Childhood: AFAB vs AMAB Presentation
In the interest of being as inclusive as possible while discussing the diagnostic disparities among biological sex, we will be using the terms Assigned Male At Birth (AMAB) and Assigned Female At Birth (AFAB). This link has more information about what those terms mean if you want to learn more!
The majority of people professionally diagnosed and treated for autism are AMAB. This translates to stereotypes about how autism presents itself that can be harmful for people who are AFAB. These stereotypes in media often include specific fixations (trains, science, etc.) and social awkwardness that is usually the comedic relief. By reducing autism to these traits, we ignore a large portion of the population and their needs.
Sex differences in diagnosis rates are slowly decreasing as diagnostic physicians are learning about the different presentations of autism, and this is also associated with the “modern increase in autism” that some people use as a claim to invalidate the autistic experience. More is being learned about autism, specifically the wide range of presenting symptoms, so as more information is gathered we will continue to see more people who fit those criteria to be diagnosed.
In American society, young AFAB children are socialized to be docile, demure, and quiet. Therefore, a child who naturally fits those traits, even to the extreme, is praised and their caregivers are not alerted to any potential issue until the child is older and can verbally express their experiences. On the other hand, a young AMAB child who is much more reserved than his peers will ring the alarm bells for his caregivers to get him evaluated for autism.
This disparity in diagnosis rates is exacerbated by the biases of physicians and pediatricians who might not be educated on the presentations of autism. Autism used to be medically considered to be a “little white boy” condition that did not impact other members of the population, but research overwhelmingly suggests that rates of autism are just as strong in other groups. AFAB children are significantly less likely to receive any kind of early intervention for their autism and often are not diagnosed until their teens or adulthood, when acquiring a diagnosis is significantly harder. This leads to worse outcomes for AFAB autistics overall because they have less access to the already scarce resources for the autistic community.
If you are wondering how this disparity applies to your family or practice, I ask you to evaluate the presence of AFAB autistics in your life. If you have one autistic child, it is significantly more likely that your other children will be autistic, so kids should be evaluated by professionals who are educated in the nuances of the condition. If you work in a practice that only seems to have AMAB autistic people receiving services, perhaps you need to evaluate the professionals you are getting referrals from to make sure that they are adequately evaluating their AFAB clients. As always, remember that the neurotypical, or non-autistic, population has a duty to ensure that their autistic counterparts are represented and respected, and that includes AFAB autistics.
