The spectrum is not an exclusively male domain: Recognising autism in females

Autism has traditionally been perceived as a ‘boy’s’ disorder.
 
‘At one stage, autism was even referred to as “extreme maleness”’, Dr James Best, a GP with a special interest in the disorder, told newsGP. ‘The idea being that if you take characteristics generally ascribed to males, such as doing one task at a time rather than multitasking or not being as good with social communication, and take them to the extreme, you end up with what we think of as autism.’
 
Autism’s identification with ‘maleness’ stems from early research into the disorder, with Dr Hans Asperger writing in 1944, ‘In the autistic individual, the male pattern is exaggerated to the extreme. It could be that autistic traits in the female only become evident after puberty. We just don’t know’. 
 
Dr Asperger’s declaration has influenced assessment and diagnosis ever since, but more recent research has questioned such assumptions, revealing that females who experience the disorder may have gone undiagnosed because they present differently from males.
 
‘Females [with autism] are much more prone to trying to disguise differences that they have,’ Dr Best said. ‘So, for example, they can often present as having social skills but in a very fleeting way, like a social butterfly going from interaction to interaction.
 
‘But they also find this quite exhausting. It’s a big effort for them to behave this way.
 
‘There are also a lot of problems with eating disorders [for females with autism]. And in both female and male, gender dysphoria issues can be more common in people on the autism spectrum.’
 
Life can be a struggle for women and girls with unrecognised autism, and a diagnosis often comes as a huge relief.
 
‘Our objective is to help everyone on the autism spectrum overcome the deficits or problems they may have, and a good starting point for that is to identify them better,’ Dr Best said. 
 
‘We’ve certainly come a long way in our ability to identify autism in general, although that’s been more on the male side of things. But new thought is expanding to be more inclusive of females.’
 
While it was previously thought that the gender ratio of people with autism was 4:1 in favour of males, it is now theorised that the real numbers might be more like 3:1, with a large number of girls and women underdiagnosed.
 
Dr Best believes the best way for GPs to approach this issue is to look past earlier beliefs.
 
‘Not making the assumption that girls don’t have autism I think is a good starting point,’ he said. ‘The disorder can be more difficult to diagnose in females, just because of the way that we traditionally think about autism.
 
‘Also, girls with autism tend to camouflage their deficits quite well. We should have on our radar that any child that needs to be assessed from their social communication development.’
 
Traits common among females with autism

• Increased social imitation skills
• A desire to interact directly with others
• A desire to arrange and organise objects
• A tendency to play alone in order to maintain control
• A tendency to be shy or passive
• A tendency to mimic others in social situations
• Behaviour in check at school or in public, but explosive at home
• Strong sensory sensitivities
• Strong imagination
• Strong linguistic abilities developmentally
• Interests that focus on animals or people.

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