Autistic Women And Girls
More men and boys are currently diagnosed as autistic than women and girls. This is changing slowly but surely, as more women and girls are being diagnosed as autistic.
Attitudes towards autism and gender are changing, although we still have a long way to go. Many autistic women and girls are still struggling to get the support they need.
Here, we explain more about the gender diagnosis gap, share stories from autistic women and girls, and share some theories on why more men and boys are being diagnosed as autistic.
You can also visit our gender identity page here, where we look at autism and gender identity in more detail.
Autism And Women: Heres What You Need To Know
Autism is significantly more common among boys than girls, and while the reasons behind this skewed sex ratio are not fully understood, biological variables are believed to play a role. The way in which autism is defined and diagnosed may also influence this male to female ratio otherwise known as a diagnostic bias.
The most comprehensive data available on the sex ratio for autism is based on a 2017 analysis, published in the Journal of the American Academy of Child and Adolescent Psychiatry. Data suggests that for every girl with autism, there will be 4.2 boys diagnosed with autism.
This leads us to question the differences among boys and girls with autism in relation to female autism symptoms vs those presented in males.
Sex Differences In Autism Spectrum Disorder: Focus On High Functioning Children And Adolescents
- 1Child Neuropsychiatric Unit, University of Bari Aldo Moro, Bari, Italy
- 2Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
- 3Psychiatric Emergencies in Adolescence Unit, University of Bari Aldo Moro, Bari, Italy
Autism Spectrum Disorder has historically been studied, known, and diagnosed in males. Females tend to remain unidentified, especially those with average intelligence abilities. This sex/gender difference might be partially explained by biological risk factors, but it is probably also bound to methodological issues. The present study aims to examine phenotypic characteristics of a group of 54 females with ASD matched to a group of 55 males with ASD , all without cognitive impairment. Results suggest that there are subtle, yet potentially meaningful, quantitative, and qualitative phenotypic differences between females and males that common screening tests are not always sensitive enough to recognize. Further studies to improve practice and course for the assessment of females, reducing sex/gender-based inequities in ASD care, are required.
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Autism Spectrum Disorders: The Difference Between Boys And Girls
Children and adolescents with autism spectrum disorders are a growing patient population with 1 in 68 children being diagnosed with ASD. It is observed at a higher rate among boys, with 1 in 42 boys being identified as having ASD. This is a ratio of 1 female for every 4 males diagnosed with autism. As more is known about autism, there is a growing awareness that these gender and sex differences may be more complex than we originally thought.
What Is Autism?
Diagnosed in early childhood, Autism Spectrum Disorders have lifelong implications for a childs long term adjustment including their ability to succeed in school, relationships, and in jobs as adults. With effective treatment, children and adolescents with ASD can make remarkable gains and achievements, often living in ways that are indistinguishable from those who dont have autism or are differently, but remarkably, fulfilling.
About one-third of children with ASD remain nonverbal and are diagnosed with an intellectual disability. Additionally, medical and mental health problems can complicate a childs adjustment. Seizures, GI problems, sleep problems, ADHD, and anxiety are examples of concerns often observed among children with ASD which make living with this disorder even more challenging.
Why Do More Boys Than Girls Have Autism?
Do Referral and Diagnostic Practices Affect the Rate of Autism Among Boys and Girls?
Is Girl Autism Different Than Boy Autism?
Hypothesis Of Female Underdiagnosis
The prevalence ratio is often cited as about 4 males for every 1 female diagnosed. Other research indicates that it closer to 3:1 or 2:1.
Some authors, clinicians and experts like Judith Gould, Tony Attwood, Lorna Wing and Christopher Gillberg have proposed that autism in females may be underdiagnosed due to better natural superficial social mimicry skills in females, partially different set of symptoms and less knowledge about autism in females among experts. In his preword to the book Asperger’s and Girls, Attwood writes: “These tentative explanations for the apparent underrepresentation of girls with Asperger’s Syndrome have yet to be examined by objective research studies.”
Specifically, Gould has discussed the idea that a pervasive developmental disorder called pathological demand avoidance, which is not officially included in diagnostic manuals may offer a glimpse about how autism in females may present in some cases.
Some have suggested a differential phenotype for autistic women “a female-specific manifestation of autistic strengths and difficulties, which fits imperfectly with current, male-based conceptualisations” of autism. Autistic women have been shown to score higher in self reports of Â§ autistic masking, which may factor into the different phenotype.
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Asd Three Times More Likely In Females With Male
From a statistical analysis, the team found that having a brain that was anatomically more male-like was linked to a higher probability of ASD than having a brain that was anatomically more female-like.
For example, the results showed that female participants whose brains were anatomically more male-like were around three times more likely to have ASD than female participants whose brains were anatomically more female-like.
The authors emphasize that their study serves more as a proof of principle, and that more work needs to be done to confirm their findings and examine the underlying causes of such differences.
They suggest that further studies should now look at whether their results can be replicated in other subgroups on the autistic spectrum theirs was limited to high-functioning adults with ASD.
Researchers conclude that:
Our study demonstrates that normative sex-related phenotypic diversity in brain structure affects the prevalence of ASD in addition to biological sex alone, with male neuroanatomical characteristics carrying a higher intrinsic risk for ASD than female characteristics.
Comorbidities And Developmental Trajectories
According to recent literature , in the present study, both males and females presented a high percentage of co-occurring conditions . The most frequent comorbidity in both groups was ADHD, co-occurring in about 70% of cases, without significant differences between males and females. This evidence differs from previous literature in which ADHD comorbidity appeared more common in males . In accordance with other authors, we hypothesized that the diagnosis of ADHD was underrated in females since females with ADHD have different, more hidden, symptomatology, showing inattentive rather than hyperactive manifestations . Concerning internalizing disorders, our findings were different from previous literature reporting a statistically significant prevalence of internalizing disorders in females, in that we rather found a non-significant trend for anxiety, depressive, and eating disorders in the female group . The mean age of the sample could justify these findings since internalizing and feeding disorders often occur in adolescence or adulthood. In this study we found that caregivers ask for a first specialist medical consultation at different ages and for different reasons: females were referred later to clinical services, particularly for level 1 ASD . This finding fits with previous literature , also showing how females who received an early diagnosis of ASD often have intellectual impairment.
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Study Uncovers Why Autism Is More Common In Males
- Cell Press
- Males are at greater risk for neurodevelopmental disorders, such as autism spectrum disorder, than females, but the underlying reasons have been unclear. A large cohort study provides compelling evidence in support of the ‘female protective model,’ which proposes that females require more extreme genetic mutations than do males to push them over the diagnostic threshold for neurodevelopmental disorders. Researchers found that females diagnosed with a neurodevelopmental disorder or ASD had a greater number of harmful CNVs than did males diagnosed with the same disorder. Moreover, females diagnosed with ASD had a greater number of harmful SNVs than did males with ASD. These findings suggest that the female brain requires more extreme genetic alterations than does the male brain to produce symptoms of ASD or neurodevelopmental disorders.
Males are at greater risk for neurodevelopmental disorders, such as autism spectrum disorder , than females, but the underlying reasons have been unclear. A large cohort study published by Cell Press on February 27th in the American Journal of Human Genetics provides compelling evidence in support of the “female protective model,” which proposes that females require more extreme genetic mutations than do males to push them over the diagnostic threshold for neurodevelopmental disorders.
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Sexual Dimorphism In The Human Brain
Additional support for the EMB theory of ASC comes from evidence of neural sexual dimorphism across development. Some key examples of typical sexual dimorphism reveal an extreme of the typical male profile in the neurodevelopment of ASC . However, one caveat to keep in mind is that just as all psychological sex differences do not constitute an exaggerated form of maleness in ASC, neither do all neural differences. Indeed, given that the EMB theory is defined at the psychological level, we should expect only a narrow set of neural sex differences will be involved in such hyper-masculinization in ASC. A key finding supporting this prediction is that infant males on average have a larger brain than females and children with autism have even larger brains early in life right around the time they would typically receive a diagnosis . In addition, independent of global differences in brain size, the amygdala in typical males tends to be larger than in females , and early in development the amygdala in autism is even more enlarged than that observed in typical males . In addition to such structural sexual dimorphism in the brain, exaggeration of neural sexual dimorphism extends to brain function and corroborates predictions from the EMB theory .
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What Are The Benefits Of Improved Understanding Of Autism In Girls
Research on gender differences could help in the development of non-biased diagnostic criteria and diagnostic instruments in future.
- It will raise awareness among health professionals who are involved in early identification and diagnosis of autism. It would help diagnose women those who would otherwise be undiagnosed.
- Understanding of how autism presents differently in females will also help in understanding their different needs and providing them with the right supports and interventions.
- It could also help to understand whether transitions differ in both sexes and if yes, how do we help girls to have successful transitions?
They Often Go Undiagnosed Because They Dont Fit Autism Stereotypes And They Mask Symptoms Better Than Boys Do
Many more boys than girls are diagnosed on the autism spectrum: more than four boys for every autistic girl, according to the latest numbers from the Centers for Disease Control. Researchers point to genetic differences. But clinicians and researchers have also come to realize that many higher functioning autistic girls are simply missed. Theyve been termed the lost girls or hiding in plain sight because theyre overlooked or diagnosed late. They dont fit the stereotypes or their symptoms are misinterpreted as something else. And they may be better at hiding the signs, at least when theyre young.
Even when girls presentation is clearer, they can be overlooked. Take Melissas two children. Both have an autism diagnosis. But while daughter Lisas symptoms were much more obvious than son Justins, the girls were waved off for three years by a variety of clinicians.
On paper, Melissa says, she seemed to check all the boxes. Lisa had a significant language delay she didnt speak in sentences until she was 4 did no pretend play, and had several meltdowns each day. There were also other signs, like lining up her stuffed animals, spinning in circles, and constantly seeking sensory input. She was also unable to handle any change in routine.
Though Lisas challenges qualified her for Early Intervention at 18 months, it wasnt until she was 6 that a developmental neurologist would diagnose her with autism.
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Autism More Common In People Whose Brains Are Anatomically More Male
A new study finds that in addition to autism being more common in males than females, differences in brain structure can also be a factor, regardless of biological sex. It suggests that having a brain with features more commonly found in male brains is linked to higher probability of having autism spectrum disorder.
First author Dr. Christine Ecker, of the Goethe University in Frankfurt, Germany, and colleagues report their findings in the journal JAMA Psychiatry.
Autism spectrum disorder more commonly known as autism are terms used to describe a range of complex brain development disorders that can result in significant social, communication, and behavioral challenges.
ASD is a wide-spectrum disorder: no two people with ASD will have exactly the same symptoms.
People with ASD may interact with others and learn in ways that are different from most other people. Some people with ASD need little help in their daily lives, while others need a lot.
According to the Centers for Disease Control and Prevention , around 1 in 68 children in the United States
In their paper, Dr. Ecker and colleagues refer to a study that also finds that some brain structures known to differ among males and females overlap with areas implicated in psychiatric conditions such as ASD.
Why Autism Strikes Mostly Boys
Why does autism strike four times as many boys as girls? The answer may lie in specific biological shielding mechanisms that operate in girls, but not boys, even when both sexes have the same genetic defects associated with the disorder.
That conclusion leapt from the data in a study led by University of Minnesota researcher Nicola Grissom, Ph.D., an assistant professor of psychology. Published in Molecular Psychiatry, the study opens a door to understanding and one day better treating the disorder.
“Researchers have known about the ‘female protective effect’ in autism spectrum disorders for quite a while, but the reasons why girls might be protected while boys are vulnerable have remained mysterious,” Grissom said.
This effect means a boy has a 1-in-42 chance of being diagnosed, but a girl has only a 1-in-189 chance, according to the Centers for Disease Control. Those who do develop the disorder have difficulty in responding to rewards that would otherwise serve as cues that help shape social behavior.
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Sex Differences In Genetic Contributions To Asd Risk
Biological theories for the sex difference in ASD prevalence most frequently take the form of a multiple-threshold multifactorial liability model , in which females have a higher threshold for reaching affection status than males . Thus, genetic studies operating under this model hypothesize that females with ASD are likely to be carrying a higher heritable mutational âloadâ than affected males. This model predicts that relatives of female probands should be at increased risk for ASD as compared with relatives of male probands, which is supported by a recent twin study . In contrast, other studies have failed to support the genetic loading hypothesis, including a study of 882 families and another recent study of high risk siblings of autistic probands that found that only the sex of the sibling was a significant predictor of their future ASD status . However, a new study of more than 9000 dizygotic twin pairs from population-based cohorts provides the most conclusive demonstration of female-protective factors to date, showing that siblings of autistic females exhibit significantly greater autistic impairments than siblings of autistic males . This finding also supports a role for heritable variation in ASD liability under the threshold model.
Future Directions For Research
Research into camouflaging using either discrepancy or observational/reflective approaches is still very much in its infancy. However, there are some particular areas of future research which should be addressed. Firstly, much research into camouflaging in autism has focused on the experiences of autistic adults, or of younger children based on parent-reported behaviours. Camouflaging behaviours are likely to develop across the lifespan, but may have significant impact during later childhood and adolescence as individuals learn patterns of behaviour used for the rest of their lives. Research should aim to identify when and how camouflaging behaviours first develop, particularly when considering the potential negative outcomes over the longer term.
Secondly, most research into gender and camouflaging has used a binary approach to gender, comparing the experiences and behaviours of males and females. While this is of relevance to the concept of a female autism phenotype, in contrast to the often male-biased diagnostic criteria and assessment tools, this approach ignores the substantial minority of autistic individuals who report a non-binary or fluid gender identity . It also raises issues regarding the appropriateness of male and female norms for transgender autistic individuals, who may have experiences of living and interacting as different genders in different stages of life .
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Differences In Motor Skills And Communication Skills
One study looked at the gender differences as related to symptoms of autism and developmental functioning. Those who were assessed in this study included children in the age range of 17 to 37 months who also met the criteria for a diagnosis of autism spectrum disorder .
In this study, no gender differences were found related to symptom severity. However, this study which examined toddlers with ASD, found that girls at this age range had more motor skill deficits but less communication skill deficits compared to boys.