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DSM-5 and Challenges to Female Autism Identification

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  1. Ratios are commonly reported as 4:1 or 3:1 boys to girls (Egerton and Carpenter 2016; Dworzynski et al. 2012: Loomes et al. 2017), but have been suggested to be as low as 2.5:1 (Kim et al. 2011), 2:1 (Zwaigenbaum et al. 2012) or 1.8:1 (Mattila et al. 2011). A cause of this discrepancy may be found in a closer examination of the study samples. In study samples including intellectual disability, the male–female ratio is likely to be lower, whereas, in study samples including normal to high IQ, the ratio is likely to be greater. Furthermore, Happé suggests that studies including girls and women are generally not fully representative as they predominately focus on only diagnosed participants and, consequently, far less is known about those who are not officially diagnosed (Happé 2019). As discussed below, it is this, frequently hidden, subset of the autistic population, along with more complex and hard to diagnose cases of female autism, which is the focus of this letter.

  2. Dunne (2015) describes the Internet as providing her with ‘an online tribe for the tribeless, a diaspora of aliens in a neurotypical universe.’.

  3. For example Wrong Planet, Talk about Autism.

  4. This is well captured in Rebecca Westcott and Libby Scott’s collaborative writing on autism from a semi-autobiographical perspective of a young female adolescent: ‘Anxiety rating: 9. And believe me when I tell you that an anxiety rating this high at home would mean an instant meltdown. But I’m here with everyone and I can’t let my true feelings out, so instead they’re all bottled up, eating away at me from the inside like nasty little insects’ (Westcott and Scott 2020).


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Thank you to Dr. Luke Beardon and Dr. Nick Chown for comments.

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Correspondence to Elsa K. Suckle.

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Suckle, E.K. DSM-5 and Challenges to Female Autism Identification. J Autism Dev Disord 51, 754–759 (2021).

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