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  • Monique Nash

Neurodivergence in AFAB Folx: A Hidden Epidemic

Within my practice, I am often taking part in reviews and consultations with colleagues and recently was asked if I am noticing any trends in my clients. The most prominent trend I currently notice is clients who are AFAB (a female at birth) struggling with neurodivergence that has gone undiagnosed/untreated or misdiagnosed.

Often times these folx have seen many professionals and educators along the way who did not suspect or investigate the possibility of neurodivergence. Sometimes, they were given other diagnoses and given treatments that were unhelpful, leading to confusion and harm. This blog entry is an attempt to give a general overview of why this trend is being noticed by not only myself, but other clinicians as well.

Neurodivergence, encompassing conditions like autism, ADHD, dyslexia, and others, manifests differently across genders. One striking trend is how often neurodivergence goes undiagnosed in individuals assigned female at birth (AFAB). This oversight can have profound effects on their well-being, development, and access to appropriate support. Understanding the reasons behind this phenomenon is crucial for improving diagnostic practices and ensuring equitable care.

1. Gender Bias in Diagnostic Criteria:

  • Historically, diagnostic criteria for neurodevelopmental disorders were based on observations of male behavior, leading to criteria that may not fully capture how these conditions present in AFAB individuals.

  • Symptoms of neurodivergence can manifest differently in AFAB individuals, often aligning more closely with societal expectations, which can lead to under-recognition.

2. Masking and Camouflaging Behaviors:

  • AFAB individuals are more likely to develop coping mechanisms to camouflage their neurodivergent traits, such as mimicking social behaviors or suppressing stimming, which can mask underlying symptoms.

  • This masking can lead to a mismatch between observed behavior and internal experiences, making it challenging for clinicians to recognize neurodivergence.

3. Stereotypes and Social Norms:

  • Societal expectations of how girls and women should behave can create a bias against considering neurodivergence, as symptoms may be attributed to personality traits or gender-specific experiences.

  • AFAB individuals who excel academically may be overlooked, as their academic success can mask struggles with executive functioning or social interaction.

4. Intersectional Challenges:

  • AFAB individuals from marginalized backgrounds, such as those who are BIPOC or LGBTQ+, face additional barriers to diagnosis due to intersecting biases and systemic inequalities in healthcare.

5. Lack of Awareness and Education:

  • Many healthcare professionals, educators, and even individuals themselves may not be aware of how neurodivergence presents in AFAB individuals, leading to missed opportunities for early intervention and support.

6. Advocacy and Awareness:

  • Increasing awareness among healthcare providers and educators about the unique presentation of neurodivergence in AFAB individuals is essential for improving diagnosis rates.

  • Empowering neurodivergent individuals to advocate for themselves and seek evaluation from knowledgeable professionals can also help in reducing underdiagnosis.

In conclusion, the underdiagnosis of neurodivergence in AFAB individuals is a complex issue influenced by a combination of gender bias, societal expectations, and lack of awareness. Addressing this issue requires a multifaceted approach that includes improving diagnostic criteria, raising awareness, and providing support for individuals to express their true selves without fear of judgment. By recognizing and validating the experiences of neurodivergent AFAB individuals, we can create a more inclusive and understanding society for all.


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