Autism is a neurodevelopmental disorder that has experienced a huge boom in recent decades. Every day, more precise tools are available to detect it and respond to the resonances of the daily life of those who present it.
A related question (which has “aroused the interest” of the scientific community) is that of a possible bias in its diagnostic process, which reduce the likelihood that women or girls can be identified as autistic and benefit from multiple forms of therapy available for this condition.
Although a number of organic factors have traditionally been postulated to explain why there are far more boys than girls with autism, theories on psychological and social variables are beginning to emerge of enormous importance to the clinic and to the community. the research.
In this article we will address the issue of autism in women, And we will detail in more detail how autism can be expressed, both generically and in the female population. The reasons why, in the latter case, it might be more difficult to confirm their presence will also be set out.
What is autism?
Since autism was described by Leo Kanner in 1943 as a lack of interest in social aspects and an intense resistance to environmental fluctuations, this alteration in neurodevelopment has undergone many changes in its clinical formulation and even in its diagnosis.. Along with those of the aforementioned author, the contributions of Hans Asperger (with particular emphasis on verbal expression) have enabled the health sciences to articulate a series of theoretical models and practical keys aimed at their understanding and their identification in the consultation. All flourished throughout the 1970s, eventually converging on writing the criteria for the DSM-III (1980) manual.
First the possible presence of three cardinal dimensions was considered, with which the presentation of such a disorder could be summarized, Although recently these have been reduced to just two: communication or social interaction (difficulties in initiating a situation of reciprocal exchange with an interlocutor, accompanied by severe alterations in the pragmatics of language) and restrictive or repetitive type (lack of flexibility in thinking and behavior, irritability / poor impulse control and tendency to symmetry and repetition).
The new diagnostic manuals (DSM-5, 2013) also made other changes to the traditional way in which the most classic autism was viewed: elimination of Asperger’s syndrome and definitive inclusion of generalized developmental disorder and disintegrant. in a comprehensive label called Autism Spectrum Disorder (or ASD), whereby all its possible expressions are summarized in a single and heterogeneous category. These changes were not exempt from some criticism, based primarily on an increase in ambiguity.
Also, with this new redefinition, it has become necessary for clinicians who have made such a diagnosis to also indicate the existence of a certain degree of intellectual disability in their patient (since they do not all present it in the same intensity. ) and the attributable severity threshold. to the problem. For this case, a differentiation was made into three possible levels (the eloquent level 1, 2 and 3), according to the power of the symptoms to interfere with the evolution of daily life. In this way, autism has acquired a dimensional nuance, as opposed to its old categorical prism.
The greater theoretical / clinical contextualization of autism in recent years has made it possible to have a lot of information available on its epidemiology. Today we know that 1.6% of people suffer from some form of autism (Of all those mentioned above and to varying degrees), and that such a percentage has grown very remarkably over the past decade. Likewise, all the literature on this subject agrees in emphasizing that it is a more common condition in men than in women (about 80% of those affected are men).
The latest data, which have been unanimous since the start of the study on autism, even supported by hypotheses such as that of the “hypermasculinized” brain, that the prestigious Simon Baron-Cohen proposed in the 90s after having researched by many people with ASD), is in the process of seriously and drastically rethinking. It is postulated that the traditional results on the distribution of the biological variable of sex in this population could be conditioned by gender stereotypes or explained by the popular camouflage theory.
Autism in Women: Are There Distinctive Features?
The truth is that the question posed in the title of this section still does not have clear answers. There are a variety of studies aimed at exploring this question further, but their results are ambiguous and inconclusive. Today, we know that whatever differentiates neurotypical (non-ASD) boys and girls in the way they interact might also shift to the territory of those living with a neurodevelopmental disorder, which is why they might have more refined social skills in the early years and into adulthood.
The differences at the cognitive level do not give a clear profile either.. In some cases, it has been described that women with this diagnosis have more alterations in dimensions such as attention and / or inhibitory control, but this has not been consistently reproduced. The same can be said of emotional regulation, where very contradictory results are observed. All of these functions, which are included in the considered executive (and which depend on the functional integrity of the frontal lobe), would not successfully “discriminate” between children / men and girls / women.
Let’s see what are the signs that could help detect this problem in girls, Although the isolated presence of these traits is insufficient to confirm that you have ASD. However, knowing them is crucial, as it is common for misdiagnoses to occur (confusion with ADHD or other psychopathological mood disorders or even anxiety disorders).
1. Visible insulation
Girls with ASD can sometimes resort to seclusion in situations where other boys maintain active play behaviors (parties or hobbies, for example). In these contexts, especially when children with whom they have a closer bond are not present, they choose to retreat to a quiet place and cease all interaction. These behaviors can be interpreted as sadness, although they are not always related to this emotion..
2. Unusual emotional responses
Another common behavior among girls with ASD is show emotional reactions that do not seem to respond to a situation that is objectively in the environment. This is why they can cry or scream unexpectedly or unexpectedly, and even suffer from acute anxiety attacks without being able to find a trigger.
This is often a source of concern for parents, which deserves to be consulted by various health professionals in their painful search for reasonable explanations.
3. Imitation and absence of spontaneity
The social behavior that develops in autistic girls is not entirely natural. The adult who observes him has the feeling of not being in his place, as if he were only clumsily reproducing what others are doing. And it is that these girls do not seek to participate spontaneously, but generally do so on the initiative of others. This is why they seem to focus, without much interest, on what they are doing; ignoring all of their “original” contributions (in form and content).
4. Self-centeredness and rigidity
Girls with autism can adopt rigid habits, even when they play. In the event that a classmate wishes to participate in these dynamics, he usually behaves with excessive “authority”, direct the activity and put very narrow limits on what can be considered correct and what cannot. This is why their opinions are “immutable” and it is not easy to change their mind when the task becomes boring for the rest of those involved.
5. Excluding friendships
Autistic girls they may develop a tendency to seek out friendships that are reserved for them, Forge a limited social network (in numerical terms), but for which they draw a link of great dependence. Added to this is the possibility that they will become “obsessed” with who they consider their friend, limiting the possibility of them expanding their own circle and insistently seeking their presence. These relationships come to life out of anxiety and even cause intense outbursts of jealousy.
6. Rigid clearance
On many occasions, girls with autism focus their efforts more intensely on the prologues of the game than on the game itself. This way, they spend a lot of time explaining how to play and setting up the necessary items for this purpose (dolls, for example), but they take little part in the play itself. It is common for this process to make other children bored or even stop interacting with them. This could be the reason for many early forms of rejection.
7. Difficulty understanding jokes
Girls with ASD may have difficulty understanding made-up sentences or even popular sayings, as these use metaphorical language that requires a very high degree of verbal abstraction. that’s why a particular literality arises in the use and understanding of the message, Which is also manifested by difficulties in “adapting” the jokes made by his teammates during the match.
Alternative vision for the low prevalence of female AED
Many studies have been done on autism and most confirm this higher risk in men, at a ratio of 4: 1 compared to women. These data have been explained very frequently by alluding to disparate neurological and genetic reasons, although recently social nuances have been incorporated to signal such a problem (as well as psychological and socio-cultural). We are continuing to explore this issue.
While autism can be detected in the first few months of life as signs of great subtlety (eye contact, for example), it is most common to be a little later (3 to 7 years) when it can make the diagnosis more certain. Most studies agree that during this period, boys have more obvious symptoms than girls, for whom these are usually evident in adolescence. This is when not only does its social impact become evident, but also co-morbid mood and anxiety issues arise that obscure its expression.
Girls with autism often have different issues in adolescence with the way they interact with their peers and compared to boys. Social expectations of each other are also different, so that they are expected to forge friendships in small groups and to have more peaceful activities in the activities they share., While among them, a more active involvement is expected in large groups where friendship acquires a shade of greater collectivism. This makes isolation more easily detectable in men, so that suspicion of ASD is precipitated very quickly, even among teachers.
The feminine dynamic makes it easier for autistic girls to forge dyadic (“best friend”) relationships, following the model provided in their case, while “watching over” a problem that would be expressed much more. Eloquent if a “social model” similar to that of men is expected of them. Many authors argue that they have better social skills than their own, as well as a better ability to imitate and better use of language, which would also contribute decisively to the camouflage of the problem.In short, they could better “disguise” their difficulties (from the age of six).
Other authors consider that the narrow range of interests of women with ASD is more socially accepted than that generally adopted by men. Thus, it would be common for these to be associated with fashion or literature, to name just a few examples. Thus, this would generate less alert among parents, because these would be activities for which the company reserves a positive judgment and the presence of the problem would not be suspected.
In short, the different expectations that parents and society place on their children based on their gender, as well as the disparate social expression of boys / girls, could be an explanatory factor for the particular distribution of TEA by biological sex ( with traditional genetic and neurological variables). In fact, there is evidence that (based on a comparable cognitive / intellectual level) parents detect autistic symptoms worse in girls than in boys. And all this despite the fact that, if necessary, the psychopathological consequences linked to social difficulties are more severe in adolescence.
- Lawson, W. (2017). Autistic Women and Girls: A Profile. Journal of Intellectual Disability, Diagnosis, and Treatment, 5, 90-95.
- Milner, V., McIntosh, H., Colvert, E. and Happe, F. (2019). A qualitative exploration of the female experience of autism spectrum disorder (ASD). Journal of Autism and Developmental Disorders, 49 (4), 38-47.