Men’s Health Week: Unconfirmed Autism in Men

It is Men’s Health Week 2024. As part of this, More Than Quirky is looking into an aspect of autism that isn’t often discussed: undiagnosed males. What happens if we don’t adequately recognise our autistic boys, and they grow into unconfirmed autistic men?

It is often shared that the increase in females and gender-diverse young people being diagnosed with autism is related to initial definitions of autism being based on the typical “male presentation”. Autistic girls are said to be around 4 times less likely than autistic males to be confirmed as autistic as a young child. Increasingly often middle-aged women are joining the late-diagnosed club. Women who have careers, children, spouses, key roles in the community… Women who are very capable, but for whom this success requires more effort, and is more difficult. While it seems many men are joining the late-DX club when it comes to ADHD, it does seem that the gender divide in autism diagnosis is impacting greatly on unconfirmed-autistic adult males who are not receiving the support they need.

“Girl autism”

One reason, of many, that statistically fewer females are confirmed as autistic earlier in life is that the traits of autism more likely to appear in males are perceived by society as problematic.

Society is more accepting of shy or quiet females than shy or quiet males. More concerned if males have motor coordination difficulties. And less worried if girls are bookworms, intensely interested in a particular topic, homebodies, or prefer non-team activities. As such, many autistic girls fly under the radar.

Females with an ASD diagnosis and IQ scores within the average range show increased functional social behavior compared to males with ASD 

Sex and gender differences in autism spectrum disorder: summarizing evidence gaps and identifying emerging areas of priority 2005: https://molecularautism.biomedcentral.com/articles/10.1186/s13229-015-0019-y

Similarly, studies indicate that females are more likely to camouflage or mask their autistic traits, imitating the behaviours of allistic – particularly neurotypical – peers.

camouflage seems to be more common among females who report more autistic symptoms themselves and are perhaps more aware of their challenges in social situations

Camouflage and masking behavior in adult autism: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10060524

However, while autistic traits do seem to have some gender leanings, there is certainly not a clear delineation. It is not a case that some traits appear in males, and others in females. There is simply a statistical likelihood. And so while some girls meet the criteria early for what some jokingly refer to as “boy autism” and therefore are confirmed when young, the inverse is problematic. It seems that males with stereotypically female presentations of autism are not only not being diagnosed when young. They are also not reaching that magical point of realisation in their adult lives either.

Unconfirmed, Unsupported Men

If these men have made it through childhood and the majority of their adult lives without recognising that they’re autistic, why is it important now?

Late-diagnosed women often reach confirmation because they’ve reached a point of burnout. After confirmation, they often share a sense of relief, self-forgiveness, improved relationships, increased self-esteem, and many other positives. Unconfirmed autistic men are likely reaching the same point of burnout, but are:

• Brushing it off as being in a senior, high-stress point in their career
• Being diagnosed with depression
• Self-medicating in a way that society often perceives as acceptable for middle-aged men: alcohol, gambling, pornography
• Discussing it with their closest mates – who are statistically likely to also be neurodivergent whether they know it or not, especially if they’re friends from childhood – and deciding they largely feel the same and therefore it must be normal
• Being diagnosed with coexisting conditions such as ADHD. Feeling frustrated that the medication is not fixing as many issues as expected
• Forcing a patriarchal role, and expecting family, friends, colleagues/staff, etc, to accommodate their needs without question
• Having meltdowns, and dismissing them as having anger management problems
• Experiencing what is seen as a mental health crisis or breakdown

What Might It Look Like?

Again, acknowledging that there is no such thing as “male autism” and “female autism”, traits in autistic adult males who aren’t recognised as autistic might include:

Nonspeaking Communication Differences and Social-Emotional Differences:

Not being good at “reading the room” such as noticing when a colleague is a bit down, recognising when someone is bored listening to a story they’re recounting; not being very good at hiding boredom, disinterest, or contempt when listening to someone; not smiling in a situation when most people do; not making eye contact in a typical way; talking rapidly when sharing something they’re interested in (even something like a reel they enjoyed online) without absorbing the other person’s reaction until they feel finished.

Relationship Difficulties:

Problems with or disinterest in dating, or marital difficulties; lack of effort in established relationships, taking unconditional relationships for granted; not making new friends, not communicating with old friends often; poor attachment with parents, spouse, and/or children; inconsistent parenting style

Repetitive and Restricted Behaviours:

Spending all of their time focused on work and/or one or two hobbies; having “encyclopaedic knowledge” on a particular subject

Stimming:

Pen tapping, nail chewing, twisting on swivel chairs, twitching, excess consumption of sugar and/or caffeine, snacking

Sensory Differences:

Disliking or loving noisy places, spicy foods, bright rooms; hating certain fabrics, sounds, or textures; complaining of “getting the icks” about washing up, changing nappies, gardening, etc

Resistance to Change:

Following the same routine, liking things to live in very specific locations, preferring to holiday in the same place(s), enjoying eating the same food often, buying the same brand and style of socks every time

How Can I Help?

If you’ve had an inkling that your son is autistic, but he doesn’t present in the stereotypical way, don’t discount the idea. Boys who are communicative, empathetic, and make eye contact, can still be autistic! And just because they don’t demonstrate behaviours that look like they’re struggling, it doesn’t mean they aren’t.

Teens and adults who have undiagnosed autism can struggle with symptoms that may lead to depression, anxiety and self-harm

UCSB Koegel Autism Center at the Gevirtz Graduate School of Education: https://education.ucsb.edu/about/news-press/ggse-news/undiagnosed-autism-in-teens-and-adults-can-lead-mental-health-issues#:~:text=SANTA%20BARBARA%20–%20Teens%20and%20adults,Gevirtz%20Graduate%20School%20of%20Education.

If any of the descriptions above sound like your child, teenager, or even husband, look further.

Particularly if anyone else in your family is neurodivergent, especially autistic or ADHD.

Discuss with the males in your life, if appropriate. Seek support and additional advice if you need help.

Don’t let them be dismissed as “an outsider”, “a bit stressed”, or “just quirky”.