Over time we have heard, read and experienced in schools and in society at large higher male prevalence in autism diagnosis. For every 4 child diagnoses there is a girl.
But the current reality is that today there is a greater diagnosis of girls with ASD: for every 3.2 boys, there is one girl.
This reality makes us rethink our professional practice and raises situations and experiences with our patients that we must know in order to approach them rigorously, because received ideas have led many late diagnoses in women.
Differences between women and men with autism
Although the causes of this phenomenon are not yet clear, we can know that, on the one hand, there are different manifestations of ASD (autism spectrum disorder) in women compared to men.
On the other hand, there is also a lack of sensitivity in detection and diagnostic tools. We can also be conditioned by history itself, which leads us to believe that this condition occurs mostly in men; and this causes a bias to the professionals themselves. We must therefore relearn, get rid of our own stereotypes and discover a little further.
What can be behind these differences?
In the various studies on the differences in the manifestation of ASD, explanations of different origin such as those cited above are sought and found.
1. Neurobiological differences
Studies such as Zhang et al. (evidence of the “female protective model”) shows us female genetic protection against ASDmust have a greater genetic impact on the phenotype for this condition to be expressed.
2. Differences in nuclear manifestations of ASD in girls and women
Social and communication skills may be better for girls. Additionally, they may be more prone and effective at masking their difficulties. There is less intensity in repetitive behaviors or restricted interests, and moreover, if they exist, they generally match their age and time of evolution, and may even appear more adjusted or similar to their peers .
3. Sensitivity of ASD detection and diagnostic instruments
In the have developed and validated most of the detection and diagnostic tools for the male population, may result in a lack of sensitivity in identifying ASD symptoms in girls and women, even if they are obvious. For all this, a greater variability of the criteria would be necessary.
4. Gender bias
The bias would be given by the professionals in the diagnostic evaluation, predisposed to see other types of disorders in the case of womenin search of alternative explanations for the various difficulties expressed and manifested in them, causing a lack of diagnosis of autism.
Other issues to consider
Moreover, at the clinical, medical level, we find it very difficult; and do early detection protocols are not implemented in primary care, leading to a delay in diagnosis.
It is important to know that the consequences of a misdiagnosis or a late diagnosis of ASD can be: depressive disorders, anxiety, eating disorders, inappropriate prescription drugs and psychopharmacological treatments, bullying at school and/or sexual addiction, emotional dependence, difficulty making friends or relating to other people, school or professional difficulties, conflicts with one’s own gender identity, etc.
Much remains to be done, and it is important that we understand that the autistic condition is present in both sexes, as well as learn and hear from women with autism all they can give usleaving behind what limits us in our work.
Author: Irene de la Granja Muñoz, Master in Special Education, Master in Educational Psychology, member of Centro TAP.