Four times more boys than girls are diagnosed with ASD. But this is not only because more boys have autism. The condition is often missed in girls as their symptoms may look very different. In the article below, we explain why girls often fail to receive an appropriate autism diagnosis.
Symptoms of Autism in Girls
Girls and boys share many symptoms of autism, such as repetitive movements (also known as stimming), sensitivities to sensory inputs, in addition to speech and language difficulties. However, some signs of autism are more likely to occur in girls, such as:
- Appearing to be shy, quiet, and passive
- Having passionate but limited interests
- Restricting conversations to limited topics of interest
- Difficulty making and keeping friends
- Challenges with social communication, which increases with age
- Suffering from depression, anxiety, and other mental health conditions
- Difficulty controlling emotion
- Having epileptic seizures. Research indicates that epilepsy is more common in autistic girls than boys.
Many girls with autism learn how to hide their symptoms from a young age, in particular those who are on the high-functioning end of the spectrum. They, for example:
- Rely on their classmates to speak for them
- Don’t seek social interaction or avoid them altogether
- Mimic others’ speech and actions in social situations to be able to blend in
- Imitate the expressions and gestures of others
- Limit conversations to topics related to their special interests, like animals, music, or art
- Prepare expressions, phrases, and jokes in advance to use in conversations with friends
- Hold their emotions in check at school, but get easily frustrated and have meltdowns inappropriate for their age at home.
Girls who have clear signs of autism are usually diagnosed early. However, those with subtle symptoms who have learned to mask autism may not be diagnosed until they are pre-teens, teens, or even adults.
Below, we list some of the symptoms of autism that are commonly missed in girls.
Common Missed Signs of Autism in Girls
Some signs of autism in girls are overlooked because they are perceived as simply being part of their personality, for example:
- Having difficulties making and keeping friends, or understanding how other girls behave
- Appearing to be quiet and shy in school and other social situations
- Being unusually passive in order to be accepted among peers
- Finding it hard to join conversations, raise their hand in class, or respond quickly, even if they have advanced language skills
- Having a highly developed imagination and enjoying pretend and fantasy play
- Having a tendency to arrange and organize objects
- Engaging in repetitive behaviors, such as hair twirling
- Not playing cooperatively with peers, for example, dictating the rules of play or preferring to play alone to maintain control
- Finding social communication increasingly difficult with age, especially in teen years
In the following section, we explain some of the reasons why girls are often diagnosed late with autism or misdiagnosed with another disorder.
Why Do Girls With Autism Go Undiagnosed?
It is estimated that boys are four times more likely to be identified as being on the autism spectrum than girls. Because doctors more frequently diagnose autism in boys, parents and healthcare professionals alike may be less likely to look for symptoms in girls. The term “lost girls” is used to describe girls on the spectrum whose symptoms go unnoticed and who don’t receive adequate support.
Masking autism symptoms
Girls are often more self-aware and conscious of the importance of fitting in socially than boys. For example, they may learn to smile and make eye contact to hide their differences. Many successfully mask their challenges with socializing, which is one of the main indicators of autism, making the condition more difficult to diagnose.
Nevertheless, once social expectations become more complex in the early teenage years, communication and social difficulties also get harder to manage.
Controlling behaviors
Girls with autism spectrum disorder are more successful at controlling their behavior in public than boys. However, although they may be able to keep emotions at bay in social settings, they often release upsetting emotions and distress at home.
Social norms
Due to societal stereotypes when it comes to typical male and female behaviors, parents may miss autism symptoms in girls. For instance, girls are often expected to be quieter and behave in less assertive ways than boys, so these characteristics in girls are not automatically associated with autism.
Prevalent autism symptoms
Certain signs of autism, such as difficulty with impulse control and repetitive behaviors (hand flapping, spinning objects, asking the same question over and over again) are more common in boys than in girls. These symptoms are also easier to spot than difficulties with communicating or socializing, for example. As a result, when boys display symptoms of autism, they are more likely to be recognized by parents and health professionals.
Dealing with symptoms
Another reason that girls are less often diagnosed with autism than boys is that they deal with their symptoms differently. As we have seen above, girls may learn to hide the signs of autism and put more effort into learning social norms in order to fit in.
In addition, autism symptoms may cause stress in children, leading to different behaviors in girls and boys. Girls are more likely to react to stress in ways that are not immediately noticeable, such as self-harm. At the same time, boys more often become angry and frustrated, displaying behaviors that are more visible and may flag autism sooner.
Misdiagnosis
Girls are more likely than boys to be misdiagnosed with similar conditions, such as anxiety, depression, obsessive-compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD). This is one of the reasons why they may receive a late autism diagnosis, or none at all.
On the other hand, some symptoms of autism can cause a lack of self-confidence and self-esteem, which in turn can lead to anxiety and the development of co-morbid mental health issues. This is particularly the case if autism has not been formally diagnosed.
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