Is there an increase in female autistic diagnoses in adults, and what are the results and effects of that rise?
I wrote this essay for my 1st year of my Psychology degree (2023-2026) for the developmental module. I got a first for it. This is a topic close to my heart.
Please do not plagiarise my work.
Human-written, AI-free!
Is there an increase in female autistic diagnoses in adults, and what are the results and effects of that rise?
This essay aims to identify the prevalence of higher male diagnoses of autism and the impact of late diagnosis on adult women with autism. By challenging the perception that males are diagnosed earlier, the negative effect on women’s well-being can be explored, which in turn could have been prevented with better understanding, diagnosis, and treatment for autistic females. In addition to identifying the problem with practical solutions.
Autism is a developmental disorder that is characterised and diagnosed by ‘Persistent deficits in social communication and interaction’ alongside ‘Restrictive and repetitive behaviours’ with severity levels 1 to 3. In addition, it is more than 4 times more common among boys than among girls (CDC, 2023).
Developmental psychology is important for the understanding, diagnosis and treatment of autistic people with autism to allow them to support their needs, permitting them to have the best life possible (Pellicano, 2007). This underdiagnosis of women prevents this from happening.
Researching how many individuals have autism and discovering if there is a difference between the sexes, in addition to how this affects the persons with Autism spectrum disorder (ASD) by examining data reviews and reports on the significance of ASD diagnosis.
The Global prevalence of autism was reviewed by Zeidan, J. et al (2022), of which the previous systematic review done in 2012 indicated that there was a ‘4:1 ratio’ of boys to girls children globally diagnosed with autism. However, this does not account for the adults diagnosed with autism, and therefore cannot be a true representative of the numbers. Zeidan highlighted that now approximately 1 in 1000 children are diagnosed with autism worldwide, and the findings reflect the changes within the definition of autism, the differences in methodology and context of the prevalence studies. Discrepancies include ‘an under-reporting from Eastern Europe and Africa’, which could affect the overall true identity of people with autism. Zeidan emphasises addressing barriers that impact diagnosis and the treatment of autism. A discussion on the variations in the prevalence of autism is determined by several factors, including the hypothesis of the ‘Female protective effect’ whereby women have a phenotype, such as girls being more socially adaptable, with lower IQ’s. Zeidan ends the review with ‘compelling evidence for health disparities affecting underserved groups.’ (778-787), which overall reinforces the lack of the true numbers of individuals with autism and the effects caused.
In relation to Zeiden’s research findings, G. Russell et al. (2021) examination reports indicate that there was a higher rate of diagnosing more autistics, over the last 20 years, from 1998 to 2018. Russell discovered that there was a 787% diagnostic increase in autism, resulting in a rise in the number of adult females getting diagnosed. However, there must be consideration in how autism is measured within the different countries, including fewer diagnostic criteria being required for individuals, and previous studies having conflicting findings. The report features the importance of early diagnosis and the provision of adult autism diagnostic centres. Moreover, the gender bias within autism diagnosis favours boys, with a vast amount of research and acknowledgement in the underdiagnosis of girls and the prevalence of the lack of communication within services, long waiting lists and the cost of having to pay for a private diagnosis, which lacks communication with the NHS. Findings within the study revealed that, on average, girls were diagnosed 2 years older than boys, at the age of 14; likewise, the lack of earlier diagnosis as needed (G. Russell et al., 2021).
Amidst a sharp rise in adult females getting diagnosed over the years, with no explanation for why, although there has been an increase in adult diagnostic services since 2009. Further suggestions of identification changes and recording of autism diagnosis, together with greater public awareness from the neurodivergent movement, and destigmatization efforts by work placements, provide a greater demand for professional diagnosis. Additionally, researchers’ hypothesis that females are not getting diagnosed, due to their ability to ‘mask’ and that they have separate symptoms from their male counterparts. Meanwhile, females demonstrate fewer repetitive behaviours and have higher cognitive abilities, resulting in less intense symptoms than males( 674–682). This does not indicate ‘higher functioning’ because they experience other challenges; future research can identify this overarching difference and the ratio differences of the sexes for autistics.
Meanwhile, the research identified the merging of diagnoses and the impact this can cause for the overall numbers of diagnosed individuals on the autism spectrum. Strengths include the vast data set and avoiding clinical bias. That being said, there is a lack of data from private companies, which also contributes to the improper overall ratio of individuals with autism and additionally, the need for reaching rural areas and the minorities (G. Russell, et al., 2021). Therefore, there still is no true number of individuals suffering from autism; the identification now that women present differently, and this could be the main cause of underdiagnosis of female autistics.
Lundstrom, S. et al (2019) study report suggests that girls diagnosed with autism represent more than thought and that the ratio that boys have more prevalence is inaccurate. Furthermore, ‘Future studies may benefit from examining the use of sex-specific cut-off scores.’ The prominence of the need for a change in the diagnostic criteria is needed, due to the differences between the sexes. Specifically, females were reported to have etiological differences due to ‘an increased number of de novo likely gene disrupting mutations, and autosomal copy number variants than males.’ Including going unnoticed, because of their intellectual difficulties, with their slighter social communication problems and then being later diagnosed. Moreover, the norm sample studies are predominantly male, disregarding females altogether. Especially when females who have standard IQs are harder to recognise with autism, and sex has not been considered within the diagnostic criteria for autism, though research has suggested vast differences between the sexes (Lundstrom, S. et a., 2019). This stresses the fact that female suffering and dysfunction is greater than that of males, because of the lack of, or later diagnosis of autism.
Furthermore, Halladay, A.K. et al (2015) earlier report focuses on the hypothesis ‘Female protective effect’ [FPE] that women are ‘protected against some of the symptoms’ of autism spectrum disorder [ASD], in which they exceed the clinical diagnosis, which is not specific for ASD either. These overall burdens affect female autistics, and they should be properly recognised. For example, females often have higher language abilities, plus less aggression and hyperactivity than males; the ‘presentation of symptoms may be misinterpreted, and accurate diagnosis may be delayed.’ As well as the differences in development within the sexes, meaning females do not show signs until adolescence, rather than boys presenting earlier as toddlers. Late diagnosis could decrease quality of life, in addition cause dysfunction and issues. Including difficulties maintaining work and relationships as adults. Therefore, early diagnosis is paramount, with the provision of resources and services for lifelong support for individuals with ASD(1-4).
This phenotype of autism in females, which causes a later diagnosis and acknowledgement of their condition, results in destructive and debilitating effects for individuals with ASD. Here, Bargiela, S. Steward, R., and Mandy, W (2016) examine this overarching effect for women and the disadvantages when diagnosed late. Resulting in exhaustion and difficulties in understanding one's identity when ‘social camouflaging’, this incorporates being manipulated due to their vulnerability, people pleasing, and not having their needs met. Furthermore, struggling with the typical gender stereotype of being a woman and finding living in a neurotypical world challenging. This involves the difficulty fitting in, in addition to not identifying with their assigned gender at birth, relating to gender dysmorphia. Moreover, these struggles are internal, resulting in depression, anxiety and lack of recognition and support for the individuals. They propose changes to reduce these barriers of diagnosis for women: including removing the bias of autism diagnosis, additional testing for females who are high functioning to prevent misdiagnosis, improved education for all, such as teachers, doctors, and other professionals, to avoid the gatekeeping of information preventing diagnosis, which can make their lives easier with better support and elevated distress. This includes preventing labelling stereotypes that can be harmful. Proper diagnosis can help individuals become a part of the ASD community, strengthening connections and support. Meanwhile, reducing the emotional effects of missed and late diagnosis. Bargiela identifies that further investigation is needed for the effects of older women being diagnosed, and the stress of inclusion of female norm samples for ASD, with research done on the female phenotype, to reduce further risk to females (Bargiela, S., Steward, R., and Mandy, W., 2016).
There have been no ethical considerations in the research of these reports and theories, which complement the findings.
In conclusion, research has analysed the overall number of individuals with ASD, and the identification of an increased diagnosis of autistic adult women in the last 20 years led to the findings that the ratio and numbers of persons with ASD are not a true reflection of the diagnosis, and that females are significantly underdiagnosed.
This also explains why there was such a number of females being missed, whereby results show a female phenotype and a bias towards male stereotype due to typical male sample norms, resulting in a variety of negative effects for females, due to delayed diagnosis. This indicates the importance of proper research into developmental psychology, to prevent such suffering and to provide an overall better diagnosis, support and treatment for individuals with ASD, providing earlier diagnosis and better quality of life.
In conclusion, the true impact of seeing past a male-dominated perspective can cultivate so many lives that women deserve. Reducing the emotional distress of female ASD patients. In addition, even encouraging more autistics in the workforce, reducing benefits and healthcare costs overall, benefits society as a whole by improving lives exponentially. Further research into the true effect of missed diagnosis for adult women is needed, and an emphatic need to change the stereotypical male samples, including providing adult support for adult autistics, which is lacking vastly. Providing such support could improve their well-being.
References:
Bargiela, S., Steward, R., Mandy, W. (2016). The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. J Autism Dev Disord, 46, 3281–3294. DOI 10.1007/s10803-016-2872-8
Center for Disease Control and Prevention. ( 15th December 2023). Diagnostic criteria.https://www.cdc.gov/ncbddd/autism/hcp-dsm.html
Russel, G. et al. (2021). Time trends in autism diagnosis over 20 years: a UK population-based cohort study. The journal of child psychology and psychiatry, 63(6), 674-682. https://doi.org/10.1111/jcpp.13505
Halladay, A.K. et al. (2015) Sex and gender differences in autism spectrum disorder: summarising evidence gaps and identifying emerging areas of priority. Molecular Autism 6, 36. https://doi.org/10.1186/s13229-015-0019-y
Lundström, S. et al. (2019). Assessing autism in females: The importance of a sex-specific comparison. Psychiatry research, 282. https://doi.org/10.1016/j.psychres.2019.112566
Zeidan, J. et al. (2022) Global prevalence of autism: A systematic review update. Autism research, 15(5), 778-790. https://doi.org/10.1002/aur.2696
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