Gender and diagnosis - PSY2004

Male to Female autism diagnosis ratio

Traditionally estimated at 4:1

Research suggests true ratio closer to 3:1 - underdiagnosis in females (Loomes et al., 2017)

Effect of Historical male bias in autism

Shaped diagnostic criteria around male-typical traits

Many females misdiagnosed, or overlooked - the "Lost Generation"

How much later than boys are girls with ADHD diagnosed

5 years later

50-75% adult women with ADHD remain undiagnosed

Boys vs girls ADHD diagnosis %

Boys 13.2%

Girls 5.6%

Why are girls with ADHD less diagnosed

Girls tend to display inattentive symptoms, less likely to trigger referrals.

ADHD in girls often masked by internalising symptoms - anxiety depression - complicating diagnosis.

Extreme Male Brain (EMB) Theory (Simon Baron-Cohen, 2002)

Suggests autism is an exaggeration of male-typical cognitive traits: high systemising and low empathising.

EMB support

Males score higher on the Autism Spectrum Quotient (AQ) and Systemising Quotient (SQ).

Females score higher on the Empathising Quotient (EQ).

EMB criticism

Over-reliance on questionnaire data.

Ignores sociocultural influences and diversity of female presentations.

Female Protective Effect

Suggests females require a higher genetic load to develop autism (Robinson et al., 2013).

Female Protective Effect Support

Evidence from sibling and twin studies indicates females may be biologically more resilient, making autism less likely to present or be diagnosed.

Diagnosis Biases and Stereotyping

Diagnostic tools and studies have historically centred on male behaviour.

Gender stereotypes conflict with typical autism profiles

Female Autism Phenotype

-Interests may be more socially acceptable (e.g. animals, celebrities), so appear typical.

-Fewer externalising behaviours.

-Stronger motivation to fit in socially.

Social Camouflaging (masking)

Women often mask or compensate for autistic traits, especially in social situations (Hull et al., 2017; 2020).

Can lead to late diagnosis, misdiagnosis, and increased mental health issues

Camouflaging includes

Copying others' social behaviours.

Forcing eye contact.

Rehearsing conversations.

Women Symptoms

Often show internalising symptoms (anxiety, depression, self harm)

Men Symptoms

Externalising symptoms (aggression)

Internalising vs Externalising

Externalising symptoms are more noticeable, leading to higher referral rates for males.