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The Hidden Disorder: Undiagnosed Autism Spectrum Disorder in Women
Autism Spectrum Disorder (ASD) is thought to be more prevalent in males than females, and this is especially true at the higher end of the spectrum. However, females are often diagnosed later than males, suggesting that rather than females being less likely to have the disorder, it is possible they are more likely to be missed; either going undiagnosed or being misdiagnosed with a mental health condition.
Objectives:
The current study aimed to determine the rate of undiagnosed autism in males and females in a large sample of individuals responding to an online survey. The study also aimed to evaluate the number of mental health diagnoses among participants who met the cut-off on an ASD screening tool as a function of gender and diagnostic status.
Methods:
A screening survey was distributed to all UK universities and advertised to the general public via radio and TV. Participants were not informed about the nature of the survey until after completion. Amongst other measures, the survey consisted of the Autism Quotient (AQ) and a simple self-report mental health checklist. The survey received 7,537 respondents (mean age = 32 years, SD 13.77, range 16 - 88). Responses were grouped according to their AQ scores and current diagnostic status (e.g., meets the AQ cut off for concern/diagnosed, meets cut off/undiagnosed, does not meet cut off).
Results:
A significantly higher number of female respondents met the AQ cut off without a diagnosis than male respondents fulfilling the same criteria (22% of females v. 17% of males). These women had significantly fewer mental health conditions (M = 1.20) than women who met the cut off and were diagnosed (M = 1.70), but a similar number to males who met the cut off and had a diagnosis (M =0.90).
Conclusions:
Our findings suggest that there is a large proportion of women who may meet the criteria for autism but do not have a diagnosis. Our findings further suggest that women may require more mental health problems prior to a diagnosis of ASD. This would support the Female Masking Effect theory of ASD, which suggests that females need to reach a higher threshold of difficulties before being noticed or diagnosed. Females with ASD may only arouse suspicion after seeing numerous professionals and presenting with a complex symptom history.