Geschlechtsunterschiede in der Autismusdiagnostik

Zusammenfassung

Die Autismus-Spektrum-Störung (ASS) wird vor allem bei Jungen und Männern diagnostiziert. Es gibt Hinweise darauf, dass dies auch daran liegt, dass Autismus bei Mädchen und Frauen oft nicht oder spät diagnostisch erkannt wird. Diese Studie untersuchte Geschlechtsunterschiede in der Diagnostik, vorrangig im Diagnosealter und Fehldiagnosen, im Weiteren im Unterstützungsbedarf, der psychischen Gesundheit und der Lebenszufriedenheit bei ASS. Es wurden Daten von 659 in Bayern lebenden Autist:innen im Alter von 3–67 Jahren im Rahmen einer Online-Fragebogenstudie erhoben (215 davon weiblich). Frauen mit ASS wurden im Mittel 7–11 Jahre später diagnostiziert als Männer und erhielten mit höherer Wahrscheinlichkeit mindestens eine Fehldiagnose. Sie hatten häufiger unerfüllten Unterstützungsbedarf im Bildungsbereich und komorbide internalisierende psychische Störungen als Männer mit ASS. Die Ergebnisse dieser Studie zeigen einen deutlichen Geschlechtsbias in der Diagnostik von ASS in Deutschland und weisen somit auf Optimierungsbedarf hin.

Abstract

Autism spectrum condition (ASC) is predominantly diagnosed in boys and men. There is evidence that this is also because girls and women with ASC don’t receive a diagnosis, or, if they do, only later in life. This study investigates gender differences in diagnosis, support needs, mental health, and life satisfaction among individuals with autism spectrum condition (ASC) in Germany. Data of an online questionnaire study with 659 persons with ASC from 3–67 years of age living in Bavaria, Germany, were analyzed (215 thereof were female). It was found that women with ASC are diagnosed 7–11 years later than men and are more likely to receive at least one misdiagnosis. They are more likely than men to have unmet educational support needs and comorbid internalizing psychiatric disorders. The results of this study point towards a strong gender bias in clinical diagnosis of ASC in Germany and need for improvements in the case of women.

Schlüsselwörter

Autismus-Spektrum-Störung - Geschlechtsunterschiede - Frauen - Diagnostik - Geschlechtsbias

Key words

Autism spectrum condition - gender differences - women - diagnosis - gender bias

Publication History

Received: 01 May 2022

Accepted: 23 February 2023

Article published online:
05 May 2023

• Literatur

• 1 American Psychiatric Association. American Psychiatric Association, Hrsg. Neurodevelopmental disorders: DSM-5 selections. Arlington, VA: American Psychiatric Association Publishing; 2016
• 2 Kenny L, Hattersley C, Molins B. et al. Which terms should be used to describe autism? Perspectives from the UK autism community. Autism 2016; 20: 442-462 DOI: 10.1177/1362361315588200.
• 3 Kirkovski M, Enticott PG, Fitzgerald PB.. A review of the role of female gender in autism spectrum disorders. J Autism Dev Disord 2013; 43: 2584-2603 DOI: 10.1007/s10803-013-1811-1.
• 4 Van Wijngaarden-Cremers PJM, van Eeten E, Groen WB. et al. Gender and Age Differences in the Core Triad of Impairments in Autism Spectrum Disorders: A Systematic Review and Meta-analysis. J Autism Dev Disord 2014; 44: 627-635 DOI: 10.1007/s10803-013-1913-9.
• 5 Schuwerk T., Kunerl E., Witzmann M., Schilbach L.. Bayerische Autismus-Umfrage 2019: Ergebnisbericht. 2020 https://nbn-resolving.org/urn:nbn:de:bvb:m347-dtl-0000001810
• 6 Rynkiewicz A, Janas-Kozik M, Słopień A.. Girls and women with autism. Psychiatr Pol 2019; 53: 737-752 DOI: 10.12740/PP/OnlineFirst/95098.
• 7 Rynkiewicz A, Schuller B, Marchi E. et al. An investigation of the ‘female camouflage effect’ in autism using a computerized ADOS-2 and a test of sex/gender differences. Mol Autism 2016; 7: 10 DOI: 10.1186/s13229-016-0073-0.
• 8 Bargiela S, Steward R, Mandy W.. The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. J Autism Dev Disord 2016; 46: 3281-3294 DOI: 10.1007/s10803-016-2872-8.
• 9 Green RM, Travers AM, Howe Y. et al. Women and Autism Spectrum Disorder: Diagnosis and Implications for Treatment of Adolescents and Adults. Curr Psychiatry Rep 2019; 21: 22 DOI: 10.1007/s11920-019-1006-3.
• 10 Halladay AK, Bishop S, Constantino JN. et al. Sex and gender differences in autism spectrum disorder: summarizing evidence gaps and identifying emerging areas of priority. Mol Autism 2015; 6: 36 DOI: 10.1186/s13229-015-0019-y.
• 11 Lai M-C, Lombardo MV, Pasco G. et al. A Behavioral Comparison of Male and Female Adults with High Functioning Autism Spectrum Conditions. PLoS ONE 2011; 6: e20835 DOI: 10.1371/journal.pone.0020835.
• 12 Lundin K, Mahdi S, Isaksson J. et al. Functional gender differences in autism: An international, multidisciplinary expert survey using the International Classification of Functioning, Disability, and Health model. Autism Int J Res Pract 2020; 1362361320975311 DOI: 10.1177/1362361320975311.
• 13 May T, Cornish K, Rinehart N.. Does gender matter? A one year follow-up of autistic, attention and anxiety symptoms in high-functioning children with autism spectrum disorder. J Autism Dev Disord 2014; 44: 1077-1086 DOI: 10.1007/s10803-013-1964-y.
• 14 Baldwin S, Costley D.. The experiences and needs of female adults with high-functioning autism spectrum disorder. Autism 2016; 20: 483-495 DOI: 10.1177/1362361315590805.
• 15 Ramsey RK, Nichols L, Ludwig NN. et al. Brief Report: Sex Differences in Parental Concerns for Toddlers with Autism Risk. J Autism Dev Disord 2018; 48: 4063-4069 DOI: 10.1007/s10803-018-3583-0.
• 16 Begeer S, Mandell D, Wijnker-Holmes B. et al. Sex Differences in the Timing of Identification Among Children and Adults with Autism Spectrum Disorders. J Autism Dev Disord 2013; 43: 1151-1156 DOI: 10.1007/s10803-012-1656-z.
• 17 Hull L, Petrides KV, Mandy W.. The Female Autism Phenotype and Camouflaging: a Narrative Review. Rev J Autism Dev Disord 2020; 7: 306-317 DOI: 10.1007/s40489-020-00197-9.
• 18 Leedham A, Thompson AR, Smith R. et al. ‘I was exhausted trying to figure it out’: The experiences of females receiving an autism diagnosis in middle to late adulthood. Autism 2020; 24: 135-146 DOI: 10.1177/1362361319853442.
• 19 Albantakis L, Brandi M-L, Zillekens IC. et al. Alexithymic and autistic traits: Relevance for comorbid depression and social phobia in adults with and without autism spectrum disorder. Autism 2020; 24: 2046-2056 DOI: 10.1177/1362361320936024.
• 20 Hull L, Lai M-C, Baron-Cohen S. et al. Gender differences in self-reported camouflaging in autistic and non-autistic adults. Autism 2020; 24: 352-363 DOI: 10.1177/1362361319864804.
• 21 Leiner DJ.. SoSci Survey. 2019 Im Internet www.soscisurvey.de
• 22 MacKay T, Boyle J, Connolly M. et al. The microsegmentation of the autism spectrum: economic and research implications for Scotland. 2018
• 23 RStudio Team. RStudio: Integrated Development Environment for R. Boston, MA; 2020. Im Internet: www.rstudio.com
• 24 Loomes R, Hull L, Mandy WPL.. What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis. J Am Acad Child Adolesc Psychiatry 2017; 56: 466-474 DOI: 10.1016/j.jaac.2017.03.013.
• 25 Raffelhüschen B, Grimm R.. Deutsche Post Glücksatlas 2019. 2019
• 26 Hirvikoski T, Mittendorfer-Rutz E, Boman M. et al. Premature mortality in autism spectrum disorder. Br J Psychiatry 2016; 208: 232-238 DOI: 10.1192/bjp.bp.114.160192.
• 27 Albantakis L, Schilbach L.. Differenzialdiagnostik von Störungen der sozialen Interaktion & Autismus im Erwachsenenalter. PiD – Psychother Im. Dialog 2020; 21: 36-40 DOI: 10.1055/a-0987-5193.
• 28 Kanfiszer L, Davies F, Collins S.. ‘I was just so different’: The experiences of women diagnosed with an autism spectrum disorder in adulthood in relation to gender and social relationships. Autism 2017; 21: 661-669 DOI: 10.1177/1362361316687987.
• 29 Rapsey CM, Scott KM, Patterson T.. Childhood sexual abuse, poly-victimization and internalizing disorders across adulthood and older age: Findings from a 25-year longitudinal study. J Affect Disord 2019; 244: 171-179 DOI: 10.1016/j.jad.2018.10.095.
• 30 Sasson NJ, Morrison KE.. First impressions of adults with autism improve with diagnostic disclosure and increased autism knowledge of peers. Autism 2019; 23: 50-59 DOI: 10.1177/1362361317729526.
• 31 Schmidt L, Kirchner J, Strunz S. et al. Psychosocial Functioning and Life Satisfaction in Adults With Autism Spectrum Disorder Without Intellectual Impairment: Psychosocial Functioning in Autism. J Clin Psychol 2015; 71: 1259-1268 DOI: 10.1002/jclp.22225.
• 32 Cumin J, Pelaez S, Mottron L.. Positive and differential diagnosis of autism in verbal women of typical intelligence: A Delphi study. Autism 2021; 136236132110427 DOI: 10.1177/13623613211042719.