A Closer Look at Gender Differences in Autism Spectrum Disorder

Written by: Lynn Tran

Edited by: Preeti

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent challenges in social interaction, communication, and restricted or repetitive behaviors (American Psychiatric Association, 2013). Despite increased awareness, diagnostic disparities remain. One such difference is the diagnosis rate and age between men and women. While men are four times more likely to be diagnosed with ASD than women, research suggests that this gender disparity is due to bias and societal misconceptions (Lai & Szatmari, 2020). Women with ASD often go undiagnosed or even misdiagnosed with other conditions such as anxiety or depression due to gender differences in how symptoms present.

Autism, like many disorders, has historically been studied primarily in males, leading to statistics and symptom profiles that are not fully reflective across the gender gap. Males tend to exhibit more observable repetitive behaviors and social difficulties, which align more closely with historical diagnoses, including trouble initiating or sustaining conversations, interpreting nonverbal cues, and maintaining eye contact. Women, on the other hand, often display more subtle signs such as internalized stress, socially acceptable repetitive behaviors like obsessively reading or writing, and the ability to mimic neurotypical social behavior through imitation or masking (Rynkiewicz et al., 2019). 

One contributing factor to the underdiagnosis in females is “masking” — the conscious or unconscious effort to suppress autistic traits in social settings. This includes mimicking their peers’ expressions, forcing eye contact, scripting conversations in advance, and concealing sensory sensitivities (Hull et al., 2020). While masking allows women to appear neurotypical, it also complicates the diagnostic process, leading to delayed or incorrect diagnoses. As a result, many women are misdiagnosed with conditions like anxiety or depression, which may not address the underlying autism spectrum disorder. A 2017 study conducted by Hull et al. found that women with autism engage in these camouflaging behaviours significantly more frequently than men. This may help explain why women are more likely to receive diagnosis later in life, often after seeking help for secondary mental health challenges. Within the study, many women reported that finally receiving an autism diagnosis in adulthood provided a sense of validation after years of feeling misunderstood. 

Due to frequent misdiagnoses, many women with autism are prescribed treatments that fail to address their actual needs, and in some cases, these treatments may even prove to be harmful. For example, an individual with undiagnosed autism may be diagnosed and treated for borderline personality disorder. That individual would have undergone years of therapy that is both costly and time consuming and never addresses the root neurological differences. Additionally, the delayed or incorrect diagnosis of autism can have profound effects on an individual’s life. For instance, a study by Bargiela et al. in 2016 demonstrated that women misdiagnosed with anxiety disorders or depression experience higher rates of mental health issues, including negative self-esteem, social isolation, and academic or career difficulties. 

Misdiagnosis and underdiagnosis of women skew the apparent prevalence of autism, which in turn limits gender-specific research and the development of targeted therapeutic interventions. As the majority of autism studies have historically been male-centric, this has contributed to a lack of services, policies, and public perception tailored to the unique needs of women with autism (Hull et al., 2020). This not only affects clinical practice but also societal awareness, which can reinforce stigmatization and marginalization of women on the spectrum.

Efforts are being made to refine diagnostic tools and increase awareness of gendered differences. For example, the development of the Camouflaging Autistic Traits Questionnaire (CAT-Q) has been a critical step in addressing this issue. This tool helps clinicians assess masking behaviors by asking individuals to rate their own experience with camouflage strategies. This can be particularly useful in identifying women who may have been overlooked in traditional diagnostic processes, as it provides a more comprehensive view of autism traits that are not immediately visible as in many of their male counterparts (Hull et al., 2017). 

In light of growing awareness around gender disparities in autism diagnosis, it is essential that clinicians be trained to recognize the diverse ways autism presents in women. Research must continue to explore the gendered differences in symptoms and develop diagnostic tools that address these differences. Additionally, increasing access to support services and awareness can ensure that all individuals can receive the appropriate care, leading to overall improved quality of life. 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders, 46(10), 3281–3294. https://doi.org/10.1007/s10803-016-2872-8

Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M. C., & Mandy, W. (2020). Putting on my best normal: Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 50(7), 2276–2290. https://doi.org/10.1007/s10803-017-3166-5

Hull, Laura, Mandy, W., Lai, M.-C., Baron-Cohen, S., Allison, C., Smith, P., & Petrides, K. V. (2019). Development and validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q). Journal of Autism and Developmental Disorders, 49(3), 819–833. https://doi.org/10.1007/s10803-018-3792-6

Lai, M. C., & Szatmari, P. (2020). Sex and gender impacts on the behavioural presentation and recognition of autism. Current Opinion in Psychiatry, 33(2), 117–123. https://doi.org/10.1097/YCO.0000000000000575

Rynkiewicz, A., Schuller, B., Marchi, E., Piana, S., Camurri, A., Lassalle, A., & Baron-Cohen. (2019). An investigation of the “female camouflage effect” in autism using a computerized ADOS-2 and a test of sex/gender differences. Molecular Autism, 10(1), 1–9. https://doi.org/10.1186/s13229-016-0073-0