Autism - Why Are Girls Being Missed?
Written by: Emilie Chretien, B.Sc.S., Speech-Language Pathology Graduate Student
Autism, or autism spectrum disorder (ASD) is a developmental condition that has a very wide spectrum, which means that it can look extremely different from one affected person to another. Some people with autism require a great deal of support and may not yet speak or interact with others. At the other end of the spectrum, those who are high functioning can have average intelligence and the appearance of typical social skills, to the point where no one would even suspect there were anything atypical about them.
People are becoming increasingly aware of autism and its impacts on a person, but one aspect that is still poorly understood is how autism looks in girls, particularly in high functioning girls. Several studies have found that girls are often diagnosed later than boys1. Many are only diagnosed as adults and some are never diagnosed at all2. There are three main factors that make it more difficult to identify these girls :
1. Diagnosis is based on criteria for boys
Girls with high functioning autism may be harder to diagnose because their symptoms are often different than boys’. Through the years, many studies on autism only included boys, consequently making the criteria for diagnosing autism more specific to boys3. Studies have found that some high functioning girls may not exhibit enough symptoms to meet the criteria to be diagnosed with today’s testing methods2.
Girls with high functioning autism also seem to be better at camouflaging their symptoms in order to try to fit in with others1. Unlike many boys, high functioning girls still have a desire to interact and to be social with others. These girls can be good actors and will often imitate others’ behaviour. Instead of being themselves, they pretend to be someone they are not in order to be accepted by others and to make friends. Because they are acting like the other children around them, they don’t fit into the typical stereotypes we associate with autism2.
3. Unusual interests are not so unusual
We also expect children with autism to have unusual interests, however, girls often have special interests in things that are not necessarily seen as unusual, such as princesses or horses2.
Why does it matter?
If girls with high functioning autism are able to fit in and function in society, then why is it still important to identify them? The problem with missing these girls is that they go so long pretending to be someone they are not and trying so hard to fit in that it wears them out5. As they get older and the demands on their social skills increase, many girls begin to struggle even more5. They have the insight to know they have difficulties with social communication and that they are different, but they don’t understand why. This can lead to the development of mental health disorders, such as anxiety and depression. In fact, research suggests that anxiety disorders are more than twice as common in individuals with autism than in the general population4.
Identifying girls with high functioning autism is critical because early identification and treatment of these individuals has been found to lead to better outcomes5.
Could you or your child be at risk of having autism?
There are screening questionnaires for all ages available on Autism Canada’s website that can give you an idea of whether or not someone might be at risk of having autism. However, you should remember that a screening tool does not provide a diagnosis and just because a result of “high risk” or “low risk” is obtained, it does not mean that someone does or does not have autism. Autism has many overlapping symptoms with a wide variety of other disorders, such as attention deficit hyperactivity disorder (ADHD) and developmental delays. Even typical children who have restricted interests or who are highly intelligent could be mistaken as having autism. If you have any concerns regarding your child’s development, it is always best to see a healthcare professional as soon as possible because early intervention is the key to better outcomes.
The links to the screening tools are listed below :
National Autistic Society (2020). Autistic women and girls. https://www.autism.org.uk/advice-and-guidance/what-is-autism/autistic-women-and-girls
Autism Awareness Australia (2020). Autism and girls. https://www.autismawareness.com.au/could-it-be-autism/autism-and-girls/
Szalavitz, M. (2016). Autism - It’s different in girls. Scientific American - Mind, 27 (2), 48-55. doi: 10.1038/scientificamericanmind0316-48
Nimmo-Smith V, Heuvelman H, Dalman C, Lundberg M, Idring S, Carpenter P, Magnusson C, Rai D. (Jan. 2020). Anxiety Disorders in Adults with Autism Spectrum Disorder: A Population-Based Study. Journal of Autism and Developmental Disorders, 50(1), 308-318. doi: 10.1007/s10803-019-04234-3
Arky, B. (s.d.). Why many autistic girls are overlooked. https://childmind.org/article/autistic-girls-overlooked-undiagnosed-autism/