Gender-Based Differences In Autism: What Are The Variations?
Autism first became a diagnosis within the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980 as its own diagnosis. Since it is a newer diagnostic label compared to some others, initial studies on autism were done primarily in men. For this reason, there are a few gender-based differences to consider when looking at the experience of being Autistic or living with autism spectrum disorder (ASD).
A history of the gender gap in autism research
Autism and developmental disorders tend to be diagnosed more in cisgender boys and men than in cisgender girls and women. The Centers for Disease Control and Prevention’s Autism and Developmental Disabilities Monitoring Network notes that autism spectrum disorder (ASD) is “nearly four times more common among boys than among girls.” Current research indicates that while autism is likely occurring at higher rates among boys, one reason for the gap between boys and girls could be bias in the diagnostic process.
Since fewer women and girls met the diagnostic threshold for ASD, there were fewer female research subjects for ASD studies, meaning researchers continued not fully understanding how ASD could present in girls and women. This lack of understanding led to the continued use of male-heavy symptomology that excluded many women and girls from diagnosis. However, more recent research is seeking to address these issues and develop a more nuanced understanding of sex and gender differences in ASD symptoms.
Gender differences in autism presentation
It can be tricky to ascribe certain qualities to a particular gender, as there may be people whose traits and experiences do not align with gender expectations. However, researchers have identified several characteristics that are more associated with Autistic cisgender girls and women than Autistic cisgender boys and men. More research is recommended to understand the experiences of people with autism spectrum disorders who do not identify with a gender or identify as a gender within the non-binary spectrum.
Traits associated with Autistic women and girls that may differ from men and boys include the following:
- Awareness of the importance of social interaction and desire for social interaction
- Imagination
- Linguistic ability
- “Masking” or finding ways to camouflage autistic traits like repetitive behaviors and stimming in social settings
- Mimicry of other people’s behavior, especially those who are perceived as socially successful
- Exhaustion and “Autistic burnout” associated with such masking and mimicry
- Passivity
- Developing strategies to disguise social confusion and other difficulties associated with autism spectrum conditions (consistently using these strategies may also be linked to worsened mental health outcomes)
- Controlling tendencies
- Determination
- Perfectionism
- Eating challenges
- Fine motor skills
- Initiating friendships and relationships
- Emotional expression, including reciprocating conversations, adjusting their behavior to the situation, and appropriately aligning hand gestures and facial expressions with words
These differences have led to the tentative development of a “female autism phenotype” among researchers who study pervasive developmental disorders. According to the phenotype, the following sex differences may also be observed between male and female adults and children with autism:
- Girls and women might be better able to evaluate nuances of social conventions and a group’s emotional atmosphere.
- Girls and women may be labeled “shy,” while boys and men might be labeled “odd.”
- Girls and women may be more likely to apologize during instances of social conflict than to express anger or frustration (they may feel the same amount of anger, but they might not communicate it in the same way or at all).
- In childhood, girls may play closer to their peers, while boys may play alone some distance away.
- Girls and women may be more likely to flout gender conventions and be described as “tomboys.”
- Girls and women may work harder at figuring out ways to “fit in,” possibly because of societal gender expectations.
- Girls and women may be more likely to be overlooked by their peers, while boys and men can have more experiences of outright social rejection and bullying.
- The special interests of girls and women may be considered more socially acceptable, often involving themes like celebrities, pets, TV shows, fashion, literature, pop music, horses, etc.
- In childhood and adolescence, girls may express reactivity, behavioral difficulties, and sensory sensitivity at home. Still, they may understand such actions would have negative social consequences at school and could learn to suppress their urges. This symptom may result in better school behavior but intensified meltdowns at home and an increased risk of developing depression.
- Girls and women may be more likely to find a peer group or forge a few close friendships, while boys and men may make no such effort and be perceived as “loners.”
- Girls and women might adopt a different “persona” for social interactions.
- Girls and women may be better able to understand the concepts of fiction and fantasy, which in childhood might help them facilitate social connections and reduce social anxiety. They might be more comfortable playing “make-believe” games than socializing “typically.”
- Girls may be more likely to learn to imitate their peers, while boys may be more likely to imitate their parents.
Consequences of the diagnostic gap
Autism is a form of neurodivergence, meaning there is no cure for the condition. However, there are medical and psychological interventions that can help people with ASD more effectively manage some of their more distressing symptoms and better navigate a world generally built for neurotypical people.
Often, the earlier ASD is recognized and diagnosed, the more constructive these interventions may be, which can result in a higher quality of life for Autistic individuals. Girls and women who are not diagnosed until later in life because of medical bias and lack of understanding around different presentations of autism may miss the opportunity for such interventions. In addition, Autistic women may learn to think of themselves as somehow “broken” or “defective” as compared to other people instead of recognizing that their brains function differently.
Girls and women are also much more likely to be misdiagnosed or diagnosed with another mental health condition when they are Autistic. These conditions include but are not limited to the following:
- Personality disorders, particularly borderline personality disorder (BPD)
- Schizophrenia
- Eating disorders
- Depression
- Bipolar disorder
- Phobias
- Separation anxiety disorder and selective mutism (in children)
Being misdiagnosed can have serious consequences. Girls and women may be prescribed medication that is inappropriate for their condition and may undergo therapeutic techniques that are ineffective, potentially leading them to conclude that there is something “wrong” with them if interventions that have worked for other people do not make a difference for them.
Finding support
Living with undiagnosed ASD can be a challenge. Even girls and women who do receive an ASD diagnosis may still experience difficulties, as ASD interventions have historically been developed and tested through research that primarily focuses on the experiences of boys and men. This lack of support could lead to mental health challenges and co-occurring mental health conditions like anxiety and depression.
It can sometimes be difficult for people with ASD to see a therapist in person. Sensory sensitivity can make navigating public transportation and waiting rooms difficult, and the pressure to understand social cues can make an in-person conversation a source of stress instead of relief.
In these instances, online therapy through a platform like BetterHelp might be a helpful alternative. With online therapy, you can access your therapy session without leaving your house and choose to communicate with your therapist in multiple ways. If you are uncomfortable with face-to-face conversation, you could speak to your therapist over the phone or via live in-app messaging.
Current research indicates that online therapy could have similar outcomes to in-person therapy when it comes to mental health interventions, including for ASD. One study found that online therapy resulted in improved outcomes and reduced mental health concerns for people with autism spectrum disorder and other neurodevelopmental conditions. If you are experiencing insufficient support for your ASD, online therapy could be a beneficial resource.
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