Autism: what is social camouflage, which makes it difficult to diagnose in girls

Autism spectrum disorder (ASD) is characterized by an alteration in brain development that causes changes in social communication and repetitive and stereotyped behaviors. For those who live with the condition, sensory changes, such as extreme discomfort with certain noises or textures, and a specific repertoire of interests —also called hyperfocus— are often common.

“Autistic people have a different way of perceiving the world. This makes them turn their attention to other elements of the environment that are not necessarily social stimuli. In a crowded environment, for example, it is possible that the noise of a instrument or a car engine on the street draws more attention than people’s voices”, explains psychiatrist Mirian Revers Biasão, professor at the International School of Development (EID).

The doctor, who researches autism, explains that, because of this, the experience of a person with ASD results in different learning and different actions from those usually socially expected among neurotypical people.

“I, for example, learned to behave in a certain environment because I watched and someone, like my mother, taught me. What happens with autistics is that they can learn how to interpret other people’s actions and understand what is expected of them. , but it doesn’t happen so naturally”, he says.

It is this process of trying to mimic behaviors considered socially accepted in groups such as friends at school, at work and even in family relationships, which is known as “social camouflage” or “masking”. “As it is not so natural for neuroatypicals, these attitudes end up spending more brain energy and the person can become exhausted, both physically and emotionally”, explains Biasão.

The harm of social camouflage to the mental health of autistic people

Several studies show that the effort of social camouflage made by autistic people is related to higher rates of depression, anxiety and exhaustion. One of them, published in 2017 in the scientific journal Autism, raises the hypothesis that autistic men suffer even more from these effects, since women generally have less difficulty in performing camouflage.

“Crises due to sensory overload can also contribute to these conditions, which is why diagnosis is so important. Once we know someone is autistic, we can start working the limits with that patient. Instead of spending four hours at a party , for example, it may be more comfortable for that person to stay just two hours”, says Biasão.

Social camouflage is more common in autistic girls and women

One of the theories accepted by science is the difference between the brains of men and women.

Some studies, such as an analysis published in the journal Neuroscience and Biobehavioral Review, show that the female brain is subtly more developed in areas that correspond to social behaviors. This makes the more stereotyped actions, such as those represented in series with autistic protagonists, such as “The Good Doctor” and “Atypical” not so prevalent in women with ASD, especially if they have a mild degree.

“This even makes it difficult for girls to be diagnosed”, points out Joana Portolese, coordinator of the Autistic Spectrum Disorders Program at the IPq (Psychiatry Institute) at the Hospital das Clínicas in São Paulo. According to a study carried out in Sweden, the estimate is as high as 10 boys diagnosed for every girl.

Another issue, explains Portolese, is that the fear of committing “social mistakes” is greater and the hyperfocus of girls tends to be focused on interests that are not so different from those presented by peers of the same age. In addition, society itself already determines many rules for girls, and this demand makes them start to camouflage themselves earlier.

If the diagnosis does not come in childhood, it is possible that women will become increasingly better at “disguising” the signs of autism, delaying diagnosis for years. “I once heard Temple Grandin, an autistic psychologist, say that the idea of ​​being autistic is that you gradually become less and less autistic, because you keep learning how to behave. She says it’s like acting in a play,” he says. the IPq psychiatrist.