Functional gender differences in autism: An international, multidisciplinary expert survey using the International Classification of Functioning, Disability, and Health model.

Karl Lundin,Johan Isaksson,Soheil Mahdi,Sven Bölte

doi:10.1177/1362361320975311

Abstract

In this study, we explored if professionals working with autistic people in different regions of the world perceive differences between females and males diagnosed with the condition. A total of 131 professionals responded to a survey that included an open question about gender differences in autism. Of these, 32 responded that they do not perceive gender differences in autism. The information provided by the other 99 experts was analyzed to identify common patterns. Three main differences were found, (1) Matching the clinical conceptualization of autism where professionals described differences in core symptoms of autism, and that autistic females were less similar to the conceptualization of autism. In (2) Co-existing problems, professionals described that autistic males display more apparent problems including hyperactivity, while autistic females were perceived as having more internalizing issues such as anxiety and eating disorders. In the last category, (3) Navigating the social environment, experts perceived autistic females as more socially motivated, and more inclined to camouflage social difficulties, making their challenges less evident. Professionals also perceived differences in the social environment, for example, that autistic girls receive more support from their peers while autistic boys are more often bullied. Our results suggest that professionals working in different parts of the world acknowledge gender differences in autism, but also that there might be some regional differences. Finally, we found that gender differences reported by the international professionals could largely be assessed with a shortened version of the International Classification of Functioning by the World Health Organization, specifically developed for autism.

Highlights

Autism spectrum conditions are associated with limited outcomes in a multitude of functional domains, including general adaptive capacities (Kenworthy et al, 2010), education, employment, and relationships (Howlin & Moss, 2012), as well as lower quality of life, somatic complications, and premature mortality (Hirvikoski et al, 2016; Jonsson et al, 2017; Pan et al, 2020)
The aim of this study was threefold: first, to explore the perception of functional gender differences in autism in an international group of professionals; second, to investigate to what extent aspects of functioning pertaining to the female autism phenotype are covered in the ICF Core Sets for autism; and third, to explore similarities and differences in the perception of functional gender differences among professionals in high-income countries (HICs) and middleincome countries (MICs)
The survey included an open question about gender differences in functioning in autism: “In your experience with individuals with ASD, are there any aspects of their functioning and impairment that are specific to gender? If yes, please type your answer below” to which 134 (59.6%) of all participants responded to

Summary

Introduction

Autism spectrum conditions ( autism) are associated with limited outcomes in a multitude of functional domains, including general adaptive capacities (Kenworthy et al, 2010), education, employment, and relationships (Howlin & Moss, 2012), as well as lower quality of life, somatic complications, and premature mortality (Hirvikoski et al, 2016; Jonsson et al, 2017; Pan et al, 2020). Neurotypical females exhibit higher social motivation than neurotypical males (Head et al, 2014), which has been found among autistic females when compared to male equivalents (Head et al, 2014; Sedgewick et al, 2016); whereas males in the general population display more externalizing behavior than females (Zahn-Waxler et al, 2008), similar to what has been reported for autistic people (Hiller et al, 2014; Mandy et al, 2012). The elevated risks of both suicide and suicidal behavior for autistic people as a group appear to be especially pronounced among autistic females (Hirvikoski et al, 2016, 2020), contrasting findings in the general population where males are at higher risk to die from suicide (World Health Organization [WHO], 2019)

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