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Gepubliceerd in: Journal of Autism and Developmental Disorders 2/2021

25-06-2020 | Letter to the Editor

DSM-5 and Challenges to Female Autism Identification

Auteur: Elsa K. Suckle

Gepubliceerd in: Journal of Autism and Developmental Disorders | Uitgave 2/2021

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Excerpt

As the assumed predominance of autism in males shifts and a more realistic appreciation of the gender ratio is established several questions are pertinent. 1 Do current diagnostic criteria adequately reflect the behavioural evidence seen in autistic females or does this criteria need to adjust for gender? Alternatively, is there something about how autism presents in girls and women that makes the process of identifying the same behavioural evidence more complex? These questions stem from the broader challenge of mapping and charting the underlying neurocognitive architecture of autistics on the basis of observed outward behaviour. Arguably, within female autism this process is particularly complex, as there is frequent discrepancy between observable behaviour and underlying experience (Egerton and Carpenter 2016; Szalavitz 2016). In order to address this challenge, this letter provides best practice guidelines for diagnosticians and gate-keepers to diagnosis outlining where behavioural evidence might both look different and be harder to detect in autistic females. Most importantly, the letter suggests that it is not that autism is a different neurocognitive entity in females, or that the diagnostic criteria fails females through inherent bias towards male prototypical signs, but rather that circumstantial factors, such as, masking, diagnostic overshadowing, environmental and temporal differences aggregate difficulties within the process of female autism identification. …
Voetnoten
1
Ratios are commonly reported as 4:1 or 3:1 boys to girls (Egerton and Carpenter 2016; Dworzynski et al. 2012: Loomes et al. 2017), but have been suggested to be as low as 2.5:1 (Kim et al. 2011), 2:1 (Zwaigenbaum et al. 2012) or 1.8:1 (Mattila et al. 2011). A cause of this discrepancy may be found in a closer examination of the study samples. In study samples including intellectual disability, the male–female ratio is likely to be lower, whereas, in study samples including normal to high IQ, the ratio is likely to be greater. Furthermore, Happé suggests that studies including girls and women are generally not fully representative as they predominately focus on only diagnosed participants and, consequently, far less is known about those who are not officially diagnosed (Happé 2019). As discussed below, it is this, frequently hidden, subset of the autistic population, along with more complex and hard to diagnose cases of female autism, which is the focus of this letter.
 
2
Dunne (2015) describes the Internet as providing her with ‘an online tribe for the tribeless, a diaspora of aliens in a neurotypical universe.’.
 
3
For example Wrong Planet, Talk about Autism.
 
4
This is well captured in Rebecca Westcott and Libby Scott’s collaborative writing on autism from a semi-autobiographical perspective of a young female adolescent: ‘Anxiety rating: 9. And believe me when I tell you that an anxiety rating this high at home would mean an instant meltdown. But I’m here with everyone and I can’t let my true feelings out, so instead they’re all bottled up, eating away at me from the inside like nasty little insects’ (Westcott and Scott 2020).
 
Literatuur
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Metagegevens
Titel
DSM-5 and Challenges to Female Autism Identification
Auteur
Elsa K. Suckle
Publicatiedatum
25-06-2020
Uitgeverij
Springer US
Gepubliceerd in
Journal of Autism and Developmental Disorders / Uitgave 2/2021
Print ISSN: 0162-3257
Elektronisch ISSN: 1573-3432
DOI
https://doi.org/10.1007/s10803-020-04574-5

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