If you are having a heart attack, you had better hope you are a man. Women are 50 per cent more likely than men to be misdiagnosed when having a heart attack. The main reason? Stereotypes: we tend to think of heart attacks as a 鈥渕an thing鈥�.
Autism, too, has long been seen as a condition predominantly affecting men. As with heart attacks, this perception is widely held by the public and often portrayed in cultural characterisations of autism. But it is also a self-propagating belief that has affected scientific research for decades. The more that autism researchers studied the condition, the more they looked for it in boys and men, and so their assertion that this group is most affected appeared to be increasingly validated. Autism research has focused almost exclusively on boys and men. Gold-standard diagnostic tests, too, have been designed for and validated on this group.
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Girls have paid the price. Most autistic girls will reach 18 years old without a diagnosis, as neuroscientist Gina Rippon writes in 鈥淎 revolutionary new understanding of autism in girls鈥�. Late-diagnosed women might describe a lifetime of 鈥渄iagnostic bingo鈥� 鈥� being told they have such things as borderline personality or social anxiety disorder, before finally receiving an autism diagnosis, often late in adulthood.
Women might describe a lifetime of 'diagnostic bingo' before finally getting a diagnosis
But new studies of girls鈥� brains have revealed that autism can look very different in girls and boys, revolutionising our understanding of the condition.
So what happens next? It would be nice to think this will automatically improve things for autistic girls, but we need only look at heart attacks to know it isn鈥檛 that easy. We have long known that cardiovascular disease affects as many women as men, yet the 鈥渉eart attack gender gap鈥� persists. In the case of autism, the gender bias has been embedded within the research for decades. Thus, on a systemic level, we need better bias checks within the peer-review process. As for the tests currently used to diagnose autism 鈥� which often dismiss women as 鈥渘ot autistic enough鈥� 鈥� a swift and radical overhaul of these would be a good place to start.
