Over time we have heard, read and lived in schools and in society in general, that there is a higher male prevalence in the diagnosis of autism. For every 4 diagnoses in boys, there is one girl.
But the current reality is that, today, there is a greater diagnosis of girls with ASD: for every 3.2 boys, there is one girl.
This reality makes us rethink our professional practice and presents us with situations and experiences with our patients that we must know in order to be able to approach them with rigor, since preconceived ideas have led to many late diagnoses in women.
Differences between women and men in the face of autism
Although the causes of this phenomenon are not yet clear, we can know that, on the one hand, there are different manifestations of ASD (Autism Spectrum Disorder or Condition) in women compared to men.
On the other hand, a lack of sensitivity has also been observed in detection and diagnosis tools. We can also be conditioned by History itself, which leads us to believe that this condition occurs mostly in men; and this causes a bias in the professionals themselves. Therefore we must learn again, get rid of our own stereotypes and discover a little further.
In the different studies on the differences in the manifestation of ASD, explanations of different origins such as those mentioned above are sought and found.
1. Neurobiological differences
Studies such as that of Zhang et al. (evidence of the “female protective model”) show us female genetic protection against ASD having a greater genetic impact on the phenotype for this condition to be expressed.
2. Differences in the nuclear manifestations of ASD in girls and women
Social and communication skills may be better for girls. Furthermore, they may be more willing and effective at masking their difficulties. There is less intensity in repetitive behaviors or restricted interests and, in addition, if they exist, they tend to be in accordance with their age and developmental stage, and they may even seem more adjusted or similar to their peers.
3. Sensitivity of ASD detection and diagnosis instruments
To the most detection and diagnosis instruments have been developed and validated with the male population, this can cause a lack of sensitivity when identifying the symptoms of ASD in the case of girls and women, even if they are evident. For all this, greater variability in criteria would be needed.
4. Gender bias
The bias would occur on the part of the professionals in the diagnostic assessment, predisposed to see other types of disorders in the case of women seeking alternative explanations for the different difficulties expressed and manifested in them, causing a lack of diagnosis of autism.
Other problems to take into account
Furthermore, at a clinical, medical level, we encounter great difficulty; and it is that early detection protocols are not implemented in primary care, which leads to a delay in diagnosis.
It is important to know that the consequences derived from erroneous or late diagnoses of ASD can be: depressive disorders, anxiety, eating disorders, prescription of inappropriate medication and psychopharmacological treatments, school and/or sexual bullying, emotional dependence, difficulty making friends or relating to other people, school or work difficulties, conflicts with one’s own gender identity…
Conclusion
There is still much to do, and it is important that we understand that the autistic condition is present in both sexes, as well as learn and listen to women with autism about everything they can give us leaving behind what limits us in our work.
