Females and Autism

Abstract

Females with autism are often undiagnosed, misdiagnosed, or receive a diagnosis of autism at a later age than males. This can result in adverse outcomes in their well-being, mental health, education, employment, and independence. Furthermore, the autism spectrum in females is associated with adverse outcomes after puberty, including anxiety, depression, high incidence of suicide, eating disorders, and high rates of other medical problems. The term “autism spectrum disorder” (ASD) and “autism spectrum condition” (ASC) and autism are used interchangeably, including in the citations of this article, and in the article itself. The term “autism spectrum condition” (ASC), coined by Simon Baron-Cohen, is used in the literature to respect both females and males on the autism spectrum who feel that the term “disorder” is stigmatizing, whereas ASC presents both the strengths and difficulties of individuals on the autism spectrum. Autism has traditionally been considered a male-dominated diagnosis, and its current features linked with descriptions in the major diagnostic classification systems are based primarily on males. While researchers continue to question the epidemiology, prevalence, and presentation of autism, there is an emerging awareness and growing clinical recognition that autism in females has a unique symptomatology and may, in fact, be more common in this population than previously acknowledged. Cultural and social aspects may also impact on the autistic characteristics presented by autistic females. Autism may also manifest itself differently, and more subtly, especially in individuals who are not recognized early in life or who do not have profound intellectual or communication difficulties. The current diagnostic assessments have mainly been developed for an autistic male population, and thus may lack the required sensitivity to identify autistic females. It is argued that these assessments may have an inhibitory potential in confirming the diagnosis of autism in females, as they do not reflect the unique presentation of autism in females, demonstrated by greater compensatory capacity and an ability to develop sophisticated methods of “camouflaging” and masquerading in order to blend in with neurotypical peers. Sex and gender stereotypes and differences in patterns of autistic behavior may contribute to females being overlooked in a diagnostic setting. Timely diagnosis and support, however, can reduce the difficulties that females with autism experience. Timely diagnosis can reduce abuse, exploitation, and certain co-occurring conditions, allowing us to better inform females’ needs in education, leisure, social relationships, and employment, so as to promote their well-being and independence.