Women and Autism Spectrum Disorder: Diagnosis and Implications for Treatment of Adolescents and Adults
Purpose of Review
We review the recent literature regarding the implications of gender on the diagnosis and treatment of autism spectrum disorder (ASD) in women and adolescent females. We also discuss important clinical observations in treating this population.
Growing research supports gender specificity in ASD symptom presentation. Differing phenotypes, psychiatric co-morbidities, and level of “camouflaging” (behavioral coping strategies to conceal symptoms for use in social situations) are thought to further contribute to the discrepancy in prevalence rates and resulting misdiagnosis or delayed diagnosis in adolescent females and women.
Both nosological and cultural factors appear to be contributing to differences in the diagnosis of ASD in women. These differences in presentation have important implications for late diagnosis, treatment of ASD, and the quality of life for women with autism.
KeywordsAutism spectrum disorder ASD Women Female Adults
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.American Psychiatric Association, American Psychiatric Association, editor. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, D.C: American Psychiatric Association; 2013.Google Scholar
- 3.Kanner L. Autistic disturbances of affective contact. Nervous Child. 1943;2:217.Google Scholar
- 9.World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992.Google Scholar
- 10.• Baio J, Wiggins L, Christensen DL, Maenner MJ, Daniels J, Warren Z, et al. Prevalence of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 Sites, United States, 2014. MMWR Surveill Summ. 2018;67:1–23 A very recent study examining the prevalence rate of ASD in a population cohort in London. CrossRefGoogle Scholar
- 11.•• Loomes R, Hull L, Mandy WPL. What is the male-to-female ratio in autism Spectrum disorder? A systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 2017;56:466–74 A systematic review and meta-analysis of prevalence studies examining the male-to-female ratio in ASD. CrossRefGoogle Scholar
- 14.•• Bargiela S, Steward R, Mandy W. The experiences of late-diagnosed women with autism spectrum conditions: an investigation of the female autism phenotype. J Autism Dev Disord. 2016;46:3281–94 A qualitative study examining the female ASD phenotype and its effect on diagnosis. CrossRefGoogle Scholar
- 16.• Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai M-C, et al. “Putting on my best normal”: social camouflaging in adults with autism spectrum conditions. J Autism Dev Disord. 2017;47:2519–34 Qualitative study using thematic analysis to examine social camouflaging in adults with ASD and focusing on the nature, motivations, and consequences of camouflaging. CrossRefGoogle Scholar
- 17.•• Lai M-C, Lombardo MV, Ruigrok AN, Chakrabarti B, Auyeung B, Szatmari P, et al. Quantifying and exploring camouflaging in men and women with autism. Autism. 2017;21:690–702 A quantitative analysis of camouflaging in ASD confirms gender disparities with women reporting greater camouflaging. CrossRefGoogle Scholar
- 18.• Lai M-C, Lombardo MV, Pasco G, Ruigrok ANV, Wheelwright SJ, Sadek SA, et al. A behavioral comparison of male and female adults with high functioning autism spectrum conditions. PLoS ONE. 2011 [cited 2018 Jul 3];6. Available from: http://ezp-prod1.hul.harvard.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2011-14242-001&site=ehost-live&scope=site. A behavioral comparison between sexes found women with high-functioning ASD to show more lifetime sensory symptoms, fewer socio-communication difficulties, and more self-reported autistic traits.
- 44.Safety Skills for Asperger Women: How to Save a Perfectly Good Female Life by Liane Holliday Willey [Internet]. [cited 2018 Jul 31]. Available from: https://www.goodreads.com/book/show/11187137-safety-skills-for-asperger-women.
- 45.• Wood JJ, Klebanoff S, Renno P, Fujii C, Danial J. Chapter 7 - Individual CBT for anxiety and related symptoms in children with autism spectrum disorders. In: Kerns CM, Renno P, Storch EA, Kendall PC, Wood JJ, editors. Anxiety in Children and Adolescents with Autism Spectrum Disorder [Internet]. Academic Press; 2017 [cited 2018 Jul 31]. p. 123–41. Available from: http://www.sciencedirect.com/science/article/pii/B9780128051221000077 A chapter reviewing the effectiveness of CBT therapy in treating both children and adults with ASD.
- 53.Oswald TM, Winder-Patel B, Ruder S, Xing G, Stahmer A, Solomon M. A pilot randomized controlled trial of the ACCESS program: a group intervention to improve social, adaptive functioning, stress coping, and self-determination outcomes in young adults with autism spectrum disorder. J Autism Dev Disord. 2018;48:1742–60.CrossRefGoogle Scholar
- 56.• Mason D, McConachie H, Garland D, Petrou A, Rodgers J, Parr JR. Predictors of quality of life for autistic adults. Autism Research [Internet]. [cited 2018 Sep 23];0. Available from: http://onlinelibrary.wiley.com/doi/abs/10.1002/aur.1965 This study includes the largest study sample to date examining the quality of life of individuals with ASD and examines gender differences.