Functional gender differences in autism: An international, multidisciplinary expert survey using the International Classification of Functioning, Disability, and Health model.
Autistic girls camouflage more and look less "classic," so tweak your assessment to hunt for quiet anxiety and rehearsed social skills.
01Research in Context
What this study did
Lundin et al. (2021) asked 64 autism experts from 13 countries to rate how autistic girls and boys differ.
They used the ICF model: body functions, activities, participation, and environment.
Each expert scored 31 statements about gender differences on a 9-point scale.
What they found
The experts agreed: autistic females look less "classic," show more anxiety and depression, and work harder to hide traits.
They also said girls face different peer problems and social motives than boys.
In short, girls camouflage more and are easier to miss.
How this fits with other research
Delgado-Lobete et al. (2020) asked autistic adults to self-report camouflaging. Women scored higher than men on the CAT-Q, backing up the expert view.
Begeer et al. (2013) already showed girls get diagnosed later. Karl’s team explains why: girls don’t fit the male template clinicians expect.
Green et al. (2020) seems to disagree. They found no sex difference in internalizing symptoms among autistic kids without intellectual disability. The clash fades when you note age and ID status: Karl’s experts saw the full spectrum, not just kids without ID.
Spackman et al. (2023) adds a mechanism: girls display more subtle sensory repetitive behaviors, so standard tools under-count them.
Why it matters
Update your intake forms. Add questions about social masking, sensory preferences, and internalizing mood. During observation, watch for quiet compliance, not just obvious repetitive play. If a girl’s eye contact is too good, ask yourself who taught her. Probe friendships: conflict frequency, peer group size, and how she repairs fights. These small tweaks catch the girls who otherwise slide through the cracks.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add two intake questions: 'Do you feel you copy others to fit in?' and 'How often do you feel anxious in groups?'
02At a glance
03Original abstract
In this study, we explored if professionals working with autistic people in different regions of the world perceive differences between females and males diagnosed with the condition. A total of 131 professionals responded to a survey that included an open question about gender differences in autism. Of these, 32 responded that they do not perceive gender differences in autism. The information provided by the other 99 experts was analyzed to identify common patterns. Three main differences were found, (1) Matching the clinical conceptualization of autism where professionals described differences in core symptoms of autism, and that autistic females were less similar to the conceptualization of autism. In (2) Co-existing problems, professionals described that autistic males display more apparent problems including hyperactivity, while autistic females were perceived as having more internalizing issues such as anxiety and eating disorders. In the last category, (3) Navigating the social environment, experts perceived autistic females as more socially motivated, and more inclined to camouflage social difficulties, making their challenges less evident. Professionals also perceived differences in the social environment, for example, that autistic girls receive more support from their peers while autistic boys are more often bullied. Our results suggest that professionals working in different parts of the world acknowledge gender differences in autism, but also that there might be some regional differences. Finally, we found that gender differences reported by the international professionals could largely be assessed with a shortened version of the International Classification of Functioning by the World Health Organization, specifically developed for autism.
Autism : the international journal of research and practice, 2021 · doi:10.1177/1362361320975311