Hidden population? A qualitative and quantitative search for a female-phenotypic presentation of autism
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Date
01/12/2017Item status
Restricted AccessAuthor
Muggleton, Joshua Thomas Bailey
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Abstract
Anecdotally, females with autism present differently from males. However,
studies into autism tend to use a predominantly male sample, and make few
gender-based comparisons. Hence, there is relatively little research on
gender-specific presentations of autism. Furthermore, those studies that
have been undertaken are equivocal in their findings. Should males and
females with autism present differently, then the male preponderance in the
research population may lead to a bias in our understanding of autism, and
the diagnostic criteria it informs, creating circularity. This thesis aimed to
investigate if and how females with autism present differently, while avoiding
the problem of circularity.
As diagnostic criteria for autism consider behaviour (potentially biased to
favour males), the diagnosed samples of participants in studies will present
with similar behaviours, regardless of gender. However, gender differences
may persist in areas of cognition, such as block design. A literature review of
gender differences among people with autism on the block design task
revealed only one adequately powered study; this indicated a possible
gender difference. To expand the data available, a meta-analysis of studies
comparing people with and without autism on the block design task was
carried out. Then, the ratio of males and females within autism and control
groups was regressed as a proxy indicator of gender differences. This did not
reveal any gender differences.
An alternative approach was adopted within the research study. Through
asking professionals highly experienced in diagnosing autism about gender
differences in autism, it was hoped that they would express their own
conception of autism, beyond the present diagnostic criteria, thereby
avoiding circularity. A thematic analysis of interviews with 14 clinical
psychologists with expertise in this area was conducted. Gender differences
in presentation, but not underlying pathology, were noted by participants.
Trans-diagnostic constructs such as social awareness and motivation were
thought to drive the gender differences in presentation. However, although
the presentation and constructs were gender biased, they were not gender-specific,
suggesting a broader view of autism is needed beyond dichotomous
gender differences.