Under-identification of ASD in females: A case series illustrating the unique presentation of ASD in young adult females

Authors

  • Andrea Trubanova Department of Psychology, Virginia Polytechnic Institute and State University
  • Katharine Donlon Department of Psychology, Virginia Polytechnic Institute and State University
  • Katharine Donlon Department of Psychology, Virginia Tech, 109 Williams Hall (0436), Blacksburg, VA 24061, USA
  • Nicole L. Kreiser Department of Psychology, Virginia Tech, 109 Williams Hall (0436), Blacksburg, VA 24061, USA
  • Nicole L. Kreiser Department of Psychology, Virginia Polytechnic Institute and State University
  • Thomas H. Ollendick Department of Psychology, Virginia Polytechnic Institute and State University
  • Thomas H. Ollendick Department of Psychology, Virginia Tech, 109 Williams Hall (0436), Blacksburg, VA 24061, USA
  • Susan W. White Department of Psychology, Virginia Tech, 109 Williams Hall (0436), Blacksburg, VA 24061, USA
  • Susan W. White Department of Psychology, Virginia Polytechnic Institute and State University

Keywords:

females, autism, ASD, comorbidity, diagnosis

Abstract

Background: Autism spectrum disorder (ASD) is diagnosed more often in males than females, with the male-to-female gender ratio reported to be around 4.3:1 to 5:1. It is possible that the underrecognition of ASD in females partially con-tributes to this uneven ratio. Recent attention has been placed on understanding the processes that give rise to this gender difference in ASD prevalence. Socialization may contribute to the unique presentation of ASD in females, which may underlie this condition’s subsequent underidentification in this group.

Objective: The purpose of this case series is to demonstrate how symptoms of ASD may uniquely manifest in females without co-occurring intellectual impairment.

Method: An examination of three case examples of young women diagnosed with ASD will illustrate the processes that contribute to the atypical manifestation and underidentification of ASD in females.

Results: Across cases, the females in this study demonstrated shared symptom presentations within three domains: 1) unique core symptom manifestation (insistence on sameness, lack of social engagement, and social processing difficulties); 2) heightened psychiatric comorbidities with internalizing disorders (anxiety, depression, and borderline personality traits); and 3) emotional dysregulation. These three domains reflect specific processes that may help to explain the underidentification of ASD in females via diagnostic overshadowing.

Conclusions: Consideration of atypical symptom presentations, heightened comorbidities, and emotion regulation
difficulties may help with the understanding of why ASD symptoms in females are commonly underidentified or identified later than they are in males. Social difficulties in combination with internalizing psychiatric disorders and emotional dysregulation may lead to the development of a specific symptom presentation in females that obscures the detection of ASD symptoms. Suggestions for clinical practice are made to promote the accurate identification of ASD and to inform case formulation and treatment planning.

Downloads

Published

2014-07-10

How to Cite

Trubanova, A., Donlon, K., Donlon, K., Kreiser, N. L., Kreiser, N. L., Ollendick, T. H., Ollendick, T. H., White, S. W., & White, S. W. (2014). Under-identification of ASD in females: A case series illustrating the unique presentation of ASD in young adult females. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, 2(2), 66–76. Retrieved from https://tidsskrift.dk/sjcapp/article/view/15902

Issue

Vol. 2 No. 2 (2014): Special Issue: Autism Spectrum Disorder

Section

Articles

License

Authors who publish with this journal agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work’s authorship and initial publication in this journal.
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal’s published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).