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Individuals who are assigned as female at birth are less likely to be diagnosed with autism spectrum disorder and are more vulnerable to a number of risks associated with autism.
While it is often misperceived that autism occurs more often in males at a ratio of 4 to 1, a recent study (McCrossin, 2022), suggests that the true ratio is 3 to 4, with 80% of girls on the spectrum remaining undiagnosed by the age of 18. It is likely that females are undiagnosed since their special interests are more probable to blend in culturally, and since females tend to be more interested in humanitarianism, religion, animals, people, and pop culture (Hull et al., 2020). Girls are also likely undetected because they may mask their differences and socially blend in (i.e., “masking”), even though they often experience relationship difficulties and experience the same social-communication differences as males (Hull et al., 2020). Put another way, girls are sometimes more apt to control behavior in pubic. They may have learned how to smile or may eye contact, and they may display greater interest in peers than boys on the spectrum. Oftentimes, girls may be diagnosed with ADHD instead, which can appear similar upon initial screening. Notably, there is evidence to support that the diagnostic process is less likely to identify autism in women with average to high IQs (Hull et al., 2020).
Emergent research also suggests that females are more likely to experience impact in brain regions that impact fine motor skills, executive functioning, and emotional regulation, while they often show less social-communication differences (Cauvet et al., 2020; Jack et al., 2021; Supekar et al., 2022).
Due to "masking" tendencies, girls have a propensity to miss out on receiving support that can aid in supporting them to understand their unique differences, build upon their exceptional skills, and become successful in school and work. Girls often become fatigued or exhausted from all of that effort that it takes to fit in. Adolescents in particular are more likely to be bullied as the social interactions become more nuanced and it becomes easy to miss social cues. Research suggests that the efforts required to camouflage can result in increased stress, anxiety, and depression (Hull et al., 2020).
Depression and anxiety are both internalizing difficulties common in autism. Females with ASD are more likely to experience internalizing symptoms, in comparison to their male counterparts who are more likely to externalize (e.g., display aggression and behavioral difficulties).
It is important for early intervention and diagnosis in order to limit these co-occurring challenges.
References
Hull, L., Petrides, K. V., & Mandy, W. (2020). The Female Autism Phenotype and Camouflaging: a Narrative.
Sedgewick, F., Leppanen, J., & Tchanturia, K. (2020). Gender differences in mental health prevalence in autism. Advances in Autism