Written by: Manahil Chaudry
Edited by: Taina Stuart
Autism Spectrum Disorder (ASD) is a condition characterized by difficulties in social interactions along with repetitive behaviors that is manifested in a variety of ways amongst different people. Historically, ASD has only been observed amongst a predominantly male population, with more recent research emerging on ASD presented within females. Women are not only less likely to be diagnosed with ASD, but often mask any traits associated with autism, for fear of backlash or otherwise. Emerging research explains that women with ASD mask their traits due to them being more likely to understand the need to fit in with the environment around them. From Henry Wood-Downie’s collection of studies, one interview of ten female adolescents with autism described the need to mask in order to be accepted socially and achieve friendship (Wood-Downie el al., 2020). The need to mask can lead to later diagnoses, misdiagnoses, and delayment of treatment and support for their condition. In order to properly aid the diagnosis and treatment of females with autism, addressing why they are often not diagnosed can help in increasing awareness of the issue.
According to Lockwood and associates, physicians often perceive autism as mainly a male-dominated disorder, characterized by hyperactivity, aggression, and shortened attention spans. Eating problems were also common among boys diagnosed with autism at an early age. Girls, on the other hand, often showed signs of intense staring and seizure symptoms like sudden jerking movements, fainting, and migraines (Lockwood et al., 2021). Although hyperactivity is shown to be a common characteristic between both genders, other behavioral differences can often lead to later diagnoses in females compared to their male counterparts. For instance, girls with ASD are more likely to mask their symptoms to fit in with peers, have worse communication skills, and their parents were less likely to get them a diagnosis (Lockwood et al., 2021). Overall, because girls did not express traits previously seen amongst boys with ASD, whom the majority of studies were conducted on, they were not able to get a diagnosis. Instead, they often went undiagnosed for lack of explanation for their behaviors, which explains the later diagnoses. This can also lead to misdiagnosis, since professionals may attribute these behaviors to a different disorders like OCD and social anxiety. Attitudes towards females with symptoms of autism have shown to also be a major factor to why they are not often diagnosed. A first hand account from a mother of an autistic daughter interviewed by Lockwood and associates to understand how others’ perceptions can hinder the diagnosis of females. They found that most people were shocked when they described their daughters had autism. Because it was a small town, most people had little knowledge on autism and assumed it was mainly boys who are diagnosed with it (Lockwood et al., 2021). This can lead to a lack of resources to help support females with ASD, as most research focuses on boys diagnosed with ASD. As a result, girls are often misrepresented in diagnoses. With parents unable to access resources addressing the appearance of ASD in their daughters, they may not be inclined to take them for a diagnosis, leaving her diagnosis until later in her life.
Females with ASD are often misdiagnosed due to masking their behaviors which would otherwise be similar to that of their male counterparts. Females with ASD often mask in social situations and hide any apparent signs of ASD unless they find themselves in an overwhelming situation they are unable to cope with, such as complex social interactions like playing and iterating with other children on playgrounds (Milner et al., 2023). Along with masking as a mechanism to blend in, females also face challenges in diagnosis through the need to present more symptoms. Due to bias among physicians, females often need to present additional difficulties such as intellectual disability or more complex presentations of autism to receive a diagnosis (Milner et al., 2023). This means that not only are they less likely to get diagnosed for appearing okay in social settings, they often have to portray additional symptoms such as hyperactivity or aggression, as previously mentioned. All of these challenges pose an obstacle to the diagnosis of girls with ASD.
To help solve this issue, including women in studies on ASD and its symptoms can help physicians in correctly diagnosing autism earlier in female patients. Including them in research helps to open up different avenues of expression and can help support them with the proper tools earlier on in life. Addressing the bias among physicians through sensitivity training to help aid in better diagnoses too. Understanding the reasoning why women are less likely to be diagnosed with ASD can help in future understanding of the issue, helping to lessen the misconceptions surrounding their diagnosis.
References:
Lockwood Estrin, G., Milner, V., Spain, D. et al. Barriers to Autism Spectrum Disorder Diagnosis for Young Women and Girls: a Systematic Review. Rev J Autism Dev Disord 8, 454–470 (2021). https://doi.org/10.1007/s40489-020-00225-8
Milner, V., Colvert, E., Hull, L., Cook, J., Ali, D., Mandy, W., & Happé, F. (2023). Does camouflaging predict age at autism diagnosis? A comparison of autistic men and women. Autism Research, 1–11. https://doi.org/10. 1002/aur.305
Wood-Downie Henry, Wong Bonnie, Kovshoff Hanna. et al. Sex/Gender Differences in Camouflaging in Children and Adolescents with Autism. J Autism Dev Discord 2021 51(4): 1353–1364 (2020). doi: 10.1007/s10803-020-04615-z
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