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Investigating the Female Profile of Autism
Conference Paper · May 2010
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The female profile of high
functioning autism
Victoria Miller
Janine Manjiviona
Tony Attwood
Mark Stokes
 Camouflage hypothesis
• Because of the diagnostic focus upon
language and social skills, female superiority
in these areas may mask autism presentation
(Wing, 1981), rendering females apparently
unaffected, when in fact they may be subtly
affected
• Difference found
Previous studies
Girls better than boys
• Age appropriate interests
– Kopp & Gillberg, 1992 (6 HFA girls , <10 years)
• Appropriate play & imaginative play
– Lord et al., 1982 (384 M & 91 F, aged 3 to 8 years)
– McLennan et al. 1993 (21 M & 21 F, IQ matched)

Boys better than girls

• Higher intelligence
– Lord & Schopler, 1985 (487 M, 136 F; IQ range 0-100)
• Functional communication
– Carter et al. 2007 (22 F and 68 M with ASD [mean: 28 months])
• Fewer social, attention, cognitive problems
– Holtmann et al., 2007 (23 F & 23 M matched for age, IQ)

• No difference
IQ profile
– Volkmar et al., 1993 (diagnostic case records 199 autism, 74 PDD-NOS, and 215 with non-PDD
developmental disorders); Lord et al., 1982 (384 M and 91 F, aged 3 years to 8 years)
Autism Quotient
– Baron-Cohen et al., 2001 (45 M, 13 F AS/HFA adults)
ADI-R, CARS, or ADOS
– Pilowsky et al., 1998 (18 M & 18 F matched age & IQ), Holtmann et al., 2007 (23 M & 23 F matched
for age, IQ)
 Questionnaire development
• Broad questions based on DSM-IV diagnostic
criteria to given 1000 clinicians
– frequently saw males and females
• 61 returned
• Factor analysed responses
• Nine domains
• Developed online instrument for parents from
factors with 99 questions
 Sample
• Participants parents of children and
adolescents
– 5 to 18 years
– Australia, USA, UK and the Republic of Ireland
Male Female

ASD: HFA, AS, PDD 283 82

TD 27 30

• Results were analyzed utilizing group

invariance confirmatory factor analysis
 Group invariance factor analysis
• Model can have:
• Equal structure
• Equal structure, factor weights & error values
– An equivalent model
Group 1 model Group 2 model
 Group invariance factor analysis
• Model can have:
• Equal structure
• Equal structure, factor weights & error values
– An equivalent model
Group 1 model Group 2 model
 Why not simply look at means?
10
• Scales (i.e.: ADI, CARS, 9
ADOS, etc) made up of 8
7
subscales that give a 6
summary score 5
4
• Summary scores are then 3
2
averaged 1
0
• Averages are compared 0 2 4 6 8 10
between groups Mean g1: 3.93 SD g1: 2.62
Mean g2: 4.66 SD g2: 1.996
t-test = 0.73
• Groups may differ on p = 0.24
scales, which when added
give the same result –
averages hide differences
 Behaviour - Factors
ASD Males ASD Females TD Females

Opposit- Quiet- Engage- Attent- Opposite- Quiet- Engage- Attent- Distrac- Opposite- Quiet- Attent-
ionality ness ment ion ionality ness ment ion ted ionality ness ion
Isolated from family 0.27 0.26 -0.35 0 0.12 0 -0.49 0 0.32 0.66 0.13 0.19
Physically aggressive 0.74 0 -0.1 0.11 0.78 0 -0.19 0 0 0.89 0 0.26
Poor concentration 0.16 0 0 0.98 0.3 -0.13 0 -0.58 0.31 0.27 0.14 0.95
Outgoing 0 -0.77 0.15 0 0 -0.64 0.13 0 0 -0.2 -0.98 0
Quiet -0.16 0.77 0 0 -0.15 0.73 0 0 0 -0.28 0.74 0
Defiant 0.73 0 0 0.19 0.7 0 -0.15 -0.18 0.28 0.8 0.21 0.11
Disruptive 0.77 0 0 0.24 0.76 -0.18 0 -0.2 0 0.75 -0.2 0.38
Interested in family -0.12 -0.13 0.99 0 -0.16 0 0.98 0.1 0 -0.49 -0.39 -0.11
Good concentration -0.17 0 0.18 -0.69 -0.19 0 0 0.97 0 -0.32 -0.19 -0.78
Verbally aggressive 0.82 0 0 0.13 0.78 0 0 -0.11 0 0.88 0 0.17
Withdrawn from others 0 0.6 -0.11 0 0.13 0.63 0 0 0.47 0.39 0.77 0.27
Distracted obsessive interests 0.11 0 0 0.24 0 0 0 0 0.66 0.75 0.16 0.38
 Behaviour – Factor Loadings

Oppositionality Quietness

Interested in family Outgoing

Good concentration Interested in family

Quiet Disruptive

Outgoing Good concentration

Poor concentration Verbally aggressive

Withdrawn from Physically

others aggressive

Isolated from family Isolated from family

Distracted Poor concentration

obsessive interests
Distracted
Disruptive
obsessive interests

Defiant Defiant

Verbally aggressive Quiet

Physically Withdrawn from

aggressive others
1

0.8

0.6

0.4

0.2

-0.2

-0.4

-0.6

-0.8

-1
1

0.8

0.6

0.4

0.2

-0.2

-0.4

-0.6

-0.8

-1
Behaviour – Factor Loadings

Attention

Good
concentration

Interested in family

Quiet

Outgoing

Defiant

Verbally aggressive

Isolated from family

Physically
aggressive
Withdrawn from
others

Disruptive

Distracted
obsessive interests

Poor concentration
1

0.8

0.6

0.4

0.2

-0.2

-0.4

-0.6

-0.8

-1
Behaviour - Variance
 ASD females relatively fit
TD Girls ASD male model
ASD Girls – (c2/df=1.65 , RMSEA=.09,
ASD Boys CFI=0.91)

ASD males relatively fit ASD

females model
– (c2/df=2.16, RMSEA=.06,
CFI=0.97)

ASD females relatively fit TD

model
– (c2/df=2.12 , RMSEA=.12,
CFI=0.86)

TD females DO NOT fit ASD

female model
– (c2/df=3.13 , RMSEA=.27,
ASD females and males appear similar CFI=0.78)

ASD females are more attentive, less

disruptive & less defiant than ASD boys or
TD girls
 Communication - Factors
ASD Males ASD Females TD Females
Good Good
Unusual Eye Positive Negative Unusual Eye Positive Negative Unusual Positive Negative
Speech Contact NVC NVC Speech Contact NVC NVC Speech NVC NVC
Eye contact 0 0.97 0.21 0.12 0 0.65 0.31 -0.22 -0.14 0.97 -0.22
Some eye contact 0 0.69 0.13 0 0 0.96 0.26 0 -0.26 0.89 0
Tendency to stare 0.15 0 0 0.47 0.17 0 0.11 0.41 0.25 0.12 0.72
Avoids eye contact 0 -0.49 -0.11 0.12 0.23 -0.17 -0.13 0.18 0.23 -0.58 0.54
Copies others body language 0.2 0 0.18 0.4 0.25 0 0.15 0.3 0 0 0.65
Restless 0.11 0 0 0.48 0.17 0 0 0.44 0.26 -0.4 0.67
Uses appropriate body language 0 0 0.83 0 0 0.28 0.96 0 -0.27 0.65 -0.17
Poor sense of personal space 0.24 0 -0.18 0.48 0 0 0 0.66 0.43 -0.38 0.63
Good control over use of body 0 0.23 0.44 -0.19 -0.12 0.21 0.3 -0.65 -0.32 0.51 -0.37
Uses socially app. facial expressions 0 0.25 0.53 0 -0.24 0.34 0.58 0 -0.36 0.75 -0.19
Uses strange voices 0.72 0 -0.13 0.24 0.77 0 0 0.12 0.5 -0.36 0.39
Uses a high pitch tone of voice 0.74 0 0 0.24 0.71 -0.15 0 0 0.72 -0.5 0.26
Uses strange/exaggerated intonation 0.87 0 -0.12 0.15 0.82 -0.1 -0.13 0.22 0.85 -0.37 0.38
Exhibits no articulation difficulties -0.11 0 0 0 0 0.13 0 -0.11 -0.2 0.48 0.25
 Communication - Loadings
Unusual Speech Good Eye Contact vs TD
Positive NVC
Uses socially app. facial expressions Avoids eye contact

Good control over use of body Uses a high pitch tone of voice

Uses appropriate body language Restless

Some eye contact Poor sense of personal space

Exhibits no articulation difficulties Uses strange/exaggerated intonation

Eye contact Uses strange voices

Copies others body language Copies others body language

Avoids eye contact Tendency to stare

Tendency to stare Exhibits no articulation difficulties

Restless Good control over use of body

Poor sense of personal space Uses appropriate body language

Uses strange voices Uses socially app. facial expressions

Uses a high pitch tone of voice Some eye contact

Uses strange/exaggerated intonation Eye contact

1

0.8

0.6

0.4

0.2

-0.2

-0.4

-0.6

-0.8

-1
1

0.8

0.6

0.4

0.2

-0.2

-0.4

-0.6

-0.8

-1
 Communication - Loadings
Positive Non-Verbal Negative Non-Verbal
Communication Communication
Avoids eye contact
Good control over use of body

Uses a high pitch tone of voice

Eye contact

Restless Uses socially app. facial expressions

Poor sense of personal space Uses appropriate body language

Uses strange/exaggerated intonation Some eye contact

Uses strange voices Exhibits no articulation difficulties

Copies others body language Uses a high pitch tone of voice

Tendency to stare Uses strange/exaggerated intonation

Exhibits no articulation difficulties Uses strange voices

Good control over use of body Avoids eye contact

Uses appropriate body language Poor sense of personal space

Uses socially app. facial expressions Copies others body language

Some eye contact Restless

Eye contact Tendency to stare

1

0.8

0.6

0.4

0.2

-0.2

-0.4

-0.6

-0.8

-1
1

0.8

0.6

0.4

0.2

-0.2

-0.4

-0.6

-0.8

-1
Communication - Variance
 Communication - Variance

ASD males & females appear similar

 Communication - Variance

ASD males & females DO NOT appear similar

 ASD females absolutely fit ASD
male model
TD Girls – (c2 = 73.68, df=59, p=ns,
ASD Girls RMSEA=.06, CFI=0.95)
ASD Boys
ASD males relatively fit ASD
females model
– (c2/df=1.92, RMSEA=.06,
CFI=0.95)

ASD females DO NOT fit TD

female model
– (c2/df=2.67 , RMSEA=.15,
CFI=0.69)

TD females relatively fit ASD

female model
– (c2/df=1.63 , RMSEA=.15,
CFI=0.89)

ASD females can be explained by ASD male factor structure

Multivariate ASD Female Non Verbal skills appear closer to TD
 Presentation - Factors

ASD Males ASD Females TD Females

No Manag-
Interest ing own
Personal Present- Groom- in Personal Present- Groom- Personal Present- present-
Care ation ing Fashion Care ation ing Care ation ation
Good personal care -0.73 0.23 0.35 0 -0.63 0.19 0.54 0.67 0.26 -0.51
Difficulty initiating self care 0.62 -0.2 0 0 0.73 -0.12 0 -0.4 0 0.66
Wears makeup -0.49 0.34 -0.12 0 0.85 0.13
Wears clean clothing -0.15 0.28 0.81 0 0 0.17 0.84 0.86 0.16 -0.29
Not interested in fashion 0.11 0 0 0.99 0.4 0 -0.2 -0.34 -0.25 0.7
Strong or unusual body odour 0.13 0 -0.33 0.1 0.37 -0.12 -0.24 -0.36 0.35 0.4
Requires assistance with personal hygiene 0.78 0 0 0 0.78 -0.1 0 0 0 0.99
Doesn’t care about appearance 0.57 -0.12 -0.14 0.23 0.59 -0.18 -0.14 -0.39 -0.52 0.25
Wears neat and tidy clothing -0.23 0.47 0.54 0 -0.23 0.36 0.63 0.85 0.4 -0.23
Attends to finger nails 0 0.5 0.2 0 -0.11 0.57 0.24 0.39 0.76 -0.12
Good presentation -0.29 0.94 0.14 -0.14 -0.33 0.9 0.3 0.51 0.72 -0.25
 Presentation - Loadings
Personal Care Presentation

Difficulty initiating self care Doesn’t care about appearance

Doesn’t care about appearance Not interested in fashion

Strong or unusual body odour Difficulty initiating self care

Not interested in fashion Requires assistance with personal

hygiene

Wears makeup Wears clean clothing

Requires assistance with personal

Good personal care
hygiene

Attends to finger nails Strong or unusual body odour

Good presentation Wears neat and tidy clothing

Good personal care Good presentation

Wears neat and tidy clothing Attends to finger nails

Wears clean clothing Wears makeup

1

0.8

0.6

0.4

0.2

-0.2

-0.4

-0.6

-0.8

-1
1

0.8

0.6

0.4

0.2

-0.2

-0.4

-0.6

-0.8

-1
 Presentation - Factors

ASD males & females appear similar

 Presentation - Factors

ASD males & females DO NOT appear similar

 ASD females relatively fit ASD male
model
TD Girls – (c2/df=2.16, RMSEA=.12,
ASD Girls CFI=0.90)
ASD Boys
ASD males do not fit ASD females
model
– (c2/df=5.26, RMSEA=.12,
CFI=0.86)

ASD females relatively fit TD

female model
– (c2/df=2.69, RMSEA=.14,
CFI=0.86)

TD females absolutely fit ASD

female model
– (c2=31.26, df=28, p=ns,
RMSEA=.07, CFI=0.97)
Some ASD females can appear like TD females
Only in multivariate analyses can we discern ASD males from
ASD females
View publication stats

Summary
• ASD females and males show superficial similarity in behaviour,
communication, & presentation

• Both groups show subtle differences in behaviour, communication, &

presentation

• Camouflage hypothesis

– ASD females may be better presented than ASD males, and may
appear similar to TD females

– ASD females may be quieter, less disruptive than ASD males, more like
TD females

– ASD females may superficially show communication skills typical of TD

females