The differences in autism based on gender
Far more males than females are diagnosed with autism in Australia. In fact, four Australian males are diagnosed on the spectrum to every one female.
Why is this?
There is evidence that the higher diagnosis of males may not really reflect the true gender ratio of autism. Instead, it could be a range of reasons, including a bias towards males in the diagnostic process.
According to National Guidelines, several studies have found that boys are more likely to be identified as being on the spectrum than girls, even when their symptoms are at the same level.
There is also evidence that some females are better able to ‘camouflage’ their symptoms by using strategies to mask communication and social difficulties. For example, girls may watch others and mimic their behaviour to better blend in. This is particularly the case when girls have an average or high range IQ.
Added to this, the diagnostic criteria for autism and the instruments used to assess autism reflect a presentation that is more common in males than females – and may not have adequate sensitivity and specificity to identify autism characteristics in females.
Fast fact: Girls are typically diagnosed with autism much later than boys.
Knowing the gender differences
Autism can present vasty differently for individuals, and can be influenced by age, language, cognitive and functional skills, and gender. It is important to remember that the autism assessment criteria is the same for all genders.
When making an assessment, the professional should be observing the signs and characteristics of autism and the impact these have on the individual, rather than their gender.
Interestingly though, when you look at the History of autism, males have been recognised as having autism at higher rates than females.
Boys on the spectrum
It is important to remember that gender differences are as vast as autism differences. While some of the characteristics below are commonly observed in males, they too are often observed in females.
They can include difficulty with:
- Social or emotional communication. For example, they’re less likely to smile or show you things.
- Reading and using non-verbal communication, such as nodding and shaking the head, or using hand gestures.
- Developing and maintaining relationships appropriate to their age.
- Developing close friendships.
- Using eye contact when speaking or being spoken to.
- Changes occurring in routines.
- Stereotyped or repetitive speech, movements or use of objects, such as flapping hands or toe walking.
- Strongly reacting to sensory input such as sound, pain or textures.
- Restricted or fixated interests, such as only playing with certain toys or discussing certain topics.
Girls on the spectrum
It is important to remember that gender differences are as vast as autism differences. While some of the characteristics below are commonly observed in females, they too are often observed in males.
They can include:
- Lack of awareness of the need for social interaction.
- A lack of desire to interact with others.
- Being perceived as a ‘loner’ or ‘shy.’
- A tendency to imitate others (copy, mimic or mask) in social interactions, which may be exhausting.
- A tendency to ‘camouflage’ difficulties by masking or developing compensatory strategies.
Having just one, or a few, close friendships.
- Behaving in an intense or possessive way within friendships.
- A tendency to be ‘mothered’ within their primary school peer group; or perhaps being bullied in secondary school.
- Advanced language skills for their age.
- A good range and frequency of non-verbal communication.
- Demonstrating a good imagination and can easily escape into fiction and pretend or fantasy play, but play is prone to being one-sided, scripted and overly controlled.
According to the National Diagnostic Guidelines, girls on the spectrum are likely to display:
“Less frequent and severe repetitive behaviours and stereotypes and use greater range and frequency of non-verbal (gestural) communication (than males)…particularly amongst individuals without Intellectual disability.”
Restricted interests may be less focused on objects or things and more focused on movement, people or animals. For example, girls are more likely to be interested in soap operas, celebrities, pop music, fashion, horses, pets, and literature. And repetitive behaviours might include constant hair ‘twirling’.
It is important to remember that many males will also demonstrate these characteristics.
Fast fact: Studies published in 2012, 2014 and 2016 indicate that a ‘higher level of genetic risk’ is required for a female on the spectrum to reach the diagnostic threshold. This is known as the ‘female protective effect’ hypothesis. However, more research is needed in this area.
Women on the spectrum
Like girls, women on the spectrum may camouflage or mask their characteristics of autism. Women with higher cognitive and functional skills are particularly adept at this. For example, women on the spectrum may:
- Mimic the behaviour of others in order to blend in.
- Force themselves to make eye contact with people during conversations.
- Imitate gestures or expressions they see others using.
- Have a steady stream of pre-prepared responses, jokes or phrases to use when conversing with others.