What are the differences and similarities in how boys and girls experience autism?
Research suggests that the symptoms of autism spectrum disorder, namely difficulties in social skills, difficulties in communication skills, and restrictive or repetitive behaviors, may look different based on the gender of the person with autism.
Autism is diagnosed more often in males than in females.
For every four males that are diagnosed with autism, only one female is diagnosed with autism.
Research questions the reason for this difference in rate of diagnosis in males versus females.
Some suggest that it may be due to the way autism is diagnosed – the symptoms that are used as part of the diagnostic criteria.
However, there may be some level of reality in that males experience autism more often than females (Halladay, Bishop, Constantino, et. al., 2015).
One study looked at the gender differences as related to symptoms of autism and developmental functioning. Those who were assessed in this study included children in the age range of 17 to 37 months who also met the criteria for a diagnosis of autism spectrum disorder (Matheis, Matson, Hong, et. al. 2019).
In this study, no gender differences were found related to symptom severity. However, this study which examined toddlers with ASD, found that girls at this age range had more motor skill deficits but less communication skill deficits compared to boys.
Females are often underrepresented in people who have a diagnosis of ASD when higher IQ is taken into account. This means that of people with higher intelligence level, females are less likely to be given a diagnosis of autism spectrum disorder. This may be because females with higher intelligence can use their intelligence to develop coping strategies and to learn ways to navigate their life experiences despite their ASD symptoms.
Even within the range of average intelligence, females are often able to display more socially acceptable or functional skills in their social interactions as compared to males. This may be due to how females can learn to imitate those around them even when social skills don’t come naturally for them.
One theory of the differences between males and females and the ASD symptom related to restrictive and repetitive behaviors is that females may have fewer of these types of behaviors.
Another theory is that females have different types of restrictive or repetitive behaviors.
The restrictive or repetitive behaviors of females may not be noticed as much or may appear more ‘appropriate.’ For instance, a female may repetitively pick the skin around her fingernails or itch her skin when their is no medical cause.
Females may also have ritualistic behaviors such as making lists excessively or following a specific routine.
A female who tends to line items up or organize items during what seems like pretend play, such as with dolls or other typical toys of early childhood, may not be recognized as displaying restrictive behaviors even though she is not playing in ways similar to her peers. She is actually just placing the toy items in new locations either by putting them in a neat line or organizing the toys in a certain way and not truly just playing with them.
Females may also have limited interests but these interests may appear to be acceptable by society so they are less noticed as a symptom of ASD. For example, if a female’s restricted interest is in the area of psychology or self-help books, it may not appear to others that this is a symptom of ASD even when she doesn’t have many other interests in her life.
This is not to say that males don’t experience these examples of restrictive or repetitive behaviors, but females may experience less noticeable behaviors of this type which may make it more difficult for them to obtain an ASD diagnosis or to identify appropriate interventions for them in this area.
Gender Differences in Males and Females with ASD
The above information provides an overview of just some of the differences found in the symptoms of autism spectrum disorder when comparing males and females.
In summary, males and females differ in the following ways when looking at the diagnosis of ASD:
- males are diagnosed at a 4:1 ratio when compared to females
- at a young age (in the toddler years), females seem to have more motor deficits and lesson communication deficits when they are identified as meeting criteria for an ASD diagnosis at that time
- as intelligence level (IQ) increases, females are less likely to be diagnosed with ASD which may have to do with their ability to develop coping strategies to manage their life experiences despite having ASD
- females may display different types of restrictive or repetitive behaviors (one of the symptoms of ASD) as compared to males; sometimes these behaviors are less noticeable to outside observers
Halladay, A.K., Bishop, S., Constantino, J.N. et al. Sex and gender differences in autism spectrum disorder: summarizing evidence gaps and identifying emerging areas of priority. Molecular Autism 6, 36 (2015) doi:10.1186/s13229-015-0019-y
Matheis, M., Matson, J.L., Hong, E. et al. J Autism Dev Disord (2019) 49: 1219. https://doi.org/10.1007/s10803-018-3819-z