An estimated 1 in 252 individuals who are sex assigned female at birth in the United States are diagnosed with an autism spectrum disorder (ASD) compared to 1 in 54 individuals who are sex assigned male at birth. Females are less likely to be identified with an autism spectrum disorder due to a variety of factors.
There has been a male gender bias both in research and development of testing and diagnostic instruments. In addition, females are often less likely to be diagnosed unless there is a pre-existing intellectual disability or speech delay. Additionally, many females with autism mask their social difficulties. Females on the autism spectrum typically present with “normal” social behavior, whereas males show greater difficulty with poor eye contact, motor clumsiness, and awkwardness with physical contact. Social difficulties tend to be subtle and manifest later in life during puberty, such as during middle school, when social relationships become more complex. There has also been evidence to suggest that females show less repetitive stereotyped behaviors than males and more age appropriate restricted interest (e.g., sports, fantasy novels, animals). Additionally, females with ASD are more likely to have sleep problems, anxiety, and depressed mood (Hartley & Sikora, 2009) than externalizing behaviors (e.g., aggression, hyperactivity, etc.).
Without clear observation of concerning or aggressive behavior, fewer females are referred for assessment and treatment. Without appropriate diagnosis, many females are misdiagnosed or overlooked. Differentiation of characteristics between males and females is crucial to provide adequate support for school, emotional well-being, and socialization.
Signs specific to Females that may indicate an ASD diagnosis:
Typical interests for age/gender (animals, Disney characters, horses, etc.), but highly intense/specific.
Difficulty applying social skills in the real world (may be frequently excluded or bullied, tend to be bossy in play, always have to be in charge).
Blame others for their social difficulties.
Typically very bright, with subtle difficulties with semantic-pragmatic language.
Excellent imagination and pretend play (create elaborate fantasies), more likely to play with dolls as friends or have intense imaginary friendships.
Self-esteem and identity issues.
Rigid/concrete thinking. Difficulties being flexible when faced with change.
Viewed as naïve, innocent or sweet.
Overwhelmed easily, difficulty coping with stress.
General difficulties with regulating emotion.
Have any questions in regard to Autism Spectrum Disorder, or are interested in a neuropsychologoical examination? Feel free to reach out to our office!
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