If someone meets criteria for a condition, it seems as though it should be equally obvious in biological males and females, right? A diagnosis is a diagnosis, after all. Data shows us that for Autism Spectrum Disorder (ASD) this is not the case. Older data indicates a diagnostic rate of 4:1, biological male to female, but it has since been recognized that females are underdiagnosed by practitioners due to many factors. The current autism ratio is now believed to be 3:4, male to female, with eighty percent of biological females being undiagnosed until over the age of 18.
These startling statistics show us just how significant the disparity is between male and female diagnoses of ASD. One of the reasons for this discrepancy is the ways in which autism presents in the two biological genders. Autism symptoms can also be perceived differently for males and females by mental health practitioners. Diagnosis is not an exact science. Often conditions are misinterpreted as being something else, due to overlapping symptoms. Even with this factor being noted, the number of women misdiagnosed is greater, with forty two percent initially misdiagnosed at least once.
Black and Latino children are also less likely to get an early diagnosis of ASD compared to white children, delaying the intervention of helpful services. Given this combination of factors, black and Latino female children and adolescents are at greatest risk for having autism missed completely or diagnosis delayed.
Differing ASD Presentation in Biological Genders
One reason ASD is diagnosed less frequently in biological females is due to masking. Females with Autism are better at masking communication and sociological symptoms of autism than males; this is partially due to the increased social pressures on females to fit into behavioral norms in our culture.
Biological females are often overlooked for ASD diagnosis because symptoms present with greater intensity in males and are more likely to be noticed from a young age. Females often do not receive a diagnosis from an early age unless they also exhibit signs of an intellectual disability. Another factor that impacts the timeliness of an ASD diagnosis is the way biological females’ special interests are interpreted. Females with ASD often focus or on topics that are relatively mainstream, such as books, celebrities and animals, and these topics are often overlooked as clinically significant by evaluators as a result.
The ways in which biological females inadvertently camouflage symptoms makes ASD tricky to diagnose, even with standardized measures. All testing relies on human interpretation, and symptoms vary significantly between males and females, as do cultural norms. These factors make an ASD diagnosis a complex matter for girls and female adolescents. As a result, a huge percentage of females with autism remain undiagnosed until far later in life.
Culture also plays a role. Even details such as how questionnaires for parents are interpreted and responded to during the diagnostic process can impact whether people from varying cultures receive a diagnosis of ASD. This demonstrates that when it comes to autism, testing needs to be as diverse as the human population and should include a variety of validity screening options. Specific testing for varying cultures, genders and sociological factors should be considered to provide the most accurate results.
Why is Social Skills Training and Practice so Important?
Early intervention has always been the benchmark for social skills training for people with ASD. When diagnosis of autism is delayed, as it often is for biological females and BIPOC (Black, Indigenous, People of Color) , social skills training is also delayed. This can result in challenging dynamics for undiagnosed kids in elementary through high school and a lot of time spent struggling that could have been devoted to social skills training and practice.
Social skills training can provide kids with ASD a framework to interpret the behaviors of others and practice the skills that can help ease social interactions. This practice can help develop a sense of self-identity and connection with others that can dramatically shape the long-range quality of life for people with autism. As autism continues to be studied and interventions are improved to include cultural and gender factors, better results will emerge for all.
Talley Webb, MA, CRMC