Female Autism and Externalizing Disorders

Psychiatric comorbidities in autism spectrum disorders are very common: it is reported that up to 70% of ASD people present one psychiatric comorbid condition. Attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder, aggression, delinquency, and substance use are included under the umbrella term of “externalizing” behaviors. The current literature about the prevalence by sex/gender of externalizing symptoms in ASD is rather limited and heterogeneous, with often conflicting findings among studies. Some authors reported higher levels of parent-rated aggression, hyperactivity, and inattention in boys than in girls with ASD, while others found higher levels of irritability and externalizing behaviors in girls, and still others reported no sex differences in externalizing disorders among individuals with ASD. In this chapter, current literature on externalizing disorders in female autism is examined, with particular focus on the role of intellectual disability in mediating aggressive behaviors, but also on ADHD comorbidity in female autism, as aggressive behaviors (including self-directed aggressive behaviors), substance use, and criminal behaviors. Available studies are characterized by significant heterogeneity, but despite this limitation, clinicians should keep in mind that a specific attention to externalizing comorbidities also in females with autism is indicated given their clinical relevance and the potential for treatment to reduce functional impairment and improve quality of life.