Parent-Teacher Discrepancies Suggest Camouflaging Of Autism Traits In Females At School

Autistic females may show different traits than males, often masking social difficulties.

Examples of camouflaging autistic characteristics include forcing eye contact and facial expressions may develop during school years due to gendered expectations and peer interactions, more common in females.

This can lead to missed or late diagnoses. Examining parent-teacher discrepancies in ratings of autistic youth could provide evidence for the development of camouflaging in females, particularly in school settings.

Putnam, O. C., McFayden, T. C., & Harrop, C. (2024). Sex Differences and Parent–Teacher Discrepancies in Reports of Autism Traits: Evidence for Camouflaging in a School Setting. Journal of Autism and Developmental Disorders, 1-12. https://doi.org/10.1007/s10803-024-06498-w

Key Points

• Teachers reported males as having significantly more autistic traits than females, despite no sex differences in parent ratings or clinician assessments of autism severity. This suggests a potential bias or lack of recognition of female autism traits by teachers.
• For females only, parents reported significantly more autistic traits than teachers across multiple domains. This parent-teacher discrepancy may reflect camouflaging of autistic traits by females in the school setting.
• Older age and being female predicted greater parent-teacher discrepancy, while non-white race predicted less discrepancy. However, these factors explained a small amount of variance, suggesting other variables like teacher knowledge of autism may play a larger role.
• Using discrepancy between parent and teacher ratings on autism trait measures could help identify camouflaging in autistic youth, especially females. This may alleviate negative consequences of camouflaging.

Rationale

Despite increasing recognition of autism in females, a male-to-female diagnostic ratio persists into school age, suggesting under-identification of school-aged autistic females (Baio et al., 2018; Maenner, 2023).

Qualitative reports indicate teachers may overlook signs of autism in girls due to behavioral and academic strengths or gender stereotypes (Bargiela et al., 2016; Cridland et al., 2014).

Preliminary evidence shows parent-teacher disagreement on measures of child behavior is greater for autistic females than males (Mandy et al., 2012; Sturrock et al., 2020).

The current study directly compares parent and teacher ratings of autism traits in females versus males on the same validated measure, and explores factors predicting informant discrepancies.

Results may illuminate sex-based biases in teacher perceptions and quantify descriptions of female camouflaging from the autism community.

Method

• Examined sex differences and parent-teacher discrepancies in autism trait ratings
• Used sex-matched sample of 388 autistic youth from Simons Simplex Collection
• Parents and teachers completed Social Responsiveness Scale (SRS)
• Compared mean SRS scores between males and females within each informant group
• Compared mean SRS scores between parents and teachers within each sex group
• Calculated informant discrepancy scores (parent minus teacher) and predictors

Sample

• 194 males, 194 females; matched on age (4-17 years) and IQ (19-142)
• No sex differences in clinician-rated autism severity on ADOS-2
• Predominantly white (80%) and non-Hispanic (92%)

Measures

• Social Responsiveness Scale (SRS): 65-item parent/teacher rating of autism traits. Domains: Social Awareness, Social Cognition, Social Communication, Social Motivation, RRBs
• ADOS-2: Clinician rating of autism characteristics; compared calibrated severity scores
• Cognitive assessments: Wechsler, DAS-II, or Mullen; compared full-scale IQ scores

Results

Below are the results of this study:

1. No sex differences in parent SRS ratings, but teachers rated males higher than females on total score and all domains.
2. No parent-teacher differences for males, but parents rated females significantly higher than teachers on total score, Social Awareness, Social Cognition, and RRBs.
3. Females had greater positive informant discrepancies (parent>teacher) than males on all scores. For females only, higher average severity predicted less discrepancy.
4. Regression showed female sex and older age predicted greater discrepancy, non-white race predicted less discrepancy for some domains. Models explained small variance.

Insight

This study provides empirical evidence for qualitative reports and preliminary findings of sex differences in teacher perceptions of autistic traits and potential female camouflaging in schools.

Critically, while parents and clinicians did not differ in their ratings of females vs. males, teachers consistently rated males as more impaired.

Parent-teacher discrepancies for females align with research operationalizing camouflaging as a difference between “external” behavioral presentation and inner autistic experience or traits.

Examining item-level differences suggests discrepancies center on behaviors females report consciously monitoring to “fit in,” like eye contact and imitation.

Employing an SRS discrepancy approach could help schools recognize struggling females. Predictors like age have implications for identifying camouflaging earlier.

Strengths

This study had several methodological strengths, including:

• Direct parent-teacher comparison using a validated autism trait measure
• Sex-matched sample across a wide age and IQ range
• Exploration of item-level discrepancies to connect to camouflaging experiences
• Examination of predictors of discrepancies and implications for identifying camouflaging

Limitations

This study also had several methodological limitations, including:

• Cross-sectional data from 2008-2010; changes in autism recognition over time may affect current discrepancies
• Sample limitations: predominantly White, non-Hispanic; only simplex families
• Lack of data on informant characteristics like teacher autism knowledge
• Camouflaging measured indirectly; cannot determine conscious/effortful camouflaging

Implications

• Highlights critical need for teacher training on female autism presentations
• SRS discrepancy scores could identify struggling students, especially females
• Importance of gathering multi-informant data and discussing discrepancies
• Predictors like age relevant for earlier identification and support for females
• Advances quantification of camouflaging in children; need to integrate self-report

References

Primary reference

Putnam, O. C., McFayden, T. C., & Harrop, C. (2024). Sex Differences and Parent–Teacher Discrepancies in Reports of Autism Traits: Evidence for Camouflaging in a School Setting. Journal of Autism and Developmental Disorders, 1-12. https://doi.org/10.1007/s10803-024-06498-w

Other references

Baio, J., Wiggins, L., Christensen, D. L., Maenner, M. J., Daniels, J., Warren, Z., Kurzius-Spencer, M., Zahorodny, W., Rosenberg, C. R., White, T., Durkin, M. S., Imm, P., Nikolaou, L., Yeargin-Allsopp, M., Lee, L.-C., Harrington, R., Lopez, M., Fitzgerald, R. T., Hewitt, A., … Dowling, N. F. (2018). Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. MMWR. Surveillance Summaries, 67(6), 1. https://doi.org/10.15585/mmwr.ss6706a1

Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of autism and developmental disorders, 46, 3281-3294. https://doi.org/10.1007/s10803-016-2872-8

Cridland, E. K., Jones, S. C., Caputi, P., & Magee, C. A. (2014). Being a Girl in a Boys’ World: Investigating the Experiences of Girls with Autism Spectrum Disorders During Adolescence. Journal of Autism and Developmental Disorders, 44(6), 1261–1274. https://doi.org/10.1007/s10803-013-1985-6

Maenner, M. J. (2023). Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR. Surveillance Summaries, 72(2), 1–24.

Mandy, W., Chilvers, R., Chowdhury, U., Salter, G., Seigal, A., & Skuse, D. (2012). Sex Differences in Autism Spectrum Disorder: Evidence from a Large Sample of Children and Adolescents. Journal of Autism and Developmental Disorders, 42(7), 1304–1313. https://doi.org/10.1007/s10803-011-1356-0

Sturrock, A., Marsden, A., Adams, C., & Freed, J. (2020). Observational and Reported Measures of Language and Pragmatics in Young People with Autism: A Comparison of Respondent Data and Gender Profiles. Journal of Autism and Developmental Disorders, 50(3), 812–830. https://doi.org/10.1007/s10803-019-04288-3

Keep Learning

1. How might the intersection of a child’s gender identity and autism traits influence informant discrepancies and potential camouflaging? What are the implications for non-binary or gender diverse autistic youth?
2. In what ways could parent and teacher characteristics like race, education level, or prior experience with autism contribute to discrepancies in perceived autism traits? How can we disentangle informant “bias” from camouflaging behavior?
3. What are the potential negative consequences of camouflaging autism traits in the school setting for students’ mental health, self-concept and access to support? How can schools create environments where camouflaging is not necessary for autistic students to succeed?
4. Given the limitations of the current study sample, how might future research incorporate more diverse, intersectional, and longitudinal perspectives to examine informant discrepancies and camouflaging over time and across contexts? How can the results of this study inform adaptations to autism diagnostic assessments, educational practices and policies to better identify and support autistic students, especially females, who may be overlooked? What training do teachers need?