The main concern for individuals diagnosed with Autism Spectrum Disorder (ASD, or what was formerly known as Asperger’s) is difficulties with social communication. This can include acquiring basic social skills (i.e., eye contact and understanding of body language), making friends, and maintaining relationships at an age-appropriate rate. Beyond the social aspect of ASD, individuals often struggle with restricted and repetitive behaviors like sensory aversions, rigidity, or obsessive behaviors. When the social communication differences are present in conjunction with the areas of associated challenges, a formal diagnosis of ASD is warranted. It was not until more recently that researchers began to recognize specific gender differences in the presentation of ASD that must be studied when considering this particular diagnosis in females. For years, researchers understood ASD to impact males in far greater numbers than females. In fact, given the significant gender difference, research studies typically only included male participants, which skewed the research data. Unfortunately, recognizing the differences between males and females often results in a later diagnosis for females—as much as two years later.
Gender differences related to ASD most often focus on females’ ability to camouflage or mask their social struggles. This means that females are often successful with imitating basic social skills such as eye contact and reading body language. They recognize there are inherent social rules such as social reciprocity, although engaging beyond the simple “Hello, how are you?” can be beyond their skill set. Often it is not until the female is an adolescent that the social challenges become more obvious. At that time, the gap in age-appropriate social skills widens, and females struggle to keep up with the social rules and nuances. Navigating the complex social world of friendships, romantic relationships, and even the management of personal hygiene during puberty often are overwhelming for females diagnosed with ASD.
Another area that may mislead adults in the female’s life is restricted interests. Individuals diagnosed with ASD frequently exhibit intense interests or obsessions. Interestingly, females may choose socially acceptable obsessions such as American Girl dolls, unicorns, or horses. It can be challenging to distinguish between an interest and an obsession. In turn, this aspect of the diagnosis may go unnoticed for years.
For those who are undiagnosed until adolescence, depression, and anxiety develop as they struggle to navigate a world that is beyond their ability. Understanding gender differences associated with ASD is important to accurately diagnose females and inform appropriate interventions.
Dr. Lisa Hahn is a clinical neuropsychologist, board-certified in both neuropsychology and the subspecialty of pediatric neuropsychology. Dr. Hahn is a life-span neuropsychologist with specialties in children and adolescents with a variety of neurodevelopmental and acquired conditions including Autism Spectrum Disorder, epilepsy, Attention-Deficit/Hyperactivity Disorder (ADHD), and learning disabilities. She is experienced in providing Independent Educational Evaluations (IEEs) for families and school districts. Dr. Hahn is a reviewer for professional journals and a consultant for a local professional sports organization regarding concussion. She is a member of the American Academy of Clinical Neuropsychology (AACN), International Neuropsychological Society (INS), New Jersey Psychological Association (NJPA), and Morris County Psychological Association (MCPA).
