At present, there are more boys and men diagnosed with autism than girls and women.
Does that mean this is a boys’ condition? Not necessarily! Today we’re going to look at the
autism gender ratio and the theories that attempt to explain it.
Autism is a super-complicated complicated condition which manifests itself in different
people differently. For the most part, it makes itself known through restricted and
repetitive behaviours and through difficulty processing sensory information, forming
memories and interacting with other people. There’s currently a test for autism that’s
based on behavioural criteria, but there is no biological test yet.
Different Rates of Diagnosis
Plenty of studies and anecdotal evidence have tried to come up with a proper ration of
men to women with autism, but their results vary widely. Some have suggested the
difference is pretty high, with a ratio of 2:1. Others have suggested the ratio could be as
unbalanced as 16:1.
❖ In Leo Kanner’s 1943 paper on autism, a small group of children with autism were
studied in a boy-girl ratio of 4:1.
❖ Lorna Wing explained in “Sex ratios in early childhood autism and related
conditions” (1981) that “the excess of males was much more marked in language
and socially impaired children who were of higher ability, or who had a history of
typical early childhood autism,” while the ratio in individuals with severe autism was
a more balanced 2:1.
❖ The Adult Psychiatric Morbidity Survey (2009) found that “The ASD prevalence rate
was higher in men (1.8 per cent) than women (0.2 per cent). This fits with the gender
profile found in childhood population studies.”
❖ The ratio of men to women accessing support through The National Autistic
Society’s adult services in 2015 was around 3:1, while the ratio of boys to girls
accessing equivalent services was approximately 5:1.
❖ Ehlers and Gillberg carried out a larger study in 1993 of Asperger Syndrome in
Swedish mainstream schools, finding a boy-girl ratio of 4:1.
❖ In Hans Asperger’s “Autistic Psychopathy in Childhood” (1944) he suggested that no
women or girls could be affected by the condition, but he later changed his mind.
Diagnostic Overshadowing & Misdiagnosis
Frustratingly, we have very limited knowledge about the ASC (Autism Spectrum Conditions)
profile of women and girls. In many cases, a girl’s underlying ASC can be hidden by a
coexisting condition, like ADHD, or by secondary symptoms like mental health disorders
including anxiety, conduct, depression, sleep and personality disorders, paranoia, OCD or
Often, this means the woman is instead referred to non-ASC services who will continue to
misidentify the cause of these ASC-related difficulties. Misdiagnosis results in incorrect
treatment and a lack of management of the real problem, which in turn will mean that
Autism can continue negatively affecting her long after she should have been diagnosed.
What’s Going on with the Gender Split?
So where are all the autistic women and girls? There are a number of theories that could
explain why so many women and girls are being misdiagnosed or not diagnosed at all.
❖ Some suggest that there’s a specific “female autism phenotype” which isn’t picked
up by the normal assessment tools, which are based on the ASC profile of men and
boys. One solution would be to modify the diagnostic tests given to women and girls
to allow for more accurate diagnoses.
❖ One theory suggests that autism is a result of an “extreme male brain”, caused by
the impact of foetal testosterone on the development of the brain.
❖ Some believe that women and girls are less susceptible to organic damage than
boys and men, either through acquired infection or inherited conditions. As it is
widely accepted that autism has an organic cause, it is possible that boys are simply
more likely to have autism.
❖ It is also suggested that indicators of autism in girls are underreported by teachers.
❖ Some believe that women and girls just do a better job of hiding or masking their
❖ Another theory suggests that autism is a sex-linked trait, like colour-blindness, which
is more likely to be inherited by boys.
❖ Some suggest that autism is simply an exaggeration of “normal gender differences”.
Why Should We Care About Understanding Girls’ Autism Better?
Whatever the reason for the gender split, it’s definitely important that we learn more about
autism in girls. Research on gender differences in autism could contribute to the
development of better, less biased diagnostic tools and criteria in the future.
❖ Better understanding of these differences will raise awareness among the
professionals responsible for diagnosis and early identification of the condition. This
means that women who would otherwise remain undiagnosed will finally get the
diagnosis they’re waiting for.
❖ A better understanding of autistic traits in females would also provide us with a
better understanding of the types of support they would benefit from.
Autism and Gender Dysphoria
“Gender dysphoria” is the name given to the feeling of distress a person might experience if
their perceived biological sex doesn’t match with their gender identity. For example,
someone might be assigned male at birth (AMAB) but identify as female (this person would
be a trans woman), while someone else might have been assigned male at birth but not
identify as male or female (this individual would be a non-binary person).
Statistically, it appears as though people with autism are more likely than neurotypical
people to experience gender dysphoria, but we are yet to figure out why that is.
Some interesting resources to check out include an interview with Dr Wenn Lawson on the
subject of autism and gender dysphoria, a video by Ollie, a non-binary person with autism
and this article from the American Academy of Child and Adolescent Psychiatry.
For more information about autism, check out Need2Know’s Essential Guide to Autism
which provides practical advice from professionals and other parents of autistic children,
and The Essential Guide to Asperger’s Syndrome which deals with how to develop
communication, how to deal with obsessive behaviour and how to get further help and
support. Whatever your gender, you deserve access to all of the the information and
treatment you require!