Considerations for Girls/Women

Based on current data, autism is approximately four times more common in boys than in girls; however, many experts believe that more accurate identification of girls and women will result in a 2 to 1 ratio. To make sure that girls and women who have autism spectrum disorder are recognized, a different approach to identification is needed.  

The early descriptions of autism written in the 1940's were based almost exclusively on observations of males on the spectrum. These descriptions continue to have an impact today. In fact, the characteristics of autism that are utilized in our current diagnostic system find their roots in these observations. In addition, researchers in the area of autism have often used male-only participants. These factors have led to what is called a “self-reinforcing cycle” of research and diagnosis biased toward recognizing autistic boys and men and failing to identify girls and women on the spectrum. 

(From Autism Internet Modules)

Research increasingly indicates that some of the difference in the rate of identification of girls and boys results from a failure to recognize how autism looks in girls. Many autistic girls and women are not being referred for assessment. Simply because more boys have been identified on the autism spectrum, there is a tendency not to consider the possibility of autism as readily when assessing girls and women who have characteristics that are often related to the spectrum. Often, other things are considered first. Sometimes autism is never considered at all.   

Once a referral is made, their characteristics of autism may not be recognized by evaluators. It is important for those who provide autism evaluations to be familiar with the different characteristics, experiences, and needs of autistic girls and women.   

Researchers, including the neuroscientist, Francesca Happe, believe that gender bias is resulting in the under-identification of girls and women on the autism spectrum (Devlin, 2018). Other researchers have found that in order to receive a diagnosis, girls on the spectrum often require characteristics or challenges beyond the features of autism (Dworzynski, Ronald, Bolton, & Happé, 2012). In other words, girls tend to be overlooked unless they have significant behavior difficulties, cognitive deficits, or have other conditions that may be disruptive to their environment. For boys, the characteristics of ASD are sufficient for identification: ASD = ASD. In contrast, girls with autism must have an additional condition or conditions (X). So unfortunately, the inaccurate equation sometimes used for girls is ASD + X = ASD.

Not only are girls under-identified with autism - when autism is recognized, it tends to be later in comparison to when it is diagnosed in boys. On average, ASD diagnosis in females occurs two years after caregivers express concerns. Both in childhood and adulthood, girls and women are diagnosed at later ages than boys and men.   

Failure to see the underlying autism and resulting failure to provide services has consequences that may include:

• Social isolation and rejection
• Poor academic performance
• Greater risk for mental health and behavioral distress, such as anxiety, eating disorders, and depression during adolescence and adulthood  

At the individual level, without identification, a girl continues her course of development without critical interventions and becomes increasingly at risk for depression, anxiety, and victimization. At the system level, the failure to identify girls perpetuates this failure for future generations.