Autism in women: its 7 distinctive features

Let's see what are the typical aspects of autism when it is developed by women.

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 would would reduce the likelihood that women or girls could be identified as autistic and benefit from the multiple forms of therapy available for this condition. available for this condition.

Although a series of organic factors have traditionally been postulated with the aim of explaining why there are many more boys than girls with autism, theories on psychological and social variables of enormous importance for the clinic and for research are beginning to emerge.

In this article we will address the issue of autism in femalesWe will also detail how autism can be expressed, both in generic terms and in the female population. We will also outline the reasons why, in the latter case, it may be more difficult to confirm its presence.

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 disorder has undergone numerous changes in its clinical formulation and even in its diagnosis.. Together with those of the aforementioned author, the contributions of Hans Asperger (with special emphasis on verbal expression) allowed the health sciences to articulate a series of theoretical models and practical keys aimed at its understanding and identification in the consultation. All of them flourished throughout the 1970s, eventually converging in the drafting of the criteria of the DSM-III manual (1980).

At first the possible presence of three cardinal dimensions was considered, with which one could summarize the presentation of such a disorderThe new diagnostic manuals (DSM-5, 2013), although recently these have been reduced to only two: communication or social interaction (difficulties in initiating a situation of reciprocal exchange with an interlocutor, together with severe alterations in the practice of language) and restrictive or repetitive behavior (inflexibility of thought and behavior, irritability/poor impulse control and 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 contemplated: elimination of Asperger syndrome and definitive inclusion of pervasive developmental disorder and disintegrative disorder in a comprehensive label that received the name of Autism Spectrum Disorder (or ASD), by means of which all its possible expressions are summarized in a single label. all possible expressions are summarized in a single heterogeneous category.. These modifications have not been free from some criticism, mainly based on an increase in ambiguity.

Also, with this new redefinition, it became necessary for the clinicians making the diagnosis to also indicate the existence of some degree of intellectual disability in their patient (since not all of them present it in the same intensity) and the threshold of severity attributable to the problem. For this case, a differentiation was made in three possible levels (the not very eloquent levels 1, 2 and 3), according to the power of the symptoms to interfere in the evolution of daily life. In this way autism acquired a dimensional nuance, as opposed to its former categorical prism.

The increased theoretical/clinical contextualization of autism in recent years has made much information on its epidemiology available. It is now known that 1.6% of people suffer from some form of autism. (among all those mentioned above and with very different degrees), and that this percentage has experienced a very notable increase in the last decade. Similarly, all the literature on this topic agrees that it is a condition more common in men than in women (approximately 80% of those affected are men).

The latter fact, which has been unanimously accepted since the dawn of the study of autism (even supported by hypotheses such as that of the "hypermasculinized" brain, which the prestigious Simon Baron-Cohen proposed in the 1990s after investigating many people with ASD), is now being seriously and rigorously reconsidered. It is being postulated that traditional findings about the way in which the biological sex variable is distributed in this population could be conditioned by gender stereotyping or explained by the popular camouflage theory.

Autism in women: does it have distinctive characteristics?

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 great variety of studies aimed at delving into this question, but their results are ambiguous and inconclusive. Today we know that everything that differentiates neurotypical boys and girls (without ASD) in their way of interacting could also be transferred to the territory of those living with the neurodevelopmental disorder, which is why they could have more refined social skills in the early years and during adulthood.

Cognitive differences also do not yield a clear profile.. In some cases it has been described that women with this diagnosis have more alterations in dimensions such as attention and/or inhibitory control, but this has not been consistently replicated. The same can be said with respect to emotional regulation, where very contradictory results are observed. All these functions, which are included within those considered executive (and which depend on the functional integrity of the frontal lobe), would not allow us to successfully "discriminate" boys/men and girls/women.

Let us see which are the signs that could help to detect this problem in girls.Although the isolated presence of these traits is insufficient to confirm ASD. However, it is essential to know them, since it is common for misdiagnosis to occur (being confused with adhd or other psychopathological mood disorders or even anxiety).

1. Apparent isolation

Girls with ASD may sometimes resort to isolation in situations where other children engage in active play behaviors (e.g., parties or recess). 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..

Unusual emotional responses 2.

Another of the common behaviors in girls with ASD is that of show emotional reactions that do not seem to respond to a situation that is objectively found in the environment.. Thus they may cry or scream unexpectedly or unexpectedly, and even suffer acute anxiety crises 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 anxious search for reasonable explanations.

3. Imitation and lack of spontaneity

The social behavior displayed among girls with autism lacks any naturalness.. The adult who observes her has the sensation that she is out of place, as if she only reproduces with a certain clumsiness what others are doing. The fact 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, on what the others are doing, ignoring all their "original" contributions (in form and content).

4. Egocentrism and rigidity

Girls with autism may adopt rigid habits, even when playing. In the event that a peer wishes to participate in these dynamics, they tend to behave with excessive "authority", directing the activity and imposing very narrow limits on what can be considered correct and what 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 involved in it.

5. Exclusive friendships

Girls with autism may develop a tendency to seek out friendships that are reserved only for them, forging a limited social network (and not just for themselves).They forge a limited social network (in numerical terms), but for which they form a highly dependent bond. To this situation is added the possibility that they become "obsessed" with the person they consider their friend, restricting the possibility of expanding their own circle and insistently seeking his or her presence. Such relationships come to be lived from the anguish, and even provoke intense explosions of jealousy.

6. Rigid play

On many occasions, girls with autism focus their efforts more intensely on the prolegomena of the game than on the game itself. In this way, spend a lot of time explaining how to play and arranging the necessary elements for this purpose (dolls, for example), but they only participate a little in the play activity itself. for this purpose (dolls, for example), but they only participate a little in the play activity itself. It is common that this way of proceeding causes 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 problems trying to understand idioms or even popular sayings, as these use metaphorical language that requires a very high degree of verbal abstraction. This is why a special literalness in the use and understanding of the message arises, which also manifests itself in the use and understanding of the message.This also manifests itself in difficulties to "fit" the jokes made by their peers during the game.

Alternative view for the low prevalence of female ASD

Many studies have been conducted on autism, and most of them confirm a higher risk among males, in a 4:1 ratio with respect to females. a higher risk among males, in a 4:1 ratio with respect to females.. This fact has been most frequently explained by alluding to disparate neurological and genetic reasons, although recently social nuances (as well as psychological and sociocultural) are being incorporated to account for this issue. We now proceed to explore the issue.

Although autism can be detected as early as the first months of life in the form of subtle signs (eye contact, for example), it is usually later in life (from 3 to 7 years of age) that the diagnosis can be made with greater certainty. Most studies agree that during this period boys show more evident symptoms than girls, for whom these are usually evident in adolescence. It is at this time when not only their social impact becomes evident, but also when comorbid mood and anxiety problems arise that mask their expression.

Girls with autism tend to have different problems in adolescence regarding the ways of interacting with their peers and/or classmates, when compared to those experienced by boys. Social expectations about each other are also different, in such a way that girls with autism are expected to forge girls are expected to forge friendships in smaller groups and to share activities of a calmer nature, while boys are expected to have a more relaxed and relaxed attitude towards their peers.The boys are expected to be more actively involved in larger groups where friendship takes on a more collectivist tone. This makes isolation more easily detectable in boys, so that suspicion of ASD precipitates very quickly even among teachers.

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

Other authors consider that the restricted range of 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, for example. This would generate less alarm among parents, since these 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 depending 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 genetic and neurological variables). In fact, there is evidence that (assuming a comparable cognitive/intellectual level), parents detect autistic symptomatology worse in girls than in boys. And all this despite the fact that, in their case, the psychopathological consequences associated with social difficulties are more severe when they reach adolescence.

Bibliographical 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., & 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.