Health professional’s perceptions of diagnostic difficulties in autism spectrum disorder in girls

Authors

DOI:

https://doi.org/10.37293/sapientiae111.08

Keywords:

Autism Spectrum disorder, Diagnosis, Gender, Girls, Angola

Abstract

This study aimed to explore the perceptions of health and education professionals regarding the difficulties in diagnosing Autism Spectrum Disorder (ASD) in girls living in Luanda, Angola. The research followed a qualitative-descriptive approach, conducted at the Amazing School Center, with the participation of 13 professionals working with children with special educational needs. Data was collected through structured interviews, organized into five thematic blocks: clinical aspects, social skills, masking, repetitive behaviors, and recommendations. The main findings revealed that girls with ASD tend to mask symptoms, displaying internalized behaviors such as anxiety, shyness, and social withdrawal, which hinders early identification. Additionally, there was a lack of specialized training and gender-sensitive assessment tools. It is concluded that there is an urgent need to train professionals and adapt diagnostic processes to consider the specific characteristics of ASD in girls, promoting more effective interventions in the Angolan context.

References

Associação Americana de Psicologia UNIFORMAR. (2014). Manual Diagnóstico e estatístico de transtornos mentais: DSM-5. Artmed.

Barreto, N. (2022). Diagnóstico de Autismo em Meninas. https://br.academiadoautismo.com/diagnostico-de-autismo-em-meninas/

Begeer, S., Mandell, D., Wijnker-Holmes, B., Venderbosch, S., Rem, D., Stekelenburg, F & Koot, H. (2013). Sex differences in the timing of identification among children and adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43(5), 1151–1156. https://doi.org/10.1007/s10803-012-1656-z

Begeer, S., Koot, H., Rieffe, C., Meerum Terwogt, M., & Stegge, H. (2008). Emotional competence in children with autism: Diagnostic criteria and empirical evidence. Developmental Review, 28(3), 342–369. https://doi.org/10.1016/j.dr.2007.06.002

Bruzaca, C. (2022). Transtorno do espectro autista (TEA): porque é mais frequente em meninos que meninas?. https://bruzaca.com/doencas-raras/transtorno-do-espectro-autista-tea-porque-e-mais-frequente-em-meninos-que-meninas/#:~:text=O%20cromossomo%20X%20possui%20mais,apenas%20portadora%2C%20salvo%20algumas%20exce%C3%A7%C3%B5es

Costa, F. (2020). Representações sociais de mulheres com o nível 1 do transtorno do espectro autista sobre “ser normal” em seu passado escolar. 2020. 133 p. Dissertação- Universidade Estácio de Sá, Rio de Janeiro-RJ. https://portal.estacio.br/media/4683846/flaviacosta_disserta%C3%A7%C3%A3o_vers%C3%A3o-final.pdf

Dean, M., Harwood, R., & Kasari, C. (2017). The art of camouflage: Gender differences in the social behaviors of girls and boys with autism spectrum disorder. Autism, 21(6), 678–689. https://doi.org/10.1177/1362361316671845

Félix, M. (2024). Aumentam os diagnósticos de autismo em mulheres, apesar dos desafios. https://drauziovarella.uol.com.br/psiquiatria/aumentam-os-diagnosticos-de-autismo-em-mulheres-apesar-dos-desafios/#:~:text=Marina%20Almeida%20explica%20que%2C%20nas,momento%20mais%20adequado%20para%20isso

Fernández, P., Ortega, R., y García, M. (2021). Autismo en niñas: manifestaciones clínicas e implicaciones diagnósticas. Revista Española de Pediatría, 77(4), 215–222. https://www.revistaepediatria.es/articulo/77-4-215

Flick, U. (2007). Introducción a la investigación cualitativa (T. del Amo, Trad.). Ediciones Morata.

Gaugler, T., Lambertus, K., Sanders, S., Bodea, C., Goldberg, A., Lee, A., Mahajan, M., Manaa, D., Pawitan, Y., Reichert, J., Ripke, S., Sandin, S., Sklar, P., Svantesson, O., Reichenberg, A., Hultman, C., Devlin, B., Roeder, k., Buxbaum, J. (2014). Most genetic risk for autism resides with common variation. Nature Genetics, 46(8), 881–885. https://doi.org/10.1038/ng.3039

García, C., Soloviova, Y., & Quintanar, L. (2020). Evaluación e intervención neuropsicológica en un caso de trastorno del espectro autista (TEA) severo. Revista Iberoamericana de Psicología: Ciencia y Tecnología, 13(2), 99–112. Recuperado de https://dialnet.unirioja.es/servlet/articulo?codigo=7723705

Hiller, R. M., Young, R. L., & Weber, N. (2014). Sex differences in autism spectrum disorder based on DSM-5 criteria: Evidence from clinician and teacher reporting. Journal of Abnormal Child Psychology, 42, 1381–1393. https://doi.org/10.1007/s10802-014-9881-x

Hull, L., Mandy, W., & Petrides, K. (2020). Behavioural and cognitive sex/gender differences in autism spectrum condition and typically developing males and females. Autism, 24(5), 1045–1061. https://doi.org/10.1177/13623613166690

INEURO (2024). Descubra diferenças entre o cérebro feminino e o masculino. https://ineuro.med.br/descubra-diferencas-entre-o-cerebro-feminino-e-o-masculino/

Kerches, M. (2023). Invisibilidad del autismo femenino: el reto del camuflaje social. Revista Iberoamericana de Neuropsicología, 15(2), 99–112

Lai, M.-C., & Baron-Cohen, S. (2015). Identifying the lost generation of adults with autism spectrum conditions. The Lancet Psychiatry, 2(11), 1013–1027. https://doi.org/10.1016/S2215-0366(15)00277-1

Lampreia, C. (2004). Os enfoques cognitivista e desenvolvimentista no autismo: uma análise preliminar. Psicol. Reflex. Crit. 17, (1),111-120. https://doi.org/10.1590/S0102-79722004000100014

Loomes, R., Hull, L., & Mandy, W. P. L. (2017). What is the male-to-female ratio in autism spectrum disorder? A systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 56(6), 466–474. https://doi.org/10.1016/j.jaac.2017.03.013

Mello, A. (2005). Autismo: guia prático. (Quarta edição). AMA: CORDE.

Meng-Chuan, L., Lombardo, M., Auyeung, B., Chakrabarti, B., & Baron-Cohen, S. (2015). Sex/gender differences and autism: Setting the scene for future research. Journal of the American Academy of Child & Adolescent Psychiatry, 54(1), 11–24. DOI: 10.1016/j.jaac.2014.10.003

Pellicano, E., Dinsmore, A., & Charman, T. (2014). What should autism research focus upon? Community views and priorities from the United Kingdom. Autism, 18(7), 756–770. https://doi.org/10.1177/1362361314529627

Ratto, A., Kenworthy, L., Yerys, B., Bascom, J., Wieckowski, A., White, S., Wallace, G., Pugliese, C., Schultz, R., Ollendick, T., Sydney, A., Register-Brown, k., Martin, A., Gutermuth, L. (2018). What about the girls? Sex-based differences in autistic traits and adaptive skills. Journal of Autism and Developmental Disorders, 48(5), 1698–1711. DOI: 10.1007/s10803-017-3413-9

Sadock, B., Sadock, V. e Ruiz, P. (2017). Compêndio de psiquiatria: ciência do comportamento e psiquiatria clínica. (Décima primeira edição). Artmed. Porto Alegre

Santo, H; Sousa, L & Fonseca, A. (2022). Fatores de risco gestacional em mães de crianças diagnosticadas com autismo. Research, Society and Development, 11, (15)¸ 01-15). http://dx.doi.org/10.33448/rsd-v11i15.37837

Tillmann, J., Cáceres, A., Chatham, CH., Crawley, D., Holt, R., Oakley, B., Banaschewski, T., Baron-Cohen, S., Bölte, S., Buitelaar, JK., Durston, S., Ham, L., Loth, E., Simonoff, E., Spooren, W., Murphy, DG., Charman, T. (2019). Investigating the factors underlying adaptive functioning in autism in the EU-AIMS. Autism Res. 12, (4). 645-657. https://doi.org/10.1002/aur.2081

Vasconcelos, M. (2022). O camuflaje social no TEA: um desafio ao diagnóstico feminino. Revista de Psicologia Clínica, 41(2), 75–89.

Zvarick, L. (2024). Diagnóstico precoce de autismo é mais difícil em meninas; conheça os sinais do transtorno. https://ipqhc.org.br/2024/04/02/diagnostico-precoce-de-autismo-e-mais-dificil-em-meninas-conheca-os-sinais-do-transtorno/#:~:text=Diferentes%20pesquisas%20internacionais%20indicam%20que%20o%20diagn%C3%B3stico,anos%2C%20enquanto%20sobe%20para%2014%20em%20meninas

Zanon, R; Backes, B; Bosa, C. (2017). Diagnóstico do autismo: relação entre fatores contextuais, familiares e da criança. Revista Psicologia: Teoria e Prática, 19, (1), 152-163. https://doi.org/10.5935/1980-6906/psicologia.v19n1p164-175

Published

2025-07-08

Issue

Section

Articles/Papers

How to Cite

de Almeida, A., Magalhães, A., Duarte, M., & Tonet, N. (2025). Health professional’s perceptions of diagnostic difficulties in autism spectrum disorder in girls. SAPIENTIAE, 11(1), 116-130. https://doi.org/10.37293/sapientiae111.08