Autism Spectrum Disorder is a social communication disorder that impacts 1 in 44 children in the United States (CDC). While the prevalence is 4 times more often in boys than girls based on statistics, there is a higher chance that girls have been undiagnosed and that statistic is incorrect. So that leaves the question, why are girls underdiagnosed? Autism in girls often looks different than autism in boys. Earlier when research was created around autism it was entirely focused on boys and then the established “typical” symptoms were categorized as being autistic. Most of these characteristics can be found in girls as well but often will be displayed differently. And the more difficult diagnosis, regardless of gender, tends to be for Level 1 autistic children. Level 2 or 3 autism can be easier to spot versus those that are level 1, but again, the difficulty increases when diagnosing girls overall!
Autistic girls are more overlooked in their younger years than boys because they tend to have stronger abilities to interact in social settings and are often more capable of making friends and engaging in interactive play with friends. Due to these skills, their communication deficits are not picked up on by parents, teachers, or even some providers, especially pediatricians. As a result, girls are most often diagnosed as adolescents or teenagers when social interactions are more complex and challenging.
Some common red flags to look out for include:
- Having passionate/obsessive but limited interests—These interests may be very socially appropriate and this keeps them from standing out as a trait of “special interests”
- Difficulty making or keeping friends
- Appears shy, quiet, passive, or more people pleasing—This can also be viewed inappropriate as a social anxiety disorder
- Increased anxiety or depression
- Struggling with emotional control or regulation
- Increased anxiety in social setting
- Conversations that seem very typical but limited to her topic of choice
- Struggle with challenging behaviors at home but not at school
- Talk about friends but not actually spend much time engaging with them
- Unusually passive especially in the school environment where they enjoy being accepted and rewarded
- Require longer times to process or understand information
- Conversations seem scripted but very appropriate in the setting
- Makes appropriate eye contact at times but seems forced and lack a sense of connection
Another way girls are overlooked is related to the idea known as masking. This simply means that autistic girls are able to hide or blend in social settings and engage in behaviors that are expected of them. Girls are able to mimic behaviors of others much easier than boys. Some areas that girls mask include, making eye contact, suppressing their desire to stim, providing scripted answers to questions, or mimicking facial expressions as an appropriate response within a conversation. Girls learn these skills by observing others, watching TV, and studying peers that seem to “always” behave appropriately. While this can be a great skill to “fit in” it is inherently detrimental to their emotional, physical, and mental well-being.
If any of this information gives you reason to suspect a diagnosis it is important to seek out a trained mental health professional that specializes in autism or developmental disorders. Early intervention can change the prognosis of your child’s mental and emotional health in the future. At Dandelion, we are here to support you!
Author: Alyse Bone
References:
Bargiela, S., Steward, R. & Mandy, W. The Experiences of Late-diagnosed Women with Autism Spectrum Conditions: An Investigation of the Female Autism Phenotype. Journal of Autism and Developmental Disorders 46, 3281–3294 (2016).
Hull, L., Petrides, K.V. & Mandy, W. (2020) The Female Autism Phenotype and Camouflaging: a Narrative Review. Review Journal of Autism and Developmental Disorders 7, 306–317.
Leedham, A., Thompson, A. R., Smith, R., Freeth, M. (2020) ‘I was exhausted trying to figure it out’: The experiences of females receiving an autism diagnosis in middle to late adulthood. Autism, 24(1),135-146,