Study Finds Evidence of Gender Bias Toward Diagnosing Boys

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Study Finds Evidence of Gender Bias Toward Diagnosing Boys With Autism

Science Daily article


ScienceDaily (Nov. 19, 2010) — Social factors can play a key role in whether or not a child is diagnosed as autistic, a new study has found.

Boys were more likely to receive a diagnosis of autistic spectrum disorder (ASD) than girls, even when symptoms were equally severe, according to researchers at the universities of Exeter and Bristol.
"We wanted to find out what distinguishes those children without diagnosis but with autistic traits from those who have received a formal ASD diagnosis in the clinic," explained lead researcher Ginny Russell, from Egenis at the University of Exeter. "We thought that there may be social and demographic factors that explain why some children are diagnosed and others are not. Understanding social factors that act as access barriers may provide useful insights for clinicians in practice."
The researchers examined data from a long-term study, the Avon Longitudinal Study of Parents and Children and have published their findings in the journal Social Psychiatry and Psychiatric Epidemiology.
Ginny Russell explained: "Boys were more likely to suffer from severe autistic traits, whether diagnosed with an ASD or not. However, even with the severity of autistic traits held constant, boys were still significantly more likely to receive an ASD diagnosis than girls.
"Boys are more than four times more likely to have ASD and are clearly more likely to suffer from these types of symptoms. More interesting is our finding that even with symptom severity held constant, there is still a gender bias towards diagnosing boys. Our analysis suggests that girls are less likely to be identified with ASD even when their symptoms are equally severe." The researchers suggested that the popular conception of autism as a 'male' disorder may contribute to this bias.
The study also found that the average age of mothers of children with an ASD diagnosis was three years higher than in the population generally.
The association between maternal age and ASD diagnosis was stronger than that between maternal age and ASD traits per se in the sample. The authors suggested one possible interpretation is that older mothers are better at identifying their children's difficulties and have more confidence in bringing concerns to the clinic. Younger mothers may find it harder to identify problems.
Ethnic origin, maternal class and mother's marital status did not significantly predict a child either having an ASD diagnosis or displaying severe autistic traits.

My theory:

1. Baron-Cohen's crap about autism being an "extreme male brain" isn't helping girls get diagnosed.

2. There's a stereotype that autism = math/science genius and, according to the common bias, girls can't be math/science geniuses. Of course, it's not true that autism has anything to do with being good at math/science, nor is it true girls can't be good at math/science. Double fail!

Oh, and I believe doctors, especially male doctors, have a tendancy to want to pin most female problems on "emotional issues" as opposed to "real" issues. Just a guess.

I bet that maybe the actual prevalence is really much lower for females. I doubt there's any conspiracy. There are biological differences between the two genders. I doubt diagnosticians refer to the popular press to influence who they think is on the spectrum or not. I was diagnosed and don't really fit many of the stereotypes. Probably the same with some others who have been diagnosed even if for different reasons.

It may well be the case that actual prevalence is lower in females, however I still believe that biases exist in diagnostics. The way that the condition can manifest with, for instance, more social masking. Often women in general have a greater tendency to be more verbal, so women with AS can mask their condition with verbal and social interactions using mimicing, more than men with AS would.
I do not believe these manifest differences in the condition between men and women are widely enough recognised to allow for comprehensive assessments of all women who may have AS.

A woman can't so much as cry in this diagnosis society without being diagnosed as having a personality disorder, being hysterical, depressed, over-anxious, obsessive, over-emotional...

One of the symptoms I exhibit (apparently due to BPD but I'm disputing this) is mood swings. The other day a member of staff said, 'I've seen you go through every emotion in the space of a few hours.' I was upset (not visably) then he added, 'but I think that's just part of being a lady. Lots of ladies I know get like that and they're not diagnosed...'

Truer words could not be said. Also has anyone noticed that the majority of Psychologists/psychiatrists seem to be MALE therefore are looking upon a female through a man's eyes? Of course a man doesn't know what it feels like to be a woman in the same way a woman won't know what its like to be a man.

I believe that gender bias against diagnosing girl with AS began back in the day when boys were considered more important than girls. Girls didn't have to be 'normal' because it was expected that someone was going to take care of them all their lives anyway. My theory is that many of the girls who slipped under the radar back in the day are now being diagnosed later in life (like me) and finally discover as adults the reason why they were misfits all their lives.

you seem to have a valid point

I wasnt official DX until three weeks ago, and Im a guy.
I dont know your age, but if its like me (over 40) it would be highly unlikely you would have been diagnosed with aspergers UNTIL you were over 40 because for most of your life the mental health establishment never even heard of the condition. So the delay in your diagnosis doesnt necessarily have anything to do with a gender bias.

Why does everything have to be made part of some gender war? Boys get diagnosed more, so that must be some kind of oppresion against girls, amirite? If girls were diagnosed more that would be considered a disadvantage to girls too. Or maybe, just maybe, females don't have to be considered perpetual victims in every situation.

Hi BlueMage.

Well, personally, I wasn't posting as part of a victimhood/oppression kind of saga being released to the general public, I was more posting the article as a pointer, or statement of fact. Suggested statement of fact, even.

Let's make it ok for ASDs in girls to be occurring slightly differently than in boys, and yes we are all entitled to help where and when we need it.

that is what i think, but i don't think it's conscious or deliberate. that's just the filter people see women through: we're more emotional so something we're going through is more likely assumed to be emotional in origin even when it isn't.



most everyone agrees it is lower. somewhere between 2:1 (Tony Attwood estimate based on both diagnosed and undiagnosed) and 4:1 (more official number)

however this is about diagnostic bias, not about the ratio when properly diagnosed

read again:







it's not a conspiracy, it's lack of interest or ignorance or people clinging to their preconceptions that ASDs are so much rarer in women it's not worth looking for?



agree, but this article suggests quite plainly, and i have read elsewhere, that in addition to the possibility of milder (or different) presentation in women, even when women present with the same traits, with the same severity, they are less likely to be diagnosed.





i never use that stupid emoticon, but that post deserves it.

if women are being overlooked, misdiagnosed, or underdiagnosed by diagnosticians it is something that should be brought to the attention of professionals in the field so they can be aware of it, learn to look for it and recognize it so everyone can get the help they need. that's all.

Yes. Well put, katzefrau.

I was being conservative about the diagnostic biases, though I have read similar things, too. It can be a problem and I, also, believe the solution is about awareness.