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Writer's pictureDr. Theresa Regan

Autism in Women: Mental Rituals

Updated: Jun 6, 2020

Photo by Kyle Broad on Unsplash

Women with autism display characteristics similar to men, but often with a twist. It's important to be alert to how ASD features may present in the female.


One of the criteria for autism has to do with ritualistic behavior. Ritualistic means "invariably performed in the same way." Difficulty within the center and front of the brain can lead to sticky and repetitive behavior. Someone may say, "I always brush my teeth before my shower. I never brush my teeth after." Sometimes the order in which tasks are completed is very important to the individual. The autistic person may get stuck in routines like taking the same route to work every day, parking in the same spot in parking lots, and ordering the same meals at restaurants.


Although many people will say, "Well, I do that too" or "Everyone likes routine," for the ASD individual, the stickiness and rigidity of the routine is very significant. When the behavioral pattern is prevented, the autistic individual becomes very stressed and may have a meltdown (externalizing reaction) or appear to mentally shut down (internalizing reaction).


One thing I have learned in my practice is the importance of asking females on the spectrum if they have any mental rituals. Females may be more able to "mask" autistic characteristics with others, and therefore the qualities may go unnoticed even while causing significant fatigue and stress for the individual. Examples of mental rituals may include counting streetlights while riding in a car, mentally reciting all the prime numbers backward from 100, or mentally sorting daily experiences into an image of a pyramid with different sections and meanings.


It's not that any of these habits are "wrong," but rather that the brain that leans toward those behaviors may have certain subcortical/frontal lobe characteristics. Other ASD qualities may also be present for this individual. The real price to pay is often in the mental fatigue or distress caused by the effort of performing (or not performing) the rituals in various contexts or of being more distracted than others (e.g., missing important parts of conversations because of internal processing of the ritual).


If you know a woman who may be on the spectrum, ask about hidden characteristics such as mental rituals!


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1 commentaire


Tony Diaz
Tony Diaz
22 oct. 2023

Dear Doc, My name is Tony. I noticed your article while I was doing research on women with autism. The more research I've done the more mad I get that these women are simply overlooked when it comes to mental health and diagnosis. I'd like to raise a bigger red flag for women on the spectrum. I'm currently working on a story of a 20 year old women who has just been diagnosed with autism but also has to deal with 1 the death of her mother at the age of seventeen, 2 just being a female in todays world and 3 feelings of heavy guilt. I just want to get some insight on this subject and would appreciate any…

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