Why Females Are Less Likely To Be Diagnosed

The vast majority of referrals for a diagnostic evaluation for Aspergers (high functioning autism) are boys. The ratio of males to females is around 10:1; however, the epidemiological research for Aspergers suggests that the ratio should be 4:1. Why are girls less likely to be identified as having the characteristics indicative of Aspergers? 

Below are some possible reasons (yet to be validated by academic research):

1. Each individual with Aspergers develops his own techniques and strategies to learn how to acquire specific skills and develop coping mechanisms. One technique is to have practical guidance and moral support from one’s friends. We know that kids with Aspergers elicit from others, either strong maternal or ‘predatory’ behavior. If the individual’s natural peer group is females, they are more likely to be supported and included by a greater majority of their friends. Thus females with Aspergers are often ‘mothered’ by other females. They may prompt the youngster when they are unsure what to do or say in social situations and comfort them when they are distressed. In contrast, “normal” males are notorious for their intolerance of kids who are different and are more prone to be ‘predatory’. This can have an unfortunate effect on the behavior of a boy with Aspergers and many complain of being teased, ignored and bullied by other males. It is interesting to note that some males with Aspergers actually prefer to play with females who are often kinder and more tolerant than their male friends.

2. Females are more likely to be enrolled in speech and drama lessons, and this provides an ideal and socially acceptable opportunity for coaching in body language. Many individuals with Aspergers have a prodigious memory and this can include reciting the dialogue for all characters in a play and memorizing the dialogue or ‘script’ of real life conversations. Knowing the script also means the youngster does not have to worry about what to say. Acting can subsequently become a successful career option although there can be some confusion when grown-ups with Aspergers act another persona in real life as this can be misconstrued as Multiple Personality Disorder rather than a constructive means of coping with Aspergers.

3. Females are more motivated to learn - and quicker to understand key concepts - in comparison to males with Aspergers of equivalent intellectual ability. Thus, they may have a better long-term prognosis in terms of becoming more fluent in their social skills. This may explain why females with Aspergers are often less conspicuous than males with the disorder and less likely to be referred for a diagnostic assessment. Moms with Aspergers appear to have more ‘maternal’ and empathic abilities with their own kids than dads with Aspergers, who can have great difficulty understanding and relating to their kids.

4. It appears that many females with Aspergers have the same profile of abilities as males but a subtler or less severe expression of the characteristics. Moms and dads may be reluctant to seek a diagnostic assessment if the youngster appears to be coping reasonably well, and therapists may be hesitant to commit themselves to a diagnosis unless the signs are conspicuously different to the normal range of behavior and abilities.

5. One must always consider the personality of the individual with Aspergers and how he copes with the difficulties he experiences in social reasoning, empathy and cognition. Some individuals are overtly active participants in social situations. Their unusual profile of abilities in social situations is quite obvious. However, some are reluctant to socialize with others, and their personality can be described as passive. They can become quite adept at camouflaging their difficulties and clinical experience suggests that the passive personality is more common in females.

6. Some individuals with Aspergers can be quite ingenious in using imitation and modeling to camouflage their difficulties in social situations. One strategy that has been used by many females and some males is to observe individuals who are socially skilled and to copy their mannerisms, voice and persona. This is a form of “social echolalia” or mirroring where the individual acquires a superficial social competence by acting the part of another individual.

7. We have a stereotype of typical female and male behavior. Females are more able to verbalize their emotions and less likely to use physically violent acts in response to negative emotions such as confusion, frustration and anger. We do not know whether this is a cultural or constitutional characteristic but we recognize that kids who are violent are more likely to be referred for a diagnostic assessment to determine whether the behavior is due to a specific developmental disorder and for advice on behavior management. Thus males with Aspergers are more often referred to a psychologists or psychiatrist because their violence has become a concern for their moms and dads or schoolteacher. A consequence of this referral bias is that not only are more males referred, therapists and academics can have a false impression of the incidence of violence in this population.

8. When a youngster would like more friends but clearly has little success in this area, one option is to create imaginary friends. This often occurs with young females who visualize friends in their solitary play or use dolls as a substitute for real individuals. Females with Aspergers can create imaginary friends and elaborate doll play which superficially resembles the play of other females.

We need more epidemiological studies to establish the true incidence of Aspergers in females. In the meantime, females Aspies are likely to continue to be overlooked and not to receive the degree of understanding and resources they need.

The Aspergers Comprehensive Handbook