Many more boys are diagnosed with autism than girls; in fact, four times more boys are diagnosed. While the reason for the disparity between male and female autism rates is relatively unknown, there are several theories. One theory is that the possible mechanism for the transmission of autism is on the sex-linked X chromosome, but researchers are still a long way from identifying a simple genetic cause for autism. Females are sometimes thought to be “protected” from autism but the reason remains unknown. The reason for this imbalance between the sexes may be something much simpler—autism presents differently in females. Autistic girls “look” different from autistic boys.
Girls Are Not Referred for Diagnosis
More boys are diagnosed with autism, but is it because more boys have autism? Tony Attwood, an Australian psychologist specializing in Asperger’s Syndrome, asserted that many girls with Asperger syndrome, a form of high-functioning autism, are never referred for diagnosis, and so are simply missing from statistics. Boys tend to be more noticeably “different” or disruptive than girls. It is important to recognize the different ways autism may present in girls because autistic girls who go undiagnosed, or are diagnosed late (instead of in early childhood) are at a greater risk to develop anxiety, depression, and eating disorders.
Girls Mask Symptoms
Girls with Asperger’s Syndrome, or high-functioning autism, may be better at masking their difficulties in order to fit in with their peers, and in general have a more even profile of social skills. Many times this alone eliminates a referral, or diagnosis because the current diagnostic model is based on autistic behavior in boys. Some of the main characteristics that we see in autism, are still present in girls; they may just look different.
Special Interests are Different
Special interests, sometimes seen as obsessions are a common trait in autism. In fact, it is one of the diagnostic criteria an “encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.” Boys tend to have non-conventional special interests; interests that are rare enough to catch attention. A girl on the autism spectrum may not appear to have any “odd” special interests; however, these interests are still present. Girl’s special interests tend to be more “normal” focusing on such things like ponies, princesses, or unicorns; interests that seem completely normal for a little girl. What needs to be looked at however, is the intensity and focus. Because girl’s special interests tend to be more in tuned with those of the typical female child, this important symptom, or trait, of autism can often be missed or appear to not be present.
Language Development
Girls in the general population tend to have more developed verbal skills than boys. Girls with autism, or Asperger’s Syndrome, may also possess advanced verbal skills, or be hyperlexic. Hyperlexia is the ability to read on a level way above what is expected for the child’s age, but with a below average ability to understand spoken language. In this child, pragmatic language may be affected. However, if the girl is overlooked, her difficulties masked, she may never be referred for speech services, or have her pragmatic language skills tested.
Social Skills and Interaction
Autism is a disorder that affects social communication. Boys and girls on the spectrum have difficultly interacting in social situations. They are often seen avoiding socialization, or not having any friends. For many boys on the spectrum this holds true, but many autistic girls enjoy socializing, and have at least one or two close friendships during childhood—yet another fact which can preclude them from being referred for diagnosis. An autistic girl will usually have one friend, or socialize with one friend at a time. Many times these tend to be “built-in” friends, friends that are set in place by where they live, or children of their parent’s friends. The friend will likely be very social and take the lead in conversations or integrating activities with other children. Although they may become overwhelmed in large groups, they enjoy socializing (as many boys do) in a one-on-one setting, or when the socialization is activity based. The social interaction, however, comes at a price. She may not be able to endure long, or fall apart after the event. She may be exhausted, and need a lot of time to recuperate and decompress, after spending time with her friend, something that a neurotypical child would not experience. Additionally, when a girl is more withdrawn or avoids social situations she is usually seen as extremely shy. This shyness can also explain away incidences of selective mutism, a persistent failure to speak in select settings, that girls on the spectrum often experience.
Stimming/Stereotypical Repetitive Motions
“Stimming” is short for self-stimulatory behavior, or stereotypical repetitive motions, another diagnostic criterion for autism spectrum disorders. Hand flapping, foot tapping, spinning, rocking, and hair twirling are all examples of stimming behaviors. Girls tend to engage in these repetitive behaviors less frequently than boys do.
Co-morbiity
Many autistic children have co-morbid diagnoses. Several medical conditions are commonly seen with autism. Seizure disorders, gastrointestinal issues, sensory processing dysfunction, pica, anxiety, OCD, and depression are just a few.
Girls with autism grow up knowing they are different in a socially unacceptable way. Statistics show that even those who do receive a proper diagnosis do so on average later than boys. Late diagnosis can cause these girls to miss the opportunity for early intervention services. Many girls have gone undiagnosed until adulthood. There is no adequate explanation for why more boys appear to develop autism more often than girls; however, the way autism presents in girls coupled with the diagnostic criteria that is geared toward male behaviors, may indicate that many girls are being missed and are not included in the current statistics. Boys are four times more likely to be diagnosed with other developmental disorders in early childhood such as learning disabilities and attention deficit disorder. Girls on the other hand, appear to be over represented in disorders that begin after puberty such as depression, and anxiety.
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