“Only Boys Can be Autistic”: A Qualitative Exploration of Gender Stereotype and Socialization on the Diagnostic Journey

Abstract

Background:

Prior research exploring phenotypic gender differences in autism suggests that females are less likely to meet the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria and receive a diagnosis. Recent findings also propose camouflaging and gendered expectations impact diagnostic rates for those who were not socialized as males, suggesting a male-oriented stereotype and bias within the diagnostic system. As such, this article explores how the male stereotype of autism impacts the diagnostic trajectory of autistic adults.

Methods:

In total, 24 autistic individuals, consisting of 14 genderqueer, 8 female, and 2 male participants, shared their experiences with the diagnostic system through interviews. The research team conducted a reflexive thematic analysis using theories of gender socialization and feminist disability models.

Results:

Themes revealed that the male gender is inexplicitly tied to diagnostic representation of autistic individuals, failing to encompass the difficulties experiences of those socialized as females. Clinicians and family members often gave a differential interpretation of symptoms for those who did not identify as male, leading to late or missing diagnoses. Lastly, participants discussed how their socialization as a female directly led to the suppression of their autistic traits.

Conclusion:

These findings shed light on the pervasive impact of gender stereotypes on diagnosis and recognition of autism.

Community Brief

What was the purpose of this study?

Research shows that girls and women are often less likely to be diagnosed with autism because their challenges can look different from those typically seen in boys. On top of that, some people may mask their difficulties to fit in, which makes spotting the signs even harder. Since many diagnostic tools and clinicians’ understanding of autism are based on the idea that it mostly affects boys, this article looks at how that stereotype creates barriers for non-male individuals to get an accurate diagnosis.

What did the researchers do?

We interviewed 24 autistic adults. Of these, 14 identified as genderqueer, 8 as female, and 2 as male. We used reflexive thematic analysis, a method that considers both the researchers’ identities (being autistic, etc.) and explains common themes by relating them to other research in the field about disability and gender.

What were the results of the study?

Our first theme showed that autism is often seen only as a “male” condition, which has led clinicians and family members to overlook the participants’ autism. In another theme, participants shared that the traits that are seen as autistic in males—like their male cousins or siblings—weren’t seen as autism in them. Overall, participants felt that their gender and the expectations that were associated with their gender impacted how they expressed their autism and how others perceived it.

How will these findings help autistic adults in the future?

This suggests that the diagnostic system may be even more biased than researchers originally thought and that there may be people missing diagnoses as a result.