The Centers for Disease Control and Prevention (CDC) estimate that one in 59 children has autism. Furthermore, they have found that boys are four times more likely to be diagnosed with autism than girls. However, it's a misconception to say that boys are more vulnerable than girls because the evidence supports the fact that the gender gap is not as wide as it seems. Why does this happen?
Doctors say that girls don't manifest the classic autism symptoms, hide it better, or work harder to "fit in." Simply put, girls with autism are hiding in plain sight. That's why they are often underdiagnosed, misdiagnosed, or diagnosed later in life. It's vital to recognize the signs of autism early. Early intervention is key to supporting children and adults with autism spectrum disorder (ASD) to find success and living a fulfilling life.
READ MORE: Does Autism Get Worse with Age?
So, does your daughter have autism? The answer is not so evident because the signs of autism are not the same as boys. They can be easily missed, especially if you are dealing with high-functioning autism.
The Gender Differences
A 2005 study at Stanford University showed that there is less repetitive behavior in girls than boys. Evidence points that boys engage in repetitive behavior more often than girls. This can happen because of the sex difference in children's brain activity. Since boys and girls use different parts of the motor system, researchers could distinguish between autistic boys and girls according to brain patterns. A leading autism researcher at Yale University states that the brain activity in girls is not considered "autistic," and it's similar more to that of an ordinary boy.
More studies suggest that the pastimes of autistic girls are similar to that of neurotypical girls. An autistic boy can be interested in trains, for example, but girls with ASD can be obsessed with Disney characters like any other girl. That's why it's easier to spot repetitive behavior symptoms than communication and socialization difficulties.
Differences in Social Communication
Girls learn to navigate social interactions and maintain friendships while compensating for other challenges like differences in thinking. Moreover, girls are more supportive of their friends. More studies suggest that the mother-daughter relationship helps teach social behavior in little girls. All of these reasons make it harder for doctors to spot autism in women.
Differences in Behavior
Traditional ideas that girls should play with dolls and boys with cars complicate the process of spotting autism in girls. Society dictates socially gendered behavior norms, and that's why autistic behavior is wrongly interpreted. It's generally accepted that girls should be interested in their favorite princess and could be seen as a developmental phase rather than an autism diagnosis.
Why Girls Are Underdiagnosed
Some autistic girls have apparent symptoms such as self-stimulating behaviors (stimming), speech and language difficulties, or significant cognitive challenges. Others show more subtle signs. Their intelligence often allows them to mask the symptoms, and they may only be diagnosed as teenagers. Since the belief is that autism is more common in boys, many parents and healthcare providers overlook autism symptoms in girls.
See also How to Spot Autism in Children.
Each gender deals with symptoms of autism differently. Girls camouflage their symptoms better and put much more time, effort, and energy into learning social norms. They want to "fit in" socially and are more self-aware. They are also more likely to form relationships than boys with autism. The downside is that girls cannot be diagnosed until their teenage years when social norms and friendships become more complicated. It will get more challenging for them to relate to their peers.
Our culture might be at fault for the misdiagnosis since girls are meant to be quieter and less assertive than boys. These stereotypes about how a girl should behave are harmful. "Feminine" girls are those who appear shy and withdrawn, while boys with the same behavior are atypical. Girls that are unengaged and space out are described as "dreamy," while boys like that are viewed negatively.
It's easy for autism symptoms to be masked since many doctors see having trouble with socializing as a key symptom. Girls are also able to react to stress in unnoticeable ways, such as self-harm. Autistic boys get angry or misbehave—it's more visible.
READ MORE: Telling Your Child About Their Diagnosis.
The Story of Jennifer O’Toole
Let us tell you the story of Jennifer O'Toole, the author and founder of the Asperkids website and company. She was not diagnosed with autism until after her family was diagnosed with ASD. On the outside, she looked normal. In college, she was a cheerleader and sorority girl. However, for her, it was hard to maintain a social life. It didn't come naturally, and the effort exhausted her. Due to her high level of intelligence, she was able to mimic the behavior of others and became an "actress." For her, it was like one might study math. This obsessive focus on finding rules in social life is a characteristic of girls. Autistic boys are not that interested in having friends, while females want to connect.
This is an excellent example of an individual's power to compensate for a developmental disability. Another reason why girls can hide their symptoms is that you will never notice if there's anything different about a person.
Autism Symptoms in Girls
Autism has a wide range of symptoms. For example, many autistic kids have trouble communicating. Some common symptoms include:
- Not responding when called by their name
- Difficulty explaining what they need
- Avoid eye contact or not looking when someone points at an object
- Cannot understand how people are feeling
- Do not follow simple instructions
Other symptoms refer to strict routines and repeated actions. This can mean from rocking side to side or being unusually attached to specific objects. Some children with autism might not like a change in routine or have unusual responses to smell, taste, or sounds. They can also spend a lot of time organizing things, repeat specific phrases or words, and most have movement problems and balance impairments.
These symptoms should appear during childhood, but no single sign suggests autism. Also, they should be severe enough to limit daily function, meaning that if the girl is successful in other ways, it does not mean she's autistic. However, let's that a look at some of the symptoms common to girls:
- She’s unusually sensitive to loud noises, bright lights, or strong smells. Autistic girls can experience sensory challenges that might trigger violent behavior or meltdowns;
- She has limited interests that are very restrictive. People with autism love to gather facts and if your daughter is a fan of a particular show, let’s say, they might talk endlessly about the characters but know little about the plot;
- Following the previous point, a good sign is if her topics of interest restrict your daughter's conversation. She's not able to follow the conversation or be interested in a response from you;
- She has unusual degrees of depression and anxiety and is otherwise moody. While this does not mean she's autistic, autism is associated with mood disorders, and she can't control her feelings. She can also be described as "shy" when often your child can't jump into conversations or raise her hand to answer a question. This may lead to unwanted behavioral interventions;
- While some girls, like O'Toole, are able and want to make friends, some might have difficulty making them. She's unaware of social cues (can't read expressions or body language, etc.) and can't imitate other girls' behavior;
- Your daughter acts in a passive way, which means your daughter doesn't know what to say or do. As a result, she prefers to say as little as possible to not attract attention. This behavior is more evident as she enters her teenage years, and she can't keep up with social communication.
In addition, it will be good to know some common forms of masking, such as preparing jokes ahead of time. The most used symptom is mimicking social behavior, like imitating expressions and gestures. Some girls even force themselves to make eye contact during conversations. It's important to note that experts do not have the necessary information about these differences, and long-term studies are needed to draw an accurate conclusion.
Is My Daughter Autistic?
While autism may appear to be more common in boys, researchers are starting to understand the difference between the genders. Autism symptoms are very similar, but the point is that they are less obvious (or less likely to occur) in girls. They don’t fit the stereotypical autistic person, which can lead to a later diagnosis. But not being diagnosed can be detrimental to your child’s health. Autism doesn’t have a cure, but early intervention can make this disorder easier to handle.
Understanding these symptoms can make a difference. If you feel that what you've read in this article applies to your daughter, then seek help. A professional evaluation team can test your child and see whether she's autistic or not. Remember: some girls are good at hiding their symptoms, so it might be harder to spot.
Don't lose hope; an autism diagnosis is not the end of the world. Awareness of autism is growing, and many resources can help women get a diagnosis and find treatment.
What Causes Autism in Females?
Experts are not sure of what causes autism, but several factors likely cause it. Genetics and environmental factors also play a role in this, but it's hard to determine the exact cause given the wide range of symptoms. However, some evidence points that boys have a higher chance of developing it. Girls are born with a protective factor that shields them from developing autism.
Is There a Test for Autism?
No medical test can diagnose autism. To find out, you have to go through a complex process that requires visiting several doctors. If you suspect your daughter has autism, talk to your doctor so he can evaluate the symptoms and rule out potential causes. While early intervention is the key to a fulfilling life, diagnosing autism in adults is more complicated, requiring many visits. Also, don't be afraid to ask for a second opinion. If your doctor is not taking you seriously, you shouldn't be treated like that.
How Is Autism Treated?
There is no cure for autism, unfortunately. Medication can improve specific severe symptoms, but it does not cure autism. However, many types of autism treatment are available, from occupational therapy to applied behavior analysis that can help you manage your symptoms. Check out The Different Types of Therapies for Children with Autism in this article.
How Can I Get Support?
Since women are often underdiagnosed and good at masking their symptoms, they are often alone. It can give them a sense of isolation. Moreover, women are more emotional, and revisiting childhood behaviors can be a lot. You can find a support group and non-profit organizations like The Autistic Women and Nonbinary Network dedicated to supporting autistic females. There are also many blog stories and recommendations online for people that are not ready to interact with others.