Males and females in these studies had comparable levels of autistic characteristics, suggesting that a greater genetic hit is required for females to meet the diagnostic threshold. In support of FPE, autistic females possess relatively more spontaneous, non-inherited mutations associated with autism than males (Gilman et al. It proposes that females require greater environmental and/or genetic risk than males to express the same degree of autistic characteristics, and, hence, that females are ‘protected’ from autistic characteristics relative to males with a comparable level of risk factors (Robinson et al. The female protective effect theory (FPE theory) comes from research into proposed genetic and environmental factors affecting autism development. The other proposes that females may be more likely to develop autism than we currently estimate, but that diagnostic biases and variation in the ways autism is expressed in females mean we do not pick up autism in females to the same degree as males (Dworzynski et al. One argues that there is something inherent in being female that ‘protects’ females from the likelihood of developing autism (Robinson et al. ![]() When attempting to account for the discrepancies in diagnosis, researchers have drawn upon two distinct ideas, which are contrasting but not mutually exclusive. In individuals with intellectual disability, the ratio is closer to 2:1 (Yeargin-Allsopp et al. When screening the entire population using gold standard assessments, current estimates suggest around three males receive an autism diagnosis for every female however, in clinical samples who have already received an autism diagnosis, that ratio is higher at over four males to each female (Loomes et al. Gender Differences in DiagnosisĪutism is more commonly diagnosed in males than in females across age groups (Fombonne 2009 Russell et al. 2016) alternatively, there may be lifestyle factors in more developed nations which lead to greater incidence of autism. This could suggest that there are significant numbers of autistic people in other nations, including African and Asian nations, who are not recognised by or receiving support from medical or educational systems (Hossain et al. 2016), and these tend to be higher than those estimated in low-income countries (Elsabbagh et al. Prevalence estimates are most often determined in western, higher-developed nations (e.g. ![]() 2018), while in the UK, estimates are higher at 1 in 59 (Russell et al. The most recent estimates suggest a prevalence of 1 in 69 children in America (Christensen et al. Estimates of autism prevalence are continually updated. ![]() ![]() In particular, there has been a focus on the difficulties experienced by autistic women in obtaining autism diagnoses, for reasons which will be discussed in greater detail below.Īs there are no reliable biomarkers of autism, the condition is diagnosed behaviourally, based on observation and description of the core characteristics impacting everyday functioning to a ‘clinically significant’ degree (American Psychiatric Association 2013 World Health Organization 2018). There have been many studies examining the needs and experiences of individuals who seek an autism diagnosis in adulthood (Crane et al. Changes to diagnostic criteria which are linked to an increase in overall diagnostic levels include the integration of previously separate diagnostic categories (such as ‘Autism’ and ‘Asperger Syndrome’) into one ‘autism spectrum disorder’ category (Murphy et al. For similar reasons, we use identity-first language (‘autistic person’) throughout to respect the preferences of a majority of autistic people (Kenny et al. Note: we use ‘autism’ to refer to the clinical diagnosis of autism spectrum disorder, as some members of the autism community feel the label ‘disorder’ produces stigma and emphasises the difficulties associated with autism while minimising the strengths. However, in recent years, there has been a significant increase in the rate of adult diagnosis, particularly as diagnostic criteria have been broadened such that individuals who may not have received an autism diagnosis in childhood may now meet current diagnostic criteria (Happé et al. Autism diagnosis has traditionally been most common in childhood, when differences from neurotypical peers may first become obvious.
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