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Girl Unmasked How Uncovering My Autism Saved My Life

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Understanding Autistic Girls: How Uncovering Neurodivergence Saves Lives

Introduction: Why Autistic Girls Are Systematically Missed

Autistic girls are diagnosed on average six years later than boys, with 80% remaining undiagnosed at age 18. This Diagnostic gap isn’t because fewer girls are Autistic—it’s because assessment tools were developed primarily from research on cisgender white boys, and girls’ autistic traits present differently through socialization and masking.

Emily Katy’s memoir reveals how being well-behaved, high-achieving, and creative paradoxically prevented her Diagnosis despite experiencing significant Autistic challenges. The requirement that Autistic traits “persistently and significantly impair” functioning means thriving Autistic children remain invisible until crisis point.

The Two Types of Imagination: Creative Vs. Social

A persistent autism myth is that Autistic people lack imagination. The reality is more nuanced—Autistic people often possess intense creative imagination while struggling with social imagination.

Creative imagination: The ability to generate novel ideas, fantasies, artistic concepts, and elaborate worlds. Many Autistic people excel here.

Social imagination: The ability to process unfamiliar situations, predict social outcomes, understand abstract social concepts, and navigate ambiguous social dynamics. This is genuinely challenging for many Autistic people.

Research shows Autistic people have enhanced Sensory discrimination and increased perceptual capacity—experiencing the world in vivid detail rather than lacking imagination. Emily designed elaborate fantasy kingdoms with detailed maps and backstories while being unable to predict how peers would react to her gifts or understand rhetorical questions.

The Neurological Reality of Sensory Processing

Autistic brains process significantly more Sensory information simultaneously than neurotypical brains. This creates genuine Neurological sensory overload, not behavioral problems requiring suppression.

Emily’s “kettle metaphor” explains this experience: Sensory input fills like water until the brain “boils over” into meltdowns, shutdowns, or irritability. Common sensory sensitivities include:

  • Clothing labels causing skin irritation and rashes
  • Mud, sand, and textures like tights causing visceral distress
  • Strong smells (chlorine, bacon, fried onions) triggering nausea
  • Loud noises (school bells) causing ear pain for extended periods
  • Bright fluorescent lights creating visual distress

However, heightened Sensory perception also brings benefits: 5% of Autistic people have perfect pitch (versus 0.05% in the general population), and many experience the world in vivid detail—seeing 200 shades of green where others see 20, hearing musical nuances others miss, or noticing patterns invisible to neurotypical perception.

The Heavy Cost of Masking and Camouflaging

Autistic masking is the exhausting process of pretending to be neurotypical by copying others’ behaviors, Facial expressions, social scripts, and suppressing stimming. Emily’s masking included:

  • Practicing “happy” expressions in mirrors until faces felt alien
  • Controlling tone of voice (told she sounded “rude” or had “wrong” intonation)
  • Making uncomfortable eye contact against natural preference
  • Learning scripted responses for social situations
  • Wearing Sensory-painful clothing to fit in
  • Suppressing stims and authentic reactions until safe at home

Masking creates a devastating dual reality: the public persona (quiet, agreeable, controlled) and the private self (authentic interests, unfiltered thoughts, overwhelming emotions). Research links heavy masking to increased suicide risk and PTSD symptoms.

For marginalized autistic people, unmasking carries life-threatening risks. Black Autistic people face disproportionate harm when displaying authentic Autistic behavior, including police violence and overpolicing. Emily acknowledges her white privilege and lower Support needs made masking protective rather than physically dangerous, though it ultimately damaged her mental health.

School As Environment of Cumulative Trauma

Emily’s reflection on a “typical school day” reveals how environments without Neurodivergent accommodation create trauma:

  • Inadequate sleep from Anxiety about the coming day
  • Uncomfortable uniform causing skin rashes and Sensory distress
  • Chaotic hallways with unexpected social interactions
  • Incomprehensible jokes causing shame and social confusion
  • Painful bell sounds creating auditory distress
  • Unexpected schedule changes creating cascading Anxiety
  • Sensory-overwhelming spaces (crowded canteens, strong-smelling classrooms)
  • Group work expectations despite Autistic difficulty with peer collaboration
  • Being labeled “bossy” when directing tasks and seeking clarity
  • Perfectionism-driven homework extending for hours
  • Inability to “switch off” mentally before sleep due to Anxiety

This daily bombardment teaches Autistic children that pain and emotional overwhelm are acceptable and normal—a lesson with lifelong consequences for boundary-setting.

Under the Equality Act 2010, schools have legal obligations to make reasonable adjustments based on need—not requiring official Diagnosis. Specific Accommodations include:

These adjustments level the playing field and protect mental health.

The Reality of Bullying and the Power of Peer Education

By age 7-8, peers identified Emily as “weird” and excluded her deliberately. Seventy-five percent of Autistic young people report bullying; Emily believes the actual rate is higher. Bullying involved verbal insults, deliberate exclusion, public humiliation, and social manipulation.

Remarkably, a school assembly where the SENCo (Special Educational Needs Coordinator) educated students about Autism shifted peer behavior. The assembly explained how sounds cause pain, emotions are hard to regulate, and social situations overwhelm Autistic people—framing autism as Neurological difference rather than targeting individuals.

Afterward, a classmate who had previously mocked Autistic behavior apologized and showed understanding. Peer education demonstrating that understanding, not condemnation, is possible proved transformative.

Special Interests As Essential Coping and Foundation for Thriving

Grunya Sukhareva identified “strong interests pursued exclusively” in 1925—decades before Kanner or Asperger—recognizing what we now call special interests. The DSM-5 lists “restricted, repetitive patterns of behavior, interests or activities” as Diagnostic criteria, using language that frames difference as pathology.

However, research on nearly 2,000 young Autistic people found special interests bring joy, rarely interfere with functioning, and correlate with good wellbeing, strong careers, and societal benefits.

Emily’s special interests (books, dolphins, Harry Potter, writing, musicals, autism itself) provided structure, certainty, escape from overwhelming reality, joy, and social connection. Her brain cycles quickly through intense hyperfixations—lasting days to months—typical of Autistic people with ADHD traits (which she was later diagnosed with at age 21).

Special interests are “like oxygen” for Autistic people; deprivation causes distress. They provide safe havens when daily life becomes unbearable and can form the foundation for fulfilling careers and friendships when accommodated rather than suppressed.

Literality and Social Misunderstanding

Emily’s literal thinking created repeated social friction:

  • Misunderstanding instructions (“write as much as you can” = literally 20 pages instead of 2)
  • Not recognizing rhetorical questions as unanswerable
  • Taking sarcasm and idioms literally
  • Trying to “help” teachers by correcting grammar and spelling
  • When told to wait “outside,” waiting outside the building rather than in the corridor

Her literality also blurred reality and fantasy boundaries; after reading Enid Blyton books, she nearly ran away with her brother to have adventures, not fully grasping potential danger.

Perfectionism and Academic Privilege: the Double Edge

Emily thrived academically, winning reading awards, poetry competitions, and excelling in most subjects. She built identity around being “the smart one”—an identity that provided protection within school systems. Teachers praised her abilities rather than viewing her as disruptive.

However, perfectionism became exhausting—redoing essays multiple times, checking homework bags repeatedly, pre-studying for tests to anticipate questions. This perfectionism was driven by her need for control and certainty in an uncertain world; it was survival strategy, not personality trait.

Academic achievement masked Sensory difficulties, social overwhelm, and mounting Anxiety until her mental health reached crisis point.

The Crisis Journey: Panic, Ocd, and Hospitalization

Panic Attacks and Fight-or-Flight Physiology

Panic attacks occur when the sympathetic nervous system triggers unnecessarily. Walter Cannon’s 1915 research identified that stress activates this system, releasing adrenaline for “fight-or-flight”—increasing heart rate, redirecting blood to muscles, releasing hormones, activating sweat glands, and slowing digestion.

For someone experiencing panic, all physiological symptoms occur (rapid breathing, racing heart, trembling, intense fear) despite no real threat, creating terror and sensation of imminent death.

Supporting Someone During a Panic Attack:

  • Stay calm and speak slowly (voices may sound distant or jumbled—speaking louder doesn’t help)
  • Offer water without forcing it; cold sensation can ground
  • Provide usual stress-management tools (ear defenders, headphones, weighted blankets, ice, fidget toys)
  • Remind them they’ve survived this before and will again
  • Reassure that guilt or embarrassment isn’t needed
  • Help move to quiet space if possible
  • Encourage focusing on your voice rather than Anxiety
  • Suggest counting-based breathing (inhale 4, exhale 4)
  • Do not touch unless requested—touch distresses many Autistic people; ask if they want to hold your hand instead
  • Ground them by ensuring feet are firmly on ground
  • Cool them down (open window, ice cube)
  • Once alert, use grounding technique: five things you see, four you hear, three you feel, two you smell, one you taste

Ocd in Autistic People: Recognition and Distinction

OCD consists of obsessions (intrusive, distressing repetitive thoughts) leading to compulsions (repetitive actions to reduce Anxiety). Emily’s first manifestation was obsession with head lice at age 10: after genuine infestation, she became convinced she had recurrent lice despite evidence otherwise.

Years later, OCD “befriended” her existing Anxiety: if she tapped her bookshelf 10 times, she wouldn’t have panic attacks; if she tapped a lamppost 3 times and used hand gel, she wouldn’t get ill. OCD promised control.

OCD versus Autistic traits:

  • Autistic special interests and hyperfixations are usually enjoyed, provide comfort and safety, and help functioning
  • Autistic ritualistic behaviors are often contentedly performed; distress comes from prevention, not the routine itself
  • OCD compulsions feel wrong but irresistible; Autistic routines feel right
  • OCD creates Anxiety and sense of danger when prevented; Autistic routines just feel incomplete

Autistic people experience higher OCD rates (17% versus 1.2% non-Autistic) possibly due to neurotype predisposing to latching onto intrusive thoughts.

The Psychiatric Hospitalization Experience

After severe panic during French class, Emily ran from school into woodland beyond field boundaries, fleeing Sensory and emotional overload. She was missing and eventually found. This episode marked escalation to crisis level.

Subsequently, Emily experienced severe depression characterized by physical pain, intrusive suicidal thoughts, complete withdrawal from daily functioning, and belief that recovery was impossible.

She was admitted to a psychiatric unit for approximately three months. The ward environment was profoundly stressful for her Autistic neurology:

  • Constant staff supervision (one-to-one watch)
  • Loud environments and unpredictability
  • New surroundings and people
  • Loss of control and inflexible rules
  • Sensory chaos
  • Removal of her diary—a hyperfixation object and primary coping mechanism

When staff took away her spiral-bound diary, Emily experienced severe distress and self-harm, leading to her being sectioned rather than being recognized as an Autistic person in crisis.

Psychiatric units contain disproportionately high numbers of Autistic people: research suggests Autistic people may account for 40% of suicides, with 41% of suicide completers showing elevated Autistic traits. Despite these statistics, Autistic presentations went completely unrecognized during Emily’s hospitalization.

Diagnostic Bias and Misdiagnosis

Why Autistic Girls Are Systematically Missed

  1. Assessment tools developed from biased samples: Kanner’s 1943 foundational study included 8 of 11 boys, all white. Hans Asperger claimed never to have met an Autistic girl. Simon Baron-Cohen’s “extreme male brain theory” further embedded male-centric understanding.

  2. Social interests are less likely to trigger referrals: Girls’ special interests (animals, reading, writing, horses) are more socially acceptable than boys’ interests.

  3. Gendered socialization increases masking: Girls are socialized to be quiet, compliant, and socially aware—facilitating more effective masking.

  4. Girls are labeled “shy” or “anxious”: Rather than Autistic, high-achieving girls with social difficulty are diagnosed with anxiety disorder.

  5. Diagnostic framework requires visible impairment: The DSM-5 and ICD-11 require that traits “persistently and significantly impair” functioning. Happy, thriving Autistic people remain undiagnosed until they break down.

Personality Disorder Misdiagnosis

Upon discharge, Emily received diagnoses of Generalised Anxiety Disorder and Mixed Personality Disorder (emotionally unstable and anankastic/obsessive-compulsive types). Her safety plans listed Autistic traits perfectly—“finds change difficult,” “needs routine and structure,” “finds loud noises distressing”—yet Autism was never considered.

Emotionally Unstable Personality Disorder (EUPD) is frequently misdiagnosed in Autistic people, particularly Autistic women. The Diagnostic criteria emphasize “intense and unstable emotions, impulsive behaviour, anger, difficulty making relationships, recurrent suicidal behaviour and self-harm”—all of which can describe a traumatized Autistic person in crisis.

The Transformative Power of Diagnosis

At age 16, Emily’s parents arranged a private autism assessment. Despite her frustration with infantilizing activities, the three assessors reached a clear conclusion: Emily was Autistic.

This single moment transformed her life. Walking out of the Assessment building, Emily felt overwhelming relief, confusion about why it took so long, joy at finally knowing the truth, sadness for lost years, and anger at adults who hadn’t noticed.

Critically, she realized she wasn’t “stupid”—she was Autistic. For the first time, she could stop blaming herself for everything that went wrong. The Diagnosis explained not just her struggles but also her strengths: her ability to hyperfocus, her pattern recognition, her loyalty, her intensity of feeling.

Reframing Autism Myths Versus Reality

Emily addresses widespread misconceptions:

  • Autism is primarily a “boy condition” (false—Diagnostic bias, not prevalence)
  • Autistic people lack imagination (false—many are highly creative)
  • Autistic people don’t make eye contact (false—some do, some don’t, some make too much)
  • Autistic people can’t understand jokes (false—many have unique, intense humor)
  • Autistic people lack empathy (false—Damian Milton’s double empathy theory suggests the disconnect is between different neurotypes)
  • Autistic people are good at math (false—varies by individual)
  • Autistic people aren’t social (false—many seek connection intensely)
  • Autism is a learning disability (false—it’s a Neurodevelopmental condition)
  • You can tell autism by looking at someone (false—masking is common)
  • Everyone is “a little bit Autistic” (false and dismissive)
  • Meltdowns are tantrums (false—involuntary overwhelming responses)
  • The autism spectrum is linear (false—it’s more circular)

The “cupboard”: Safe Space and Recovery

After discharge and Diagnosis, Emily found a crucial Support tool: a small storeroom (“cupboard”) off a classroom in the school’s special educational needs building. This eight-square-foot space became her safe haven during panic attacks.

A supportive staff member would sometimes sit with her while she calmed down, encouraging breathing and helping identify triggers. This staff member introduced Emily to a new spiral-bound notebook (“What being Autistic means to me”) decorated with gel pens, stickers, and sequins—a replacement for her confiscated diary and a tool for exploring autism.

Autistic Traits: Recognized and Under-discussed

Commonly recognized traits include:

  • Love of certain Sensory experiences with difficulty tolerating others
  • Periods of not speaking or hyperverbality
  • Exceptionally strong interests
  • Black-and-white thinking patterns
  • Difficulty with social navigation
  • Need for routine and sameness
  • Difficulty with change
  • Intense emotions (including intense joy)
  • Hyperfocus ability
  • Meltdowns/shutdowns after social demands

Less frequently discussed traits include:

  • Difficulty recognizing faces (prosopagnosia)
  • Having no verbal filter
  • The “autism accent” (distinctive speech pattern)
  • Difficulty with motor skills (dyspraxia)
  • Talking too fast or loudly
  • Extreme obedience (detrimental to wellbeing)
  • Lack of fear toward danger
  • Stronger connection with animals than people

Mental Health and Comorbidity

Eighty percent of Autistic people experience mental health problems during their lives, most commonly depression and Anxiety. Autistic children are 28 times more likely to attempt suicide; Autistic adults without intellectual disability are 9 times more likely to die by suicide.

The undiagnosed Autistic child works “ten times harder than everyone else” to function, reaching breaking point at adolescence when cognitive demands and social complexity increase exponentially.

Vulnerability, Safety, and Support Systems

Heightened Vulnerability to Exploitation

Autistic people face heightened vulnerability to exploitation, abuse, and sexual assault—research suggests Autistic women are 2-3 times more likely to experience sexual assault than non-Autistic women. Risk factors include:

  • Difficulty recognizing unsafe situations
  • Tendency to trust strangers
  • Shutdown responses that prevent Self-advocacy
  • Struggle to distinguish between Anxiety-provoking and genuinely dangerous situations
  • Fear of authority figures that can lead to compliance with harmful requests

Support During Crisis and Self-harm

Self-harm is hurting oneself to cope with emotional pain, distressing memories, or stress. It does not indicate suicidality, though many who attempt suicide have self-harm histories.

Supporting someone you love who self-harms:

  • Research self-harm to enter conversation informed
  • Start conversations during activities rather than formal settings
  • State clearly you’re not angry, disappointed, or upset
  • Offer to help clean or dress wounds but don’t force
  • Tell them they can reach out if urges strike
  • Create alert systems (code word text, sad face on door)
  • Normalize conversation
  • Seek Support yourself

Post-Diagnostic Support and Identity Formation

After Diagnosis, Emily received books and websites—effectively “Congratulations! Here’s a reading list.” No ongoing Support was offered. This systemic gap leaves many Autistic people without the understanding they need to process Diagnosis, build a positive Autistic identity, or navigate a non-Autistic world.

Emily eventually worked with a psychologist for 18 months who met her with consistent presence and validation. This relationship proved transformative. The psychologist gave her a small navy mirror decorated with red flowers and birds as a parting gift, telling her to see within it all the gifts she has to give others and to remember that she deserves to receive these things from others.

Finding Purpose and Autistic Joy

After surviving her suicide attempt, Emily eventually pursued mental health nursing as a career, working with Autistic children in inpatient psychiatric units. She began blogging about autism on social media and gained significant following, using her platform to advocate for Autistic acceptance and understanding. She became trustee of the Autistic Girls Network.

Autistic joy is described as a complete consumption that radiates through the body, where everything else melts away and only the source of joy matters. Emily experiences profound joy at Disney World or other hyperfixation-related situations.

Historical Context: Hans Asperger and Eugenics

Emily details the troubling history of autism Diagnosis, particularly Hans Asperger’s Nazi connections. He sent hundreds of Autistic children he deemed “unbearable burdens” to Am Spiegelgrund in Vienna where approximately 800 were murdered through starvation and lethal injection. This history haunts contemporary discussions of disability value and societal burden narratives.

Systemic Issues and Advocacy

Conditional Acceptance As Harm

Communities that initially welcome Neurodivergent people but withdraw Support when needs become inconvenient create devastating rejection. After years of attending youth group weekly where she felt loved and accepted, Emily was excluded from a festival trip with an email stating they “couldn’t manage” her. This rejection devastated her—not just losing the festival, but losing a healing community.

The Need for Systemic Change

Emily emphasizes that Autistic people’s vulnerability to abuse, bullying, and suicide stems not from inherent weakness but from living in environments not designed for Neurodivergent minds. Understanding oneself as Autistic—rather than as broken, weird, or failing—fundamentally shifts self-worth and possibility.

Practical Strategies and Support

Sensory Accommodation and Environmental Modification

Rather than asking Autistic people to tolerate pain, create environments that reduce Sensory triggers:

  • Clothing modifications: Offer label-free, flat-seamed clothing
  • Auditory environment: Provide ear defenders, noise-cancelling headphones, quiet spaces
  • Visual environment: Reduce fluorescent lighting, offer positioning away from bright lights
  • Sensory refuge spaces: Create designated quiet rooms for retreat
  • Permission for movement: Allow fidget toys, movement breaks, stimming

Advance Planning and Predictability

Autistic brains thrive with predictability:

  • Provide schedules in advance
  • Notify of changes immediately with explanations
  • Create familiar routines
  • Use countdowns for significant events
  • Build transition time
  • Document important information

Special Interest-Based Learning and Connection

Rather than viewing special interests as behaviors to suppress:

  • Integrate special interests into education
  • Use special interests for social connection
  • Support career exploration
  • Validate interest intensity
  • Recognize cycling between interests
  • Create space for expression

Direct, Literal Communication

Autistic people think literally:

  • Use concrete language
  • Avoid idioms and sarcasm
  • Clarify ambiguous statements
  • Explain the purpose of requests
  • Provide written instructions
  • Be consistent

Ocd Recognition and Differentiation

Distinguishing OCD from Autistic traits:

  • Assess distress level (OCD feels wrong, Autistic traits feel right)
  • Ask about thought content (intrusive vs. Enjoyable)
  • Explore consequences of prevention
  • Note behavioral features
  • Refer for specialist Assessment

Key Takeaways

  1. Autism Diagnosis Requires Recognizing Actual Support Needs: Creative imagination and academic ability paradoxically prevented Diagnosis despite significant Autistic traits.

  2. Sensory processing Differences Are Neurological: Autistic brains process significantly more Sensory information simultaneously, causing genuine pain and cognitive overload.

  3. Masking Carries Severe Mental Health Costs: While protective in some contexts, masking disconnects Autistic people from themselves and contributes to mental health crises.

  4. Schools Teach Autistic Children That Their Needs Don’t Matter: Daily accumulated Sensory overload creates cumulative trauma with lifelong consequences for boundary-setting.

  5. Special Interests Are Essential Coping Mechanisms: Rather than viewing intense interests as pathological, they should be nurtured as sources of joy and potential careers.

  6. Autism in Girls Is Systematically Missed Due to Bias: Girls are diagnosed on average six years later than boys; Assessment tools were developed from biased samples.

  7. Psychiatric Systems Are Often Harmful to Autistic People: Despite clear Autistic traits, psychiatric hospitalization often results in misdiagnosis rather than recognition.

  8. The Diagnostic Framework Pathologizes Difference: Language of “deficits” and “impaired functioning” biases Diagnosis toward distressed Autistic people.

  9. Late Diagnosis Can Be Profoundly Relieving: Diagnosis transforms shame into clarity and provides permission for self-compassion.

  10. Post-Diagnostic Support Is Critical and Currently Absent: Most systems provide Diagnosis plus a resource list with no ongoing guidance.

  11. Conditional Acceptance Is Harm: Authentic relationships that accept all of a person are grounding that enables survival and recovery.

  12. Neurodivergent Vulnerability Requires Systems Change: Autistic people’s vulnerability stems from environments not designed for Neurodivergent minds.

Critical Warnings

Mental Health Crisis and Suicide Risk

Autistic children are 28 times more likely to attempt suicide; Autistic adults without intellectual disability are 9 times more likely to die by suicide. Research suggests Autistic people may account for approximately 40% of suicides. The combination of undiagnosed autism, masking, trauma, and system failures creates compounding vulnerability.

Self-Harm and Psychiatric Hospitalization

Self-harm does not indicate suicidality but should be taken seriously. Psychiatric hospitalization can be necessary for safety but often involves Sensory and emotional overwhelm for Autistic people. Removal of coping mechanisms can escalate crisis.

Diagnostic Bias and Misdiagnosis

If you’ve been diagnosed with personality disorder (particularly emotionally unstable personality disorder), consider requesting autism Assessment. The overlap between Autistic trauma responses and personality disorder criteria is significant.

Vulnerability and Safety

Autistic people face heightened vulnerability to exploitation, abuse, and sexual assault. Safety strategies include telling trusted people when uncomfortable, maintaining boundaries, avoiding unfamiliar situations alone, and recognizing that needing Support isn’t failure.

Resources and Support

Books and Resources

Organizations and Support

Crisis Support Resources

Conclusion: Toward Understanding and Acceptance

Emily Katy’s journey from crisis to clarity reveals the profound impact of late autism Diagnosis and the systemic failures that leave Autistic girls unrecognized and unsupported. Her story demonstrates how understanding neurodivergence transforms suffering into self-knowledge, and how authentic acceptance—not conditional tolerance—enables thriving.

The key insight is that autism is not a tragedy to be overcome or a superpower to be celebrated, but a difference to be understood and accommodated. Autistic people deserve to live as their authentic selves without constant masking, in environments designed for Neurodivergent minds, with Support that recognizes their actual needs rather than suppressing their differences.

By recognizing Autistic girls earlier, providing appropriate Accommodations, understanding the intersection of autism and mental health, and creating communities of authentic acceptance, we can prevent the crises that come from years of unrecognized neurodivergence and enable Autistic people to thrive as themselves.