Do Girls Experience Autism Differently?

October 23, 2020 The Ed Psych Practice No Comments Referrals ASD & Girls, Developmental Neuropsychologist, Diagnosed Late, High School, Masking, Overlooked, Paediatrician, Quieter Representations, Speech and Language Therapist

Takeaway: Autism affects girls differently to boys, at many levels — biologically, psychologically, socially, and emotionally. But, it’s often overlooked because girls are skilled at ‘masking’ their differences. And the longer your child goes undiagnosed, the greater the chances of her developing issues like depression, anxiety, and low self-esteem. So, if you suspect your daughter has autism, consider consulting a specialist who can offer her the help she deserves.

You’d think that boy or girl, autism is autism. It should show up in the same way, right? But it doesn’t. And that’s the fascinating part.

Autism is now widely recognised by both healthcare professionals and the general public. But there are aspects of it which still bewilder us. For example, the phenomenon of it being perceived differently in boys and girls. Take two siblings with autism, and the boy is much more likely to be diagnosed before the girl. There’s an instinct to think, ‘Oh, it’s a girl? Then it’s not autism.’ So, a mother might notice that her daughter starts babbling, walking, and talking much later than usual. Or that she was delayed in learning to respond to her name. But as long as she seems sociable and happy, doctors and psychologists are tempted to rule out autism immediately.

So, why is autism different in boys and girls? Well, the story begins with how we define autism spectrum disorder (ASD).

ASD is a developmental difference where a child’s brain wires itself uniquely as it grows and evolves. It brings many strengths, like the ability to hyperfocus on a subject. But it also brings challenges — like a difference in the way she communicates and interacts socially, or a strong desire for routine and order. She might also do things repetitively — flapping her hands or rocking back and forth, for example. And she might experience her senses (sights, smells, sounds, etc.) much more vividly than usual. (Learn more about ASD.) The thing is, all these defining components of ASD were highlighted by observing how autism presents itself in boys. Without studying how it shows up in girls (it presents itself more subtly, here), we’ve been working with an incomplete picture. That, for a start, is why we tend to think that autism is four times more common in boys than in girls: we haven’t always known what to look for.

The differences between autistic boys and girls reach down to a biological level.

Both autistic boys and girls process information differently to their non-autistic classmates. So, you’d think that autistic boys and girls would have similar brains. But that isn’t the case. Autistic girls tend to show the same kind of brain activity as non-autistic boys, rather than their autistic counterparts. So, at a structural (and biological) level, there are fundamental differences between boys and girls. It appears they are ‘autistic’ in different ways.

Genetic and hormonal factors also modify how autism is expressed.

Some early research shows that girls might have genetic factors that lower their chances of being autistic. And the ‘extreme male brain’ theory suggests that when a foetus is exposed to high levels of male hormones in the uterus, it changes the way it develops. So, certain traits that get magnified through autism (e.g., the love of categorising objects), are more associated with the male brain. And these in turn are what we’ve learned to spot.

This leads us to gender stereotypes. Because some autistic traits seem okay when we spot them in girls, but not when we spot them in boys.

Boys and girls often develop an interest in different things. So, obsessiveness in boys might show up as a fascination for train schedules — which is clocked as a sign of autism. But, obsessiveness in girls — a fascination for dolls, for example — is seen as expected behaviour and therefore overlooked. Then, girls are expected to be quieter and happier playing alone. So, we might not notice they’re being socially withdrawn. But a boy is expected to be loud and boisterous. So, if he isn’t, we notice right away. And this can become a vicious cycle: Since we’re primed to look for autism more in boys than girls, we overlook the girls that show its traits. And that primes us even further to ignore the signs in girls.

The unfortunate reality is that for a girl to be diagnosed with autism, her symptoms have to be much more severe than a boy’s.

In a 2012 study of 15,000 twins, researchers found that girls have to have significantly greater problem-behaviours or intellectual disabilities, to be diagnosed — as compared to boys. So, girls on the less-affected end of the autism spectrum (with Asperger’s syndrome, for example) are easily missed.

Also, girls learn to ‘mask’ their autistic traits in a way that boys don’t. And this masking breaks down only much later in life.

Autism is easiest to spot when children have trouble fitting in or behaving appropriately. And girls with autism are very skilled at figuring out how to do both these things. For one, blending in seems to be more important to them, so they take the effort to do things like smile and make eye contact (which autistic boys rarely do). But also, they’re better at forming friendships, when compared to boys their age. So they find it easier to camouflage themselves socially. It’s only later on in life, when socialising becomes more complex, that they reach their capacity and the mask comes off. A perfect example of camouflage in a young girl is when she plays with a Barbie set. It’s not fun, imaginative play for her. Rather she’s attempting to mimic her friends’ behaviour. It’s a re-enactment of what she thinks she’s supposed to be doing.

The problem with undiagnosed autism in girls is that it can worsen their quality of life.

Children often need help to cope with some of their autistic traits. But that’s the most basic effect of autism. Built on it are secondary issues that also need attention. For example,

Autistic girls are more likely to get bullied. They might miss key social cues, which makes them easy targets for teasing and harassment. And later on in life, it makes them vulnerable to sexual predators. They might miss the red flags that other girls spot.
They are more likely to be depressed, anxious, or have low self-esteem. Remember, on the outside they mask their differences and seem just like their friends. But on the inside they likely feel very alien and different. And girls are more likely to respond to this by causing self-harm (which is easy to miss) whereas boys often act out in anger (which is spotted immediately).
They might not get the help they need. Many autistic traits overlap with those of ADHD, OCD, and even things like anorexia. But no amount of therapy or treatment will help if the underlying autism isn’t diagnosed, too. Do note, however, that it is possible to be autistic AND have depression/anxiety/ADHD, etc., so it’s not necessarily an either/or situation. But whatever the reality, it’s a nuanced issue that needs to be handled carefully.

Luckily, there is a solution. A healthcare professional can diagnose autism and set up a care plan to support your child’s needs.

One test for autism is the Autism Diagnostic Observation Schedule (ADOS), which takes about 40 minutes. And this is used along with the Autism Diagnostic Interview-Revised (ADI-R), which takes about an hour and a half. Based on these tests, the Paediatrician and the Speech and Language Therapist can suggest ways to best help your child adapt to her school and home needs. And this in turn will allow her to live a happier, more fulfilling life.

Do you suspect your child might have autism spectrum disorder? Consider consulting a specialist.

The Ed Psych Practice offers consultation, advice, and problem solving for parents, nurseries, schools, and colleges, in London. We have paediatricians, psychologists and therapists who can help assess your child and offer guidance and support.

Phone: +44 (0) 78 3344 7356 /
(0) 79 9053 8654
E-mail: Office@TheEdPsych.com