Autism in Women and Girls

Autism is a neurodevelopmental condition characterised by differences in the way people process the world and interact with others around them. We are academics who work closely with autistic people and their families to conduct research into the mental health and wellbeing of autistic people, including girls and women. This blog post describes some of the health areas where we know autistic women and girls may be uniquely affected, and which we feel are priorities for future research.

Diagnosis

Autism is diagnosed in boys and men 3 or 4 times more often than in girls and women. Interestingly, research conducted by Laura and colleagues suggests that this ratio is higher (i.e. relatively more boys and men are diagnosed) when the people included have known clinical diagnoses, compared to studies where everyone in a population is screened for autism. This suggests that there may be biases against autistic women and girls receiving an accurate and timely diagnosis in clinical services. More research is needed to understand the social and contextual factors that might impact girls’ and women’s access to diagnosis, and how they might impact autistic people of all genders.

Mental Health

Autistic people of all genders are more likely to experience mental health conditions compared to the general population, with up to 70% of autistic adults having at least one mental health condition. Gender-related disparities in mental health conditions in the general population are also seen in autistic people, with Felicity’s research showing that autistic women and non-binary people are more likely to report anxiety and eating disorders compared to autistic men. In adolescence, autistic girls are also more likely to seek emergency psychiatric care than autistic boys, with particularly high levels of suicide or self-harm.

The mechanisms underlying these mental health conditions may be different for autistic people compared to non-autistic people. For instance, autistic women’s eating disorders may be driven in part by sensory experiences, including sensory responses to specific foods and the experience of bodily sensations associated with eating, or by the desire to control emotional states through food restriction. This is different to the shape and weight concerns that often drive eating disorders in non-autistic people. Interventions for mental health conditions that have been developed for non-autistic people should therefore be tested with autistic people, as they may not work as well or require adaptation.

Physical Health

Less is known about autistic women and girls’ physical health than mental health needs, although initial research suggests that they generally have poorer overall physical health compared to both non-autistic girls and women, and to autistic boys and men. Several health conditions associated with autism, such as epilepsy, may be more common in autistic women and girls than in men and boys. We don’t know whether gender differences in physical illness observed in the general population (such as higher rates of cardiovascular disease in men) also apply to autistic people.

Autistic women and girls may also have different experiences of physical health compared to non-autistic women and girls. Broadly, autistic women and girls are more likely than non-autistic women and girls to have endocrine disorders, such as thyroid disorders, or reproductive health conditions, such as polycystic ovary syndrome. Autistic women may also have higher levels of menopausal disorders and associated mental health problems than non-autistic women, but this needs investigation. Characteristics of autism itself may also affect women’s physical health. For instance, sensory challenges and differences in communication may make the experience of pregnancy and childbirth particularly difficult for autistic women, reflecting a broader need for health services to adapt to the needs of their autistic patients.  

Special Collection on the Health of Autistic Women: State of the Field and Future Directions

Much of the research described here focuses on autistic women in Europe, North America, and Australia; more research is needed to understand the particular health challenges experienced by autistic women and girls in developing countries. There is also limited research into the health of autistic women and girls with intellectual disability, or looking at the interaction between autism and other physical or learning disabilities. We are guest-editing a Special Collection for Women’s Health, to bring together current knowledge of autistic women’s physical and mental health needs and to identify the next steps for research in this field. Submissions are open until 30th June 2022, and we welcome any questions from authors who may be interested in submitting.

About the Authors