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Autism refers to a neurodevelopmental condition, characterised by differences in communication and social interaction in conjunction with repetitive behaviours, activities, or interests and hyper- or hyposensory sensitivities (American Psychiatric Association, 2013). According to the United States Centers for Disease Control and Prevention, the prevalence of autism in children is 2.3% (Maenner et al., 2021). Similar prevalence rates of over 3% were reported among Australian children (Australian Bureau of Statistics, 2019). Although this prevalence of autism has created greater interest and research in the field, studies focusing specifically on gender differences and the experiences of females on the autism spectrum are still new and developing (Gould, 2017).
The male to female diagnosis ratio for autism has been reported to be between 4:1 to 3:1 (Baio et al., 2018; Loomes et al., 2017). Over the past decade, however, there has been increased recognition that females on the autism spectrum are more likely to be under-identified, misdiagnosed, or diagnosed later in life than males on the autism spectrum (Begeer et al., 2013; Loomes et al., 2017). These diagnostic-related issues appear to be because of differences in the presentation of autistic characteristics from males on the autism spectrum (Bargiela et al., 2016; Green et al., 2019). A variety of theories, including that of extreme male brain theory (Baron-Cohen, 2002) and female protective effect (Robinson et al., 2013), have sought to explain the differences between males and females on the autism spectrum, but there is no consensus currently.
Hiller et al.’s (2014) study with clinician and teacher diagnostic assessments and reports indicated that females on the autism spectrum were more able to engage in reciprocal conversation and had different restricted interests than those common with males. A summary of behavioural sex differences in Lai et al. (2015) also showed females had more awareness of social interaction needs and tendencies towards perfectionism. Another notable difference is that females on the autism spectrum appear to mask or camouflage their autism characteristics, such as social communication difficulties, more than males on the autism spectrum (Lai et al., 2017; Schuck et al., 2019). Although the terms masking and camouflaging are often used interchangeably, for simplicity we will only use the term masking in this review to refer to the complex behaviours of imitating others...