In the past, Autism has been considered to occur more commonly in males than in females. Historically it has been believed that the ratio of males to females with Autism is 4:1, however recent studies suggest that it may be closer to 3:1. Further research out of Norway has also proposed that the ratio decreases with age.
Because of the historical notion that Autism occurred less in females, they have been continually under-represented in studies and literature about Autism. Thus, it has not until recently become clear that Autism may affect females differently than males. In this post, we’ll explore a couple of ways the condition may present in females, and what that might mean for those with Autism.
1. Better at camouflaging their symptoms
It has been suggested that compared to males with the condition, Autistic females are more adept at camouflaging, or ‘masking’, some of their Autistic traits, particularly in social situations. Surveys suggest that masking may happen in response to feeling that the social environment is impenetrable or distressing related to a lack of understanding of social rules.
Autistic females may use skills such as keen observation, imitation and acting to navigate these situations, and hide any differences which may make them appear to not fit in with others.
As a result of this acquired ability to project competence and adaptability in social situations, Autistic females may appear to have less social difficulties than people would expect based on the widely accepted profile of Autistic people as challenged with social interactions.
Whilst it may not outwardly be apparent, social interaction still has emotional consequences for Autistic females in a way that non-Autistic people may not experience. When surveyed, they expressed social interactions left them feeling anxious, unhappy, and as if they could not express their ‘true self’ around others.
2. More normative special interests
The special interests that Autistic females hold may blend in with those of their typical peers in topic. These topics may be more ‘relational’ in nature, in that they may allow the individual to feel more connected with the world or their peers. Some of these topics may include animals, psychology, or culture. These interests may also be different to what is stereotypically expected from Autistic people, as these perspectives are based on the long-studied male presentation of the condition.
Autistic males are stereotypically known to show a stronger interest in topics such as mechanics, technology, transport and science.
3. Internalized expression of some traits
External symptoms of Autism that are typically seen as ‘hallmarks’ of the condition, including behavioral conduct challenges and hyperactivity, may be more aligned with the male presentation of Autism compared to the female experience. Females may be more likely to internally experience symptoms, which may result in feelings of anxiety and depression.
Internal presentations of Autism may also to some extent overshadow the presentation of the condition itself, which may also contribute to the proportion of Autistic females that fly under the diagnostic radar.
4. Less obvious repetitive behaviors
Autistic females have been found to exhibit fewer repetitive behaviors towards objects than males, such as in the arrangement, manipulation, and repetitive use of objects. They may also be less likely to perform repetitive hand and finger mannerisms, which would be obvious to an external observer.
As previously alluded to, females may present with a more internalized expression of these repetitive behaviors, which may appear as ruminating or obsessive thoughts. The expression of repetitive behaviors may also be simply less obvious, or more culturally normative in nature, such as twirling the hair or shaking the leg up and down when seated.
5. More affected by sensory sensitivities
Some research has shown that Autistic females may be more affected by sensory sensitivities than Autistic males over their lifetime, measured by unusual sensory interests, undue general sensitivity to noise, and abnormal response to specific sensory stimuli. However, further investigation is required to provide more information about this possible difference.
6. Missed or late diagnosis as a result of male bias
All of these variations in presentation culminate to form a clearer narrative, which may help to explain why Autistic females have largely remained undiagnosed or misdiagnosed. The male bias in the stereotypes and literature surrounding Autism spectrum disorder is obvious when the factors mentioned in this article are considered.
With an affinity for camouflaging their Autistic traits, more developmentally and culturally normative special interests, fewer outwardly obvious repetitive behaviors, and more internalized rather than externalized hyperactivity, it’s no wonder parents, peers and clinicians alike may overlook the presence Autism in some females.
And it’s not their fault, for the most part – the criteria that is used to diagnose Autism is based on the historically accepted depiction of the condition, which tends to more easily fit the stereotypically male presentation. In order to see change in the proportion of Autistic females who continue to fly under the radar and are left to navigate the world without the appropriate information and support, it may be necessary to amend the clinical criteria to ensure the female Autistic presentation is not missed.
This may look like updating diagnostic measures such as screening questionnaires, to more accurately identify Autistic individuals presenting with a less historically normative symptom profile. Updated criteria may more closely examine how often and to what extent an individual uses camouflaging techniques, subtle but present repetitive behaviors, or their mental health status, including anxious or depressive thoughts.
We hope you’ve found this blog post interesting and insightful. If you know someone that you think might benefit from learning a bit more about how Autism can present in females, please share this post with them! We’d love for our resources to reach those who need them.