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Cited by 123Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesGenetics and Neurodevelopmental Disorders

Understanding and recognising the female phenotype of autism spectrum disorder and the “camouflage” hypothesis: a systematic PRISMA review

Open access
Allely, Clare Sarah·2019·Advances in Autism
DOI 10.1108/aia-09-2018-0036
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Abstract

Purpose: Females with autism spectrum disorder (ASD) may display superficial social skills which may mask their ASD symptomology impacting on the identification of the disorder – known as the “camouflage” hypothesis. Compared to males with ASD, it is increasingly recognised that females with ASD have a stronger ability to imitate behaviour which is socially acceptable, particularly those females who have higher cognitive abilities (i.e. intelligence considered to be within the normal range) (Ehlers and Gillberg, 1993). The paper aims to discuss this issue. Design/methodology/approach: This paper will explore the literature on camouflaging or masking behaviour in females with ASD. A systematic PRISMA review was conducted. Findings: The capacity to “camouflage” social difficulties in social situations is considered to be one of the main features of the female phenotype of ASD (e.g. Kenyon, 2014). Social imitation or camouflaging enables some level of success and coping, which results in some females never receiving a diagnosis of ASD. They typically may not exhibit any observable functional impairments. However, under the surface of the camouflage, females may experience high levels of subjective stress, anxiety and exhaustion and a need to re-charge or recuperate by withdrawing from any social interaction. Research limitations/implications: There is relatively little understanding and knowledge of the female phenotype of ASD. This lack of understanding and knowledge impacts significantly on the ability to identify females with ASD (Lai et al. , 2015; Bargiela et al. , 2016), which can have a number of negative consequence (Adamou et al. , 2018; National Collaborating Centre for Mental Health (UK), 2012). Practical implications: There is a need for the development of a camouflaging measure. Originality/value: There is a real need for further research exploring the positive and negative impact of the phenomenon of “camouflaging”, or “pretending to be normal” in females with ASD.

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  • Reported co-occurrences are potentially skewed by underdiagnosis of neurodivergence in females.

    “Importantly, however reported co-occurrences are potentially skewed by underdiagnosis of neurodivergence in females.45”

    From Variant connective tissue (joint hypermobility) and its relevance to depression and anxiety in adolescents: a cohort-based case–control study (2022) · cites this paper as [45]

    In “Males and females may require partly different criteria in defining ‘having’ ASD” (page unavailable), the review suggests that under-identification of autistic females with typical intellectual functioning may explain the reported higher prevalence of co-occurring intellectual disability among diagnosed females. This supports a possible skew in that specific co-occurrence, but the claim extends it to reported co-occurrences and neurodivergence generally, which the passage does not establish. (LLM, conf=0.86)

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1 of the 79 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Allely, C. S. ( ). Exploring the Female Autism Phenotype of Repetitive Behaviours and Restricted Interests (RBRIs): A Literature Review.
  2. Gould, J., & Ashton-Smith, J. (2011). Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum. Good Autism Practice (GAP), 12(1), 34-41.
  3. Holliday Willey, L. (2015). Pretending to be normal: Living with Asperger's Syndrome (Autism Spectrum Disorder) (Expanded Edition). London: Jessica Kingsley.

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Authors
Allely, C. S.
Affiliations
University of Salford (GB)
Corresponding author
Allely, Clare Sarah
ORCID
Allely, Clare Sarah
Venue
Advances in Autism
Publisher
Emerald
Published
2019-03-12
Volume
5
Issue
1
Pages
14-37
ISSN
2056-3868 (ISSN-L)
DOI
10.1108/aia-09-2018-0036
OpenAlex
W2906540201
Cited by
123
References
79
Citations by year
2026: 13 · 2025: 17 · 2024: 20 · 2023: 16 · 2022: 17 · 2021: 25 · 2020: 9 · 2019: 6
FWCI
5.96
Type
journal article
Language
en
Open access
Licence
Locations
  • Advances in Autism (publishedVersion)
  • University of Salford Institutional Repository (University of Salford) (submittedVersion, cc-by)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetics and Neurodevelopmental Disorders
Keywords
autism spectrum disorder, female phenotype, camouflaging, social imitation, underdiagnosis, social skills, anxiety, exhaustion, gender differences

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