Gender Differences in Diagnosis of Autism
By Amelia Zannoni
The Autism Gender Divide
Looking at the statistics it would be wise to raise an eyebrow. According to the National Institute of Health, the prevalence of autism spectrum disorder (ASD) is higher in males than in females. In the United States, reports show that one in 38 boys and one in 152 girls aged eight years are diagnosed with ASD. Even though the average prevalence of autistic males to females is approximately four to one. The discrepancies in these diagnoses raise the possibility that the typical presentation of ASD may be biased toward males, requiring females to exhibit more intense or a greater number of symptoms to receive a diagnosis.
Diagnosing & Camouflaging
Many suggest that females with ASD are more likely to engage in “camouflaging,” where they mask their autistic traits. This suggests that ASD symptoms might be more challenging to detect in females, potentially resulting in misdiagnosis, delayed diagnosis, or no diagnosis at all. It is crucial to understand the distinctive aspects of ASD presentation in females to provide proper treatment and support.
It’s relevant to note, that girls and boys mature at different rates, with girls maturing at a faster rate than boys. This is important when it comes to diagnosing because when a girl goes to see a Health Care Provider showing signs of a pathology in her development, she may not meet the criteria for an ASD diagnosis that is created for a boy her age. The little girl then walks out of the doctor’s office with either a misdiagnosis or no diagnosis, which down the road may cause more mental, physical, and social harm to her. Recent reports indicate an underdiagnosis or misdiagnosis of ASD in females, particularly, those who present with more subtle or camouflaged symptoms are higher at risk of developing eating disorders.
Women, ASD, and Eating Disorders
The underdiagnosis or misdiagnosis of autism in females, has gained significant attraction over the recent years. This phenomenon highlights the need for a better understanding of how ASD looks in females and how it may be related to eating disorders.
There is significant gender bias in ASD diagnosis historically, with the condition being more frequently diagnosed in males. This bias is attributed to the fact that ASD diagnostic criteria and assessment tools were initially developed based on observations in males (Reference: Fombonne, E. (2005). Epidemiology of autistic disorder and other pervasive developmental disorders. The Journal of Clinical Psychiatry, 66(Suppl 10), 3-8.)
Some autistic females exhibit a more subtle or atypical presentation of the condition; their symptoms may be less pronounced and may overlap with other conditions, making the diagnosis more difficult. Subtle ASD traits can include difficulties in social communication, sensory sensitivities, executive functioning challenges, and repetitive behaviors, but these may not meet the traditional diagnostic criteria (Dworzynski, K., et al. (2012). How different are girls and boys above and below the diagnostic threshold for autism spectrum disorders? Journal of the American Academy of Child & Adolescent Psychiatry, 51(8), 788-797.)
The link between camouflaging behaviors, including the suppression of autistic traits, may contribute to the development of co-occurring conditions, including eating disorders. As a way to cope with the challenges of camouflaging, sensory sensitivities, and social stressors, some women may develop an eating disorder (Tchanturia, K., et al. (2014). An investigation of autism spectrum disorders in anorexia nervosa: A pilot study using a standardized assessment tool. International Journal of Eating Disorders, 47(6), 733-739.)
Improved Recognition and Correct Diagnosing
While the underdiagnosing and misdiagnosing issue persists, there are efforts underway to improve the recognition of ASD in females. This includes revising the diagnostic criteria and assessment tools to better capture the diversity of ASD presentations in both men and women. Clinicians are increasingly encouraged to consider gender-specific diagnostic assessments and to be aware of the potential for camouflaging in females.
Early intervention and support for autistic individuals, especially females, are crucial. Timely recognition and diagnosis can lead to more effective interventions that address both ASD and any co-occurring conditions like eating disorders. This requires a multidisciplinary approach that considers the unique needs of each individual in order to provide comprehensive care (Maenner, M. J., et al. (2020). Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2016. MMWR. Surveillance Summaries, 69(4), 1-12.).
In short, the diagnosing issue of ASD in females is a complex issue that impacts both clinical practice and research; the efforts to better understand the presentation of ASD in females and to improve diagnostic practices are ongoing. The goal is to provide appropriate support and intervention for individuals, especially those at risk of developing coexistent conditions.
Amelia Zannoni is currently an undergraduate student at Nova Southeastern University studying neuropsychology. She is currently studying how neuropathologies work and hopes to go onto developing many beneficial techniques in her field.
