“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.

Introduction

There currently is little understanding of why femalesa are diagnosed with autism at significantly lower rates than males. Research has largely replicated the discrepancy between male and female diagnoses of autism with male-to-female ratio of diagnosis differing up to 4:1.^1,2 However, recent epidemiological research has reported a significantly lower male-to-female autism ratio, of 2.5:1.³ Historically, researchers accredited this difference to a higher likelihood^b of males being autistic; however, current research is uncovering other factors that may influence this gender^c difference.^1,7 Current evidence suggests researchers and clinicians have consistently overlooked and underdiagnosed autism in female and genderqueer^d individuals.²

A great amount of research has explored phenotypic differences between autistic boys and girls.^e,^4,5 Some researchers suggest autistic females tend to have a milder outward expression of autism. This may lead those who are socialized as females to be less likely to meet the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, criteria and to receive a diagnosis later in life than their male counterparts.⁶ Studies support these findings conveying that females require more risk factors, such as genetic mutations or higher level of familial aggregation of autism, to exhibit the traits of autism.⁸ This phenomenon, referred to as the “female-protective effect,”⁸ fails to take into account clinician bias and pervasive stereotypes that may further drive diagnostic inaccuracies. Others report there are significant differences in phenotype, as girls tend to score lower than boys on measures of restricted and repeated behaviors (RRBs).^9–11 Considering current diagnostic standards emphasize RRBs, this focus may explain the underdiagnosis of autism in those socialized as females.¹² However, overall, differences of phenotype found in autism research for autistic male and female individuals remain inconsistent.¹³ Additional explorations of diagnostic differences by gender identity, as an explicitly explored construct rather than an assumed identity based on sex, have not been made. This has led to a gap in the understanding of the diagnostic trajectories of both females and gender diverse individuals.

Autism research has proposed that higher rates of camouflaging may be another explanation for the diagnostic disparities, since autistic girls might appear to have better social skills due to practicing and scripting behaviors from other people.^13–17 Camouflaging is a social strategy to cope with social situations by blending in with neurotypical individuals or hiding autistic traits,¹⁵ which inherently impacts how one’s internal characteristics are displayed externally on a diagnostic measure. While camouflaging is prevalent in both autistic males and females, camouflaging’s complex nature creates an unclear picture of whether autistic females camouflage more than males,¹⁷ considering camouflaging also should not be conflated with the impacts of the female protective effect.⁵ Some research suggests that societal expectations for female-identifying individuals have caused them to refrain from getting a diagnosis due to increased pressures to fit in and socialize with neurotypical traits.^13,14,16 As per traditional gender norms, this is rooted in the notion that womanhood is associated with emotionality, sensitivity, and nurturing, while manhood is often associated with logic, toughness, and stoicism.¹⁸ Autistic female individuals, however, tend to present to neurotypical populations as socially awkward or assertive early on, which often leads to friends and family ostracizing or constantly criticizing through avenues such as relational aggression.¹⁸ Thus, to avoid isolation, many females report “performing gender” so as to appear “normal”—neurotypical—masking their “abnormal”—autistic—traits.¹⁸ Lai and colleagues validated these observations,¹⁹ finding that autistic females reported more lifetime sensory differences and fewer social communication difficulties than males.^2,19 Additionally, research suggests that these differential challenges are driven by a different social environment and gendered socialization.²⁰ Though camouflaging may play a part in the discrepancy of diagnosis rates, it is likely not the whole explanation, as there is no clear answer as to whether autistic female and male individuals really do mask at different levels, accounting for the differences seen in diagnostic rates.^15,17,20

Gendered expectations may also partially account for the underdiagnosis of autism in females both in forms of gender performativity and precarity.²¹ Specifically, gender socialization causes autistic AFABs to perform gender often in the form of actions or interests. This then impacts their gendered precarity, or the differential conditions that cause their support networks to fail in recognizing the need for a diagnosis. For example, autistic individuals socialized as female report having “gender accepted/normal” special interests, such as jewelry, art, and animals.¹⁸ Parents may, for instance, inaccurately receive a restricted interest in dolls as pretend play, even if the intensity of the interest remains unusual. Furthermore, girls who exhibit social difficulties that are not related to hyperactivity or aggression, which are usually foundational in autism referrals but more accurate to the male presentation of autism, may also cause clinicians or parents to misinterpret these difficulties as the individual merely exhibiting traditionally feminine traits of shyness or passivity.¹⁸

Furthermore, gender differences in the rates of co-occurring mental health difficulties may also play a role in the diagnostic rates of females and males. While females on the spectrum report higher rates of internalizing difficulties, such as anxiety and depression,^22,23 they report lower rates of externalizing difficulties, such as substance use difficulties and conduct issues in contrast to their male counterparts.^22,24,25 Less externalizing difficulties in autistic females may contribute to referral bias,^26–28 while co-occurring internalizing difficulties may make it more difficult to identify autism, lead to misdiagnoses, or delay diagnoses.^29,30 Studies have also found that autism may have an additive effect on internalizing difficulties in females.³¹ Again, these factors may bolster the under-identification and delayed treatment of autism in those socialized as females.

Further to this, newer research presents the fact that those socialized as females are largely absent from samples in autism research.³² In most cases, clinicians diagnose women and gender diverse individuals later in life and less frequently, resulting in their absence from autism studies involving younger subjects.^6,32–34 This underrepresentation may have influenced results of research to show that there are no phenotypic differences due to gender because the female participants are likely exhibiting stronger, more masculine autistic traits, and those who are missing from these studies represent key unknown and unique phenotypes that enable their diagnosis avoidance.³² The cycle of exclusion of female and gender diverse individuals from autism diagnosis directly bars their entrance into heavily funded autism research, such as intervention and diagnostic research for autistic youth, to correct these biases, causing their lack of representation to be perpetuated. Considering most research samples have more women than men,^35,36 the continuous exclusion of gender diversity further perpetuates the researched understanding of the “binary” and does not allow for nuances by gender identity to be noticed.

The current diagnostic criteria for autism diagnostic instruments may also be contributing to the disparity in diagnostic rates. Research suggests the current diagnostic criteria may continually be excluding those socialized as females from getting diagnosed due to its construction from male-based phenotypes.³² Research has utilized majority male samples to create the majority of gold standard autism diagnostic instruments, leading researchers to question the validity of their application to those socialized as females.³² This bias results in female diagnosis being restricted solely to areas where females display traits similar to males, meaning specific traits of autism of those socialized as females are often missed.³⁶

Further investigation into the diagnostic instruments involved in the diagnostic journey of those socialized as females is important. If we accomplish this, then we can learn about the barriers causing gender diverse and female-identifying individuals to miss an early diagnosis and understand differences in their autism characteristics. This study will further inform the validity of the current autism diagnostic instruments by investigating various autistic individuals’ diagnostic experiences. The current study hopes to encourage the creation of gender-specific criteria that provide better representation and accessibility for non-binary^f and female individuals to obtain an autism diagnosis if desired by providing the perspective of diagnosis from a diverse sample of gender identities. With this, we asked the following research question: How does gender socialization, through performance and precarity, impact the experience of receiving a diagnosis or identifying as autistic?

Methods

The present study is the first segment of a two-part study examining the experiences of autistic adults attempting to receive an autism diagnosis in the context of their gender identity. This qualitative study used brief semi-structured interviews to establish the experiences of autistic adults depending on their gender identities, specifically shedding light on the contrasting diagnostic experiences of those who were socialized as females. The second part of this study aims to explore the experiences of specifically autistic, gender diverse individuals and their concept of gender.

Participants

Participants were 24 autistic individuals with a clinical diagnosis of autism (n = 16) or self-identified autism (n = 8). While at least one of the self-identified participants are now formally diagnosed, this was a characterization of the individuals at the time of the interview. Participants identified as non-binary, agender, or genderfluid (n = 14), female (n = 8), and male (n = 2). While one of our participants had multiple identities, she identified the primary/host self as female, so we counted her demographically as female despite having multiple identities. To clarify terminology, these demographics are based on participants’ reported gender identity. However, some participants spoke about their experiences socializing as one specific gender that may or may not match their current gender identity. With these distinctions, we received feedback to utilize the term “being socialized as female/male” to distinguish the experiences of participants who underwent the process of gender socialization for one specific gender rather than using their sex assigned at birth (SAAB). We utilized these terms to honor participant perspectives on their own gender socialization journey, having varied significantly from one another, as SAAB did not necessarily indicate their socialization experiences.

Our sample was majority White (79%) and only speaking individuals (see Table 1 for the full demographic breakdown of our participants), despite speaking ability not being a part of the inclusion criteria. Inclusion criteria for the present study were (1) living in the United States, (2) being at least 18 years old, and (3) identifying as autistic. We invited both clinically diagnosed and self-identified individuals to take part in the study to ensure greater discovery of the barriers faced by individuals trying to get diagnosis as well as inclusion of individuals assigned female at birth who may be misdiagnosed. Detailed participant demographic information can be found in Table 1. Names were changed for anonymity.

Table 1.

Participant Characteristics

Participant ID	Age	Gender identity	Pronouns	Ethnicity	Age of diagnosis	Formally diagnosed/self-identified
Henry	31	Male	He/him	White	26	Formally
Harper	21	Non-binary	They/them	n/a	20	Formally
Eleanor	20	Female	She/her	White/European	20	Formally
Charles	33	Male	He/him	White	33	Formally
Amelia	18	Female she/her (uncertain)	She/her (uncertain)	White/European American	17	Formally
Ari	18	Agender/non-binary	They/them	White	16	Formally
Evelyn	41	Female	She/her	Scottish/Irish	N/A	Self-identified
James	22	Non-binary	They/them	Middle Eastern	18	Formally
Rosalie	19	Female	She/her	White	11	Formally
Avery	29	Degendered/gender fluid	They/them	Caucasian	28	Formally
Katherine	47	Female (core/host self)	She/they	White/Caucasian	N/A	Self-identified
Alex	27	Non-binary/agender	They/them	Ashkenazi Jewish	N/A	Self-identified
Isabella	20	Female	She/her	Hispanic, Latino, and White	17	Formally
Lewis	21	Transmasc non-binary	He/they	White, Non-Hispanic	N/A	Self-identified
Blake	18	Gender fluid	They/them	White and Hispanic	18	Formally
Finley	19	Non-binary	They/them	White	N/A	Self-identified
Wendy	39	Female	She/her	Vietnamese	N/A	Self-identified
Ellis	38	Agender	They/them	White, non-Hispanic	N/A	Self-identified
Jordan	28	Genderfluid	Any	White	27	Formally
Samara	24	Female	She/her	White	21	Formally
Rowan	20	Non-binary/agender	She/they	Latino	18	Formally
Ash	19	Trans non-binary	Any	White	N/A	Self-identified
Morgan	31	Non-binary	They/them	White	29	Formally
Taylor	24	Transmasc non-binary	They/them	White	19	Formally

Procedure

The research team recruited autistic individuals via two routes: social media recruitment and distribution of institutional review board–approved fliers via email. Recruitment materials asked participants to discuss their autism diagnostic journey within the context of their gender identity and invited participants of all gender identities to participate. We invited the participants to schedule a brief 10- to 40-minute Zoom interview (M = 19.07). The interview length was determined by how much the participants wished to discuss the topic, which significantly varied from participant to participant. While most of our questions were open ended and allowed participants to elaborate, as we wrote to the participants in an instruction guide that included the questions, the short nature of the questions allowed for participants who found the topic of their gender identity and autism diagnostic journey to be a sensitive topic to address what they wanted to quickly. In one circumstance, the interview questions were answered via email due to internet failure. Participants received interview questions and the study information sheet prior to their interview and gave verbal or written consent at the beginning of each interview. We provided the participants with the option to keep their videos off depending on preference, which the interviewers matched. The University of California, Los Angeles, institutional review board granted ethical approval for this study.

Measures: Interview questions

The interviewers used an interview guide for the semi-structured interviews (see Supplementary Appendix SA1), covering the following topics: receiving or attempting to receive an autism diagnosis, gender identity, and later life diagnosis. The research team designed the questions, informed by previous research in the field, which were open ended to allow for follow-up questions and more specific inquiries as research topics came up during discussion.

Data analysis

The research team recorded, transcribed verbatim, and inductively coded all interviews using qualitative data analysis software Dedoose. We examined interview data immediately after each interview to identify themes and adjust interview questions based on the responses. Autistic and non-autistic members of the research team as well as the participants created, reviewed, and finalized the themes, allowing for both internal consistency within the way that the codes were identified and the validity of the codes themselves. After the first 10 transcripts were coded and the researchers created the majority of themes as they were going through the transcripts, two coders compared codes to finalize themes and subthemes. While prior literature supported several themes, themes were only chosen explicitly out of the transcript inductively. We then checked themes after three more coded transcripts to ensure coherence, consistency, and clarity. Following this internal consistency process, the primary coder coded the remaining transcripts. The secondary coder examined the codes for reliability and reached a final consensus on the codes. They reviewed the transcripts one final time to reach “theoretical sufficiency,”³⁷ that being the point where the researcher is able to claim that all the code categories are the ones the data itself suggested. The article, themes, and findings were sent out to the individuals who participated in the interview for member checking, where participants were encouraged to provide feedback, thoughts, and clarifying questions.

Qualitative coding frameworks

Our study draws on feminist disability models,^38,39 which acknowledges that gendered constructs for females and social constructs of disability are often positioned as the “other,” which is then exacerbated at the intersection of the two.⁴⁰ With the co-constitutive embodiment of both disability and gender identity in gender minorities, these theories both challenge traditional feminist theories that have overlooked disability and allow for the challenging of the current societally gendered understanding of autism. The central argument of McRuer’s “crip theory” discusses how the foundation of queer theory focuses on able-bodied norms, such as heteronormativity. Considering concepts of heteronormativity are socially constructed and imposed, this suggests a desire for able-bodiedness in order to hold multiple identities and excludes disabled identities.⁴¹ Additionally, we center this research around gender performativity theories,²⁰ stating that gender socialization is both passive precarity and an individual performance. With this, we align the research around the disorientation that those whose bodies and existence align more poorly with societal norms experience.⁴² Lastly, the societal emphasis on success, productivity, and mobility is tied to capitalist, heteronormative, and patriarchal values and norms, invalidating the experiences of autistic participants,⁴³ creating an inequality of experiences to research in the first place. As such, we center the research on the impact of having minority and intersectional identities within ableist and heteronormative contexts.

Two coding members of the research team used reflexive thematic analysis,⁴⁴ a theoretically flexible method that allowed for the analyses to be informed by the tenants of gender socialization and role theories, disability visibility theories, feminist disability theories, and queer theory. Our analysis attempted to reflect the common themes among participants’ lived experiences and the introspection of their own diagnostic trajectories within their perception of how these experiences align with their societal-based expectations. This approach allowed for a connection of individual experiences to theoretical explanations by critically examining the impact of gender socialization on participants’ attributed experiences. Because gender socialization is present in both internalized and unconscious thought as well as explicit social processes, this process allowed us to frame the impact of gender socialization empirically, grounded in individuals’ experiences. Furthermore, designing our research with a phenomenological perspective that centers around understanding individual lived experience allows for an understanding from both the participant and the researcher of the retrospective reports leading up to the participants’ present understanding of their autistic experiences.

Reflectivity, positionality, and community involvement statement

The researchers recognize the nature of qualitative research means our lived experiences impact this analysis. As such, we found it important to disclose the positionality of members in our team. The primary researcher on the team identifies as an autistic and cisgender woman of color. The rest of our research team identifies as cisgender and both neurodivergent and neurotypical. As such, members of the autistic and the non-autistic community carried out the research design, implementation, interpretation, and dissemination of findings. With a majority neurodivergent team of researchers, our research questions came out of a personal interest in advocating for autistic individuals with intersectional identities. The researchers’ desire to connect with their community in a way that would produce recommendations for a better diagnostic system supported the methods and analysis. Before submission, we sent out the article to those we interviewed for feedback on our findings.

We intended to sample a small number of the community for this project to inform a better understanding of how gender as a construct is impacted by the bias within the autism diagnostic system. Our initial goal of the study, therefore, was to sample primarily individuals who did not identify as cisgender men, since the primary research question revolved around the alternate experiences of the diagnostic system, with any cisgender male participants providing evidence of a primary narrative within the current diagnostic system. The recruitment materials explicitly asking individuals to discuss their gender identity, as well as the inclusion of gender identity–related questions, resulted in many initial participants who found the relationship between their gender identity and their diagnostic journey to be significant. The majority of participants expressed interest in participating after we already reached our initial goal of 10 participants due to recruitment materials still being available on social media. Considering the participant-reported lack of resources for autistic and gender diverse individuals and the samples within autism research still being skewed heavily toward White males,⁴⁵ our research team felt it was important, as individuals in a position of power to produce new knowledge on autism, to allow as many from a previously silenced community to contribute their voices to our research.

Findings and Discussion

The research team created three themes to build an understanding of how the male-stereotyped understanding of autism and gender socialization impacted the diagnostic trajectories of those who identified as male in comparison to those who identified as female and gender diverse. Some members of the latter group spoke solely of experiences on being socialized as a female. As not all the participants discussing their socialization as one gender identified as the same gender, participants are labeled with their preferred pronouns.

Stereotypes of autism impacting diagnosis: “Only boys can be autistic”

This theme explores how the male gender is inexplicably tied to the diagnostic accuracy of autistic individuals, as differing difficulties often failed to encompass the difficulties those socialized as females experienced. The male stereotype of autism, dating back to the original DSM description of autism,⁴⁶ has long prevailed and is thought to impact diagnostic rates.⁴⁷ Those who discussed how being socialized as a female led to precarity and inequality in how others failed to acknowledge their autistic difficulties expressed this sentiment, which is contrasted to the experiences of the two males in our sample. With our researched understanding of autism being heavily informed by fabricated social constructs, ones that are heavily implicated in patriarchal and male-centered views,^48–50 an intersectional lens would posit a detrimental impact on intersectional identities. These participants recognized the disadvantage they were at being autistic in a male-dominated world, such as Blake (they/them) who stated, “I know that like it’s harder for people that aren’t white males presenting typical autism to get their diagnosis,” as if it were an unchangeable fact and a known adversity for their journey.

Other participants directly blamed the diagnostic assessment tools, saying the Autism Diagnostic Observation Schedule did not resonate with their experiences (Harper, they/them; Rosalie, she/her) or expressing that they “don’t follow the autism stereotype since the DSM-V is sexist” (Ash—any pronouns). Both the lack of official diagnostic tools and the language used to describe these tests were seen as invalidating and failed to capture participants’ experiences. Considering these monetized and expensive measures and neuropsychiatric evaluations are made within a community that emphasizes capitalistic success, or within “high theory” academic intellectualism,⁴³ alternative models of resistance and solidarity to the standard autistic experiences are not considered. Consequently, participants often resorted to online questionnaires, such as the Ritvo Autism Asperger Diagnostic Scale, a self-report questionnaire designed to identify adult autistics who escape diagnosis due to a subclinical level presentation. The disorientation participants reported, in line with theories positing that those who align poorly with stereotyped norms feel a sense of disorientation,^42,49,50 was only further exacerbated by diagnostic measures that did not capture their experiences.

The male-oriented autistic stereotype seemed to bleed directly into parental beliefs about what autism was. Participants reported their parents both overtly and covertly expressed sentiments towards the stereotypes of autism, such as Amelia (she/her) who stated her parents refused to accept her diagnosis.

My parents, even when I talked to them almost a year ago now, about me being autistic they were very adamant that I wasn’t because they still had the stereotype that it is only like a male condition.

She spoke in a confessional way, as if defeated after disputing with her parents about her identity. Furthering the male stereotype of autism is the media depiction of the condition, which further perpetuates the embodiment of a minority status, like disability, being male. One study highlights that media is one of the most salient contributors to building stereotypes and perpetuating them,⁵¹ especially among minorities such as those with disabilities.^49,52 Morgan (they/them) said, “on TV? You see it like geeky or awkward people.” With this, they said, come the general stereotypes of autism.

Some attributed the diagnostic disparity to the socialization and gender precarity in general society leading to beliefs that “only boys can be autistic” (Rosalie—she/her) or that “the people who I knew that had autism were, you know, little boys” (Wendy—she/her), differentially impacting those who identified as male and those who identified as female and non-binary. Yet, interestingly, the stereotype of autism being male seemed to not be intertwined with the male or masculine stereotype. Specifically, it appeared, based on our two participants, that the male stereotype was more salient to others than an autistic stereotype. This was discussed among our two participants who identified as male, both of whom were formally diagnosed as a young adult (ages 26 and 33). As Henry (he/him) said,

People growing up took my rigidity either as a difficulty I have…with being sort of the male assertiveness or stubbornness and mistaking the [male] role to be right or control the situation with the desire to understand and be understood.

This demonstrates that even beyond the male-oriented stereotype of autism, the narrow view of how masculinity and autistic traits overlap had a substantial impact of how and whether those identifying as male are diagnosed later in life, leaving these participants out of access to the resources for autistic youth. Ultimately, this indicates that the male stereotype and identity were seen as more dominant than the autistic stereotypes. Specifically, this further indicates that the male stereotype is distinct, separate, and potentially more salient than the autistic stereotype. Specifically, our two participants recalled being praised for adhering to behaviors consistent with their socialization as males, with little notice that these behaviors were manifestations of a male-stereotyped autistic difficulty. As a result, this perpetuates the idea that the autistic stereotype is male but not necessarily following the masculine stereotypes.

The male stereotype of autism is still prevalent in the diagnostic community and society at large, which was then supported by these two participants discussing their straightforward journey to receiving a diagnosis, in line with the central narrative research samples perpetuate. This stereotype continues to inhibit female and female-presenting individuals from accessing a diagnosis and resources. Autistic stereotypes emerged as a major theme, as participants often attributed their difficulty with the diagnostic journey to this stereotype. Interestingly, for males, their autistic traits, which have been associated with traits of traditional masculinity, were seen as a defining feature or extension of their masculinity rather than symptomatic of autism, raising the question of how many men have not been diagnosed due to a misinterpretation of autistic traits.

Differential interpretation of symptoms: “If I checked all the boxes, nobody really cared”

This theme explores the participant’s view of their own difficulties with traits they characterize as autistic. While we initially asked participants what, in their childhood, signified they were autistic, their answer often revealed narratives of why they were missed in the diagnostic process. The experiences of our male participants were contrasted with our female and non-binary participants’ reported experiences. Specifically, responses from our two male participants revealed a very short and direct account:

Even as a kid in elementary school and knowing that there, you know, even would sort of pick up, you know, just the way I communicated.—Henry (he/him)

Despite having difficulties in childhood, Henry discussed not being diagnosed until he was an adult because he only exhibited some of the “stereotypical” traits of autism. Yet, when seeking a diagnosis, Henry reported traversing the diagnostic journey as relatively straightforward. Emphasis on symptomology, in this case, left minimal room for understanding the nuances of autism presentation. Henry’s experiences demonstrate that those who present as stereotypically autistic and whom the clinical community accepts as autistic can access early support that proves to be beneficial.

On the contrary, participants who discussed being socialized as a female reported difficulties being dismissed and being labeled “academically compelled” or “weird” rather than autistic. As such, their experiences and struggles were often weaponized as a negative attribute instead of bringing attention to their struggles—inherently assigning a value label on their difficulties. Considering that embracing disabled embodiments, especially as a gender minority, is a form of resistance against societal pressures to conform to able-bodied standards,⁴¹ the additional norms for female and gender diverse people to conform to societal standards directly impacted their perception of their own disability.^21,49,50 Similarly, some participants explained their intelligence or absence of academic difficulties led to the missing of their diagnoses:

[My] eccentricities might be chopped up to like. Well, you know, she reads at a high level.—(they/them)

While there is a spectrum of intellectual abilities among autistic youth, this spectrum was not extended to those who were discussed being socialized as a female. James, who now identifies as non-binary, resonated with first-hand details from autistic women discussing being dismissed because of good grades. They explained their schoolteacher mother put pressure on them to read at a high level after they repeatedly failed to read. One non-binary participant described it as having “swiss-cheese knowledge” (Taylor, they/them); having the ability to do certain, very complex things but not other very simple things, such as speaking to others on the phone or completing errands that were not a part of a regular schedule or habit. Autistic female and non-binary participants potentially compensated for the lack of general knowledge, which were often social in nature. These participants describe then taking it upon themselves to fixate on specific complex topics, in line with the rigidity of autistic presentations, but being unable to compensate for the “simpler” tasks due to the struggles with flexibility and executive functioning. Additionally, it is possible that participants’ struggle with simple tasks were only deemed as a struggle due to their performance on “simple tasks” being held to a higher expectation. For those socialized as female, the gendered expectation for females to handle “simpler” tasks, such as completing household chores with unpleasant sensory components like a loud vacuum cleaner, often came as a result of gendered socialization dictating that the tasks within female norms are ones that are deemed “simple.” Participants’ intellectual capacity also directly impacted their diagnostic trajectory as those who did not display an intellectual disability or scored high on standardized testing were denied the eligibility of services.

Sensory differences are common among youth on the spectrum, yet these issues often went unnoticed in females and non-binary individuals. While previous research shows that autistic females have significantly different profiles in sensory processing difficulties,⁵² these difficulties were often explained away by acute sensitivity. For female and non-binary participants, their sensory differences were seen as personal failings rather than symptomatic of something more:

Everyone thinks you’re weird, like something’s wrong with you…because I have this thing about scabs, where, like, if anything’s not smooth, my immediate reaction is to scratch that thing away.—Blake (they/them)

These quotes suggested despite experiencing aversive sensory difficulties (e.g., disliking sunscreen, bumps on skin, colored hair), those who identified as female and non-binary had their issues dismissed when the same dislikes were seen as a sign of autism for male participants. For those who were socialized as females, this dismissal may reflect a higher expectation of tolerance, in line with gender role and norm theories that posit that those who were socialized as females have a higher expectation of tolerance—whether that be females having a higher pain tolerance⁵² or the gendered expectation of sitting still and remaining obedient.^18,53

Furthermore, for female and non-binary participants, RRBs were used as a reason to label them as “weird” and different from their peers, rather seeking an explanation or assessment. This labeling led to detrimental social outcomes and poor self-worth often contributing to delayed diagnosis,⁴⁷ in line with disorientation one might feel when their embodiment of a societal construct aligns poorly with norms.⁴² For those socialized as females, this is aligned with higher internalizing difficulties for females than males, as these autistic traits resulted in ostracization for female and non-binary participants.

I had always, as far as I can remember, understood that there was something different about me that made other people not like me, that made other people bully me and make fun of me. They mocked the way that I spoke, the interests that I had, and the thing that bothered me wasn’t that I was different. It was the fact that I had no idea why.—Rowan (she/they)

Research has shown that females on the spectrum have social and communicative difficulties at the same rates⁵⁴ or higher⁵⁵ than males, yet they are often missed due to a gendered stereotype of being “shy or awkward”¹⁸ rather than presenting with the typical externalizing or disruptive behaviors that autistic males often do.⁴⁷ James highlights the gendered expectation for females to suffer in silence, as the mental and emotional impacts of having difficulty socially and with peers may be an engrained and societally accepted aspect of female socialization.

She’s not really misbehaving in class or anything, but she doesn’t have a lot of friends. You know, a socially awkward figure. As long as I was checking all the boxes nobody really cared that much about my behavior and friends and socializations.—James (they/them)

Seven participants reported a direct contrast with male siblings and cousins who were diagnosed autistic. Participants then attributed this comparison as the reason why family members failed not only to recognize their unique presentation of autism but also used gender-normed reasons to explain the traits. Isabella shows how participants felt let down as the same family members were willing to accept the neurodivergence of their male sibling but not recognize the struggles they were enduring.

I didn’t really know I was different. I thought everyone hid into the bathroom to stim like I thought every kid did that. I thought every kid struggled making friends or making eye contact. Because my brother got diagnosed early when he was 2, and because I’m a girl, it’s more socially acceptable for me to be more emotional.—Isabella (she/her)

Even for female and non-binary participants whose parents had a direct point of comparison, such as their siblings, the same exact difficulties were often still explained away:

My brother was diagnosed with autism at age like 4 or 5, he’s 4 years younger than me. I always had like a lot of social difficulties. I would be the only kid in the class not invited to the birthday party and just a lot of things that were kind of like written off as like, oh, you’re just quirky.—Alex (they/them)

Similar to the way that females are often described with weaker and less beneficial adjectives, this quote demonstrates the perpetual difficulty that many autistic AFAB youth or youth socialized as females struggle with being taken seriously, from a young age.

For those socialized as females, their families were more likely to perceive difficulties as a failing of the self or part of their personality, rather than an indicator of autism, even when their male siblings, cousins, or close friends had received a diagnosis with similar presentations. Specifically, several participants recounted their difficulties “being dismissed,” while their family members’ difficulties being seen as “apart of their autism.” The expectations of female-socialized behaviors complicate the way autistic traits present and are perceived. The internalization of being different and outcasted is likely to contribute to the higher rates of anxiety and depression that autistic females and genderqueer individuals experience, which also contributes to late diagnosis and delays in obtaining relevant resources.^56,57

Gender socialization: “I was raised to be in service of others”

This theme explores the impact of gender socialization and social roles and their impact on the diagnosis of autistic individuals. Gender and social role theory posits males and females learn to socially perform their assigned gender through particular behaviors and attitudes. The theory suggests that these social roles are driven by a social structure, reinforced by the division of labor between the two genders, creating gender roles and thereby gendered socialized behavior. Examining role theory from a feminist perspective, Lopata⁵⁸ suggests the major types of roles women play (being of family, kinship, employment, and domesticity) split women into different roles in the context of societal modernization. As indicated previously in the interview and within quotes, the gender a participant was socialized as does not necessarily reflect their current gender identity.

The participants saw gender as having an inherent tie to the stereotype of autism that then impacted their ability to be diagnosed. One participant reported that the perception of their identity, which did not fit with the male stereotype, led to others poorly recognizing their autism. They explained that they’re already “perceived socially,” but their internalized stigma that autism has “a certain grossness to it” clashed with their socialization as a female (Ellis—they/them). Specifically, this association of autism with “grossness” is pervasive when combined with a female expectation to be “clean” or have a proper presentation. Ellis found that this was fundamentally incompatible with the presentation of autism and led to “nobody writing about autism that includes specifically female-like traits or socializations.” This further impacts the bias from clinicians and family members through the flow of the association of traits that are seen as having high value in each gender. One participant said,

When I was getting screened for ADHD…her first comment to me was like, I think you’re too personable to be autistic…What is that supposed to mean? But also, she didn’t think [autism] fit very well [for me] from the kind of textbook classification of it and [she] had to do a lot more research on autism that wasn’t on like 6-year-old boys.—Taylor (they/them)

The interaction between gender and diagnosis varied for some participants. While many participants attributed their later diagnoses with the stereotype of autism being male associated, some also saw specific traits of their autism that were overseen as a normal aspect of gender socialization. “People, I guess, just kind of expect little girls to be more like picky and emotional and stuff. It gets overlooked a lot of the times, unfortunately” (Jordan—any pronouns). The participants used gender not only as a segregator for the societal definition of autism but also as a role that interfered with traits that were inherently seen as autistic. Critiques that feminist theories, queer theories, and disability theories cannot be examined independently as these experiences are most powerfully examined when theories are interdependent ultimately support this experience.^41,49,50 As one participant says,

I was basically raised to be in service to other people…anything that wasn’t in service, so all of my autistic traits were beaten out of me…I don’t think I would have learned to build this intensely complex system of coping if I had been a boy because it’s just not necessary. I would have been allowed to get angry and lose my shit past the age of 10. I don’t know that I would have gotten diagnosed, but I definitely think that more people would have been like, “are you sure she’s okay” versus “oh, they’re a little different, [so] we’re just not going to invite her to a party.—Avery (they/them)

Yet, on the contrary, participants who identified as male found that having a label of autism helped them in feeling freer to be themselves. Participants who were raised as male were permitted to act out and engage in non-typical behaviors attributing this to the culture of “boys will be boys.” For those socialized as males, their virtue was seen as “being able to understand the rules as opposed to deliberately trying to be rebellious” (Henry—he/him).

The gender I did identify with worked very well with my actual biology and my hyperness, and it was very much so promoted that I’d be a boy and run around and explore and do boy stuff, and I was never suppressed from doing that.—Charles (he/him)

This theme demonstrates the impact of the male stereotype of autism on diagnosis on those who do not meet this stereotype. It influences not only the diagnostic community but also those who are in the community. Furthering this is the socialization of females complicating the presentation of autistic traits, at times, leading to a suppression of them. Society at large affords males the opportunity to live without constraints or expectation, often resulting in early recognition of differences, diagnosis, and appropriate support.

Conclusion

In conclusion, the findings shed light on the pervasive impact of gender stereotypes on the diagnosis and recognition of autism. Specifically, we examined how autism’s gender-based stereotype impacted how participants identified their own difficulties. By using semi-structured interviews, participants’ retrospective narratives of their diagnostic journey and the struggles that were associated with that were captured through recurring and salient themes that captured the internalization of a male-oriented stereotype of autism, which the majority of research in autism having imbalanced samples with little focus on recruitment of females further perpetuates.^19,45 Furthermore, we examined how gender socialization impacted participants’ own expression of their difficulties and how others interpreted these difficulties. Family members, clinicians, and others whom participants interacted with in their lives were impacted by a pervasive male stereotype of autism, with failure to notice symptoms leading to misdiagnoses, a lack of validation, and poor support for participants. As prior literature indicates, misdiagnoses of autism in women are common¹⁸ and lead to poorer lifelong trajectory,¹⁶ often including significant mental health difficulties. These findings, within the context of feminist, queer, and disability theories, demonstrate the interdependent nature of minority identities and how their collective rejection of social norms leads to the internalization of norms, stigma, and poorer mental health outcomes. In practice, this study supports the need for combating clinician and societal stereotypes in the diagnostic system by re-evaluating the trajectories of diagnosis for autistic youth. Additionally, this study supports the need for a better understanding, overall, of the nuanced presentations of autistic individuals who do not identify as male.

Limitations

First, a limitation of our study is that our sample skewed heavily White and only included speaking individuals, which limits the further examination into intersectional identities and should be a purposeful inclusion variable within samples in future studies. Additionally, because of the blinded nature of the coding process, the quotes highlighted did not include those who identified as non-White, which needs to be examined as a contextual identity to the codes being deduced in future research. However, these quotes are examined within separate articles with a focus on the diagnostic disparities.^59,60 Lastly, the lack of distinction between those with gender diverse identities is an inadequate representation of the diversity in queer identities. As such, the distinctions between different queer identities and their autistic experiences should be examined in future research.

The entrenched belief that autism is predominantly a male condition not only affects diagnostic rates but also influences societal perceptions and familial attitudes toward individuals who do not fit this stereotype. Those socialized as females face significant barriers in obtaining timely diagnoses, with their difficulties often being dismissed or attributed to other factors such as personality quirks or academic prowess. Moreover, gender socialization further complicates the recognition of autistic traits, as societal expectations for those socialized as females to conform to certain behaviors and roles may lead to the suppression or misinterpretation of their difficulties. In contrast, males may be more readily diagnosed and supported due to fewer constraints on their behavior and expression. These findings underscore the urgent need for greater awareness, education, and sensitivity regarding the diverse presentations of autism across genders, to ensure equitable access to diagnosis, support, and resources for all individuals on the spectrum. As such, we suggest future research to examine the support and resource impacts that the biased diagnostic journey has resulted in.

Footnotes

Acknowledgments

The authors acknowledge the individuals who volunteered for this project. The authors are humbled by their generosity, honesty, resilience, and passion. The authors thank the participants for their courage and for sharing their experiences with us. Additionally, the authors would like to thank Jay Seibold for their help in assisting with technical aspects of the project.

Author Disclosure Statement

The authors have no funding sources or conflicts of interest or sources of funding to report.

Authorship Confirmation Statement

I.T. and A.P. created the original design and conducted the interviews. I.T., A.P., and S.S. drafted the article. S.S. and K.S. edited the article. All authors approved the final version of the article. The article has been submitted solely to Autism in Adulthood.

Funding Information

No funding was received for this article.

Supplementary Material

References

Lyall

, Croen

, Daniels

, et al. The changing epidemiology of autism spectrum disorders. Annu Rev Public Health. 2017; 38:81–102; doi: 10.1146/annurev-publhealth-031816-044318

Milner

, McIntosh

, Colvert

, Happé

. A qualitative exploration of the female experience of Autism Spectrum Disorder (ASD). J Autism Dev Disord. 2019; 49(6):2389–2402; doi: 10.1007/s10803-019-03906-4

Kim

, Leventhal

, Koh

, et al. Prevalence of autism spectrum disorders in a total population sample [published correction appears in Am J Psychiatry. 2013 Jun 1;170(6):689]. Am J Psychiatry. 2011; 168(9):904–912; doi: 10.1176/appi.ajp.2011.10101532

Rubenstein

, Wiggins

, Lee

. A review of the differences in developmental, psychiatric, and medical endophenotypes between males and females with autism spectrum disorder. J Dev Phys Disabil. 2015; 27(1):119–139; doi: 10.1007/s10882-014-9397-x

Hull

, Petrides

, Mandy

. The female autism phenotype and camouflaging: A narrative review. Rev J Autism Dev Disord. 2020; 7(4):306–317; doi: 10.1007/s40489-020-00197-9

Howe

, O’Rourke

, Yatchmink

, Viscidi

, Jones

, Morrow

. Female autism phenotypes investigated at different levels of language and developmental abilities. J Autism Dev Disord. 2015; 45(11):3537–3549; doi: 10.1007/s10803-015-2501-y

Dwyer

, Ryan

, Williams

, Gassner

. First do no harm: Suggestions regarding respectful autism language. Pediatrics. 2022; 149(Suppl 4):e2020049437N; doi: 10.1542/peds.2020-049437N

Lai

, Lerch

, Floris

, et al. Imaging sex/gender and autism in the brain: Etiological implications. J Neurosci Res. 2017; 95(1–2):380–397; doi: 10.1002/jnr.23948

Charman

, Loth

, Tillmann

, et al. The EU-AIMS Longitudinal European Autism Project (LEAP): Clinical characterisation. Mol Autism. 2017; 8:27; doi: 10.1186/s13229-017-0145-9

10.

Frazier

, Georgiades

, Bishop

, Hardan

. Behavioral and cognitive characteristics of females and males with autism in the Simons Simplex Collection. J Am Acad Child Adolesc Psychiatry. 2014; 53(3):329–340.e403; doi: 10.1016/j.jaac.2013.12.004

11.

Hartley

, Sikora

. Sex differences in autism spectrum disorder: An examination of developmental functioning, autistic symptoms, and coexisting behavior problems in toddlers. J Autism Dev Disord. 2009; 39(12):1715–1722; doi: 10.1007/s10803-009-0810-8

12.

Constantino

, Charman

. Gender bias, female resilience, and the sex ratio in autism. J Am Acad Child Adolesc Psychiatry. 2012; 51(8):756–758; doi: 10.1016/j.jaac.2012.05.017

13.

Kirkovski

, Enticott

, Fitzgerald

. A review of the role of female gender in autism spectrum disorders. J Autism Dev Disord. 2013; 43(11):2584–2603; doi: 10.1007/s10803-013-1811-1

14.

Gould

, Ashton-Smith

. Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum. Good Autism Practice (GAP). 2011; 12(1):34–41.

15.

Hull

, Petrides

, Allison

, et al. “Putting on My Best Normal”: Social camouflaging in adults with autism spectrum conditions. J Autism Dev Disord. 2017; 47(8):2519–2534; doi: 10.1007/s10803-017-3166-5

16.

Lai

, Lombardo

, Auyeung

, Chakrabarti

, Baron-Cohen

. Sex/gender differences and autism: Setting the scene for future research. J Am Acad Child Adolesc Psychiatry. 2015; 54(1):11–24; doi: 10.1016/j.jaac.2014.10.003

17.

Sedgewick

, Hull

, Ellis

. Autism and Masking: How and Why People do it, and the Impact it Can Have. Jessica Kingsley Publishers; 2021.

18.

Seers

, Hogg

. ‘You don’t look autistic’: A qualitative exploration of women’s experiences of being the ‘autistic other’. Autism. 2021; 25(6):1553–1564; doi: 10.1177/1362361321993722

19.

Lai

, Lombardo

, Pasco

, et al; MRC AIMS Consortium. A behavioral comparison of male and female adults with high functioning autism spectrum conditions. PLoS One. 2011; 6(6):e20835; doi: 10.1371/journal.pone.0020835

20.

Pearson

, Rose

. A conceptual analysis of autistic masking: Understanding the narrative of stigma and the illusion of choice. Autism Adulthood. 2021; 3(1):52–60; doi: 10.1089/aut.2020.0043

21.

Butler

. Gender trouble: Feminism and the subversion of identity. Gender trouble. 1990; 3(1):3–17.

22.

Tanner

, Reinherz

, Beardslee

, Fitzmaurice

, Leis

, Berger

. Change in prevalence of psychiatric disorders from ages 21 to 30 in a community sample. J Nerv Ment Dis. 2007; 195(4):298–306; doi: 10.1097/01.nmd.0000261952.13887.6e

23.

Boyd

, Van de Velde

, Vilagut

, et al; EU-WMH Investigators. Gender differences in mental disorders and suicidality in Europe: Results from a large cross-sectional population-based study. J Affect Disord. 2015; 173:245–254; doi: 10.1016/j.jad.2014.11.002

24.

Lundin

, Mahdi

, Isaksson

, Bölte

. Functional gender differences in autism: An international, multidisciplinary expert survey using the International Classification of Functioning, Disability, and Health model. Autism. 2021; 25(4):1020–1035; doi: 10.1177/1362361320975311

25.

Napolitano

, Schiavi

, La Rosa

, et al. Sex differences in autism spectrum disorder: Diagnostic, neurobiological, and behavioral features. Front Psychiatry. 2022; 13:889636; doi: 10.3389/fpsyt.2022.889636

26.

Dworzynski

, Ronald

, Bolton

, Happé

. How different are girls and boys above and below the diagnostic threshold for autism spectrum disorders? J Am Acad Child Adolesc Psychiatry. 2012; 51(8):788–797; doi: 10.1016/j.jaac.2012.05.018

27.

Mandy

, Chilvers

, Chowdhury

, Salter

, Seigal

, Skuse

. Sex differences in autism spectrum disorder: Evidence from a large sample of children and adolescents. J Autism Dev Disord. 2012; 42(7):1304–1313; doi: 10.1007/s10803-011-1356-0

28.

Posserud

, Hysing

, Helland

, Gillberg

, Lundervold

. Autism traits: The importance of “co-morbid” problems for impairment and contact with services. Data from the Bergen Child Study. Res Dev Disabil. 2018; 72:275–283; doi: 10.1016/j.ridd.2016.01.002

29.

Leedham

, Thompson

, Smith

, Freeth

. ‘I was exhausted trying to figure it out’: The experiences of females receiving an autism diagnosis in middle to late adulthood. Autism. 2020; 24(1):135–146; doi: 10.1177/136236131985344

30.

Kentrou

, Oostervink

, Scheeren

, Begeer

. Stability of co-occurring psychiatric diagnoses in autistic men and women. Research in Autism Spectrum Disorders. 2021; 82:101736; doi: 10.1016/j.rasd.2021.101736

31.

Schwartzman

, Williams

, Corbett

. Diagnostic- and sex-based differences in depression symptoms in autistic and neurotypical early adolescents. Autism. 2022; 26(1):256–269; doi: 10.1177/13623613211025895

32.

Kaat

, Shui

, Ghods

, et al. Sex differences in scores on standardized measures of autism symptoms: A multisite integrative data analysis. J Child Psychol Psychiatry. 2021; 62(1):97–106; doi: 10.1111/jcpp.13242

33.

Begeer

, Mandell

, Wijnker-Holmes

, et al. Sex differences in the timing of identification among children and adults with autism spectrum disorders. J Autism Dev Disord. 2013; 43(5):1151–1156; doi: 10.1007/s10803-012-1656-z

34.

Giarelli

, Wiggins

, Rice

, et al. Sex differences in the evaluation and diagnosis of autism spectrum disorders among children. Disabil Health J. 2010; 3(2):107–116; doi: 10.1016/j.dhjo.2009.07.001

35.

Rubenstein

, Furnier

. #Bias: The opportunities and challenges of surveys that recruit and collect data of autistic adults online. Autism Adulthood. 2021; 3(2):120–128; doi: 10.1089/aut.2020.0031

36.

Van Wijngaarden-Cremers

, van Eeten

, Groen

, Van Deurzen

, Oosterling

, Van der Gaag

. 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(3):627–635; doi: 10.1007/s10803-013-1913-9

37.

Dey

. Grounding Grounded Theory: Guidelines for Qualitative Inquiry. San Francisco, CA: Academic Press; 1999.

38.

Hall

. Reimagining Disability and Gender Through Feminist Studies. Indiana University Press; 2011.

39.

Johnson

, McRuer

. Cripistemologies: Introduction. Journal of Literary & Cultural Disability Studies. 2014; 8(2):127–148; doi: 10.3828/jlcds.2014.12

40.

Garland-Thomson

. Feminist disability studies. Signs: Journal of women in Culture and Society. 2005; 30(2):1557–1587.

41.

McRuer

. Crip theory: cultural signs of queerness and disability. Scandinavian Journal of Disability Research. 2008; 10(1):67–69; doi: 10.1080/15017410701880122

42.

Ahmed

. Queer Phenomenology: Orientations, Objects, Others. Durham: Duke University Press; 2006.

43.

Halberstam

. Unbecoming: queer negativity/radical passivity. In: Sex, Gender and Time in Fiction and Culture. ( Davies

, Funke

., eds.) Springer; 2011. 10.1057/9780230307087_10

44.

Braun

, Clarke

. Using thematic analysis in psychology. Qualitative research in psychology. 2006; 3(2):77–101; doi: 10.1191/1478088706qp063oa

45.

Brickhill

, Atherton

, Piovesan

, Cross

. Autism, thy name is man: Exploring implicit and explicit gender bias in autism perceptions. PLoS One. 2023; 18(8):e0284013; doi: 10.1371/journal.pone.0284013

46.

Kanner

. Autistic disturbances of affective contact. Acta Paedopsychiatr. 1968; 35(4):100–136.

47.

Bargiela

, Steward

, Mandy

. The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. J Autism Dev Disord. 2016; 46(10):3281–3294; doi: 10.1007/s10803-016-2872-8

48.

Hall

. Feminist Disability Studies. Indiana University Press; 2011.

49.

Mallipeddi

, VanDaalen

. Intersectionality within critical autism studies: A narrative review. Autism Adulthood. 2022; 4(4):281–289; doi: 10.1089/aut.2021.0014

50.

Ryan

, Milton

. The Routledge International Handbook of Critical Autism Studies. Routledge, Taylor & Francis Group; 2023.

51.

Scharrer

, Ramasubramanian

. Intervening in the media’s influence on stereotypes of race and ethnicity: The role of media literacy education. Journal of Social Issues. 2015; 71(1):171–185; doi: 10.1111/josi.12103

52.

Pirsl

, Popovska

. Media mediated disability: How to avoid stereotypes. International Journal of Scientific Engineering and Research (IJSER). 2013; 1(4):42–45.

53.

Defrin

, Shramm

, Eli

. Gender role expectations of pain is associated with pain tolerance limit but not with pain threshold. Pain. 2009; 145(1–2):230–236; doi: 10.1016/j.pain.2009.06.028

54.

Mandy

, Lai

. Towards sex- and gender-informed autism research. Autism. 2017; 21(6):643–645; doi: 10.1177/1362361317706904

55.

Kalb

, Singh

, Hong

, et al. Analysis of race and sex bias in the Autism Diagnostic Observation Schedule (ADOS-2). JAMA Netw Open. 2022; 5(4):e229498; doi: 10.1001/jamanetworkopen.2022.9498

56.

Burton

, Ratcliffe

, Collison

, Dossetor

, Wong

. Self-reported emotion regulation in children with autism spectrum disorder, without intellectual disability. Research in Autism Spectrum Disorders. 2020; 76:101599.

57.

Tint

, Weiss

. A qualitative study of the service experiences of women with autism spectrum disorder. Autism. 2018; 22(8):928–937; doi: 10.1177/1362361317702561

58.

Hamdani

, Kassee

, Walker

, et al. Roadblocks and detours on pathways to a clinical diagnosis of autism for girls and women: A qualitative secondary analysis. Womens Health (Lond). 2023; 19:17455057231163761; doi: 10.1177/17455057231163761

59.

Lopata

. Circles and Settings: Role Changes of American Women. SUNY Press; 1994.

60.

Tien

, Seibold

, Pearson

, Seers

. A qualitative exploration into diagnostic barriers of gender diverse autistic individuals. Under Review, in press.

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