Where Are All of Us?

Are there really more males than females with autism/Asperger’s and AD/HD?

Reading the diagnostic literature, one finds references to the “fact” that there are more autistic boys than girls. There certainly seem to be more hyperactive, inattentive boys diagnosed (and consequently treated with medication) than there are girls.

Curiously, when one reads through bulletin board sites for autistics/Asperger’s, there seems to be a pretty evenly balanced gender ratio (as far as one can discern from screen names or profiles). Looking at the “autiebiographies” available, the male to female author ratio is fairly even. However, such reviews are not necessarily going to be a representative sampling of a population. Publishing houses require authors to be able to present novel perspectives (pardon the pun), to have good written verbal skills, and may try to present a balance of authors. A bulletin board is naturally self-selecting for individuals who have computer access, a comfortable grasp on the language used, a willingness to identify one’s self as belonging there, plus just as importantly, an interest in socializing through Web media. The first two factors are universal requirements for access, but the last one is distinctive for a different reason.

Females are generally perceived by society as being more socially -oriented than are males, or more interested in people than in things, hence the “Men are from Mars, Women are from Venus” analogy or Dr. Simon Baron-Cohen’s recent writings on male/female differences. They are also perceived as having higher verbal skills than do males, or at least girls develop higher levels of verbal skills at younger ages than do boys. There is the possibility that even if women are outnumbered in these populations, they are more likely to crave socialization and be more adept at, or feel more comfortable with, socializing through the written medium of a Web board. But does the sex ratio evinced reflect this self-selection, or is it a good sampling and therefore indicative of the overall population?

Currently more males than females are diagnosed with autism and AD/HD, at a general rate of around 4:1. The causes of autism are proving to be complex; autism is not a single, simple thing, but varies in collative properties by individual. Thus far it is indicated to be polygenic and also affected by factors in embryonic development as well, as twins do not even develop similarly. It would not surprise anyone to find that males are more likely to be autistic; the susceptibility derived from only having one X chromosome is seen in a variety of genetic factors.

These off-repeated ratios are likely not true prevalence rates, but rather reflects diagnostic rates. Both autism and AD/HD are diagnosed by sets of behaviours that differ from the norm, and thus attract attention of those people who would make initial remarks (parents, teachers) leading to those individuals being brought to the attention of those who would make final assessments (pædiatricians, psychiatrists, psychologists).

Females often do not “present” in the same manner that males do. This is rather a reflection of the fact that the diagnostic criteria were based more upon behaviour of males from the sample populations than upon a gender-balanced population samples. Currently the psych field is abuzz with discussion that girls are being missed for ADD diagnoses because they present more in the Inattentive qualities. The quiet, daydreaming girl staring out the window is not a problem for her school teacher, so there is less concern about her erratic scholastic achievements. (After all, maybe it’s just a “blonde thing” /sarcasm.)

Part of autism is inherent in the “wiring” of the human brain, and part of autism is a social construct. That Kanner and Asperger both met with unusual children who gave them the impetus to dually conceive of the concept of autism at the same time in history, may have more to do with the fact that a public awareness of psychology, the development of social and scholastic statistical norms that created specific definition of abnormal, plus the evolving field of child psychology, more than any sudden incidence of autistics.

Likewise the concept of “minimal brain dysfunction” that has evolved to its current status of AD/HD reflects changing understanding, including distinctions between hyperactive, inattentive and combined forms. As mentioned, a hyperactive boy is simply more noticeable in a classroom setting than is a daydreaming girl, although they may have very similar difficulties with their school work, personal and social lives, and ultimately their adult worlds of work.

Amazingly, kids with AD/HD grow up to be adults with AD/HD, although the problems of the adult can be less “noticeable” because adults can develop coping mechanisms (including the acquisition of helpful spouses who eventually become very frustrated if no one realises what’s really going on). Likewise, the addition of Asperger’s to the DSM and ICD criteria reflects a greater understanding of the breadth of autistic expression, and the number of adults that would now qualify for an AS diagnosis is far greater than those who actually have such a diagnosis, simply because it was not available as a diagnosis during the school years when such things are often diagnosed. The lack of available diagnoses is not the same thing as the lack of diagnosable individuals existing.

Just as autistics sometimes face the gross error of being misdiagnosed with schizophrenia, mental retardation or other disorders, females face the similar problem of being misdiagnosed with personality disorders. The complementary dilemma to Misdiagnoses are the Missed Diagnoses, those girls and women who continue to struggle through life never understanding why they feel so different and why they find many things difficult. For these people the secondary problems with relationships, schooling and work result in lifelong stress and all too frequently in depression.

To better understand how autism or AD/HD affects the abilities of females, we need to better understand how to recognize them and to be able to see those cues when they are expressed in girls and women.

9 Comments

  1. pamelagraydon said,

    19 January 2013 at 20:03

    As a person who undoubtably has ADHD (and had the elementary and high school experiences to prove it!), and is now a special education teacher, I find this whole field facinating.
    I find it interesting to look at the latest research being done on “extroverstion versus introversion” that talks about extroverts needing a high level of stimulation in order to learn and/or function effectively, whereas introverts need low levels of stimulation and are easily overwhelmed by stimuli at which point their learning is reduced. I find it interesting to look at the list of what constitutes an extrovert – it looks virtually identical to the way that we identify ADHD. So we have two different groups in society – those that thrive and learn best in the midst of much stimulation (eg noise, activity, frequent change), and those who learn best with little external stimulation (they need quiet, lack of change and are easily overwhelmed by stimuli). Intersting, isn’t it? Maybe we just structure our schools so that they are most condusive to the introverts (stimuli avoiding) students, and label those who are extroverts as having a disability?
    At university I was able to find my own way of studying – I would do it in the midst of a noisy cafeteria where I was surrounded by “white noise”. I would cope with focusing on a lecture by upping the activity level by writing personal reflections, drawing connections to the lecture, or searching through textbooks to find specific references that related to each individual part of the lecture as it progressed – it was not enough stimulation to just listen to the lecture and take notes as my mind would wander off – I needed to make the activity more challenging and more interactive.
    I also wonder if one reason that girls get identified less with ADHD than boys has to do with the way that they manifest the ADHD. Many girls manifest it through constant chattering to the person near them, or, in the case of younger children, calling out answers (impulse control). I know my desk seemed to be permanently placed at in the back corner, or out in the hall, as a child. But girls don’t tend to be labelled as a problem because basically their behaviour is still seen as a variant of normal and is more socially acceptable. They just get comments on their report cards such as “needs to spend less time socializing with friends and more time working”. Boys are more likely to be out of their desk or throwing things at a friend or physically acting out in ways impulsively- seen as less acceptable behaviours.
    I’m generalizing of course, but I think this may be the underlying explanation for the difference in incidence of ADHD for boys versus girls. The diagnosis of ADHD only occurs at the point at which ADHD affects the learning of the child or at the point at which it becomes so disruptive that it affects the learning of other students. So maybe that is the point at which the difference occurs?

    • andrea said,

      23 January 2013 at 3:36

      Interesting thoughts … I’m an introvert with ADHD, and socially noisy backgrounds are /way/ too distracting! To really focus on studies, I have to be away from others. Sometimes I listen to instrumental music as a means of supplying extra sensory input.

      Doodling while taking notes (and also as a means of taking notes) is a strategy that works well for some people.

      And yes, the way that ADHD “presents” in girls is somewhat out of synch with the way it has been historically described, which reduces the identification percentages. (Ditto Aspergers/autism.)

      Andrea

  2. Joyce said,

    22 August 2011 at 22:47

    When i learned about AD/HD i really suspected that i have it, but when i went for a test in my country (China), the doctor refused to diagnose me because i wasn’t hyperactive and failing school when i was young. My grades have always been okay, and sometimes good, i just like dancing and arts more than my classmates.

    But it seems like i was and still am forgetting things quite easily. I remember as a kid there was a time i won a prize for story writing, but i could not find the paper certificate for the prize when i arrived home. I didn’t recall being distracted on the way back home, but i must have been distracted or else i wouldn’t have lost it.

    I never really did my homework, but when i did do them my grades were very good.

    Then again, don’t kids all daydream and get distracted from time to time when they were growing up??

    I really don’t know if i have it….. do you think i have it Andrea?

  3. nightworrier said,

    18 November 2007 at 9:02

    I have a few problems but ADHD has been the most obvious throughout my life. BTW I’m female.
    Peace,
    NW

  4. 1 June 2007 at 23:05

    […] More boys than girls are diagnosed, but I have to wonder if that isn’t due more to diagnostic criteria than actual prevalence rate. Why didn’t we see kids with these kinds of “needs” in […]

  5. MzBizzy said,

    3 January 2007 at 12:04

    I am trying to create a blog like this… Good Luck

  6. qw88nb88 said,

    19 July 2006 at 22:12

    Hah! I too got my own difficulties diagnosed in the past few years (and not all of those even have official documentation) — when I began attending college full-time. I was tutoring students with various LDs, and it began to dawn on me, “Wait a minute…”

  7. Jane Strauss said,

    19 July 2006 at 21:19

    This reminds me of the silliness of the assumption that learning disabilities were predominantly found in boys. Of course that assumption, common in the 1960s through 1980 or so, was based on some faulty research conducted in the early 60s…teacher-referred samples were assessed for learning problems at the University of Minnesota, and amazingly enough were found to have learning problems. the teacher-referred kids were of course mostly active boys who were causing problems in classroom management for their young female teachers.

    By the mid to late 1970s, the Reading and Study Skills Center at that same University was finding that 99% of the new LD diagnoses of college students made were, you guessed it , females. The girls had not made waves, but had not achieved to their potential in K-12 programs. Many finally made it into the University and were finally able to get help with problems they had had for years. Around that same time other, unbiased studies started to show approximately equal numbers of both genders with dyslexia and other learning issues.

    Food for thought, I think, from an adult who was always into stimming, had 5 kids (3 girls, 2 boys) all of whom were early labeled as having “autistic-like behaviors” as little kids with language and motor planning issues, and was finally diagnosed an Aspie last year at past 50….

  8. Jannalou said,

    11 July 2006 at 17:24

    I want to know the actual incidence of comorbid AS & ADHD, especially in women.

    And I agree – we need a lot more research into how these things affect girls/women. I bet the incidence is actually fairly near equal between genders.


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