DID YOU KNOW? Autistic female presentation is not included in the DSM-5.

Gender differences in ASD

Very often the difficulties that autistic girls experience go unnoticed by their teachers.

WHY IS THIS?!

In part, it is due to the fact that for the past decades, teachers have been acutely aware of the rise in autism in their classrooms. They’ve been trained to observe and refer their students for evaluations based upon traits detailed in the DSM’s. These behaviors however, highlight the male presentation of autism. Yes, this is true…let’s take a brief look at the reasons why.

The DSM-5 requires a presentation of extensive repetitive and ritualistic behaviors, which often may highlight males and exclude females who have the other ASD characteristics. Mandy et al 2012 JADD 42, pp 1304-1313

Further research shows that while girls had less repetitive, stereotyped behavior, they had the male equivalent social communication impairment. Girls had less ‘apparent’ difficulties at school. They also demonstrated superior fine motor skills when compared to boys. Most significantly, girls had greater emotional difficulties when compared to boys.

We can see that teachers are keeping a watchful eye on who and how to support in their elementary classrooms, but the profile which their observations are based upon is the male.

So why are females so underrepresented in the DSM-5?

Let’s take a brief look…

Criterion C states that ‘Symptoms’ must be present in the early developmental period; with girls, these symptoms may not become fully apparent until the social demands exceed their limited capacities OR they may be masked by learned strategies later on in life. Meaning that girls ‘appear’ fine because they have less apparent difficulties in elementary school.

Criterion D states that ‘Symptoms’ cause clinically significant impairment in social, occupation, or other important areas of current functioning. While the females have been experiencing difficulties in these areas all along, it becomes more obvious in the middle through high school years on into adulthood where social demands exceed their social capacity.

A more recent study; Social Interaction Abilities of Autistic Girls, Wood-Downie et al (2021) Jr Child Psychol. and Psychiatry 62, 922-936, found the following:

• Autistic females demonstrated significantly better social interaction and communication skills than autistic males

• This characteristic may not be captured by current diagnostic instruments

• Autistic traits in females become more evident in adolescence

Gender Ratio and Age, Rutherford et al.Autism2016, Vol. 20(5) 628-634

• Male: Female gender ratio in all children and adolescents 3.5:1

• Ratio for primary school children 5.5:1

• Ratio for adolescents 2.3:1

• The adult gender ratio was1.8:1

Posserud et al (2021) Acta Psychiatrics Scandinavica, Norwegian study 2.5 million children and adults (born before 2011)

• Ratio for children 3.67:1

• Ratio for adults 2.57:1

So as we can see, the research is there…the autistic female has been underrepresented. Where do we go from here? How do we identify and include females when the baseline for identification overlooks female presentation benchmarks?

DIAGNOSTIC ASSESSMENT FOR AUTISTIC FEMALES…stay tuned for out follow up blogs on this topic.

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