The Female Profile of Autism: An Examination of Friendships

Background:   Research has indicated that there are as many as four times the numbers of males diagnosed with High Functioning Autism (HFA) than females. The growing body of research which focuses on girls with HFA questions the assumption of gender invariance in HFA. Clinical observations suggest that HFA girls superficially demonstrate better social and emotional skills than boys with HFA and this may camouflage other diagnostic features. This in turn, may explain the under diagnosis of girls with HFA.

Objectives:   This study aims to explore the skewed gender distribution observed within this population and determine whether sociability and emotionality are camouflaging HFA girls from diagnosis.

Methods:   Seventy-five 10-16 year old boys and girls (HFA girls: 18, TD girls: 25, HFA boys: 15, TD boys: 17) were interviewed (using the Friendship Questionnaire (FQ)). High scores on the FQ indicate that the child experiences close, empathetic and supportive relationships. One parent of each child also completed the FQ about their child to assess differences in perception of the quality and quantity of friendships.

Results:   Independent of diagnosis, girls were found to have higher empathy than boys. Further, irrespective of their gender, HFA children demonstrated lower empathetic relationships compared to TD children. Also, the effect of HFA did not depend upon gender, meaning that both genders had a similar reduction in empathetic relationships which was associated with a diagnosis of HFA. Interestingly, while the interaction between gender and diagnosis was not significant, TD girls and HFA girls also did not demonstrate any differences between empathy scores; however, HFA girls and TD boys displayed the same degree of empathetic relationships.

Conclusions: As HFA girls scored on empathy at similar levels to TD girls, and TD boys and HFA girls demonstrated no differences between their scores, HFA girls appear to function at the level of TD boys, or even some TD girls.  Despite their diagnosis of HFA, they appear to function at normal levels with respect to empathy, and thus may be camouflaged.  It is only when assessment went beyond this superficial level that differences in HFA girls became apparent, and they are seen to function more like HFA boys.

Unsuspecting clinicians, or those with unwarranted assumptions about diagnostic characteristics, may thus conclude inaccurately that the female child was not autistic.  Girls with indications that they may be autistic must be carefully assessed, and the clinician should not assume that because they may demonstrate a TD male friendship style, that they are not autistic.