Social Camouflaging in Females with Autism Spectrum Disorder: A Systematic Review

Tubío-Fungueiriño, María; Cruz, Sara; Sampaio, Adriana; Carracedo, Ángel; Fernández-Prieto, Montse

doi:10.1007/s10803-020-04695-x

Cited by 95 publications

(73 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although much of the current research into masking does not state that masking is limited to females, 9,34,64 others do suggest that females may be more likely to mask. 65,66 Although it is important to recognize the different ways in which autism might present in intersection with other aspects of a person's identity and socialization, the labeling of this as ''female autism'' is likely to lead to more confusion in the future, which has a tangible impact outside of academia where these narratives might be perpetuated further. The idea of a female autism phenotype also fails to recognize the large number of autistic people who are outside of the gender binary, [67][68][69] potentially creating further barriers to diagnosis and support and the perpetuation of a stigmatizing narrative.…”

Section: Masking and Gendermentioning

confidence: 99%

A Conceptual Analysis of Autistic Masking: Understanding the Narrative of Stigma and the Illusion of Choice

Pearson

Rose

2021

Autism in Adulthood

249

160

View full text Add to dashboard Cite

Autistic masking is an emerging research area that focuses on understanding the conscious or unconscious suppression of natural autistic responses and adoption of alternatives across a range of domains. It is suggested that masking may relate to negative outcomes for autistic people, including late/missed diagnosis, mental health issues, burnout, and suicidality. This makes it essential to understand what masking is, and why it occurs. In this conceptual analysis, we suggest that masking is an unsurprising response to the deficit narrative and accompanying stigma that has developed around autism. We outline how classical social theory (i.e., social identity theory) can help us to understand how and why people mask by situating masking in the social context in which it develops. We draw upon the literature on stigma and marginalization to examine how masking might intersect with different aspects of identity (e.g., gender). We argue that although masking might contribute toward disparities in diagnosis, it is important that we do not impose gender norms and stereotypes by associating masking with a ''female autism phenotype.'' Finally we provide recommendations for future research, stressing the need for increased understanding of the different ways that autism may present in different people (e.g., internalizing and externalizing) and intersectionality. We suggest that masking is examined through a sociodevelopmental lens, taking into account factors that contribute toward the initial development of the mask and that drive its maintenance.

show abstract

Section: Masking and Gendermentioning

confidence: 99%

A Conceptual Analysis of Autistic Masking: Understanding the Narrative of Stigma and the Illusion of Choice

Pearson

Rose

2021

Autism in Adulthood

249

160

View full text Add to dashboard Cite

show abstract

“…The issue of missed and misdiagnoses among ASD subjects might be especially pronounced among females [ 1 , 20 ]. Several studies highlighted the more complex presentation of ASD in women [ 22 ] and the greater likelihood of females hiding their autistic symptoms, leading to camouflage among a neurotypical population [ 23 ] and hindering the diagnostic process [ 20 , 24 ]. Previous studies have shown that women with ASD tend to report lower scores in questionnaires assessing some autistic dimensions [ 25 , 26 ] and that certain mental disorders, such as anorexia, borderline personality disorder and social phobia, often stem from autism-related underpinnings, lagging unrecognized behind comorbid disorders [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Gender Differences in Misdiagnosis and Delayed Diagnosis among Adults with Autism Spectrum Disorder with No Language or Intellectual Disability

Gesi

Migliarese²,

Torriero

et al. 2021

Brain Sciences

View full text Add to dashboard Cite

Autism Spectrum Disorder (ASD) is often unrecognized, especially in mild forms and in women. Studies evaluating features associated with missed/misdiagnosis in men and women with ASD are warranted. 61 subjects (22 females, 39 males, age 28.5 ± 10.8 years) with ASD with no language/intellectual deficit were enrolled in the service for the treatment of psychiatric comorbidities in adults with ASD of the ASST Fatebenefratelli-Sacco in Milan (Italy). A detailed clinical history was gathered, and two self-report questionnaires (Autism Spectrum Quotient-AQ and Adult Autism Subthreshold Spectrum-AdAS Spectrum) were administered. 75.4% received their ASD diagnosis average eight years later than the first evaluation by mental health services. Compared to males, females showed a significantly greater delay in referral to mental health services and a significantly higher age at diagnosis of ASD. Among men, diagnostic delay inversely correlated with scores on the AdAS Spectrum total, Verbal communication, Empathy and Inflexibility and adherence to routine domains. Among women, diagnostic delay positively correlated with the Attention to detail score while the age at diagnosis of ASD positively correlated with the AdAS Spectrum Verbal communication and Restricted interests and rumination domain scores. Females were less likely to be correctly diagnosed and more likely to be misdiagnosed at first evaluation than men. Females reported significantly higher scores than men in the Hyper/Hyporeactivity to sensory input domain only among subjects who were misdiagnosed. Our findings provide gender-specific information about ASD patients seeking help for comorbid conditions and might be a primary ground for future research.

show abstract

“…Selected measures spanned broad executive function, memory, emotional, and psychiatric domains previously implicated in camouflaging or female protection. 7,16,[30][31][32][33] In brief, the Wisconsin Card Sorting Task, 34 Stroop Color and Word Test, 35 and Tower of London 36 estimated flexibility, cognitive control, and planning, respectively. The Wechsler Memory Scale -Visual Reproduction II 37 and Rey Auditory Verbal Learning Task 38…”

Section: Neuropsychological Testsmentioning

confidence: 99%

“…We acknowledge camouflaging is associated with poorer mental health in ASD. 16 Instead, the purpose of this study was to capitalize on observed sex difference in self-reported camouflaging in ASD due to its potential sensitivity to neurobiological differences related to the sex bias.…”

Section: Limitationsmentioning

confidence: 99%

“…14 A novel way to elucidate brain systems underlying the sex bias in ASD is to characterize sex-related brain correlates of behaviors that show a sex bias in ASD. For example, greater use of compensatory strategies is reported in ASD-F than ASD-M, 15,16 and this may be one mechanism by which ASD-F "work around" ASD genetic liability. The primary compensatory construct investigated in ASD is "camouflaging" (e.g., behaviors to mask or overcome ASD-related social differences).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Sex-Related Neurocircuitry Supporting Camouflaging in Adults with Autism: Female Protection Insights

Walsh

Pagni

Monahan

et al. 2021

Preprint

View full text Add to dashboard Cite

The male preponderance in autism led to the hypothesis that aspects of female biology are protective against autism. Females with autism report engaging in more compensatory behaviors (i.e., “camouflaging”) to overcome autism-related social differences, which may be a downstream result of protective pathways. No studies have examined sex-related brain pathways supporting camouflaging in females with autism, despite its potential to inform mechanisms underlying the sex bias in autism.This case-control design included 45 non-intellectually-disabled adults with autism (male/female: 21/24) and 40 neurotypical adults (male/female: 19/21) ages 18-71. We used group multivariate voxel pattern analysis to conduct a data-driven, connectome-wide characterization of “sex-atypical” (sex-by-diagnosis) and “sex-typical” (sex) brain functional connectivity features linked to camouflaging, and validated findings in females with autism multi-modally via structural connectometry. Exploratory associations with cognitive control, memory, emotion recognition, and depression/anxiety examined the adaptive nature of functional connectivity patterns supporting camouflaging in females with autism.We found 1) “sex-atypical” functional connectivity patterns predicting camouflaging in the hypothalamus and precuneus and 2) “sex-typical” patterns in the anterior cingulate and right anterior parahippocampus. Higher hypothalamic functional connectivity with a limbic reward cluster was the strongest predictor of camouflaging in females with autism (a “sex-atypical” pattern), and also predicted better cognitive control/emotion recognition. Structural connectometry validated functional connectivity results with consistent brain pathways/effect patterns implicated across multi-modal findings in females with autism.This data-driven, connectome-wide characterization of “sex-atypical” and “sex-typical” brain connectivity features supporting compensatory social behavior in autism suggests hormones may play a role in the autism sex bias. Furthermore, both “male-typical” and “female-typical” brain connectivity patterns are implicated in camouflaging in females with autism in circuits associated with reward, emotion, and memory processing. “Sex-atypical” results are consistent with the fetal steroidogenic hypothesis, which would result in masculinized brain features in females with autism. However, female genetics/biology may contribute to “female-typical” patterns implicated in camouflaging.

show abstract

Social Camouflaging in Females with Autism Spectrum Disorder: A Systematic Review

Cited by 95 publications

References 40 publications

A Conceptual Analysis of Autistic Masking: Understanding the Narrative of Stigma and the Illusion of Choice

A Conceptual Analysis of Autistic Masking: Understanding the Narrative of Stigma and the Illusion of Choice

Gender Differences in Misdiagnosis and Delayed Diagnosis among Adults with Autism Spectrum Disorder with No Language or Intellectual Disability

Sex-Related Neurocircuitry Supporting Camouflaging in Adults with Autism: Female Protection Insights

Contact Info

Product

Resources

About