Why is autism often undiagnosed in females? Given that we are now living in a society with some general awareness about the autism spectrum, one would expect the sex bias in an arguably quite established neurological disorder to be minuscule. However, according to mathematical models, around 80% of females remain undiagnosed with ASD, Autism Spectrum Disorder, at age 18, meaning most are diagnosed as adults. This makes quite the comparison when compared with males, as 50% of males with ASD will have been diagnosed before the age of 11. So why is this the case?
Autism Spectrum Disorder
ASD is commonly used as an umbrella term for many neurological disorders that may impact an individual’s behaviour. They are commonly associated with the following triad of deficits: “social reciprocity, impaired communication, and repetitive restricted patterns of behaviour or interests.” Most children with autism present their symptoms in early childhood, and many get diagnosed shortly after.
ASD in Females
Although a tremendous amount of work has been done to better understand ASD since the 1940s, samples of the population used in research were predominantly male. To put it bluntly, this means that most of our current understanding of ASD is only focused on males, making it unsuitable to be generalised to females who present their symptoms differently.
The general lack of knowledge about ASD in females is worsened by the fact that many people, even medical professionals, do not believe females can have autism at all. Ideas such as the “extreme male brain theory”, the heavily biased portrayals of autism in pop culture that only show male characters and sample-biased research only worsen the stigma surrounding ASD in females. Many females with autism have reported their difficulties in getting a diagnosis, often as adults, as specialists outright reject the idea that females could have autism, and believe “girls are too complex to be diagnosed”.
The Masking Effect
Additionally, females with autism can mask their symptoms better than males, and this phenomenon is also known as camouflaging. Autistic females are generally better at observing and picking up habits from others around them and imitating them to hide their symptoms. For example, to mask social reciprocity, females are able to maintain longer eye contact and be more involved in social conversations. Moreover, many females put substantial effort into hiding their stimming, which are repetitive physical movements or vocalizations observed in people with neurodevelopmental conditions as a form of self-stimulation. Masking is observed in both males and females with ASD as a way to appear “normal” and “navigate reality”, although it is more commonly observed in females. Often, this makes diagnosing females harder as common symptoms of ASD often fly under the radar or are simply not severe enough to be picked up by standard diagnostic measures such as the Autism Diagnostic Observation Schedule (ADOS).
The Importance of an Early Diagnosis
However, masking symptoms requires constant effort at all times, and can therefore lead to extreme exhaustion, both physically and mentally. In severe cases, individuals can experience autistic burnout, which can potentially lead to mental health issues such as depression and anxiety. This is the case with many autistic females who were diagnosed as adults, and many wish they had been diagnosed as a child. Early diagnosis of ASD can help individuals better understand themselves and access the resources to support their diagnosis. Furthermore, an official diagnosis can help individuals avoid masking, leading to an increase in their self-confidence and self-efficacy.
Conclusion
Autism Spectrum Disorder is a neurological disorder which causes deficits in some areas of individual behaviour. Many females with ASD display their symptoms differently than their male counterparts, leading to a general lack of understanding of female autism and an unfortunate lack of available support. Currently, a promising trend of increased female diagnoses has emerged in recent years, with more females becoming aware of their symptoms and seeking the benefits that come with an official diagnosis, such as receiving proper resources and support. However, although more people are now more knowledgeable about ASD in the present day, it is still important to continue raising awareness about the misconceptions surrounding females with autism so that a better understanding of their symptoms and effective methods of diagnosis can be achieved in the future.
References:
Finding the True Number of Females with Autistic Spectrum Disorder by Estimating the Biases in Initial Recognition and Clinical Diagnosis - PubMed. (2022, February 17). PubMed. https://doi.org/10.3390/children9020272
The Autism Dilemma for Women Diagnosis | Organization for Autism Research. (2018, October 26). Organization for Autism Research. https://researchautism.org/audience/research/the-autism-dilemma-for-women-diagnosis/
Werling, D. M., & Geschwind, D. H. (2013). Understanding sex bias in autism spectrum disorder. Proceedings of the National Academy of Sciences of the United States of America, 110(13), 4868–4869. http://www.jstor.org/stable/42583370
Blenner, S., Reddy, A., & Augustyn, M. (2011). Diagnosis and management of autism in childhood. BMJ: British Medical Journal, 343(7829), 894–899. http://www.jstor.org/stable/23052223
Baron-Cohen, S., Knickmeyer, R. C., & Belmonte, M. K. (2005). Sex Differences in the Brain: Implications for Explaining Autism. Science, 310(5749), 819–823. http://www.jstor.org/stable/3842756
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