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Is Autism harder to detect in females?

Temple Grandin was diagnosed with Autism at age 3. Prior to that, no one in her family understood her, especially her father. He wanted her sent to a mental institution. But Temple’s mother stood her ground. She didn’t understand what was wrong with her daughter but she was not ready to send her off to...

autism

Temple Grandin was diagnosed with Autism at age 3. Prior to that, no one in her family understood her, especially her father. He wanted her sent to a mental institution. But Temple’s mother stood her ground. She didn’t understand what was wrong with her daughter but she was not ready to send her off to a mental institution. Temple was the first child of her parents and unlike every child, she was different. From when she was a toddler she didn’t smile when tickled.  Neither did she laugh. She also didn’t hold out her hands to be carried like every other child her age. According to her parents she never said the words “I love you mummy” till she was four years.

Temple never wanted to be cuddled as a baby but would stiffen her body and withdraw herself. Temple at age 2 had not started talking. Most times she withdrew herself from others and preferred staying at a corner, writing on the wall with pencil or crayon. When she got into elementary school, It was difficult for her. She never liked the sound coming from the school bell. It was as if her senses were overactive. The slightest stimulation registered in high magnitude. She was diagnosed with autism in 1950 by a Psychiatrist. At that time autism was barely a thing in the scientific community as little research had been conducted on it. Through help from her mother, her school and other specialist Temple was able to develop the ability to use language. She was lucky to be diagnosed early and due to that the appropriate measures were put in place.

Temple is among the few lucky females to be diagnosed with ASD (Autism Spectrum Disorder) very early in life. Autism is a Neuro-developmental disorder with childhood onset that affect both sexes. However the diagnosis in both males and females has been shown to be different. For every Four males diagnosed with Autism, one female is diagnosed. This sets the ratio at 4:1. But why the difference? Does it mean that more males than females have ASD? Or is the disorder harder to detect in females than males? In the past it was considered that Autism spectrum disorder was a male disorder due to higher levels of diagnosing it in male samples. There has however been a shift in that belief as Autism spectrum disorder is present in both males and females. Temple Grandin is one example.

There has however been difficulty in making diagnosis of the disorder in the female population. Why is this so? The diagnosis criteria for most mental disorders is the Diagnostic and statistical manual of mental disorder 5 (DSM-5). There has been reports which indicates that the diagnosis criterion is gender biased as it fails to capture the symptoms in females which could possibly be due to the way the disorder is manifested in females. Except in severe occurrences, Autism might go unnoticed in the female samples. But why this bias? Why does the diagnostic criteria fail to capture the manifestations in females?

Females with ASD are usually diagnosed with other disorders like bipolar disorder, borderline personality disorder, depression, obsessive compulsive disorder amongst others. Due to their ability to mask their symptoms, wrong diagnosis are usually made. Making a diagnosis is usually based on clinical observation, informant report, and self report. Due to the difficulty in communicating their symptoms accurately, diagnosis is usually based on clinician observation and informant report. This however is biased as the symptoms in females do not fit into the diagnostic criteria. They are often misunderstood. Females with intellectual difficulties in conjunction with other symptoms are easily diagnosed with ASD than females without intellectual difficulties.

Individuals with ASD possess impairment in reciprocal social communication and social interaction.  In typical individuals (those without Autism) social interaction is characterized by a reciprocal exchange. A giving back and forth, where one individual initiates and the other reciprocates. For individuals with ASD forming social relationships is often difficult as they do not know what is expected of them in such social interaction.

This criterion is the most prominent one used in clinical diagnosis of ASD. Individuals with ASD lack the ability keep eye contact, understand body language and usually possess impaired understanding and use of body gestures. Social interactions usually involves the ample use of these skills. In some cultures, it is required for an individual to maintain eye contact during conversations, and understand the body language of the individual they are interacting with in order to have an optimal interactive relationship. This is however difficult for individuals with ASD, in interactions they are often blunt and direct without emotional expression. They often fail to understand the emotions of others or be able to place themselves in other people’s shoes. They possess a certain thought pattern that assumes that everyone thinks just like them. Given the severity of the symptoms, how does it go by undetected in females for many years.

From an early age every child is socialized into the society. They are taught the appropriate ways to behave in certain situations. How to talk. How to respond appropriately. The socialization process does well in masking the symptoms in females. In typical societies females are often expected to conform to certain gender stereotypical behaviors even among individuals without ASD.  Bringing this into the context of females with ASD, it is highly likely that these females feel more obliged to conform and adhere to certain behavioral patterns. They are forced to repress certain autistic behaviors as they consider their behaviors abnormal. This however is not conscious as the individuals in the autistic female’s life are not aware of the disorder, neither are the victims themselves.

Females with ASD have less obvious difficulties in social interactions and behavior regulations compared to male samples. It’s easier for them to copy and imitate the behavior of others and apply this behavior in social settings. Copy cat you might call them. This ability to copy is more profound in females than males possibly due to the structural differences in the brain of males and females and the fact that socially appropriate behaviors are emphasised for females than for males. Females are more socially conforming than males. Males are more readily diagnosed with ASD than females because they exhibit certain behaviors that are typical to autistic patients which females do not exhibit.

Males with ASD often possess more difficulty in internalizing difficulties. For ASD patients, emotions and sensory information gets overwhelming atimes and they need to develop coping mechanism to handle such difficulties. Males often throw more tantrums than females when faced with an overwhelming stimulation. This could possibly be due to socializing factors. Females usually camouflage their difficulties and learn how to cope with them better than males. They repress their behaviors. They might be experiencing emotional difficulties or sensory overload but do well in masking them by internalizing rather than readily expressing it. This camouflage effect leads to the disorder going unnoticed in female samples. Males with ASD often have obvious behavioural problems like getting involved in fights, squirming always, crying and throwing general tantrums than females and as such the disorder is more readily observable and diagnosed.

Another common characteristic of ASD patients is possessing one special interest. ASD patients often have one special thing they give special interest to. They learn everything about that thing are engage in it compulsively. This is probably due to the fact that ASD patients are change aversive and prefer routine activities than activities that changes readily. Due to their hyperactive sensory system, activities that involves changes are usually overwhelming for them than normal behavior. Sticking to one task reduces this and helps them block out the sensory overload. In females possessing one special interest is not considered an abnormality but it is not so for males. It is considered normal if a female takes interest in a routine activity than it is for males. This is probably due to the stereotypes attached to both genders.

This ability of Autistic females to mask the symptoms makes it more difficult to detect than in males. Temple Grandin was among the few lucky ones that got diagnosed early in life and as such was able to understand herself. She got to know that others do not think like her. She got to know that while others usually think using words, she thinks pictorially. She was able to develop coping mechanism for the ASD while actively utilizing the opportunity made available to her by virtue of having ASD.

For females with ASD that were not as lucky as Temple to get diagnosed early, they often have to face a lot of difficulties. Difficulties in expressing themselves and difficulty in understanding others. As such people misunderstood them and attach certain labels to them that are prejudiced and hurting. They struggle in trying to understand and know what they are going through and try their best to conform to what the society expects from them at their own expense. They repress their autistic behaviors and atimes when the symptoms become overwhelming, some of these females might decide to commit suicide.

There is the need to revise the diagnostic criteria for ASD to make sure that it incorporates females with ASD. There is also the need to quit emphasising certain behavioral patterns in children, especially those that find it difficult to conform to it.

 

-Sokuma Theophilus

 

References

Diagnostic and statistical manual of mental disorder. Fifth edition.

St. Montgomery (2012). Temple Grandin, how the girl who loved cow embraced autism and changed the world . Houghton Mifflin Harcourt Publishing Company: New York

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1 Comment
  1. Very good article I must say… But don’t you think feminists might find it offensive in way? Because they might think you are regarding females as being too easy. ASD has a general symptom and can be detected in both sexes.. Welldone 🙌🏾

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