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Autism is a condition that is being discussed more and more as neuroscientists and psychologists attempt to understand the brain better. One of the biggest unanswered questions with the condition, however, is why are more boys diagnosed with autism than girls?
Previous research has consistently found that for every 1 girl diagnosed with autism 3 or 4 boys are given the diagnosis. Are boys simply more predisposed to the condition, are there problems with the diagnostic tools, or is there a larger societal problem to blame for this gender bias?
While this question is still being looked into by researchers, it seems likely that all three factors are playing a role in creating this 4-1 ratio gender bias. While it would be nice if problems always had a single, simple answer, the truth is that something this complex probably has multiple contributing factors to consider.
This article will look into the various suggestions for the causes of this difference based on recently published scientific research. However, first it is important to have a basic understanding of the condition and what qualifies a child for a diagnosis.
How is Autism Diagnosed?
Autism is largely diagnosed based on a child displaying a set of social differences from their peers that concern their parents or teachers. This can include anything from not making friends, a failure to empathize with others, or trouble with eye contact.
Often there seems to also be some differences in sensory processing in children such as a strong dislike for certain sounds, textures, or environments. If parents or teachers see behaviors that concern them, they will then often suggest that the child receive an evaluation to look for any patterns in their behaviors that could match a known condition such as autism, ADHD, or a social anxiety disorder.
Autism is not a medical condition and so there is no medical test that psychologists can administer to give a definitive diagnosis. Instead, psychologists use a variety of checklists, interview strategies, and their professional judgment when making a diagnosis.
Autism is not really a single condition, but a wide spectrum of types of people who have some form of social or sensory issues ranging from mild to severe. Some experts argue that autism should instead be considered more of a personality type where children struggle with social skills or process sensory stimuli differently in such a way that it makes it difficult for them to manage daily life or attend formal schooling.
This is not to say that autism is not a serious condition to study or a difficult personality to have in our modern world, but many believe that psychologists and especially psychiatrists have gone too far in pathologizing and medicating any personality that does not suit a culture or society’s standard. This way of thinking may go far in explaining why more boys are diagnosed with the condition than girls, as most cultures have widely different sets of behaviors that are considered acceptable based on the child’s gender.
Reasons Why Boys get Diagnosed with Autism more than Girls
- Boys may be more likely to have social issues.
The first commonly cited possible explanation for this gender bias in diagnosis has to do with the general tendencies in development associated with each gender. In many modern societies, women’s brains seem to develop more empathy.
Studies have been conducted that often do show that women tend to develop more empathy than men and so this natural tendency to develop empathy may shield girls from the higher end of the autism spectrum while boys may be more likely to be diagnosed with a social disorder due to being more likely to struggle to develop in that area.
Of course this is only talking about large scale averages. Any boy or girl can show a high or low amount of empathy as an individual, but when measured in large meta analyses, the tendency does prove true that women tend to score higher in measures of empathy.
However, as the studies above note, it is unclear whether this is simply a biological difference or something that is created due to social desirability. If a parent spends more time developing a girl’s social skills and excusing a boy’s antisocial behavior as “boys will be boys” then it is unsurprising that girls may generally develop higher social skills due to simple social pressure.
- Autism may be more socially acceptable in girls.
Some people argue that it has nothing to do with biological development or even any meaningful, measurable differences in empathy scores, but that the symptoms that would cause a young man to be diagnosed with a social disorder such as autism are often either acceptable or even encouraged in young women in many cultures.
Things like not making eye contact, being shy or reserved, and being sensitive are often encouraged in many cultures for young women, but are mocked and considered failures in young men. It may be that rather than there being any measurable difference in symptoms or abilities between boys and girls, boys get labeled as having a mental condition whereas the same symptoms in girls are ignored or encouraged.
In many places around the world it has historically been viewed as proper for a woman to not make eye contact, especially with men, when speaking as a sign of respect. Though this practice is highly inappropriate and discriminatory to our modern ideals of gender equality, there are still places today where consciously or unconsciously women are encouraged or allowed to act in a more shy and submissive way that could mask many of the common symptoms associated with autism today.
- Diagnostic tools may be ineffective.
Another commonly discussed issue that could be causing a gender bias is the current questionnaires and checklists which some argue are predisposed to grant diagnoses based on how boys often present with the condition while ignoring the different way the condition tends to develop in girls.
Some of the suggested differences include boys having different categories of interest in obsessions than girls with boys often hyper fixating on abstract ideas like schedules and statistics, while girls with autism would hyperfixate on people or other more concrete things. Other suggested differences researchers have noted are that boys tend to be willing to be disruptive to gain objects or other things that they desire, girls are more likely to be willing to be disruptive in order to gain social validation.
Others also suggest that autism tends to be better managed by girls or that they tend to present more subtle symptoms from their male counterparts. Girls tend to get diagnosed much later than males and seem to present fewer challenges for teachers in formal school settings.
Some people argue that autism would develop the same in either gender regardless of the gender if there weren’t the social pressure differences in gender discussed above. But rather than saying that girls never develop any problems, those defending this idea suggest that girls simply present a different pattern of symptoms for autism when compared with males, but the condition is present and measurable in both with the right tools.
These researchers suggest that new diagnostic tools, questionnaires, and surveys need to be developed that focus more on the way autism tends to present in females and that it is because previous research has been on male autism that there is a diagnostic gap between the two genders.
Conclusion
Regardless of where the difference comes from, there are many reasons why more boys are diagnosed with autism than girls. Whether it be a biological difference, a socio-cultural difference, a problem with the current diagnostic tools or a mixture of two or more is yet to be firmly proven.
However, teachers should keep in mind this gender bias and ensure that their female students aren’t going undiagnosed. Whether the symptoms are usually less severe or girls simply present differently, there are many young girls with autism and it is important that psychologists and teachers do not overlook these girls by thinking that autism is a male’s disease.
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References
Burrows, Catherine A., et al. “A Data-Driven Approach in an Unbiased Sample Reveals Equivalent Sex Ratio of Autism Spectrum Disorder–Associated Impairment in Early Childhood.” Biological Psychiatry, vol. 92, no. 8, 2022, pp. 654–662, https://doi.org/10.1016/j.biopsych.2022.05.027.
Loomes, Rachel, et al. “What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis.” Journal of the American Academy of Child & Adolescent Psychiatry, vol. 56, no. 6, 2017, pp. 466–474, https://doi.org/10.1016/j.jaac.2017.03.013.
Pang, Chenyu, et al. “Are Women More Empathetic than Men? Questionnaire and EEG ESTIMATIONS OF SEX/Gender Differences in Empathic Ability.” Social Cognitive and Affective Neuroscience, vol. 18, no. 1, 2023, https://doi.org/10.1093/scan/nsad008.
Werling, Donna M., and Daniel H. Geschwind. “Sex Differences in Autism Spectrum Disorders.” Current Opinion in Neurology, vol. 26, no. 2, 2013, pp. 146–153, https://doi.org/10.1097/wco.0b013e32835ee548.
