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Autism in females
Autism Spectrum Disorders (ASD) are currently more commonly diagnosed in males, with a ratio of about 1 female for every 4 males diagnosed.〔Fombonne, E. (2009). Epidemiology of pervasive developmental disorders. Pediatric Research, 65(6), 591–598. http://doi.org/10.1203/PDR.0b013e31819e7203〕 There is some evidence that females may also receive diagnoses somewhat later than males, however thus far results have been contradictory.〔Begeer, S., Mandell, D., Wijnker-Holmes, B., Venderbosch, S., Rem, D., Stekelenburg, F., & Koot, H. M. (2013). Sex Differences in the Timing of Identification Among Children and Adults with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 43, 1151–1156. http://doi.org/10.1007/s10803-012-1656-z〕 As of yet, there have been no studies specifically addressing the occurrence of autism in intersex individuals, and this is an area that requires further research. Several theories exist to explain the male-female sex based discrepancy, such as a genetic protective effect,〔Gockley, J., Willsey, a J., Dong, S., Dougherty, J. D., Constantino, J. N., & Sanders, S. J. (2015). The female protective effect in autism spectrum disorder is not mediated by a single genetic locus. Molecular Autism, 6, 25. http://doi.org/10.1186/s13229-015-0014-3〕〔Robinson, E. B., Lichtenstein, P., Anckarsater, H., Happe, F., & Ronald, a. (2013). Examining and interpreting the female protective effect against autistic behavior. Proceedings of the National Academy of Sciences, 110(13), 5258–5262. http://doi.org/10.1073/pnas.1211070110〕〔Lai, M.-C., Baron-Cohen, S., & Buxbaum, J. D. (2015). Understanding autism in the light of sex/gender. Molecular Autism, 6, 1–6. http://doi.org/10.1186/s13229-015-0021-4〕 the Extreme Male Brain Theory,〔Baron-Cohen, S. (2002). The extreme male brain theory of autism. TRENDS in Cognitive Sciences, 6(6), 248–254. http://doi.org/10.1016/S1364-6613(02)01904-6〕〔Lai, M.-C., Lombardo, M. V., Pasco, G., Ruigrok, A. N. V, Wheelwright, S. J., Sadek, S. a., … Baron-Cohen, S. (2011). A Behavioral Comparison of Male and Female Adults with High Functioning Autism Spectrum Conditions. PLoS ONE, 6(6), e20835. http://doi.org/10.1371/journal.pone.0020835〕 and phenotypic differences in the female presentation.〔〔Lai, M.-C., Lombardo, M. V, Ruigrok, A. N. V, Chakrabarti, B., Wheelwright, S. J., Auyeung, B., … Baron-Cohen, S. (2012). Cognition in males and females with autism: similarities and differences. PloS One, 7(10), e47198. http://doi.org/10.1371/journal.pone.0047198〕〔Ludlow, a. K., Roberts, H., & Gutierrez, R. (2015). Social Anxiety and Response to Touch: A Preliminary Exploration of Broader Autism Phenotype in Females. SAGE Open, 5, 2158244015580854–. http://doi.org/10.1177/2158244015580854〕〔Torres, E. B., Isenhower, R. W., Yanovich, P., Rehrig, G., Stigler, K., Nurnberger, J., & José, J. V. (2013). Strategies to develop putative biomarkers to characterize the female phenotype with autism spectrum disorders. Journal of Neurophysiology, 110, 1646–62. http://doi.org/10.1152/jn.00059.2013〕
==Summary==
Differences in presentation of autistic traits are widely supported within the autistic community, and gaining support in the professional field. Hans Asperger was one of the first people to study autism, yet all of this students were male. Since biological differences exist between males and females, it follows that the presentation of autism would differ as well. Recent studies suggest this to be true, with evidence of increased incidence of social anxiety,〔 anorexia nervosa,〔Baron-Cohen, S., Jaffa, T., Davies, S., Auyeung, B., Allison, C., & Wheelwright, S. (2013). Do girls with anorexia nervosa have elevated autistic traits? Molecular Autism, 4(1), 24. http://doi.org/10.1186/2040-2392-4-24〕〔Rhind, C., Bonfioli, E., Hibbs, R., Goddard, E., Macdonald, P., Gowers, S., … Treasure, J. (2014). An examination of autism spectrum traits in adolescents with anorexia nervosa and their parents. Molecular Autism, 5(1), 56. http://doi.org/10.1186/2040-2392-5-56〕 and self-harm.〔Cohen, I. L., Tsiouris, J. A., Flory, M. J., Kim, S.-Y., Freedland, R., Heaney, G., … Brown, W. T. (2010). A Large Scale Study of the Psychometric Characteristics of the IBR Modified Overt Aggression Scale: Findings and Evidence for Increased Self-Destructive Behaviors in Adult Females with Autism Spectrum Disorder. J Autism Dev Disord, 40, 599–609.〕 Autistic females, and clinicians who work closely with them, have compiled many resources highlighting the traits that are often associated with autism as it presents in females. Some of the main differences noticed in females compared to their male counterparts include increased social mimicry abilities, more expressive gestures, special interests perceived as "more practical", and more prevalent interest in animals.〔 Several other characteristics of autism that have been noted specifically in females include: uneven learning profiles, difficulty in completing higher education, struggles with organization, difficulties communicating feelings or asking for help, anxiety, depression, gender dysphoria, high levels of empathy, sensitivity to suffering, and individuals are often highly intuitive. For a more complete list of characteristics please refer to some of the lists available online, such as those by (Tania Marshall ) or (Rudy Simone ).
With these differences in presentation combined with differential coping ability, often enabling females to blend in with peers through mimicry in spite of lack of understanding, ASD frequently goes unrecognized in females. This can lead to a lack of support and understanding from family, friends, teachers, and themselves which can damage self-esteem and impede the development of useful coping strategies. There are more females seeking diagnosis after the diagnosis of a close family member or friend where they learn more about the condition and how it has effected them throughout their lives. Many report feelings of relief, forgiveness and understanding within themselves upon receiving a diagnosis, as it helps to explain everything they struggled with since childhood.
While there are many suggested practices produced by the clinical research community, it is highly advocated within the autistic community to learn more about autism through interactions with actual autistic individuals. You can learn a lot from people sharing their stories on how autism has affected their lives, from every day situations, to therapy and medication. There are many books, websites, videos and blogs all dedicated to autistics advocating for themselves and sharing their stories, as well as support forums such as Wrong Planet.
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