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Females and Autism

Agnieszka Rynkiewicz1,2, Amandine Lassalle3, Bryan King4, Rachael Smith5, Artur Mazur1,6,7,10
Justyna Podgórska-Bednarz7,8, Agnieszka Słopień9, Jacek Tabarkiewicz10

1 Neurodevelopmental Disorders Research Lab, Institute of Experimental and Clinical Medicine

Faculty of Medicine, University of Rzeszow, Rzeszow, POLAND
2 Center for Diagnosis, Therapy and Education SPECTRUM ASC-MED, Gdansk & Rzeszow, POLAND
3 Department of Psychology (Brain & Cognition) University of Amsterdam
Amsterdam, NETHERLANDS
4 Child Psychiatry, University of California, San Francisco (UCSF), Child Behavioral Health Services—
UCSF Benioff Children’s Hospitals, UCSF Department of Psychiatry, UCSF Weill Institute for
Neurosciences, USA
5 Child and Adolescent Mental Health Service (CAMHS), Royal Cornhill Hospital, Aberdeen, UK
6 Department of Pediatric Endocrinology and Diabetology, Clinical Regional Hospital № 2 Rzeszow
POLAND
7 Institute of Physiotherapy, Faculty of Medicine, University of Rzeszow, Rzeszow, POLAND
8Association for Children with Attention Deficit Hyperactivity Disorder, Rzeszow, POLAND
9Department of Child and Adolescent Psychiatry, Poznan University of Medical Sciences
Poznan, POLAND
10 Centre for Innovative Research in Medical and Natural Sciences, Faculty of Medicine
University of Rzeszow, Rzeszow, POLAND
Introduction

General Overviews

Diagnosis and psychometric assessment

Gender biases in terms of agreed diagnostic criteria and how autism is defined

Gender biases in terms of diagnostic tools and how autism is recognised and identified

Gender biases in terms of research methodology

Comorbid Conditions

Mood and anxiety disorders

Eating disorders

Disordered eating patterns within autism

The other side of the coin - autistic traits within AN and other eating disorders

Overlaps in neuropsychological profiles and clinical implications for treatment

Psychopharmacology

Prescription rates of psychotropic drugs in autism and comorbidity

Endocrine system and selected hormones

Oxytocin

Testosterone

Vasopressin

Melatonin

Immunology

Neuroimaging, fMRI, EEG, MEG, eyetracking

Sensory and therapeutic needs of females with autism

Adulthood - relationships, sexuality, pregnancy, motherhood and employment

Popular science resources

Books

eBooks

Movies
Introduction

Females with autism are often undiagnosed, misdiagnosed or receive a diagnosis of autism at a later
age. This can result in adverse outcomes in their well-being, mental health, education, employment and
independence. Furthermore, the autism spectrum in females is associated with adverse outcomes after
puberty, including anxiety, depression, high incidence of suicide, eating disorders, and high rates of
other medical problems. The term ‘Autism Spectrum Condition’ (ASC) coined by Simon Baron-Cohen is
used in the literature to respect both females and males on the autism spectrum who feel that the term
‘disorder’ is stigmatising, whereas ASC presents both the strengths and difficulties of individuals on the
autism spectrum. Autism has traditionally been considered a male-dominated diagnosis where its
current features linked with descriptions in the major diagnostic classification systems are based
primarily on males. While researchers continue to question the epidemiology, prevalence, and
presentation of autism, there is an emerging awareness and growing clinical recognition that autism in
females has unique symptomatology and may, in fact, be more common in this population than
previously acknowledged. Cultural and social aspects may also impact on the autistic characteristics
presented by autistic females. Autism may also manifest itself differently, more subtly, especially in
individuals who are not recognized early in life or who do not have profound intellectual/communication
difficulties. The current diagnostic assessments have mainly been developed for an autistic male
population thus may lack the required sensitivity to identify autistic females. It is argued that it may have
an inhibitory potential in confirming the diagnosis of autism in females with current diagnostic
assessments which do not reflect the unique presentation of autism in females, demonstrated by greater
compensatory capacity and an ability to develop sophisticated methods of ‘camouflaging’ and
masquerading in order to blend in with neurotypical peers. Sex/gender stereotypes and differences in
patterns of autistic behaviour may contribute to females being overlooked in a diagnostic setting. Timely
diagnosis and support however can reduce the difficulties that females with autism experience. Timely
diagnosis can reduce abuse, exploitation and certain co-occurring conditions, allowing to better inform
females’ needs in education, leisure, social relationships and employment so as to promote their well-
being and independence.