Transtorno do espectro autista: diferenças clínicas entre meninos e meninas e seu impacto no diagnóstico

Abstract

Autism Spectrum Disorder (ASD) presents historical differences in prevalence between sexes, often related to diagnostic biases and the complexity of clinical manifestations. This study aimed to analyze the main clinical differences between boys and girls with ASD described in the contemporary literature. To achieve this, an Umbrella Review was conducted based on systematic reviews and meta-analyses published between 2015 and 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The findings suggest that the classic 4:1 diagnostic ratio may be overestimated, with the actual incidence being closer to 3:1, especially due to the phenomenon of social camouflaging, in which girls mask autistic traits, contributing to underdiagnosis and delayed recognition. In addition, the female phenotype tends to present restricted interests that are more socially accepted, greater interpersonal motivation, and a higher frequency of internalizing symptoms, such as anxiety and depression, often related to the continuous effort of social adaptation. It was also observed that instruments considered the diagnostic “gold standard” have lower sensitivity in identifying female manifestations of the spectrum. Therefore, recognizing the particularities of ASD in girls is essential to promote greater diagnostic equity, reinforcing the need for more gender-sensitive assessment tools and further studies on the subject.