Why are autistic females rare? originally appeared on Quora, the place to gain and share knowledge, empowering people to learn from others and better understand the world. You can follow Quora on Twitter, Facebook, and Google Plus.

Why are autistic females rare?

The research is pointing to the fact that they are not rare. What was thought to be a 4:1 male to female prevalence in Autism Spectrum Disorder (ASD) is now predicted to be more likely 2:1 (male to female).

Speaking as a hfASD female I can tell you that I only got diagnosed in my mid-forties despite seeing therapists since I was five years old. The reason for the therapy visits was that I had suffered significant developmental trauma (abuse) and as a result had anxiety, depression and repetitive behaviors. It was only when my autistic symptoms manifested more dramatically in my forties after a significantly traumatic experience that I was diagnosed correctly. I started spending most of my time alone, withdrew from family and friends and was quite happy in my own little world, but the change was so drastic that a number of people became very concerned. My reaction to the trauma was unusual, I did not seem concerned with it, but inside what had happened was the world had become an unsafe place for me, although I did not know this. What I felt was that I just did not want to pretend anymore. I did not want to pretend that I liked social situations or talking on the phone or any number of things that I had hidden for many years. I just wanted to be left alone and do my research. If you met me you would not know that I was autistic, after all no doctor or therapist or psychiatrist did until I showed my symptoms.

The reasons for not knowing that I was autistic nor others knowing, were that I learned to mimic and wanted to be liked and accepted. So I got really good at mimicking. When I was told by a person that I stared too much into their eyes, I practiced changing the behavior. When my parents got called into school when I was seven years old because a teacher was concerned that I was coloring everything—the Sun, the grass, people—magenta, it was assumed that the trauma was at the root of it. Also, my obsessions were socially revered; I liked to do lots of reading and research. My focus was joked about; my family said that when I had a baby I would bring the groceries home and leave the baby, but I often left the groceries as my son was my focus. Behavior after behavior I modified until I became socially adept.

I love being a hfASD (high functioning ASD) female. We are known to be deeply compassionate, caring and kind individuals. We are known to be intelligent and have lateral thinking brains. We think of things that other people don’t consider. We can lie, but prefer not to lie. The downside is the high statistics towards suicide and depression. 71% if hfASD females struggle with suicidal ideation. I have had to learn to live with the fact that these thoughts come into my head, and that they are a symptom of my hfASD; not a reality.

Here is a part of a diary edition that I wrote shortly prior to my diagnosis:

“It is never pleasant when the depression creeps in like a cold fog and surrounds my heart. And my heart begins to hurt. It feels as though I shall collapse inward—into myself, which is different than when my heart hurts with joy. There the ache like a bright sun pushes away the fog. Mostly this happens when I step through the ‘wardrobe’ into my own land. Freedom. It is only here that I can breathe. And who is to say what my reality needs to be? On this Earth people are unpredictable and I feel like a small scared squirrel. Nervous. Here on Earth I feel mostly unloved and I feel unlike by so many, always having to hide who I am."

Also, I can say more than I want about myself to people, and I have to use a rule of thumb in my head to remember to not keep talking. Get me onto a subject I am passionate about and in the past you had better have prepared for a long one-side conversation. Now I know that after one minute of conversation, I need to let the other person talk.

Males with ASD are found to show more externalizing behavior problems than females, such as aggressive behavior, hyperactivity, reduced prosocial behavior, and increased repetitive/restricted behaviors and interests and thus are more easily identified and diagnosed.

Females with ASD show greater internalizing symptoms than boys, including anxiety, depression, and other emotional symptoms as reported by parents. Parents also more frequently endorse the item “avoids demands”. Females with ASD tend to only get diagnosed if they have a low IQ and are low-functioning.

The observed sex differences raise the possibility that male-typical externalizing behaviors are more disruptive in the home or school setting than female-typical internalizing behaviors—preferentially prompting evaluation and diagnosis for boys, especially as compared to high-functioning girls. For girls then, low IQ may be more likely the secondary issue prompting evaluation and diagnosis. This scenario further implies that some proportion of the sex difference in ASD prevalence is attributable to biases inherent in the diagnostic process. Girls without diagnoses showed increased communication difficulties, but reduced social impairments as compared to non-diagnosed boys. Thus, it may be that relatively higher levels of social ability in females preclude full diagnosis of ASD, particularly for those who are high-functioning.

Here is an excellent video on hfASD females: Changing the Face of Autism: Autism in females

This question originally appeared on Quora. More questions on Quora:

* Autism: What is it like to be a parent of a child with Asperger's?

* Autism Spectrum Disorders: How did the "Vaccine causes autism" argument start in America?

* Female Autism: What is it like to be female and have autism?

Photo Credit: John Mclaird/Getty Images