Autism has long been thought of as a condition affecting predominantly boys and men. Awareness of autism in women is slowing increasing, as well as the associated social, emotional and mental health challenges faced by women with the condition.
The male-to-female ratio of diagnosis is about 3:1 (Loomes et al., 2017). However, when studies have focused only on autistic people with cognitive difficulties, it narrows considerably to 2:1 (Van Wijngaarden-Cremers et al., 2014). When studies have focused on autistic people with average or above-average cognitive capacity, the ratio can be as large as 6:1 (Kirkovski et al., 2013). A recent study has stated that 80% of autistic girls remain undiagnosed by age 18 (McCrossin, 2022).
One theory used to explain the differences in male to female diagnostic ratios is that autistic women experience and express autism differently, and that the ratio of diagnosis between men and women is impacted by these differences.
There has not been much recognition of autistic women in research. Historically, most of the symptom descriptions and diagnostic assessment methods have been developed with autistic boys and men as the subjects.
Differing social expectations for boys and girls may also play a part. Girls are generally expected to be polite, more social, and more “subdued” in their expression of emotions. Autistic girls pick up on this social pressure. They end up “not looking autistic” and do not get a diagnosis.
This is known as masking, which is very common in autistic women. Masking involves working very hard to come across as “normal” in daily life, usually to avoid bullying or isolation. The process of masking is described as overwhelming, mentally and physically taxing. In addition, it is thought that this leads to increased feelings of depression, anxiety, shame, and poor self-esteem.
Autistic women, without a diagnosis are at risk of poor mental and physical health. Without the self-understanding and access to appropriate supports that a diagnosis can bring, autistic women may rely on masking more and more to get by, which can have disastrous effects on their mental and physical health.
[1] Autistic people typically report a more fluid experience of gender than their non-autistic peers. But it is important to acknowledge that being socialised as female has significant impacts on the expression and experience of autism. So while I use the term autistic women, this information is inclusive of transgender autistic women, and those assigned female at birth who are nonbinary or genderfluid.
References
Kirkovski, M. et al. (2013). A review of the role of female gender in autism spectrum disorders. Journal Of Autism And Developmental Disorders, Vol. 43, No. 11, pp. 2584-2603.
Loomes, R. et al. (2017). What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis. Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 56, No. 6, pp. 466-474.
McCrossin, R. (2022). Finding the True Number of Females with Autistic Spectrum Disorder by Estimating the Biases in Initial Recognition and Clinical Diagnosis. Children, 9(2), 272. MDPI AG.
Van Wijngaarden-Cremers, P.J. et al. (2014). Gender and age differences in the core triad of impairments in autism spectrum disorders: a systematic review and meta-analysis. Journal Of Autism And Developmental Disorders, Vol. 44, No. 3, pp. 627-635.
