Is autism really more common in males...

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...or are the symptoms simply significantly different or under-recognised in females? I'm wondering what you think about this.

Whether it is more common is up for debate in part because it can manifest quite a bit differently in females. The consensus is that females are able to "mask" the social deficits better, and thus can remain undiagnosed for much longer.

In my case, I'm level 2 autistic. One would think that would have been readily noticeable in my childhood -- I mean, level 2 is moderate, not mild! But I wasn't diagnosed until age 29 because my social deficits were seen as shyness and nerdiness rather than clinically autistic behaviors. I also had no academic challenges and needed no additional supports in a school setting. It wasn't until many failed friendships and jobs later, and increased awareness of autism in women, that I received the official diagnostic label.

or are the symptoms simply significantly different or under-recognised in females? I'm wondering what you think about this.

I see Aspergers as a neurological variant that produces a more intense sensing and processing experience. This is responded to in different ways. Often an Aspie withdraws or minimizes social contact. Sometimes an Aspie can be a bombastic blowhard, almost a bully. I would say that often females react to the intensity of Aspie neurology with anxiety sometimes even incapacitating. The attempt to manage and minimize anxiety often leads to a “shy” characterization that is often overlooked.

Because of the intensity of their neurology, Aspies are faced with having to take more intentional and conscious control of their inner lives often with little idea of how to do so. This starts in earliest childhood and results in a divergence from the more neuro-typical path of reflexive more natural integration into the larger social world (sort of the difference between automatic pilot and manual control).

Given that Aspie children often have to “chart their own course”, it should not be surprising that there are many different ways this can influence development and one might expect great variance as well as sexual differentiation. It should also be expected that those declaring expertise in this area are going to put forth a system of classification that both fails to account for the various ways children find to cope with their circumstances as well as fail to account for different ways to manage anxiety. A girl may follow a path of mutism to avoid social entanglement that can escalate anxiety. The blowhard may reject any consideration of error also in an attempt to avoid anxiety. It is difficult to think of a single system of categorization that would account for both.

Many turn to medical and counseling “professionals” for help in dealing with Aspergers. Aside from being classified and categorized, it might be more productive to talk with older Aspies to learn what coping mechanisms and management skills they developed and build on that.

It seems to be both differently expressed symptoms and being diagnostically missed. Even though I am classically autistic (including unable to hide symptoms), was diagnosed late at 16! My developmental delays were assumed caused by my premature, very troubled birth- thus receiving no help in school. While diagnosed with AS initially, in the middle of high-school, they decided to ignore it.

A site like this might help: https://childmind.org/article/autistic-girls-overlooked-undiagnosed-autism/
P.S. it is kind of a long article.

Hmmm. That article, though well-intentioned, was rather anecdotal, and didn't really capture the spectrum well, particularly in the case of someone like me. By that, I mean it hit many of the broad ideas correctly -- the masking, not fitting as many male autistic stereotypes, and being diagnosed with other things -- but as far as details go, the girls and examples they gave didn't match well with my own experiences.

I wasn't diagnosed as a child or as a teenager, like the two girl examples. I missed out until I was 29 -- for someone with level 2 autism, that's an awfully long time! That's because I didn't have ADHD, or educational struggles, like those other girls. I had no hyperactivity and focused well in school settings. That's partly why no one suspected anything. As for the diagnosis of something else, mine was OCD in my teenage years, not ADHD.

I also never had problems with sexual abuse. Boys and men never took advantage of me, and very few ever showed interest. I was tomboyish and nerdy, seen as generally unfeminine and unattractive, and males often made it very clear that they thought of me in this way.

Finally, there is a common view that girls' obsessions are of typically female things, like the horses and unicorns mentioned in the article. I see this time and again in autism girl articles as though it were some kind of diagnostic absolute. But my obsessions were very atypical for a girl -- basketball cards, statistics about athletes (at one point as a child, I had memorized the middle names, colleges attended, heights, and weights of every NBA player in the early 1990s!), medical knowledge gathered from textbooks (pharmacopeias were a favorite), and repetitive music listening/knowledge of tonal progression of songs, especially of music not usually liked by women (electronic music, progressive rock, etc.).

Oh, I also spoke early and did tons of pretend play.

Ok, that was rather long of me to write, but not meant as disrespect -- I just thought that article didn't represent my brand of autism well, and wanted to caution against its use as a source. I don't think a layperson would be able to read that, look at me, and think it applied in much of any way. They certainly wouldn't be able to figure out how I could be level 2 autism from that link. But I very much am level 2 autism -- terrible with social cues, systematic to the point of lacking what NTs perceive as proper empathy for most given situations, near inability to detect sarcasm, and other aforementioned autistic traits I regularly exhibit.

I've only heard this a millions times and I'm sick of it because I don't think it is. Girls just don't get diagnosed as often or as early, either because we aren't as obvious or because society is sexist. Or both.

I understand what you mean and am not offended. As a girl, I liked boy-oriented toys and was well-behaved in school- until I started becoming defiant and uncaring about schoolwork due to inherited bipolar later. None of these articles fit me well either and are disappointing! It'd be great to finally have accurate ones about various severity in non-mild females.

Glad you didn't take offense.

I agree there needs to be a more objective approach with girls and autism. Studies on us are admittedly nascent, but some of the common threads I see, like ADHD, or anorexia, or more typically girl-focused interests, are not consistent with all female expression of autism.

The one common thread that appears to be universal for later-diagnosed females is better social "masking" than boys. This doesn't mean we are necessarily better with social cues; in fact we can be just as incompetent as the guys. But when we have a template present that we can imitate or model, such as another more experienced human being in the room, we can get by just enough by staying relatively quiet, or else imitating that person, so that it seems we don't have such a condition to the casual onlooker.

I'm very small for my age, known delayed social and severe sensory processing, social norms need repeated guidance vs picking it up, obsessive medical interests, moderate dyspraxia which makes me 'freeze' in new situations, unable to live on my own, use limited facial expressions, hand flap wherever (especially when happy), may have self-injurious meltdowns and get easily excited.

I believe ASDs probably are more common in males, just not to the ratios/statistics currently quoted. I've heard that it's probably more of a 2:1 ratio of males to females than 4:1. I do think there's something to the "extreme male brain" theory, and I also am a proponent of the "testosterone theory" that says that left-handedness and certain neuropsychiatric disorders tend to be more common in males due to exposure to testosterone in the womb.

I do get sick of hearing about how females' special interests are different topics than males. While some females may have special interests that are dominated by horses and fantasy worlds and literature, I don't think it's the norm by any means. It certainly isn't true for me. For instance, I've always been drawn to science, which is one of the stereotypical male interests.

I'd be willing to bet that one day the ratio figures will have shifted to an understanding that, quite possibly, there are just as many females on the spectrum as males. It's just that they have gone under the radar, for the many reasons detailed in this thread.

Seriously, I wouldn't be surprised if one day there was no difference in this anymore and it's recognized as a condition just as likely to be found among girls as boys. There's no real reason why it wouldn't be.

I don't believe that this question can be fully answered at this time. Because of the misdiagnosis of other conditions like FXS as AS, samples currently used are not only gender biased (mostly male samples are used to generalise findings to females as well) but the research suffers from sampling error to an unquantified degree). We don't know very basic information which would help such as the number of "only" adhd or OCD subjects who have been wrongly identified as AS, and how much sampling bias accrues from that, nor from missed diagnosis of people who are unrecognised as AS when they are on the spectrum.

Until there is much much more rigour in sampling technique, we may never know the answer to this question, unless a biomarker is discovered which is 100% accurate diagnostically for both sexes. This may indeed happen.

Meantime, it's a mess, and no prominent group of scientific leaders is willing to articulate nor address the issues, perhaps because reputations, careers and so much research money is at stake, and scientists are prone to bias of self interest too - more so in this century perhaps, when the competition for tenure is intense and the "publish or perish" race is more cut-throat. The race is on to get their own names out there, whatever the quality (or not) of what they publish.

I'd go with a triple explanation. Ma Nature is probably more inclined to experiment on males, who are half as likely to pass on their genes once. Losing one does not affect the birthrate of a tribe. Second, girls are probably nurtured in a way that does more to mitigate AS symptoms. Male independence allows more range for originality. Third, eccentricity is less obvious in women, who are generally regarded as confusing to men.

Given how many thousands (millions?) of autism studies and claims there are, it astonishes me that meta-analyses are so rarely conducted on autism research. The only branch this seems to have happened with some rigor is meta-analyses of ABA findings, and the meta-analyses I know of didn't support the over-reaching claims of the ABA proponents, concluding that its claims of "gold standard" and "evidence based" were on very shaky ground, not the solid earth the "professional ABA trainers" commonly claim.

This 2005 article is also interesting on research claims generally and the lack of validity and reliability:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182327/