Autism in Women

The active ascertainment population studies have identified a higher proportion of women with ASD (2.5 to 3:1)14 than was previously documented with passive studies (4 to 5:1).8,9 The public and often medical professional's male-biased understanding of ASD makes it less likely for parents and caregivers to appropriately identify signs of ASD in women and seek timely evaluations. The male bias in ASD extends to diag-nostic criteria and tools, which have developed based on nearly a century of research predominantly focused on men. There is evidence that even clinicians specialized in ASD are more hesitant to diagnose women with ASD than men with similar presenta-tions. However, in the last few years, there is increased awareness of ASD in women and their participation in research has increased.Women with ASD often have a missed or delayed diagnosis, which increases the burden of this condition by delaying and preventing access to services, leading to less desirable developmental trajectories. Relative to the "prototypical" ASD that is more aligned with a male presentation, the clinical presentation of women is often characterized by more subtle social communication deficits, less intense and unusual RRBs, and the presence of compensatory mechanisms (eg, camouflaging) that may mask otherwise noticeable ASD symptoms. The frequent presence of mental health comorbidities (eg, ADHD, anxiety, depression) also contribute to diagnostic delays and misdiagnosis as well as highlight the heightened emotional challenges experi-ences by women on the spectrum.Below are a set of strategies clinicians may use to better support female patients for whom they have concerns about a possible ASD diagnosis.