Historically, researchers have seen autism as a distinctly “masculine” neurotype. But why? Was it because they only paid attention to symptoms in boys, and the girls were not examined properly?
Boys are 10 times more likely to be referred for autism assessments than girls showed a 2020 review, and a 2023 study suggests that up to 80% of girls and women can receive a diagnosis of social anxiety, food disorder or borderline personality disorder before being correctly diagnosed as autistic.
These biases and deficiencies are the theme of “Outside the spectrum: Why the science of autism has failed with women and girls ”a new book by Gina Rippon Cerebral Imaging Expert.
Rippon, Emerite Professor of cognitive neuroimaging at the Aston brain center in Birmingham, England, investigates how and why scientists and clinicians systematically underestimated and neglected autism in women and girls.
In a 2024 review, Rippon found that of the more than 120 studies by testing brain autism models she examined, almost 70% of studies have tested only men or included very few women. She noted that less than 10% of the 4,000 participants in these studies were women.
Rippon said he was surprised to discover the extension in which she and her colleagues had fundamentally misunderstood the nature of autism in girls and women. THE CNN He recently talked to the teacher about autism in girls and women, the challenges of current diagnoses and how medical professionals can think differently about screens without bias.
Gina Rippon: “There was a very strong belief until autism was a male problem. As a result, a large industry grew around the diagnosis of autism to reliably indicate if a child had autism. But they only looked at the kind of behavior that was characteristic of the boys. If girls had similarly disordered behavior, the idea that it could be autism simply not emerged.”
She further explained: “There were tests considered gold standard, but as the tests were based on boys, the girls would be excluded. For a neuroscientist, like me who wanted to study autism in women, I could not find women who had been diagnosed as autistic. It was rooted in our conscience: ok, this is a male problem, so it is probably better to look at men.”
The teacher also reported that “diagnostic data were addicted from the beginning.” She explained that this relates to the fact that there is no “biomarker for autism.”
“There is no useful X-ray or some physical test we can use to diagnose autism. Instead, there are a huge variety of different behaviors that, over the years, have been identified as characteristic of autistic children. But everything is based on how to manifest in boys,” he said.
Kevin Pelphrey, one of the world’s leading researchers in the world, has two autistic children – a girl and a boy. His wife describes how hard it was for them to get their daughter’s diagnosis. You would think they would know what they were talking about, but their daughter’s diagnosis was discarded everywhere. Experts said, “She’s shy, she’ll get over it,” he added.
Difficult identification
Rippon reports that “there is the classic confirmation bias, which is a tendency to interpret new evidence as a confirmation of the existing beliefs themselves.”
According to her, “researchers have presented hypothetical scenarios identical to teachers, saying,” This child presents these types of questions in the classroom, so you think this child can be autistic. “
“’Do you think this child may need special support?’ Teachers are much more likely to say yes to the notion that the child was autistic and needed support if the child called himself Jack than if the child called himself Chloe, ”he continued.
“Behavioral differences in autistic children emerge early. These are times when teachers who have extensive experience with a much larger range of children should be able to say, ‘This kind of behavior is uncommon’, ‘I believe we should go further’. Instead, if the behaviors are uncommon and a boy, it is autism, but if the behaviors are uncommon and is a girl, she is shy, socially anxious, and she can say, ‘ Overcome this’ ”.
“Secondly, autism manifests itself differently in girls and boys. Girls who are distressed in some way often internalize their problems. They become withdrawn and shy, they are in the corner, do not interact with other children. If you have children who are shy and quietly in the corner, you will not think there is a problem and maybe even ignore. Table or kicking, which is most characteristic of boys, these are the children you will see more closely, ”he adds.
According to Rippon, “the third layer is that there is clear evidence that girls try to camouflage, disguise or mask their problems. This happens very early, at 4 or 5 years.”
“If you find the right way to ask them questions, they will say, ‘Other people in class think I’m strange. I try to find out why they think I’m strange and try not to behave strangely.’ I call these kids in chameleons. ”
This is not new. In the 1980s, a researcher named Dr. Lorna Wing, who was partially responsible for expanding the notion of autism, said, “Maybe girls are just better in disguising their problems” and “Maybe girls are taught to behave better early.” It is not socially acceptable for girls to act disruptively, so they do not.
Rippon reveals what the diagnosis can mean for a young woman “All the women I talked to said that their first and most powerful reaction to receiving a diagnosis of autism was a feeling of relief, because it suddenly made a lot of sense in their lives. For older women, it was often followed by a feeling of regret, how they would have been different if they knew before.”
“Particularly the girls who are so desperate to belong, what impressed me is how at disagreement with the vision of autism as a distancing – as if autistic individuals were not interested in social contact. With autistic women, it is almost the opposite. They are desperate for social contact, but we could be called social instinct, knowing how to behave in social situations,” he said.
“One of the girls I talked to to my book told me that it is a bit like people who are deaf from birth do not understand that there is such something invisible that is the sound of words, that people use to communicate with each other. Autistic girls could be described as deaf to the language of social behavior, so they do not understand how to position themselves properly or maintain eye contact, or that they should not talk about their favorite subject. A diagnosis can be very liberating and validating. ”
Rippon responds as Experts can learn to diagnose girls of younger age.
“One thing that impressed me is that the notion of hypersensitivity to sensory issues, such as clothing that scratches, bright lights, smells and so on, is more characteristic of girls in the spectrum than boys. And this was only recently included in the diagnosis. It was in the last edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-Tr),” he said.
“Although sensory issues have been very characteristic of autism as a whole – and very often there are reports of autistic children hating high noises or bright lights or anything – it was not a diagnostic feature until recently. Having this in diagnostic criteria can help. Increasing awareness and accepting that autistic children of both sexes should be allowed for special accommodation in school, such as making tests in a separate room or users Heard this is very important, ”he added.
The expert also reported: “For autistic girls like chameleons, who can be hypersensitive to what they perceive as social rejection, it is also important to teach goodness to all children. Some of the saddest interviews I had with young girls who were hyperconscious that people found them strange and weird.”
Role of Medicine
Rippon also helped understand what role medicine can play in this scenario.
“I am not a fan of pharmaceutical solutions for young children, in part because it is a time when our brains are extremely plastic. At the same time, sleep disorders and gastrointestinal problems are common characteristics between autistic children, and if untreated, there are also much about autism that cannot be treated. Many of the behavioral difficulties that autistic individuals have their autism; Anxious because they don’t know how to deal with social situations, not because they need anxiety medication, ”he says.
Rippon: “It is essential that researchers talk to autistic people and ask,“ What is it like to be you? ” This perspective is invaluable. There is a great movement for what we call inclusiveness or participatory research, where autistic people become part of the research team.
“There is a video that I recommend called ‘The girls arrived’, and in it, autistic women basically say, ‘We are autistic, and that’s how it is for us’ inclusiveness is the future “.
It completes ensuring that autism “does not only affect boys; girls can also be autistic.”
“The world has not accommodated autistic girls until the last decade more or less. Fortunately, this is changing. The girls arrived,” he adds.
Autism: Understand the different levels, subtypes and treatments
This content was originally published in a study reveals as Autism diagnosis failed with women and girls on the CNN Brazil website.
Source: CNN Brasil

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