Objective To derive the first systematically calculated estimate of the relative proportion of boys and girls with autism spectrum disorder (ASD) through a meta-analysis of prevalence studies conducted since the introduction of the DSM-IV and the International Classification of Diseases, Tenth Revision . Method Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The Medline, Embase, and PsycINFO databases were searched, and study quality was rated using a risk-of-bias tool. Random-effects meta-analysis was used. The pooled outcome measurement was the male-to-female odds ratio (MFOR), namely the odds of being male in the group with ASD compared with the non-ASD group. In effect, this is the ASD male-to-female ratio, controlling for the male-to-female ratio among participants without ASD. Results Fifty-four studies were analyzed, with 13,784,284 participants, of whom 53,712 had ASD (43,972 boys and 9,740 girls). The overall pooled MFOR was 4.20 (95% CI 3.84–4.60), but there was very substantial between-study variability (I 2  = 90.9%). High-quality studies had a lower MFOR (3.32; 95% CI 2.88–3.84). Studies that screened the general population to identify participants regardless of whether they already had an ASD diagnosis showed a lower MFOR (3.25; 95% CI 2.93–3.62) than studies that only ascertained participants with a pre-existing ASD diagnosis (MFOR 4.56; 95% CI 4.10–5.07). Conclusion Of children meeting criteria for ASD, the true male-to-female ratio is not 4:1, as is often assumed; rather, it is closer to 3:1. There appears to be a diagnostic gender bias, meaning that girls who meet criteria for ASD are at disproportionate risk of not receiving a clinical diagnosis.

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What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis

Camouflaging of autistic characteristics in social situations is hypothesised as a common social coping strategy for adults with autism spectrum conditions (ASC) Camouflaging may impact diagnosis, quality of life, and long-term outcomes, but little is known about it This qualitative study examined camouflaging experiences in 92 adults with ASC, with questions focusing on the nature, motivations, and consequences of camouflaging Thematic analysis was used to identify key elements of camouflaging, which informed development of a three-stage model of the camouflaging process First, motivations for camouflaging included fitting in and increasing connections with others Second, camouflaging itself comprised a combination of masking and compensation techniques Third, short- and long-term consequences of camouflaging included exhaustion, challenging stereotypes, and threats to self-perception

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“Putting on My Best Normal”: Social Camouflaging in Adults with Autism Spectrum Conditions

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and the presence of restricted interests and repetitive behaviors. There have been recent concerns about increased prevalence, and this article seeks to elaborate on factors that may influence prevalence rates, including recent changes to the diagnostic criteria. The authors review evidence that ASD is a neurobiological disorder influenced by both genetic and environmental factors affecting the developing brain, and enumerate factors that correlate with ASD risk. Finally, the article describes how clinical evaluation begins with developmental screening, followed by referral for a definitive diagnosis, and provides guidance on screening for comorbid conditions.

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Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation.

Conceptualising compensation in neurodevelopmental disorders: Reflections from autism spectrum disorder.

Mental health difficulties are highly prevalent in individuals on the autism spectrum. The current study examined how experiences and perceptions of autism acceptance could impact on the mental health of autistic adults. 111 adults on the autism spectrum completed an online survey examining their experiences of autism acceptance, along with symptoms of depression, anxiety and stress. Regression analyses showed that autism acceptance from external sources and personal acceptance significantly predicted depression. Acceptance from others also significantly predicted stress but acceptance did not predict anxiety. Further analyses suggested that experiences of “camouflaging” could relate to higher rates of depression. The current study highlights the importance of considering how autism acceptance could contribute to mental health in autism.

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Experiences of Autism Acceptance and Mental Health in Autistic Adults

We used Framework Analysis to investigate the female autism phenotype and its impact upon the under-recognition of autism spectrum conditions (ASC) in girls and women. Fourteen women with ASC (aged 22-30 years) diagnosed in late adolescence or adulthood gave in-depth accounts of: 'pretending to be normal'; of how their gender led various professionals to miss their ASC; and of conflicts between ASC and a traditional feminine identity. Experiences of sexual abuse were widespread in this sample, partially reflecting specific vulnerabilities from being a female with undiagnosed ASC. Training would improve teachers' and clinicians' recognition of ASC in females, so that timely identification can mitigate risks and promote wellbeing of girls and women on the autism spectrum.

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Sarah Bargiela

Papers

The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype