IMFAR 2011: Sex Differences In the Identification and Diagnosis of Autism, Asperger’s Syndrome and PDDNOS

S. Begeer

VU University, Amsterdam

Autism is a “man’s disorder” But what about the “Horse Girl” and the “Rain Women”?

Some studies reports that females with autism

  • Show more cognitive impairments
  • Have worse social and communicative functioning
  • Have a higher rate of intellectual disability: Increased self-destructive behavior, more dementia

But other studies have shown that core autism symptoms do not vary by sex:

  • No increase in psychiatric comorbidity
  • Core symptoms of autism are relatively equal

What are factors in the identification of females with autism?

  • Parental expectations may be involved (higher social expectations)
  • Clinicians expectations may be involved as well
  • There is a risk of delayed or missed diagnoses in females
  • Early identification is crucial

From the abstract:

Survey data were collected in the Netherlands from 2275 individuals with ASD. Timing and procedure of diagnosis were compared for males and females with autism, Asperger’s syndrome and PDDNOS.


Among participants < 18 years of age, females with Asperger’s syndrome were identified later than males, despite parents’ report of first concern at similar ages. No delays in identification were found for individuals with ASD and PDD-NOS, or among participants ≥18 years of age.


Among children and adolescents with Asperger’s syndrome, females are diagnosed later than males, which can result in increased family stress and critical delays in treatment initiation. Strategies for changing clinician behaviour to improve recognition of ASD in females are needed.

Self-reported shortcoming: relied on self-reported data, rather than clinical observation and data collection.