Sex and gender differences in autism
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Sex and gender differences in autism exist regarding prevalence, presentation, and diagnosis.
Men and boys are more frequently diagnosed with
Several theories exist to explain the sex-based discrepancy, such as a genetic protective effect,
Since autism is a largely genetic and
Compared to men, women are generally required to be more impaired by their autism[22] or have more cognitive or behavioral conditions[23] than their male counterparts to meet autism spectrum criteria. There is evidence of increased incidence of social anxiety,[14] anorexia nervosa[24][25] and self-harm in autistic females,[26] though the increased rates of anorexia nervosa and other eating disorders[27] may be due to confusion or conflation with avoidant/restrictive food intake disorder (ARFID), which is particularly common in autism.[28]
Autistic girls and women show higher social motivation and a greater capacity for typical friendships than autistic boys and men,
Background
Hans Asperger was one of the first people to study autism, with all of his four study subjects being male. Another early researcher, Leo Kanner described "autistic disturbances of affective contact" in the group consisting of eight boys and three girls.[36]
Today, Autism Spectrum Disorder is commonly defined as a neurological developmental disorder with symptoms of poor social communication, repetitive behaviors, sensory sensitivities, executive dysfunction, and hyper-fixations.
Theories explaining gender diagnosis disparity
Extreme male brain theory
Extreme male brain theory is an extension of the
Imprinted brain hypothesis
The imprinted brain theory suggests genomic imprinting is at least partly responsible for the sex differences in autism and implicates schizophrenia as well, claiming that genetic and physiological evidence suggests the two conditions are on a spectrum in which some mutations in certain genes cause lower social cognition but higher practical cognition (autism) while other mutations in the same genes cause lower practical cognition with higher social cognition (schizophrenia).[19][20][21]
Female protective effect hypothesis
According to the female protective effect hypothesis, more genetic mutations are required for a girl to develop autism than for a boy. In 2012, Harvard researchers published findings suggesting that, on average, more genetic and environmental risk factors are required for girls to develop autism, compared to boys. The researchers analyzed DNA samples of nearly 800 families affected by autism and nearly 16,000 individuals with a variety of neurodevelopmental disorders. They looked for various types of gene mutations. Overall, they found that females diagnosed with autism or another neurodevelopmental disorder had a greater number of harmful mutations throughout the genome than did males with the same disorders.[46] Women with an extra X chromosome, 47,XXX or triple X syndrome, have autism-like social impairments in 32% of cases.[47]
Hypothesis of female under-diagnosis
The prevalence ratio is often cited as about 4 males for every 1 female diagnosed.[3] Other research indicates that it closer to 3:1 or 2:1.[2][48]
Some authors, clinicians and experts like Judith Gould, Tony Attwood, Lorna Wing and Christopher Gillberg[49] have proposed that autism in females may be underdiagnosed due to better natural superficial social mimicry skills in females, partially different set of symptoms and less knowledge about autism in females among experts.[50] In his preword to the book Asperger's and Girls, Attwood writes: "These tentative explanations for the apparent underrepresentation of girls with Asperger's Syndrome have yet to be examined by objective research studies."[51]
Specifically, Gould has discussed the idea that a pervasive developmental disorder called pathological demand avoidance, which is not officially included in diagnostic manuals, may offer a glimpse into how autism in females may present in some cases.[52][53]
Another clinician, William Mandy, hypothesized referrals for ASD assessment are often started by teachers. Girls with ASD may sometimes lack the skills of social communication and this is not noticed until they are in a school setting. Therefore, girls suggested to have ASD may receive delayed or no clinical assessment.[54] Compared with males, females with autism are more likely to mask their restricted interests (strong or intense interests in specific topics or objects), which could decrease the chances of diagnosis.[55]
Female phenotype
Some have suggested a differential phenotype for autistic women; "a female-specific manifestation of autistic strengths and difficulties, which fits imperfectly with current, male-based conceptualisations" of autism.[48] Autistic women have been shown to score higher in self-reports of autistic masking, which may factor into the different phenotype.[56] One study found evidence for a diagnostic bias against girls who meet criteria for ASD. In some cases where females showed severe autistic traits, they failed to meet the criteria for a diagnosis, because of the lack of sensitivity to the female phenotype.[55]
Camouflaging
The DSM-5 mainly looks at two categories of autism spectrum symptoms when diagnosing someone: social deficits and restricted/repetitive behaviors and interests. Both of these categories of symptoms can be hidden by an aspect of the autistic female phenotype known as camouflaging.[57][40][58]
Autistic girls tend to camouflage more than boys, this leads to many of their symptoms being hidden and not noticed by professionals.[40] When it comes to social camouflaging, there are three sub-categories according to the Camouflaging Autistic Traits Questionnaire (CAT-Q): Masking, Assimilation, and Compensation.[59] Masking is the act of constantly monitoring one's behavior in order to hide one's autistic traits and/or putting on a fake persona.[57][59] Assimilation is known as "hiding in plain sight" or trying to blend in with non-autistic peers.[57] Finally, compensation is trying to over-compensate for a lack of social abilities. Examples of this can include mimicking real or fictional people, over exaggerating non-verbal expressions, and creating scripts or rules when having a conversation with someone.[57]
Camouflaging can also be used to hide repetitive/restricted behaviors and interests.[57] In fact, researchers have found that autistic girls are ten times more likely to not originally meet the DSM-5 criteria for restricted/repetitive behaviors.[60] Sensory overstimulation is another autistic trait that can be hidden by masking.[57] Participants of the Hull, et al., would internalize their overwhelming feelings and try to channel it through small and unnoticeable everyday objects. If those objects were not enough to calm them down, then they would try to leave the environment and recuperate by making "regular excuses'' as to why they needed to leave.[57]
Downfalls of camouflaging
Studies have shown that high levels of camouflaging is can lead to higher levels of anxiety and depression and can increase the risk of suicidal ideation.[61][48][62][40] Studies have also found that camouflaging can lead to a skewed sense of self.[48] This is especially the case for people who had been masking and mimicking other people for long periods of time.[57] Another factor of masking is mental and physical exhaustion after a camouflaging session.[40] According to the participants of the Hull, et al (2017)[57] study, the longer that autistic individuals camouflage, the worse the exhaustion becomes and the longer these individuals need to rest and recharge. This study had also found that there were increased amounts of anxiety and stress revolving around camouflaging because the participants were often worried that they did not mask enough, did not mask correctly, or did not reach the desired effects of masking in that camouflaging session. Another one of the factors that increased anxiety and exhaustion while camouflaging is the fact that it "involved a constant monitoring of the situation, as if training oneself in self-monitoring, self-awareness, and monitoring others' reactions, both during and after the interaction occurred."[57]
Differences in gender and sexuality identification
A study looking at the co-occurrence of ASD in patients with
A study conducted by Byers and Nichols (2014) explored the level of sexual satisfaction of
See also
- Epidemiology of autism
- Gender bias in psychological diagnosis
- Mental disorders and gender
- Sex differences in schizophrenia
- Autism Diagnostic Interview
- Autism in France
References
- PMID 26075049.
- ^ S2CID 20420861.
- ^ S2CID 20373463.
- S2CID 214314845.
- ^ "Data and Statistics on Autism Spectrum Disorder". Centers for Disease Control and Prevention. 25 September 2020.
- S2CID 2705562.
- PMID 25973162.
- PMID 23431162.
- ^ PMID 25973161.
- S2CID 8098723.
- PMID 21695147.
- PMID 34008924.
- PMID 23094036.
- ^ S2CID 14324454.
- PMID 23864377.
- PMID 26347127.
- PMID 17489810.
- ^ S2CID 44330420.
- ^ PMID 18578904.
- ^ PMID 19955444.
- ^ PMID 25210055.
- PMID 20345841.
- PMID 22840550.
- PMID 23915495.
- PMID 25553237.
- S2CID 23789973.
- PMID 23900859.
- ^ Shea, Elizabeth (24 May 2016). "Eating disorder or disordered eating? Eating patterns in autism". The National Autistic Society.
- PMID 24576331.
- PMID 26695137.
- S2CID 18639019.
- S2CID 1705914.
- PMID 30945091.
- PMID 29700708.
- ^ Devlin, Hannah (14 September 2018). "Thousands of autistic girls and women 'going undiagnosed' due to gender bias". The Guardian. Retrieved 13 September 2021.
- NAID 10007611258.
- PMID 26600385.
- PMID 26544750.
- PMID 21122776.
- ^ PMID 27899710.
- ^ PMID 34887388.
- PMID 20943668.
- S2CID 254569210.
- S2CID 44330420.
- ^ Baron-Cohen, Simon (November 2012). "Autism and the technical mind: live chat with Simon Baron-Cohen, November 9, 10 A.M. EST". Scientific American. Vol. 307, no. 5. pp. 72–75.
- PMID 24581740.
- PMID 33583482.
- ^ PMID 27457364.
- ^ "Gender and autism". The National Autistic Society. Retrieved 2016-06-01.
- ISBN 978-1-932565-40-9.
- ISBN 978-1-932565-40-9.
- ^ "Missed Diagnosis or Misdiagnosis? Women and Girls with PDA" (PDF). Dr Judith Gould, Dr Jacqui Ashton Smith. Archived from the original (PDF) on 2016-10-13. Retrieved 2016-01-06.
- ^ Gould, Judith; Ashton-Smith, Jacqui (31 May 2011). "Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum". Good Autism Practice. 12 (1): 34–41.
- S2CID 18639019.
- ^ S2CID 20420861.
- S2CID 197664299. Retrieved 25 October 2021.
- ^ PMID 28527095.
- S2CID 215617283.
- ^ a b Engelbrecht, Natalie. "The Camouflaging Autistic Traits Questionnaire (CAT-Q) | Embrace Autism". embrace-autism.com. Retrieved 2023-10-12.
- S2CID 254580713. Retrieved 2022-12-04.
- PMID 31820344.
- PMID 30627892.
- PMID 20094764.
- ^ Dattaro, Laura (2020-09-14). "Largest study to date confirms overlap between autism and gender diversity". Spectrum. Retrieved 5 May 2021.
- PMID 32770077.
- S2CID 143453860.
Further reading
- Hendrickx, Sarah (2015). Women and Girls with Autism Spectrum Disorder: Understanding Life Experiences from Early Childhood to Old Age. London and Philadelphia, PA: ISBN 978-0-85700-982-1.
- Brady, Fern (2023). Strong Female Character. Harmony/Rodale. ISBN 978-0-593-58250-3.