Nourish your body with a varied diet, learn what foods help you focus when, and time your carbohydrate, protein and caffeine consumption accordingly.

    Get enough exercise – physical activity is a natural dopamine regulation, which is the neurotransmitter you need for higher motivation and productivity.

    Plan rest and stress management – this could be taking walks, mindfulness or meditation.

    How I apply this in my own life:

    Habit stacking – For example, if I already get up to do my dishes, I try to add another task, such as folding laundry. I find that easier than siting back down, and then having to get up to fold the laundry again.

    Working with my circadian rhythm – I am an evening-type, so I don’t schedule any work before 10am, and try to use my ‘high-productivity window’ to plan my most challenging work. I also try to keep my sleep schedule as consistent as I can.

    Writing everything down – when I have a lot to do, I know my brain can’t hold it all, so I write down all my tasks, creative ideas, or grocery shopping lists.

    Utilizing to-do lists – weekly and monthly – I keep two to-do lists on my phone, where it’s easily accessible, to avoid getting overwhelmed. My weekly to-do list includes high-priority tasks with closer deadlines, and my monthly to-do list helps me keep track of more longer-term projects.

    Keeping my calendar updated and organized – I love my Google calendar, and I make sure it’s well-organized and color coded with different categories. I put down all my work tasks, therapy sessions or meetings, as well as social gatherings and workouts. This way, I know exactly what my week is going to look like ahead of time.

    Planning and preparing my meals in advance – I often have a hard time with coming up with something to make on short notice, so I make sure I either know what I am going to cook, or meal prep in advance if I know I won’t have time on certain days.

    Starting my day with the task I am most likely to put off – as I know willpower fades throughout the day, I try to capitalize on the moment it’s the highest, which for me is at the beginning of the day. For me, phone calls can be difficult, and if I get it out of the way first thing in the day, I then have a lot more brainpower to focus on other tasks.

    10-minute rule – I have to try for 10 minutes, and if it still feels impossible, I post-pone the task.

    Using blocker apps + do not disturb mode – I have all my social media blocked, and my phone on do not disturb when I need to focus, which usually is during the day. In the evening, when it’s time to rest, I have any apps I need for work blocked or closed, ensuring my stress levels come down.

    Note: I am a major planner, so having routines and structures helps me tremendously. For some, planning so much in advance can feel paralyzing, so it’s really about using trial and error to figure out what is most optimal for you.

    In summary, working with your brain means:

    • Focusing on what you can control
    • Designing goals the generate feedback
    • Reducing reliance on willpower
    • Figuring out what works for you, and adjusting/accommodating accordingly
    • Avoiding shaming or criticizing yourself

    It can feel overwhelming to try to figure this out on your own, and seeking therapy can be a great way to figure out what works, and how to make it stick.

    References

    Barkley, R. A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment.

    Clark, A. (2013). Whatever next? Predictive brains, situated agents, and the future of cognitive science.

    Yuste, R., & Church, G. (2014). The new century of the brain.

    Treadway, M. T., & Zald, D. H. (2011). Reconsidering anhedonia in depression: lessons from translational neuroscience

    Ratey, J. J. (2008). Spark: The Revolutionary New Science of Exercise and the Brain

    Baumeister, R. F., et al. (1998). Ego depletion: Is the active self a limited resource?

    Robertson, C. E., & Baron-Cohen, S. (2017). Sensory perception in autism

  • Asking for What You Need

    Asking for What You Need

    We all have different needs, and in an ideal world, we would get them met with ease, and feel no shame in accommodating ourselves. However, many of us have learned that having needs=being needy, from experiences in childhood with our caregivers, at school with teachers and peers, or from our first romantic relationships. This is especially true for neurodivergent people, and even more so if they were only diagnosed later in life.

    I am going to start with a personal anecdote – I recently was on vacation in a busy city, and while I was very happy to be there, I found myself getting quite overwhelmed by the sheer amount of people and noise that surrounded us. This is not news – I know I don’t deal well with noise and normally use noise-cancelling headphones when alone in these kinds of situations. However, since I was with a group of friends, I resisted getting them, for fear of seeming rude, antisocial, and even weak. However, as time went on, I found myself becoming more and more silent (and therefore, actually running the risk of seeming rude or antisocial!) as I got more and more overwhelmed. At some point, I decided to just wear the headphones, and it made my experience SO much better, and I was able to be present for my friends way better as well. But this got me thinking, why was it so difficult for me to make use of an accommodation that I know I need, with people who care about me and my wellbeing?

    The answer? Shame. And I want here to focus specifically on neurodivergent people.

    From a young age, many neurodivergent people are praised for “coping well” or “managing without help.” Over time, this creates deep shame around needing support at all (internalized ableism). And so you pretend you don’t need it. Psychologists call this masking—suppressing or compensating for neurodivergent traits to avoid social stigma. Masking is often protective, but it’s also exhausting. And when we hide our needs too long, burnout can follow.

    Therefore, asking for accommodations can feel risky, as you may fear that they are seen as special treatment, or you may be seen as lazy, difficult, or weak. However, let’s try to reframe accommodations as tools for access and self-knowledge, rather than privilege or special treatment.

    Here are a few examples:

    For ADHD: using noise-cancelling headphones, breaking tasks into smaller steps, or requesting clear written instructions.

    For autistic people: asking for predictable routines, avoiding sensory overload, or clarifying social expectations.

    In social life: asking friends to text instead of call, meeting in quieter places, or giving yourself permission to leave early.

    And here are a few practical tips:

    1. Name your needs clearly, even if just to yourself. Awareness is the first step to communication.
    2. Notice when you’re being too harsh on yourself and ask yourself: “Who’s standards am I trying to meet?”
    3. Practice asking for help in a safe environment – this could be with a specific person, such as a partner or close friend, or even in therapy.
    4. Start small – ask for one small accommodation and go from there.
    5. Connect with others – either online or in-person, seek out connection and community with other neurodivergent people. This will not only provide you with support, but also helps normalize asking for help. You can also brainstorm ways of asking for help with others.

    If you struggle with this, therapy can also help you identify the roots of shame and learn to treat your needs as legitimate. Several evidence-based approaches can be particularly effective:

    • Compassion-Focused Therapy (CFT) helps soften self-criticism and reframe shame as a universal human emotion rather than a personal flaw (Gilbert, 2010).
    • Acceptance and Commitment Therapy (ACT) focuses on living according to your values—even when fear or shame shows up (Hayes et al., 2012).
    • Internal Family Systems (IFS) or Schema Therapy can help uncover the “parts” of you that feel undeserving, lazy, or afraid of burdening others, and bring compassion to them.

    Therapy also provides a practice ground for asking for accommodations—a space to explore what it feels like to express needs without fear of judgement.

    In short, asking for what you need is not a weakness, even if it feels that way at first. Reasonable accommodations can help you enjoy your life a lot more and avoid burn-out, and it’s worth learning effective communication about your needs!

    References

    Botha, M., & Frost, D. (2020). Autistic masking and the double empathy problem: Mental health and authenticity. Autism in Adulthood.

    Brown, B. (2006). Shame resilience theory: A grounded theory study on women and shame. Families in Society.

    Gilbert, P. (2010). Compassion Focused Therapy: Distinctive Features. Routledge.

    Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. Guilford Press.