From the Guidelines
Autism in high-achieving women often presents differently than the traditional diagnostic model, which was historically based on male presentations, and is characterized by excellent masking or camouflaging abilities, intense special interests, social exhaustion, and sensory sensitivities. These women frequently demonstrate learned social behaviors, scripting conversations, and mimicking others, which can hide their autistic traits 1. Common symptoms include:
- Intense special interests that may appear more socially acceptable (like literature, animals, or psychology)
- Significant social exhaustion after interaction (often called autistic burnout)
- Sensory sensitivities that may be dismissed as being "highly sensitive" High-achieving autistic women typically struggle with unwritten social rules despite appearing socially competent, experience intense emotions and anxiety in social situations, and may have rigid routines or perfectionism that gets misinterpreted as being organized or conscientious 1. They often report feeling different from peers throughout life without understanding why, and may have histories of depression, anxiety, or eating disorders before receiving an autism diagnosis. Executive functioning challenges like time management difficulties may be present despite high academic achievement. These women frequently receive late diagnoses because their intelligence and compensatory strategies allow them to function well in structured environments while struggling significantly with the social and sensory aspects of daily life. It is essential to consider these differences in presentation to ensure accurate diagnosis and effective support for high-achieving autistic women.
From the Research
Typical Presentations and Symptoms of Autism in High-Achieving Women
- The provided studies do not directly address the typical presentations and symptoms of autism in high-achieving women 2, 3, 4, 5, 6.
- However, the studies discuss the treatment of autism spectrum disorder (ASD) and its associated symptoms, such as anxiety, obsessive-compulsive behaviors, and depression, using selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) 2, 3, 4, 5.
- One study found that SSRIs can be effective in treating anxiety disorders in children and adolescents with ASD 3.
- Another study found that SNRIs, such as venlafaxine, can be useful in treating self-injurious behaviors, aggression, and ADHD symptoms in children and adults with ASD 4.
- A network meta-analysis found that all SSRIs and SNRIs were effective for multiple symptom domains, including anxiety, obsessive-compulsive, and stress-related disorders, with minimal differences between medications concerning efficacy and acceptability 5.
- A study on early life adversity as a moderator of symptom change following SSRIs and cognitive behavioral therapy found that SSRIs may be particularly effective for individuals with early life adversity and depression symptoms, while cognitive behavioral therapy may be particularly effective for individuals without early life adversity and depression symptoms 6.