In the United States, 1 in 59 children are diagnosed with autism and prevalence rates are currently higher among males than among females (Baio et al, 2018). At first glance, these statistics may suggest that autism is a predominantly “male” condition. In fact, media outlets, such as the television show Atypical, overwhelmingly portray individuals with autism as male characters. Recent investigations, however, have emphasized that our current screening and diagnostic systems are suboptimal for detecting autism among females.
Relative to males, females must often display more impairing symptoms, as well as a higher severity of behavioral and emotional concerns, to meet criteria for autism (Dworzynski, Ronald, Bolton, & Happe´,2012; Russell, Ford, Steer, & Golding, 2010). Current explanations for this discrepancy include the proposition that diagnostic systems, which have been developed and validated within male only samples, do not adequately capture characteristics of autism that are found among females (e.g., Lai, Lombardo, Auyeung, Chakrabarti, & Baron-Cohen, 2015). For example, females are less likely to demonstrate externalizing behavior, which reduces the likelihood for referrals for evaluation and recognition of repetitive/stereotyped behavior (Van Wjingaarden-Cremers et al., 2014). Receiving a diagnosis earlier rather than later can help improve quality of life, thus adequate screening and assessment procedures for females deserve further attention.
For an emerging clinician-researcher, these discussions have highlighted the importance of thinking critically about the methods and materials we use to screen and diagnose individuals within clinical contexts. It is encouraging to witness these conversations occurring across different platforms, including autism specific blogs, mainstream news outlets, and academic journals. In addition, institutions such as the University of Illinois Autism Clinic (UIAC) and The Autism Program at the University of Illinois (TAP), are teaming up to provide a women’s group for female adolescents with autism. During these sessions, adolescents will have an opportunity to discuss a wide range of topics, including social skills, executive functioning, and sexual education. Although not directly addressing the issue of diagnosis, this initiative acknowledges and celebrates a sub-population of the autism community that has long been overshadowed.
Baio, J., Wiggins, L., Christensen, D. L., Maenner, M. J., Daniels, J., Warren, Z., ... & Durkin, M. S. (2018). Prevalence of Autism Spectrum Disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. MMWR Surveillance Summaries, 67(6), 1.
Dworzynski, K., Ronald, A., Bolton, P., & Happe´, F. (2012). How different are girls and boys above and below the diagnostic threshold for autism spectrum disorders? Journal of the American Academy of Child and Adolescent Psychiatry, 51(8), 788–797. doi:10.1016/j.jaac.2012.05.018.
Lai, M.-C., Lombardo, M. V., Auyeung, B., Chakrabarti, B., & Baron-Cohen, S. (2015). Sex/gender differences and autism: Setting the scene for future research. Journal of the American Academy of Child and Adolescent Psychiatry, 54(1), 11–24. doi:10.1016/j.jaac.2014.10.003.
Russell, G., Ford, T., Steer, C., & Golding, J. (2010). Identification of children with the same level of impairment as children on the autistic spectrum, and analysis of their service use. Journal of Child Psychology and Psychiatry and Allied Disciplines, 51(6), 643–651. doi:10.1111/j.1469-7610.2010.02233.x.
van Wijngaarden-Cremers, P. J., van Eeten, E., Groen, W. B., van Deurzen, P. A., Oosterling, I. J., & van der Gaag, R. J. (2014). Gender and age differences in the core triad of impairments in autism spectrum disorders: A systematic review and metaanalysis. Journal of Autism and Developmental Disorders, 44(3), 627–635.