The smile and pride I’m meant to express chokes me as I try to mask to express it. Because I want to be encouraging, and I want others to see that it’s okay to be open about being autistic, but is it?
People like me are needed to talk about it and be open, but it’s like asking a turkey to be proud that they’ll be the Thanksgiving dinner. Autistic pride is and should be a protest from all neurodivergent and neurotypical people alike because even someone as high masking as me struggles to keep my breath underwater in the sea of neurotypical rules and expectations.
In Romania, where I’m from, there has been a recent wave of autism awareness, but also vitriol in the presidential elections. ‘He’s autistic, poor thing’ was said by one of the candidates about the other. ‘Poor thing’, as if the PhD and the personal and professional competencies were nothing compared to a presumed diagnosis based on certain stereotypes associated with autism. I’m Cristina, which is how I like to introduce myself to everyone I meet, my patients included. I’m a paediatrics registrar, and I wear my colourful clothes and giggle with utmost joy at work, which is where I usually like to be.
I’m a PhD student passionately looking into the bias in pain diagnosis and management that our medical education spreads with each passing second rippling into what our patients feel. I’m also a trade unionist, putting everyone else’s careers and working lives above my own. I’m a cat mum, a daughter, a wife, a bookworm, and an immigrant. I am AuDHD.
What AuDHD is and what it means for me
AuDHD is a combination of autism and ADHD, which manifests in what I like to call my ‘neurodivergent spine’. Sometimes it spirals and sometimes it keeps me straight when I feel like crawling, but it’s who I am and have always been.
Colours, music, and fairy lights are my stims (sources of sensory stimulation) and I like to clap, squeak, giggle when I’m myself, which is why paediatrics is my universe. Among children I can drop my mask and be myself, without anyone questioning whether I’m genuine.
I can hyperfocus and dissect with my attention to detail even the most intricate of diagnoses. I’m also hyper-empathetic, so I will cry with them or, in my own way, feel what they feel. It spreads through me at the smallest change of environment like the summer sun burns into your skin.
I’ve been told I’m creative, I love to innovate and help others feel heard, and I also have a strong sense of justice – less for myself, but for everyone else around me. Even though I stereotypically like and am good at maths, I also love art and have experimented with everything from being a self-taught digital and traditional drawing artist, to playing the drums, cosplaying, and writing. It only took me four years to speak English with a flawless British accent after moving to the UK.
My autism is not just part of me, but who I am and the spark of all this, while ADHD makes my brain always have a project or an idea on the go, even if I don’t physically pace or fidget. It makes me read very fast (including in a second language – 67 books this year and counting!). Reading fast doesn’t mean I skim or read superficially; it just means my brain genuinely works at +1.75x speed.
Getting my diagnosis
Like many women, I went unnoticed. I was ‘shy’, ‘quiet’, ‘opinionated’, ‘distracted’, ‘looked bored’, and even ‘struggled with eye contact’. I joined a theatre troupe as a med student to ‘learn how to react in a plausible manner no matter the circumstance’.
I always bite the inside of my cheeks or my cuticles, even during conversations, which I now have learnt is mystim. I tried hard to stop throughout my life, I just can’t. I like to sit at my desk as if L from Death Note was written after me (not healthy for my spine but it’s comforting). I went through part of paediatric training with no one ever raising the question about whether I’d be autistic, except my husband. I believed vehemently I was neurotypical until my diagnosis in late August last year, at age 34.
The period of grief was immense, and still hasn’t ended, and who was I other than the masks I’ve gathered along the way? Where under this matryoshka of facial expressions, voice inflections, gestures, and shapes that others wanted me to be – where was I?
Masking and autism
Like the name suggests, masking is wearing a mask whereby you act, speak, mimic eye contact, mirror, not like yourself, but like you’ve learnt. It’s not just ‘improving your behaviour’, it’s rehearsing, hiding or minimising your special interests or your stimming, and forcing eye contact which can seem unnatural. It’s like an act on stage, every single time. It can get easier, but this doesn’t make it less energy costly.
Women are far less likely to be diagnosed with autism
They often get misdiagnosed with BPD, OCD, anxiety, and many other disorders Women don’t fit the ‘autistic profile’ generally that men tend to show, mainly because the diagnostic tools are built based on male samples.
Women mask much more, with their autistic traits visible only when their learning needs are severe. They also need to be struggling more than their male peers to get a diagnosis, with an average two to three years of a delay in getting their diagnosis compared to men.
Sometimes the strong interests of women and girls only show through perfectionism – doing things over and over again until they’re perfect. When they do show, if they are typical for their ‘gender identity’ like fashion, clothes and makeup, then no one will question it.
I did have a collection of rocks, and loved caterpillars and geology, but my ADHD made me bored easily, so it perhaps never felt that strong, especially with the financial limits of my working-class parents that were always at work. Instead of being isolated, some girls really value friendships and struggle especially when a conflict occurs.)
Gender identity and sexuality is another chapter altogether with autistic people being more likely to be under the LGBTQIA+ umbrella than neurotypicals. I’m no exception – being aromantic and asexual.
I can’t bring all my gifts to the table without a price. I like my routine, I need to be reminded to eat or drink, I like to be trusted and listened to, I need you to hear me when I need to be alone even for a few seconds to self-regulate during a meltdown, I need you to tell me what you mean not just what you say. And I’m so naively honest and trust you will be too. I am not a puzzle piece waiting to be elucidated. I’m an infinite of possibilities.
Support
I have really benefited from the support of my PHD supervisor and other doctors who have mentored and been role models to me. Some of them are autistic too. The BMA supports and advocates for neurodivergent doctors and I’ve also found the group Autistic Doctors International to be really supportive.
Resources that I have found useful:
Non-fiction:
Strong Female Character by Fern Brady
Women and Girls on the Autism Spectrum by Sarah Hendrickx
Is This Autism? by Donna Henderson
Fiction:
The Boy Who Steals Houses by CG Drews
In the Lives of Puppets by TJ Klune
Geek girl – the TV show (I’m yet to read the books)
Cristina Costache is a specialty trainee 4 in paediatrics from Wakefield, England