An investigation of the ‘female camouflage effect’ in autism using a computerized ADOS-2 and a test of sex/gender differences

Abstract

BackgroundAutism spectrum conditions (autism) are diagnosed more frequently in boys than in girls. Females with autism may have been under-identified due to not only a male-biased understanding of autism but also females’ camouflaging. The study describes a new technique that allows automated coding of non-verbal mode of communication (gestures) and offers the possibility of objective, evaluation of gestures, independent of human judgment. The EyesWeb software platform and the Kinect sensor during two demonstration activities of ADOS-2 (Autism Diagnostic Observation Schedule, Second Edition) were used.MethodsThe study group consisted of 33 high-functioning Polish girls and boys with formal diagnosis of autism or Asperger syndrome aged 5–10, with fluent speech, IQ average and above and their parents (girls with autism, n = 16; boys with autism, n = 17). All children were assessed during two demonstration activities of Module 3 of ADOS-2, administered in Polish, and coded using Polish codes. Children were also assessed with Polish versions of the Eyes and Faces Tests. Parents provided information on the author-reviewed Polish research translation of SCQ (Social Communication Questionnaire, Current and Lifetime) and Polish version of AQ Child (Autism Spectrum Quotient, Child).ResultsGirls with autism tended to use gestures more vividly as compared to boys with autism during two demonstration activities of ADOS-2. Girls with autism made significantly more mistakes than boys with autism on the Faces Test. All children with autism had high scores in AQ Child, which confirmed the presence of autistic traits in this group. The current communication skills of boys with autism reported by parents in SCQ were significantly better than those of girls with autism. However, both girls with autism and boys with autism improved in the social and communication abilities over the lifetime. The number of stereotypic behaviours in boys significantly decreased over life whereas it remained at a comparable level in girls with autism.ConclusionsHigh-functioning females with autism might present better on non-verbal (gestures) mode of communication than boys with autism. It may camouflage other diagnostic features. It poses risk of under-diagnosis or not receiving the appropriate diagnosis for this population. Further research is required to examine this phenomenon so appropriate gender revisions to the diagnostic assessments might be implemented.

Are autistic traits associated with suicidality? A test of the interpersonal‐psychological theory of suicide in a non‐clinical young adult sample

“…This limits the generalizability of results to the wider general population, and possibly to those with ASC. However, recent research has indicated that ASC may be under‐diagnosed in females [Rynkiewicz et al, ; Rutherford et al, ], and that females diagnosed with ASC, without co‐morbid intellectual disability, are at higher risk of dying by suicide than males [Hirvikoski et al, ]. Hence, it is important to explore associations between autistic traits and suicidality in females, without intellectual disability as this is particularly high‐risk group for death by suicide in the ASC population.…”

Sex Differences in Autism Spectrum Disorder: a Review

“…Males are more likely to act out in classrooms, which makes them more likely to receive attention, diagnoses, and treatment [17,172,209]. In addition, females with ASD are more likely to camouflage their symptoms and perceive them differently [188,194,210–216]. Most accepted knowledge of ASD phenotypes and diagnostic criteria is based on research on primarily male subjects, which can make diagnosis in females more difficult.…”

Convergence of Sex Differences and the Neuroimmune System in Autism Spectrum Disorder

“…Boys are diagnosed with ASD 4-5 times more frequently than girls but the origins of the male prevalence remain incompletely understood (1-7). Equally mysterious but equally compelling is the accumulating evidence that inflammation may contribute to or be a consequence of ASD (8-12).…”