An investigation of the ‘female camouflage effect’ in autism using a computerized ADOS-2 and a test of sex/gender differences

By Agnieszka Rynkiewicz, Björn Schuller, Erik Marchi, Stefano Piana, Antonio Camurri, Amandine Lassalle, Simon Baron-Cohen. Molecular Autism, 2016

305 citations recorded by the source corpus.

BackgroundAutism spectrum conditions (autism) are diagnosed more frequently in boys than in girls. Females with autism may have been under-identified due to not only a male-biased understanding of autism but also females’ camouflaging. The study describes a new technique that allows automated coding of non-verbal mode of communication (gestures) and offers the possibility of objective, evaluation of gestures, independent of human judgment. The EyesWeb software platform and the Kinect sensor during two demonstration activities of ADOS-2 (Autism Diagnostic Observation Schedule, Second Edition) were used.MethodsThe study group consisted of 33 high-functioning Polish girls and boys with formal diagnosis of autism or Asperger syndrome aged 5–10, with fluent speech, IQ average and above and their parents (girls with autism, n = 16; boys with autism, n = 17). All children were assessed during two demonstration activities of Module 3 of ADOS-2, administered in Polish, and coded using Polish codes. Children were also assessed with Polish versions of the Eyes and Faces Tests. Parents provided information on the author-reviewed Polish research translation of SCQ (Social Communication Questionnaire, Current and Lifetime) and Polish version of AQ Child (Autism Spectrum Quotient, Child).ResultsGirls with autism tended to use gestures more vividly as compared to boys with autism during two demonstration activities of ADOS-2. Girls with autism made significantly more mistakes than boys with autism on the Faces Test. All children with autism had high scores in AQ Child, which confirmed the presence of autistic traits in this group. The current communication skills of boys with autism reported by parents in SCQ were significantly better than those of girls with autism. However, both girls with autism and boys with autism improved in the social and communication abilities over the lifetime. The number of stereotypic behaviours in boys significantly decreased over life whereas it remained at a comparable level in girls with autism.ConclusionsHigh-functioning females with autism might present better on non-verbal (gestures) mode of communication than boys with autism. It may camouflage other diagnostic features. It poses risk of under-diagnosis or not receiving the appropriate diagnosis for this population. Further research is required to examine this phenomenon so appropriate gender revisions to the diagnostic assessments might be implemented.

Subfields: Clinical Psychology, Cognitive Neuroscience, Occupational Therapy

View Paper: https://www.semanticscholar.org/paper/be4d880946398e3e2994df4ecd58ce8afcb49446

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Citations in the corpus

Extending the Minority Stress Model to Understand Mental Health Problems Experienced by the Autistic Population (2018, background): “The present sample could reflect the frustration that autistic women feel at the usual exclusion from research (Rynkiewicz et al. 2016; Shefcyk 2015).”
The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype (2016, background): “However, despite promising initial investigations (e.g., Baldwin and Costley 2015; Cridland et al. 2014; Mandy and Tchanturia 2015; Rynkiewicz et al. 2016) further work is required to operationalize the construct of camouflaging, to prepare the ground for the development of measures that could be…”
Quantifying and exploring camouflaging in men and women with autism (2016, methodology): “By analysing behaviour from the demonstration activities in the ADOS-2, Rynkiewicz et al. (2016) found girls with autism used gestures more vividly than boys with autism and suspected this to be one component of enhanced camouflaging in females which ‘may pose risk of underdiagnosis or not receiving”