Gender stereotypes

Research suggests that behaviours and perceptions of men and women are governed by stereotypes, as they provide prompt assumptions toward members of social groups [12]. For example, males are perceived to have more agentic characteristics than females, as they are perceived to be more independent, assertive, and dominant; while increased empathy and greater communication abilities are often more widely perceived in females [13–15]. Females have also been found to be more emotionally expressive than males while being better able to demonstrate greater use of non-verbal communication both in-person and during online interactions [16, 17]. Shyness is also a common trait associated with females; shyness for example is much less likely to raise concerns for girls in school than boys due to the social expectation that girls are shy [18]. These expectations can then influence individuals’ perceptions of men and women and how they act [19, 20]. This isc orroborated by comparing the pressure felt by adolescents to engage in same-gender behaviour, extending the current understanding of gender identity, as men reported pressure to avoid feminine-typed behaviour [21]. On average, females are also believed to be more susceptible to social pressures than males [22].

Gender stereotypes and autism

Female stereotyped behaviours, in many ways, stand in stark contrast to typically recognized autistic traits. The language used to describe ASC is littered with certain gender expectations. For instance, the general view that women display more heightened emotional expressions, alongside greater motivation to communicate for social reasons than men, directly contrasts characteristics associated with autism [23]. Such biases may contribute to the systematic constraints that prevent girls from obtaining recognition for their ASC from their parents, educators, and peers at the same rate as their male counterparts. A reluctance to view a female as autistic likely has a detrimental effect on wellbeing. Improved understanding and more positive perceptions from peers are essential outcomes of a recognized diagnosis [24].

Recognizing an individual as autistic is critical for improving double empathy between the autistic person and the neurotypical community [25]. A public-facing autistic identity allows neurotypicals to recognize that an autistic person possesses a neurodivergent perspective equally deserving of understanding and respect. Failure to acknowledge and validate neurodivergent views is known as the double empathy problem, which may be compounded in autistic females. Specifically, as the stereotypes associated with females may be particularly at odds with perceptions of autism, there runs the risk of a heightened misunderstanding of neurodivergence in females. For instance, qualitative research [7] revealed how healthcare providers consistently dismissed autistic female clients’ accounts of their autistic traits as more indicative of conditions such as depression, as these are none to have higher female ratios. Autistic participants have also discussed how their experiences of gender dysphoria were minimized or explained away by their autistic status [11]. These accounts show how stereotypes of neurodivergence and gender can reduce double empathy and inhibit the acceptance of autistic people who may not fit the typical male-autistic presentation.

There are several dominating accounts of the social features of autism that are at odds with female stereotypes. The theory of mind account [26], which cites autistic social differences as stemming from poor perspective-taking, may also reflect a gendered stereotype favouring males. Females are believed to be better able to take other’s perspectives into account [27]. Indeed, theory of mind (ToM) tasks often reveal a female advantage, as assessed using both behavioural [28] and neural methods of investigation [29]. Another popular theoretical account of the social features of autism, the social motivation account [30], purports that autistic people are less interested in social stimuli than neurotypicals. Similarly, research suggests that females tend to be more socially motivated than males [31, 32].

Interestingly, research has not found a female advantage in social tasks. For instance, autistic females appear to have similar difficulties reading emotions in their eyes as autistic males, despite an advantage on the same task in neurotypical females compared to males [33]. To minimize differences in ways that match society’s expectations, autistic individuals often camouflage their traits [34] by attempting to emulate the social interaction style of what is deemed as neurotypical [35] to fit in more with their peers [36]. Motivation for camouflaging and masking social difficulties is increased by social pressures and expectations experienced by females [35]. For instance, women with autism ‘pretend to be normal’ by copying others’ speech patterns and body language [7, 37] as a reaction to the societal messages they receive, which tell them as females they should be more sociable than males [10].

There is a worrying association between camouflaging, autistic traits, and diminished mental health [38], alongside stress associated with autism being ‘found out’ [39]. These additional gendered pressures are of pragmatic concern. One way to improve these outcomes for women on the spectrum is to understand and recognize ASC in females, particularly as it concerns early diagnosis [9]. Equal identification of female autistic traits is imperative as, among other benefits, those recognized as autistic experience greater acceptance as there is a reason and explanation for expressing atypical behaviour [24].

Understanding discrepancies in male and female identification rates is particularly imperative in the early years. Research suggests early intervention has many benefits, including more significant gains in communication and wellbeing [40]. Unfortunately, systematic male biases negatively impact the early identification of female autistic children. For instance, researchers found gender-related assumptions about male and female children’s social engagement and activities with and without ASC at school [41]. Specifically, the social challenges of boys with ASC were viewed as more obvious than those of girls with ASC. This correlates with research that showed educators within a school setting expressed a reduced likelihood of seeking support for a female believed to have autism compared to an equivalent male [42]. Finally, parents’ perception of their child’s behaviours and difficulties may also affect an individual’s motivation to camouflage due to social expectations varying depending on the child’s gender [43]. This poses severe consequences for the welfare of females with ASC, putting them at a disadvantage to males in both educational and domestic contexts [6].

Another consequence of gendered stereotypes about autism is that they fuel common misconceptions of autism within the general population. Such stereotypes can result in unfavourable inferences about individuals with ASC based on their social, behavioural, and communicative differences, harming their mental health [44]. For instance, people form a more negative first impression of individuals with ASC than those without, whilst also being influenced by the individual’s gender, with significant differences apparent between the judgements of autistic females compared to non-autistic females [44]. This bias has also been found to occur at an unconscious, implicit level through an Implicit Association Test (IAT) [45]. In an IAT, individuals are timed on their ability to pair a set of stimulus words with a similar meaning (i.e. ‘good,’ ‘nice,’ ‘kind’) with a categorical word (i.e. ‘Muslim’, ‘British’). In an IAT test looking to test the association between autism and positive and negative words, a significant negative implicit attitudes towards autistic adults in the general population was found [46], despite participants asserting positive explicit attitudes. These results provide further explanations for the discrimination against autistic adults within society. Given the stereotypical associations between female traits and female sociality, discrimination may be particularly heightened towards autistic females.

Gendered stereotypes towards autism are also reinforced within the media as stereotypes and stigmas surrounding autism can be strengthened [47]. One example is the stereotypical use of male characters in The Curious Incident of the Dog in the Night-Time, Rain Man, The Big Bang Theory and Atypical. These popular representations can influence generalized perceptions of neurodevelopmental disorders, such as autism, even when an individual has personal experience with autism [48]. While media representations have been shown to affect implicit associations in general [49], this is especially important to consider for those that may not have access to personal experience, suggesting further reliance on the media to understand autism, further contributing to stereotyped attitudes. Furthermore, researchers report the representation of only “very high levels” to “extreme levels” of autism-related symptoms within the media [48]. This portrayal may further contribute to the high levels of missed diagnosis of females with less immediately apparent areas of functional need. Thus, the general public may form a highly stereotypical view of individuals with ASC, often through the lens of male rather than female characters.

Gender biases in autism research

Gender bias has likely filtered into academic research, resulting in a lack of sensitivity towards the symptomology presented by ASC females [8], as the current diagnostic tools for autism are believed to be geared towards the male autism phenotype [50]. Some of this may stem from the fact that autism research favours male over female participants [8]. This sampling bias likely contributes to why male presentations of autism are often used as a guide for designing and implementing current diagnostic tools, exacerbating the misidentification of autistic females [51]. These challenges may explain why females with ASC must present with more functional needs (such as more concurrent behavioural, developmental, or mental health issues) to be diagnosed compared to males [52, 53]. Indeed, among studies with autistic individuals without intellectual disabilities, the ratio between males to females is as high as 10:1 [54].

Some suggest that there is one specific theory of autism that particularly perpetuates male autism stereotypes and lacks sensitivity towards the female autism phenotype [55]. The ‘extreme male brain’ theory of autism suggests that due to their systemizing nature and hindered emotional responses [56], autistic people are an example of a hyper-masculinized group of individuals regardless of gender. Some emphasise that the term ‘extreme male brain’ simply predicts that individuals with autism will show a masculinized pattern of scores of reduced empathy and above average systemizing rather than possessing an extreme of all masculine characteristics (such as aggression) [57]. However, the gendered term may affect how the general population views autism and associates it with males.

Some [58] argue that within the term ‘extreme male brain’, the use of ‘brain’ has replaced ‘behaviour’ with no explanatory power, causing confusion and little descriptive utility. Further questioning this term, researchers compared the AQ scores of neurotypical males and females with those of autistic males and females [3]. They found that autistic female AQ scores were only similar to those of males with ASC and not neurotypical males. This suggests that the scores produced by both males and females with ASC result from the neurodevelopmental condition itself rather than possessing a ‘male brain.’ A popularisation of this term can profoundly impact societal perceptions of autism in males and females by encouraging a gendered understanding of the disorder. Indeed, qualitative accounts of autistic people with gender dysphoria have specifically mentioned how such statements exacerbate their feelings of identity confusion [11].

The high ratio of males to females diagnosed with autism has led to a great deal of genetic research investigating whether there are sex-linked genes that account for autistic symptomology. Along with the male brain theory, other influential theories, such as the female protective effect (FPE), suggests a complex differential liability model of autism and gender, which says that males carry more genetic risk factors for autism while females have specific protective factors that inhibit the development of autistic traits [59]. Similarly, some [60] hypothesize that males have a decreased plastic response to environmental changes, which may lead to enhanced perceptual functioning and social impairments indicative of ASC.

As reviewed by [61] it is difficult to separate the biological characteristics (sex) from the socio-cultural factors (gender) that may lead to an underdiagnosis of autistic females compared to males. For instance, the Autism and Developmental Disabilities Monitoring (ADDM) Network reports that 40% of females with autism have an intellectual disability. In comparison, only 32% of males with autism have an ID when identified through health and school data [62]. However [63] found that when assessing the cognitive functioning of autistic children through standardized assessment, there were no sex/gender differences. This again suggests that females are less likely to be identified as autistic unless they present with higher functional needs. Indeed, while research usually estimates the male-to-female ratio to be 4:1, an infant study looking at siblings of autistic children found the ratio to be 1.65:1 [64], suggesting that when ASC is identified using a high-risk cohort rather than clinical referrals, there is a more even ratio between genders.

It is assumed that individuals carry a gendered view of autism due to the proliferation of male media portrayals of autistic people and popularised research that suggests males are more likely to be autistic. Indeed, the gendered stereotypes of females that are often in direct contrast to autistic characteristics and popularized theoretical accounts of autism as a masculinized condition, few have directly tested this relation. However it is essential to assess the views of the general population as although attitudes towards autism may be improving [65], stigma remains common [66], and individuals’ biases towards autism can often contribute to personal and professional challenges for autistic people [67]. This population-based study explores whether gender biases the perception of autism on implicit and explicit measures.

The current study

To measure how gender colours the perception of autism at the subconscious level, an Implicit Association Test (IAT) was employed to measure participants’ implicit gendered autism associations by recording their reaction times when categorizing male and female names with autistic traits to observe potential implicit bias between the two categories. It was hypothesized that the association between autistic characteristics would be stronger with males than females in an IAT. Autism Spectrum Quotient (AQ) scores in relation to a male or female vignette were compared through a MANOVA to explore whether certain traits on the AQ will be more heavily endorsed when the AQ is being answered about a hypothetical male than a female.

Design & participants

This study employed a mixed design comparing Neurotypical/ASC—female/male implicit associations within participants and explicit endorsement of fe/male targets on an AQ between participants. A power analysis using G*Power determined that 300 participants would be needed to detect a small effect size of Cohen’s d = 0.3. This sample size and hypothesis and analysis plans were pre-registered prior to data collection (https://aspredicted.org/blind.php?x=8xn4v6). Some additional analyses were undertaken and are identified as such.

Three-hundred participants (149 male, 151 female, age range 18 to 72 years, M = 26.79 SD = 10.11) were recruited by opportunistic sampling method through study advertisements on both online research (survey swap, survey circle) and social media platforms (Reddit, Facebook). Participants’ ethnicity was as follows: 81.27% White, 2.22% Black or African American, 12.70% Asian, and 3.81% Other. Participants’ country of residence was as follows: 64.00% UK, 9.00% USA, 27.00% Other (i.e., a mixture of 43 countries with less than 3%). All participants gave full informed consent and were required to be above 18 years of age. This study received ethical approval from Edge Hill University’s ethical review board. Of the 300 participants, 14 possessed a medical diagnosis of autism (of which 8 completed the female condition and 6 the male condition).

Materials & procedure

Implicit associations were assessed using an IAT employed on Qualtrics (Provo, UT) study platform. Specifically, participants were presented with a target (male/female names) and attribute (autistic and non-autistic traits) words, one at a time, in the centre of the screen. They were instructed to press ‘E’ on the keyboard when the picture or word matched the target variable on the left and ‘I’ when the term matched the target variable on the right. On crucial trials, male/autistic and female/non-autistic words were categorized using the same key. In the remaining trials, the pairings of attributes and targets were switched. Incorrect responses presented participants with a black screen and a red ‘X’; they were then prompted to press the correct key. The speed at which participants accurately categorized the words and the number of errors was recorded. Reaction time and accuracy in response to each attribute pairing showed a stronger implicit association between the two items.

A 7-block IAT was used, with each block consisting of 20 trials [68], and in line with recommendations, all trials with reaction times under 300 ms were removed, errors made within each trial were replaced with a participant’s mean reaction time for that block, plus an error penalty of 600 ms [69]. Participants’ mean reaction time for each association pairing, male autistic/female non-autistic and female autistic/male non-autistic, were then calculated. This produced a total reaction time of both the female autism pairing and male autism pairing, which accounted for both reaction times and errors.

IAT stimuli comprised eight autistic, eight neurotypical (non-ASC) traits, and eight male and eight female names. The names used within the IAT were chosen from amongst the top 100 baby names in the 2000s due to the projected age of most participants completing the study [70]. Names were also chosen based on their phonological similarity, favouring names of a shorter length and fewer syllables [which has been shown to reduce error and increase participant response times in the IAT [71]. The ASC/NT items were chosen based on previous research which used a similar IAT to investigate implicit racial biases and how they influenced autism recognition [72]. In keeping with the recommendations that IAT stimuli be short, some original items were reduced in their word count. For example, ‘displays rigid routines’ was shortened to simply ‘rigid.’

Further IAT and autism research provided additional items for the autism category, such as ‘introverted’, ‘autistic’, ‘atypical’ and ‘different.’ Neurotypical items were identified as ‘extraverted’, ‘flexible’, ‘typical’, ‘independent’ and ‘social’ [73]. Pilot research supports these choices of words, as students were asked what behaviours they think are characteristic of an autistic individual [73]. Broader research on autism also suggests that autistic individuals struggle with social reciprocity and expressing emotion [1, 74], supporting the ‘rigid,’ ‘introverted,’ ‘reserved,’ and ‘different’ items. IATs require closely related items to comprise the two stimulus categories to make it easier for participants to respond differentially [75]. Therefore antonyms of the autistic word items were used for the words in the non-autistic category, such as introverted (autistic) and extraverted (non-autistic). A complete list of all items used can be found in Table 1.

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Table 1. Representation of IAT categories.

https://doi.org/10.1371/journal.pone.0284013.t001

In addition to the IAT, the 50-item AQ [76] and an accompanying vignette were used to measure explicit associations between certain autistic traits and male and female genders. The AQ is a screening tool devised to measure the degree of autistic qualities an individual may possess. The AQ provides participants with 50 statements, which they must rate in terms of how much they agree or disagree with the statement using a 4-point Likert-type scale ranging from 1 (strongly disagree) to 4 (strongly agree).

The AQ scores range from 0 to 50, with a higher score relating to a higher degree of autistic traits through both social (“I prefer to do things with others rather than on my own”) and non-social (“I am fascinated by dates”) aspects of cognition and behaviour. Half of the items are reverse-scored. The present study implemented the AQ to assess how participants perceived either a male or female individual described in a preceding vignette. Images were also provided alongside both vignettes, showing a male or female face. These pictures were obtained from the Karolinska Directed Emotional Faces (KDEF) [77] to further prime the gender of the character in the vignette.

The vignettes described an individual with autistic traits and were designed based on overarching autistic characteristics identified in previous research which developed vignettes through an iterative process of consulting autistic adults, clinicians, researchers and educators [42]. The outcome of this research provided the following autistic traits: difficulty socializing, restrictive interests and problems with change. Immediately after completing the IAT, participants read the following vignette (half in the male condition/half female). After that, they responded to the AQ-50 statements as if they were the individual described in that vignette.

“Matthew/Kerry is very reserved. He/she struggles to make new friends as he/she prefers to speak to people he/she is familiar and already knows. He/she doesn’t like it when his/her desk is rearranged at work and likes having a routine. At work, Matthew/Kerry has difficulty determining if his/her boss is happy with his/her performance, and he/she often struggles to understand his/her colleague’s jokes. He/she prefers speaking about topics he/she knows a lot about. In his/her leisure time, Matthew/Kerry plays individual games and sports, like golf, rather than playing games in teams.”

Finally, participants were asked to rate their pre-existing knowledge of autism using a 5-point Likert scale (1 –Not at all; 2 –A little; 3 –A moderate amount; 4 –A lot; 5 –A great deal).