Autism is a neurodevelopmental disorder that has experienced a very important boom in recent decades. Every day there are more precise tools to detect it and to address the resonances on the day to day of those who present it.
A related issue (which has “aroused the interest” of the scientific community) is that of a possible bias in its diagnostic process, which would reduce the likelihood that women or girls can be identified as autistic and benefit from multiple forms of therapy available for this condition.
Although a series of organic factors have been traditionally postulated whose objective was to explain why there are many more boys than girls with autism, theories about psychological and social variables of enormous importance for the clinic and for research begin to emerge.
In this article we will address the issue of autism in women , and we will also detail how autism can be expressed, both in generic terms and in the female population. The reasons why, in the latter case, it might be more difficult to confirm their presence will also be outlined.
- Related article: ” Autism Spectrum Disorders: 10 symptoms and diagnosis“
What is autism?
Since autism was described by Leo Kanner in 1943 as a lack of interest in social aspects and an intense resistance to environmental fluctuation, this neurodevelopmental disorder has undergone numerous changes in its clinical formulation and even in its diagnosis . Together with those of the aforementioned author, Hans Asperger’s contributions (with special emphasis on verbal expression) allowed health sciences to articulate a series of theoretical models and practical keys aimed at understanding and identifying them in the consultation. All of them flourished throughout the 70s, finally coming together in the drafting of the criteria of the DSM-III manual (1980).
At first , the possible presence of three cardinal dimensions was considered, with which the presentation of such a disorder could be summarized , although recently these have only been reduced to two: communication or social interaction (difficulties to start a situation of reciprocal exchange with an interlocutor, together with severe alterations in the practice of language) and restrictive or repetitive behavior (inflexibility for thinking and behavior, irritability / poor impulse control and tendency to symmetry and repetition).
The new diagnostic manuals (DSM-5, 2013), have also made other changes in the traditional way in which the most classic autism was contemplated: elimination of Asperger’s syndrome and definitive inclusion of generalized developmental disorder and disintegrative in a label comprehensive that was called Autism Spectrum Disorder (or ASD), which summarizes all possible expressions in a unique and heterogeneous category . These modifications have not escaped some criticism, sustained above all in an increase in ambiguity.
Likewise, with this new redefinition it was necessary that the clinicians who made such a diagnosis also indicated the existence of some degree of intellectual disability in their patient (since not all of them present it at the same intensity) and the severity threshold attributable to the problem. For this case, a differentiation was made in three possible levels (the little eloquent level 1, 2 and 3), according to the power of the symptoms to interfere with the evolution of daily life. In this way, autism acquired a dimensional nuance, as opposed to its former categorical prism.
The greater theoretical / clinical contextualization of autism in recent years has made it possible to have much information about its epidemiology. Today it is known that 1.6% of people suffer from some form of autism (among all those mentioned before and with very different degrees), and that such percentage has experienced a remarkable growth in the last decade. Similarly, all the literature on this topic coincides in pointing out that it is a more common condition in men than in women (approximately 80% of those affected are men).
The latest data, which has been unanimously accepted since the dawn of the study on autism (even supported by hypotheses such as the “hypermasculinized” brain, which the prestigious Simon Baron-Cohen proposed in the 1990s after investigating many people with ASD), is now rethinking seriously and rigorously. It is being postulated that the traditional results on the way in which the biological sex variable is distributed in this population could be conditioned by gender stereotypes or explained by the popular camouflage theory.
Autism in women: does it have distinctive features?
What is really true is that the question posed in the title of this section still does not have clear answers. There is a wide variety of studies aimed at delving into this issue, but its results are ambiguous and inconclusive. Today we know that everything that differentiates neurotypic boys and girls (without ASD) in their way of interacting could also be transferred to the territory of those living with neurodevelopmental disorder, which is why they could have more refined social skills in the first years and during adulthood.
The differences at the cognitive level do not give a clear profile either . In some cases it has been described that women with this diagnosis have more alteration in dimensions such as attention and / or inhibitory control, but this has not been able to be consistently replicated. The same can be said regarding emotional regulation, where very contradictory results are appreciated. All these functions, which are included within those considered executive (and which depend on the functional integrity of the frontal lobe), would not allow “successful discrimination” of boys / men and girls / women.
Let’s see what are the signs that could help detect this problem in girls , although the isolated presence of these traits is insufficient to confirm that ASD is suffered. However, knowing them is essential, since it is common for diagnostic errors (confusing with ADHD or other psychopathological pictures of mood or even anxiety).
1. Apparent isolation
Girls with ASD can sometimes resort to isolation in situations where other boys maintain active play behaviors (parties or recesses, eg). In such contexts, especially when children with whom they have a closer relationship are not present, they choose to retire to a quiet place and cease all interactions. These behaviors can be interpreted as sadness, although they do not always relate to this emotion .
- You may be interested: ” Theory of Mind: what is it and what does it explain to us about us?“
2. Unusual emotional responses
Another of the usual behaviors in girls with ASD is to show emotional reactions that do not seem to respond to a situation that is objectively in the environment . That is why they could cry or scream unexpectedly or unexpectedly, and even suffer acute anxiety crises without finding a precipitating factor.
It is often a matter of concern among parents, which merits consultation with various health professionals in their distressing search for reasonable explanations.
3. Imitation and absence of spontaneity
The social behavior that unfolds among girls with autism lacks all naturalness . The adult who observes it has the feeling that it is misplaced, as if only limited to reproduce with some clumsiness what others are doing. And is that these girls do not spontaneously seek to participate, but usually do so on the initiative of others. That is why they seem to concentrate, without much interest, on what they do; bypassing all his “original” contributions (in form and content).
4. Egocentrism and rigidity
Girls with autism can adopt rigid habits, even when they play. In the event that a partner wishes to participate in these dynamics, they usually behave with excessive “authority”, directing the activity and imposing very narrow limits on what can be considered correct and what is not . That is why their opinions are “immovable,” and it is not easy to change their minds when the task becomes boring for the rest of those involved in it.
5. Exclusive friendships
Girls with autism can develop a tendency to seek ties of friendship that are only reserved for them , forging a limited social network (in numerical terms), but for which they draw a bond of great dependence. To this situation is added the possibility that they “obsess” with the one they consider their friend, restricting the possibility of expanding their own circle and insistently seeking their presence. Such relationships come to live from anguish, and even cause intense explosions of jealousy.
6. Rigid game
On many occasions, girls with autism focus their efforts more intensely on the prolegomena of the game than on this one by itself. In this way, they spend a lot of time explaining how to play and arrange the elements necessary for this purpose (dolls, eg), but only participate a little in the recreational activity itself. It is common that this way of proceeding causes other children to get bored, or even to stop interacting with them. It could be the reason for many early forms of rejection.
7. Difficulty understanding jokes
Girls with ASD may have problems trying to understand phrases made or even popular sayings, since they use a metaphorical language that requires a very high degree of verbal abstraction. That is why a special literality arises in the use and understanding of the message , which also manifests itself in difficulties in “fitting in” the jokes made by his teammates during the game.
- You may be interested: ” Causes of gender inequality: differential socialization“
Alternative vision for the low prevalence of female ASD
There are many studies that have been carried out on autism, and most of them confirm a higher risk among men, in a 4: 1 ratio to women . This data has been explained with great frequency alluding to disparate neurological and genetic reasons, although recently social nuances are being incorporated to account for such an issue (as well as psychological and socio-cultural). We proceed further to explore the issue.
Although autism can be detected from the first months of life in the form of signs of great subtlety (eye contact, eg), the most common is that it is a little later (3 to 7 years) when it can be developed The safest way to diagnose. Most of the studies agree that during this period boys show more obvious symptoms than girls, for which these are usually evidenced in adolescence. It is at this moment that not only its social impact becomes evident, but also that comorbid mood and anxiety problems arise that mask its expression.
Girls with autism often have different problems in adolescence in relation to the ways of interacting with their peers and / or mates, when compared with those who live in boys. The social expectations about each other are also different, so that they are expected to forge their friendships in smaller groups and that the activities they share are of a quieter nature , while a more involved involvement is expected. active in large groups where friendship acquires a nuance of greater collectivism. This makes the isolation more easily detected in boys, so that the suspicion of ASD is precipitated very quickly even among teachers.
Female dynamics make girls with autism more easily to forge dyadic relationships (“best friend”), following the pattern provided in their case, while “watching” a problem that would be expressed much more eloquently if he will expect from them a “social pattern” similar to that of men. Many authors propose that they have better social skills than theirs, as well as a better capacity for imitation and superior use of language, which would also contribute decisively to the camouflage of the problem. In short, they could “hide” their difficulties with greater success (from the age of six).
Other authors consider that the range of restricted interests of women with ASD is more socially accepted than that usually adopted by men . Thus, it would be common for them to be associated with fashion or literature, to name an example. Thus, a lower alarm would be generated between the parents, since it would be activities for which society reserves a positive judgment, and the presence of the problem would not be suspected.
In short, the different expectations that parents and society place on their children based on their gender, together with the disparate social expression of boys / girls, could be an explanatory factor for the particular distribution of ASD attending to biological sex (together to the traditional variables of genetic and neurological order). In fact, there is evidence that (based on a comparable cognitive / intellectual level), parents detect girls ‘autistic symptoms worse than boys’. And all this despite the fact that, where appropriate, the psychopathological consequences associated with social difficulties are more severe when they reach adolescence.