Autism in women: its 7 distinctive characteristics

Autism is a neurodevelopmental disorder that in recent decades has experienced a very important boom. Every day more precise tools are available to detect it and to address the resonances on the day-to-day life of those who present it.

A related issue (which has "aroused the interest" of the scientific community) is that of a possible bias in its diagnostic process, which reduce the likelihood that women or girls can be identified as autistic and benefit from multiple forms of therapy available for this condition.

Although a series of organic factors have traditionally been postulated whose objective was to explain why there are many more boys than girls with autism, theories about psychological and social variables of enormous importance for the clinic and for the investigation.

In this article we will address the issue of autism in women, and we will also detail how autism can be expressed, both in generic terms and in the female population. The reasons why, in the latter case, it might be more difficult to confirm their presence will also be outlined.

• Related article: "Autism Spectrum Disorders: 10 symptoms and diagnosis"

What is autism?

Since autism was described by Leo Kanner in 1943 as a lack of interest in social aspects and an intense resistance to environmental fluctuation, this neurodevelopmental alteration has undergone numerous changes in its clinical formulation and even in its diagnosis. Along with those of the aforementioned author, the contributions of Hans Asperger (with special emphasis on verbal expression) allowed the health sciences articulate a series of theoretical models and practical keys aimed at their understanding and identification in the consultation. All of them flourished throughout the 1970s, eventually converging in the writing of the criteria for the DSM-III manual (1980).

In the first moment the possible presence of three cardinal dimensions was considered, with which the presentation of such a disorder could be summarized, although recently these have been reduced to only two: communication or social interaction (difficulties in starting a situation of reciprocal exchange with an interlocutor, together with severe alterations in the practice of language) and behavior of a restrictive or repetitive (inflexibility in thinking and behavior, irritability / poor impulse control, and a tendency to symmetry and reiteration).

The new diagnostic manuals (DSM-5, 2013) have also made other changes in the traditional way in which the most classic autism was considered: elimination of Asperger's syndrome and definitive inclusion of pervasive developmental and disintegrative disorder in a comprehensive label that received the name Autism Spectrum Disorder (or ASD), through which all possible expressions are summarized in a single and heterogeneous category. These modifications have not been spared a certain criticism, based above all on an increase in ambiguity.

Likewise, with this new redefinition, it became necessary for the clinicians who made such a diagnosis to also point out the existence of some degree of intellectual disability in their patient (since not all of them present it in the same intensity) and the severity threshold attributable to trouble. For this case, a differentiation was made into three possible levels (the ineffective levels 1, 2 and 3), according to the power of the symptoms to interfere with the evolution of daily life. In this way, autism acquired a dimensional hue, in opposition to its old categorical prism.

The greater theoretical / clinical contextualization of autism in recent years has made it possible to have much information about its epidemiology. Today it is known that 1.6% of people have some form of autism (of all those mentioned above and with very different degrees), and that such percentage has experienced a very notable growth in the last decade. Similarly, all the literature on this topic agrees that it is a more common condition in men than in women (approximately 80% of those affected are men).

The latest data, which has been unanimously accepted since the dawn of the autism study (even supported by hypotheses such as the brain "hypermasculinized", which the prestigious Simon Baron-Cohen proposed in the 1990s after investigating many people with ASD), is today rethinking serious and rigorous. It is postulating that the traditional results on the way in which the biological sex variable is distributed in this population could be conditioned by gender stereotypes or be explained by the popular camouflage theory.

Autism in women: does it have distinctive features?

What is really true is that the question posed in the title of this section still does not have clear answers today. There is a wide variety of studies aimed at delving into this question, but their results are ambiguous and inconclusive. Today we know that everything that differentiates neurotypical children (without ASD) in their way of interacting could also be transferred to the territory of children. living with neurodevelopmental disorder, which is why they may have more refined social skills in the early years and into adulthood.

The differences at the cognitive level do not show a clear profile either. In some cases, it has been described that women with this diagnosis have more alteration in dimensions such as attention and / or inhibitory control, but this has not been replicated in a consistent. The same can be said regarding emotional regulation, where very contradictory results are seen. All these functions, which are included within those considered executive (and which depend on the functional integrity of the frontal lobe), would not allow successful "discrimination" of boys / men and girls / women.

Let's see what are the signs that could help detect this problem in girls, although the isolated presence of these traits is insufficient to confirm that ASD is suffered. However, knowing them is essential, since diagnostic errors are common (confused with ADHD or other psychopathological pictures of the state of mind or even anxiety).

1. Apparent isolation

Girls with ASD can sometimes resort to isolation in situations where other children engage in active play behaviors (parties or recess, for example). In such contexts, especially when children with whom they have a closer bond are not present, they choose to withdraw to a quiet place and cease all interactions. These behaviors can be interpreted as sadness, although they are not always related to this emotion.

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2. Unusual emotional responses

Another common behavior in girls with ASD is show emotional reactions that do not seem to respond to a situation that is objectively in the environment. For this reason, they may cry or scream in an unexpected or unforeseen way, and even suffer acute anxiety attacks without being able to find a precipitating factor.

It is often a cause for concern among parents, which warrants consultation with various health professionals in their agonizing search for reasonable explanations.

3. Imitation and lack of spontaneity

The social behavior that unfolds among girls with autism lacks all naturalness. The adult who observes her has the feeling that she is misplaced, as if she is only limited to reproducing with some clumsiness what others are doing. And it is that these girls do not spontaneously seek to participate, but usually do so at the initiative of others. For this reason they seem to concentrate, without much interest, in what they do; ignoring all their "original" contributions (in form and content).

4. Egocentricity and rigidity

Girls with autism can adopt rigid habits, even when they play. In the event that a partner wishes to participate in these dynamics, they tend to behave with excessive "authority", directing the activity and imposing very narrow limits on what can and cannot be considered correct. That is why their opinions are "immovable", and it is not easy to make them change their minds when the task becomes boring for the rest of those who are involved in it.

5. Exclusive friendships

Girls with autism they may develop a tendency to seek friendship ties that are reserved only for them, forging a limited social network (in numerical terms), but for which they draw a highly dependent link. Added to this situation is the possibility that they become "obsessed" with who they consider to be their friend or her friend, restricting the possibility of her expanding her own circle and insistently seeking her presence. Such relationships come to be lived from anguish, and even cause intense outbursts of jealousy.

6. Rigid game

On many occasions, girls with autism focus their efforts more intensely on the early stages of the game than on the game itself. Thus, spend a lot of time explaining how to play and arranging the necessary elements in place for this purpose (dolls, for example), but they only participate a little in their own playful activity. It is common for this way of proceeding to cause other children to get bored, or even to give up interacting with them. It could be the reason for many early forms of rejection.

7. Difficulty understanding jokes

Girls with ASD may have trouble understanding set phrases or even sayings popular, since they use a metaphorical language that requires a very high degree of abstraction verbal. It is because of that a special literality arises in the use and understanding of the message, which also manifests itself in difficulties in "fitting in" the jokes made by their teammates during the game.

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Alternative vision for the low prevalence of female ASD

There are many studies that have been carried out on autism, and most of them confirm a higher risk among men, in a 4: 1 ratio compared to women. This data has been explained with great frequency referring to different neurological and genetic reasons, although recently social nuances are being incorporated to account for such an issue (as well as psychological and sociocultural). We now proceed to explore the question.

Although autism can be detected from the first months of life in the form of signs of great subtlety (eye contact, for example), the most common is that it is a little later (from 3 to 7 years) when the diagnosis. Most studies agree that during this period boys show more obvious symptoms than girls, for whom these tend to appear in adolescence. It is at this time where not only its social impact becomes evident, but where comorbid mood and anxiety problems also arise that mask its expression.

Girls with autism tend to have different problems in adolescence in relation to the ways of interacting with their peers and / or partners, when compared with those experienced by boys. Social expectations about each other are also different, in such a way that they are expected to forge their friendships in smaller groups and the activities they share to be of a calmer natureWhile they are expected to be more actively involved in larger groups where friendship takes on a more collectivist hue. This makes isolation more easily detectable in males, in such a way that suspicion of ASD is precipitated very quickly even among teachers.

Female dynamics make it easier for girls with autism to forge dyadic relationships ("best friends"), following the pattern envisaged in their case, at the same time as "veiling" a problem that would be expressed much more eloquently if a "social pattern" similar to that of the males. Many authors propose that they have better social skills than theirs, as well as better capacity for imitation and a superior use of language, which would also contribute decisively to the camouflage of the trouble. In short, they could more successfully "hide" their difficulties (from the age of six).

Other authors consider that the range of restricted interests of women with ASD is more socially accepted than that usually adopted by men. Thus, it would be common for these to be associated with fashion or literature, to name an example. Thus, less alarm would be generated among parents, since they would be activities for which society reserves a positive judgment, and the presence of the problem would not be suspected.

In short, the different expectations that parents and society place on their children based on their gender, together with the disparate social expression of boys / girls, could be an explanatory factor for the particular distribution of ASD according to biological sex (together with the traditional variables of genetic order and neurological). In fact, there is evidence that (starting from a comparable cognitive / intellectual level), parents detect autistic symptoms worse in girls than in boys. And all this despite the fact that, in his case, the psychopathological consequences associated with social difficulties are more severe upon reaching adolescence.

Bibliographic references:

• Lawson, W. (2017). Women and Girls on the Autism Spectrum: A Profile. Journal of Intellectual Disability, Diagnosis and Treatment, 5, 90-95.
• Milner, V., McIntosh, H., Colvert, E. and Happe, F. (2019). A Qualitative Exploration of the Female Experience of Autism Spectrum Disorder (ASD). Journal of Autism and Developmental Disorders, 49 (4), 38-47.