Study finds evidence of gender bias toward diagnosing boys with autism

17 Nov

As dad to a daughter and ‘step-dad’ to a ‘step-daughter’ who are both autistic, I always find stories and studies like this interesting:

With the severity of autistic traits held constant, boys were more likely to receive an ASD diagnosis than girls.


“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.”

And one of those things that they found was that boys were more likely to be diagnosed than girls. Also found was the results that ethnic origin, maternal class and mother’s marital status played no part in receiving a diagnosis whereas the average age of mothers with an ASD diagnosis was 3 years higher than in the population generally.

Financial hardship, partner cruelty and affection, home ownership status, maternal mental health, substance abuse, maternal psychopathology, and being in trouble with the police showed no significant associations with a child receiving an ASD diagnosis.

All this backs up the idea that diagnoses – or the art of diagnosing – autism depend on social factors as well as behavioural and biological factors.

14 Responses to “Study finds evidence of gender bias toward diagnosing boys with autism”

  1. Stuart Duncan November 17, 2010 at 17:51 #

    Should they make adjustments to account for females with Autism and begin diagnosing more of them, the numbers overall will also adjust and our 1 in 110 numbers will again change prompting more “epidemic” outcries… that things are “getting worse”.

  2. Trishinspace November 17, 2010 at 18:58 #

    Heck, just ask any of the women over at AWN when they were dx…for most of us it was much later in life. Most of the studies and criteria are/were based on males. Still a lot to learn about females.

  3. passionlessDrone November 17, 2010 at 22:33 #

    Hello friends –

    It would be intersting to know how much of a factor this is. I think it should be noted that our diagnosis of MR consistently showed an association with maleness ~ 2 x 1 and a ton of animal studies show that being born male is associated with biological or behavioral correlates of interest.

    – pD

  4. vmgillen November 18, 2010 at 20:02 #

    You have the diagnosis, and then the sociology of Dx’s… In the ’60s it was discovered that the incidence rate of Downs among females was much higher than previously beleived – why? Girls were supposed to be slightly retarded, socially outgoing, trusting… meanwhile, about 20 years ago ADD, and then ADHD, was misapplied to many children, and a large number of those children had ASD (HFA). . . add to that the medicalization of all of everything and the burgeoning application, for a cost, of labels and money-generating therapies and prescriptions… you get my drift. No surprises here. And, again, ASD as Dx du jour means funding for studies that generate nothing new. Rant over; thank you.

  5. esattezza November 18, 2010 at 21:58 #

    I’d like to know what the “autism” population was like for this study. From what I’ve been reading/hearing at graduate school, there is a larger M:F ratio (~5:1) in high-functioning autism (which you would expect to be more subject to this sort of bias) as opposed to more severe, “syndromic” autism (think fragileX without the known genetic link) where the ratio is more like 2:1. This could be explained either by diagnosis bias, true biological sex differences, or, more likely, both.

  6. esattezza November 18, 2010 at 22:05 #

    @PassionlessDrone: I’d be willing to bet that the difference in true MR diagnosis is at least patially the result of the presence of genetic X-linked mental retardation disorders, for which boys would need only one copy of the mutant gene, while girls would need two, making its prevalence in girls much lower. Your mention of the animal studies, however, makes me think you were referring to a phenomena beyond this. Could you please clarify?

  7. Country_Girl November 19, 2010 at 00:14 #

    This is refreshing. Even people who have a lot of info about autism seem to believe girls who are high functioning are almost non-existant. That is completly illogical. Girls who are high functioning aren’t dx very often. I wasn’t dx as a student in school and it really angers me that girls still aren’t being dx because drs who don’t have enough information are using male based criteria.

  8. passionlessDrone November 19, 2010 at 18:52 #

    Hi esattezza –

    Your mention of the animal studies, however, makes me think you were referring to a phenomena beyond this. Could you please clarify?

    Sure. Some environmental insults that we seem to have good ideas on contributing to autism might include certain drugs (i.e., valporic acid), maternal stress. In animal studies, we seem to observe increased effects of these kinds of stressors in males.

    Gender-specific behavioral and immunological alterations in an animal model of autism induced by prenatal exposure to valproic acid

    Sex-specific programming of offspring emotionality after stress early in pregnancy

    I think there are parallels in the immune activation realm, but I can’t find them now.

    – pD

  9. esattezza November 19, 2010 at 23:09 #

    Hmm… very interesting. Valproic acid is an HDAC, so right away I’d postulate the skew towards males has something to do with imprinted genomic regions. A similar argument could be made for maternal stress, which has been shown to have epigenetic effects. I’ll take a read through. Thanks for the links, pD!

  10. passionlessDrone November 19, 2010 at 23:28 #

    Hi esattezza –

    I found a few more categories that have parallels to autism, though a direct route to autism does not have as much experimental support.

    For example, maternal separation:

    (Note: I am not proposing a refrigerator mother model of autism, but the data is the data and there are a lot of similarities).

    The snipet regarding the male to female effect is not visible within the abstract, but this paper: Enduring consequences of maternal obesity for brain inflammation and behavior of offspring

    also found that males were more affected by an inflammatory gestational environment than females, with outcomes that included, microglial activation, anxiety, and differences (improvements) in spatial learning.

    – pD

  11. passionlessDrone November 19, 2010 at 23:30 #

    Errr. Html fail. Regarding maternal separation:

    Behavioural and neurochemical consequences of early weaning in rodents


    – pD


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