October 10, 2023

Autism in Girls: Signs, Symptoms and Underdiagnosis

What are the classic signs of Autism?

Autism, or as its officially called, Autistic Spectrum Disorder (ASD) is:

1. Deficits in social communication and social interactions in a variety of situations and places.
2. Restricted, repetitive patterns of behaviour, interests or activities.
3. The presence of symptoms beginning early in life.
4. The presence of symptoms that lead to clinically significant difficulties with social, educational, occupational or other important areas of functioning.>

What are the issues when diagnosing ASD in males versus females?

When Autism assessments are conduct, ASD is diagnosed at a rate more than four times the rate for females. The disorder is thus more common in males. However, this likely is the result of females often not fitting the stereotyped image of someone with Autism. As a result, many girls and women go undiagnosed.

To be more specific, clinicians and researchers have come to realise that many “high functioning” females with Autism are simply missed. “High functioning” refers to those whose intellectual functioning or IQ is not impaired or low. These girls and women have often been called “lost girls” or “hiding in plain sight” because they’re overlooked or diagnosed late. They don’t fit the stereotypes, or their symptoms are misinterpreted as something else. And they may be better at hiding the signs, at least when they’re young.

Let’s look at this in more detail:

1. Girls’ and women’s symptoms are often less obvious. Unlike males with Autism, who may express frustration by being disruptive or aggressive, females are trained to be cooperative, so they’re not as likely to be referred for an Autism assessment.
2. Although boys with ASD may be intensely focused on things like trains or
   computer games, girls with ASD often have special interests that seem typical for girls their age, like Disney movies or animals, so they don’t stand out. A 2005 study at Stanford University found that girls with Autism demonstrate fewer repetitive and restricted behaviours than do boys. The study also found brain differences between autistic boys and girls that may help explain this discrepancy.
3. Because they are better at imitating what they see around them, girls and women tend to have better eye contact or social interactions than do males with Autism. So even though they’re struggling with social communication and relationships, females are more likely to “pass” as typical until as late as middle school and do not receive an Autism assessment. They often engage in what we call “masking.”
4. Although not written about or researched, girls and women with ASD are often very private about their thoughts, feelings and relationships, and often become distressed easily when asked about them.