Recognition of Girls on the Autism Spectrum by Primary School Educators: An Experimental Study

Autism has long been considered a predominantly male condition. It is increasingly understood, however, that autistic females are under-recognized. This may reflect gender stereotyping, whereby symptoms are missed in females, because it is assumed that autism is mainly a male condition. Also, some autistic girls and women may go unrecognized because there is a "female autism phenotype" (i.e., a female-typical autism presentation), which does not fit current, male-centric views of autism. Potential biases shown by educators, in their role as gatekeepers for an autism assessment, may represent a barrier to the recognition of autism in females. We used vignettes describing autistic children to test: (a) whether gender stereotyping occurs, whereby educators rate males as more likely to be autistic, compared to females with identical symptoms; (b) whether recognition is affected by sex/gender influences on autistic presentation, whereby children showing the male autism phenotype are rated as more likely to be autistic than those with the female phenotype. Ratings by primary school educators showed a significant main effect of both gender and presentation (male phenotype vs. female phenotype) on estimations of the child in the vignette being autistic: respondents showed a bias against girls and the female autism phenotype. There was also an interaction: female gender had an effect on ratings of the female phenotype, but not on the male phenotype vignette. These findings suggest that primary school educators are less sensitive to autism in girls, through under-recognition of the female autism phenotype and a higher sensitivity to autism in males. LAY SUMMARY: Educators have an important role in identifying children who need an autism assessment, so gaps in their knowledge about how autism presents in girls could contribute to the under-diagnosis of autistic girls. By asking educators to identify autism when presented with fictional descriptions of children, this study found that educators were less able to recognize what autism "looks like" in girls. Also, when given identical descriptions of autistic boys and girls, educators were more likely to identify autism in boys. These results suggest that primary school educators might need extra help to improve the recognition of girls on the autism spectrum. Autism Res 2020, 13: 1358-1372. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.