A review by finesilkflower
Autism in Heels: The Untold Story of a Female Life on the Spectrum by Jennifer Cook O'Toole

4.0

In her memoir of living with undiagnosed autism (what used to be called Asperger's) as a young woman, Cook presents some extremely cogent and thought-provoking points about the nature of being an autistic woman:

  • Autism goes undiagnosed in young women and girls because the diagnostic tools were made for men for a boys. For example, "interest in trains" is a classic autism trait, yet most girls are not given vehicles to play with - the true 'symptom' is special interests, which in girls often look different (e.g. collecting and displaying dolls, Disney movie trivia, etc.)  She urges clinicians to look beyond the surface to the reasons that autistic people do things: i.e. it's not trains that are important, it's fixations on facts and categorization. 
  • Stereotypically feminine traits, such as interest in makeup, are seen as inherently "unautistic," for no particular reason except that nobody has bothered to study autistic women (which then leads to few women getting diagnosed, in a vicious cycle). 
  • Women and girls are held to a higher standard of social and executive functioning than men, yet the diagnostic criteria for dysfunction are based on men and boys. Cook describes a study that found that girls with Asperger's tend to function socially similar to neurotypical boys. That means that when they are tested, they are found "normal" (because there is no separate test for girls), yet in practice they are disabled because they are not able to form relationships with other girls or meet the expectations placed on them. 
  • Autistic girls are more at risk of predation in abusive relationships because of their diminished ability to spot manipulation. 
  • Autistic girls are also at a high risk of self harm because of unexplained feelings of being "never good enough." 
  • While one of the diagnostic criteria for autism is problems with theory of mind/perspective-taking, Cook argues that neurotypical people would also be considered disabled if they were being judged on their ability to take the perspective of an autistic person.

While I found Cook's story to be rambling and confusingly-organized at times (jumping from one idea to the next), the number of insights was high. Cook breaks down the mystery around what it's like to be autistic. I found myself relating to much of what she says particularly where her autism overlaps with ADHD (e.g. executive functioning and working memory problems). I wouldn't be surprised with ADHD and autism turn out to be part of the same spectrum. 

There are some sensitive and disturbing topics covered (intimate partner violence, eating disorders), but they are well labelled with trigger warnings. 
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