Autism Spectrum Disorder (ASD) is a developmental disability caused by differences in the brain. Some people with autism may not appear to have any outward symptoms of ASD.
Others may need more help with daily tasks or in stimulating situations.
Parents and adults may have a difficult time noticing signs of ASD both in their children and themselves. Because autism is a spectrum, the intensity of signs can vary. In our society, we are often more attuned to the signs that boys display than the ones girls display.
ARE AUTISM RATES HIGHER IN BOYS OR GIRLS?
It is estimated that the average age a child diagnosed with ASD is just shy of five years old.
By that age, parents might start noticing signs based on their child’s behavior. However, more boys are diagnosed than girls. According to recent data, ASD is more than three times as common among boys than among girls.
That doesn’t necessarily mean more boys have ASD compared to girls. Sometimes parents, teachers, and clinicians don’t notice symptoms in girls until much later in life.
WHAT ARE THE DIFFERENT SIGNS OF GIRLS WITH ASD VERSUS BOYS WITH ASD?
Dr. Andrew Sylvester M.D. is a psychiatrist and medical director for the Virtual Intensive Outpatient Services at UCHealth in Colorado. In his experiences working with both adults and children, he says the signs of autism in boys are quite noticeable compared to girls with autism.
When a parent is concerned their male child has autism, it often is because his behavior is externalizing — meaning he is acting out in a way that disrupts or disturbs others.
“[Boys] tend to have more externalizing behaviors. Externalizing behaviors are more problematic at home and school. They’re flipping desks, they’re erupting,” Sylvester says. “Girls, even girls with autism spectrum disorders, tend to have more internalizing behaviors. They tend to shut down instead of acting out.”
Parents often don’t know their female child is displaying signs of autism because girls are good at blending in and hiding behaviors associated with ASD.
The idea of masking or camouflaging is what many people with autism do to try to fit in with those around them. This could be hiding their own behaviors, copying others’ behaviors, and changing parts of themselves to fit in.
For example, girls will be very invested in whatever other girls their age are also invested in. That could be horses, gymnastics, art, soccer—anything that seems to be trending with girls that age.
Dr. Emily Parker, Ph.D. is an assistant professor at the University of Utah School of Medicine and a clinical psychologist at Primary Children’s Hospital. Her work involves diagnosing children with autism and educating others about ASD.
She says, “Girls’ strong interests or hyper focuses may be more socially typical, but the intensity is just very different for them.” Because these strong interests seem to align with what most girls that age are interested in, it’s harder for parents and providers to recognize there might be something more going on.
Girls may also be better at hiding or masking certain repetitive behaviors or stimming. Some repetitions could be rocking, spinning, hair twirling, scratching, rubbing, or touching fabrics.
WHEN ARE GIRLS’ AUTISM SYMPTOMS MORE NOTICEABLE?
Parker says parents, teachers, and providers may start to notice more signs of a preteen girl with ASD when the evolution of social skills ramps up. When conversation between peers becomes more back-and-forth and as girls move into middle school social dynamics, it becomes harder to imitate those social skills.
The subtleties of sarcasm or saying one thing and meaning something different are difficult for girls with ASD to pick up on and may cause frustration or fatigue.
When someone starts showing signs of anxiety and/or depression, it could be a result of autism. Many people with autism also experience anxiety and depression. Sometimes it’s unrelated to autism, and sometimes it’s a result of undiagnosed ASD. Of course, it’s also possible to have unrelated mental health problems and autism.
Because mental and developmental health is so intertwined, it’s critical that a professional perform a thorough evaluation.
HOW ARE GIRLS DIAGNOSED WITH AUTISM?
The diagnosis process is the same for boys and girls.
Parker says the gold standard autism evaluation measures work great, but it comes down to the clinician paying attention to the different ways in which autism can present.
“For either boys or girls, knowing about this more nuanced presentation just makes me ask parents more questions about some of these things so that I don’t miss something. Like, ‘Your child does pretend play? Great! What does that play look like?’ Let’s really make sure we’re understanding and not missing something,” Parker explains.
Parker says these are just a few of the questions she asks in an evaluation:
- Does the child have repetitive and restrictive behaviors and interests (that get in their way of doing other things)?
- Do they have difficulty with transitions or changes in routine?
- Do they have difficulty understanding nonverbal or indirect social cues (such as cues that someone is using humor, that someone does/does not want to talk or play, etc.)?
Sylvester explains how he looks at the child’s relationships. “Do they have poor body coordination? Are they not meeting developmental milestones on time?” Ultimately, he says it really comes down to whether or not they can understand or pick up nonverbal communication.
Though it may be tempting to find some understanding at home, he warns that online screening tests aren’t helpful.
“Those screening instruments are supposed to be administered by somebody who knows, who is validated on administering the instrument, and who can help you understand what actually fits as a symptom and what doesn't,” Sylvester states.
HOW ARE WOMEN DIAGNOSED WITH AUTISM?
Parker says the gold standard autism evaluation includes two components: a standardized assessment conducted with the person, such as the ADOS-2; and a thorough interview about the history of ASD symptoms and behaviors.
Some question whether a diagnosis is worth it if a woman is functioning mostly well in life. But women who are experiencing a lot of stress, anxiety, or depression may find help or relief in an ASD evaluation.
“Going and seeking out an evaluation can be helpful for a few reasons, one of them being just to validate their own experience and to validate these pieces of masking or camouflaging and the fatigue associated with that,” Parker says.
Katrina Hahn, a speech and language therapist at Primary Children’s found out last year that she has ASD. After years of struggling and not understanding why, she spoke to a clinician who confirmed her thoughts.
“I spent so much time masking and pretending and burying everything that I’m going through that I really didn’t know who I was ... There’s so much that’s going on that nobody’s aware of because we cover it up and fake it for so long,” Hahn says.
After her diagnosis, Hahn spent the next year adjusting to this new information she learned about herself. She says she was depressed and frustrated, but she also learned how to care for herself.
In the past, she spent lots of time learning everything about someone else’s interests in an effort to fit in. Now, she spends time with people who share her interests.
She also learned how to cope with sensory issues and feelings of overwhelm and exhaustion that took a toll on her for decades.
By speaking with a professional and learning more about herself, Hahn finally has answers and resources to make her life more fulfilling and easier to navigate.
SUPPORT AND RESOURCES FOR WOMEN AND GIRLS DIAGNOSED WITH ASD
There are numerous resources available to women and girls with ASD. The best place to start is with a health or mental health professional.
RESOURCES FOR GIRLS WITH AUTISM
Clinicians and medical professionals can guide parents to many resources.
Sylvester says there are school programs that will help children with autism learn in a way that is more effective for them.
If your young child has been diagnosed with ASD, look into an Individualized Education Program (IEP). These are tailored education plans customized to fit your child’s learning style and learning disabilities.
Your child’s provider can also inform you of support groups, home exercises, therapists, and other professionals who can help you and your child adjust to a new way of living in the world.
RESOURCES FOR WOMEN WITH AUTISM
When a woman is diagnosed with ASD, the clinician can educate her about the tools and interventions that might make life a little easier. Some examples might include therapy, exercises, books, medications, and more.
The clinician can also share support group information and contact information for people who can help.
FIND HELP
Women and parents can find help for learning, emotional, and behavioral difficulties from a medical and mental health professional. Depending on your insurance plan, you may need to see your primary care provider (PCP) before seeing a specialist or clinician. A PCP can point you in the right direction and provide any necessary referrals.
Select Health plans offer access to help through our large network of providers. To find a health insurance plan that works for you and your family, visit SelectHealth.org/Plans.
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