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Autism and Girls

March 13, 2019

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As the world celebrates International Women’s Day on March 8 this year with the theme ‘Balance for Better’, it is crucial that we get the discussion around autism right by not only involving women and girls in the autism debate but also better understand how autism present in girls and women. Apparently, there is a growing awareness on how girls and women on the autism spectrum are missing in global discuss and also the assumption that many more boys and men are autistic is being challenged. There is a need to consider the extent to which women and girls on the autism spectrum present differently from males and to explore whether they have different needs. This would have implications for the systems, instruments and processes used for diagnosis and for the types of support interventions being proposed.

Historically, it was believed that females were less likely to be autistic, yet recent research has highlighted the challenges in identifying autism in women and girls. It is now recognised from research, clinical practice and anecdotal reports that many autistic females or those who demonstrate the less traditionally obvious traits of autism are not recognised. This can result in misdiagnosis, late diagnosis, or women and girls not being diagnosed at all.

It is often stated that the differences that autistic women and girls experience are of a more subtle presentation or may appear so to others. Some autistic women and girls feel that they are masking their autism to try and hide the fact that they feel different. They may copy behaviour from others around them and can be exhausted by the constant effort to appear similar to other people or might be unaware they are ‘masking’ in the first place. This more subtle presentation of autism is also a major barrier to clinicians and other professionals recognising autism and understanding the experiences of autistic women and girls.

As a result, many women and girls report feeling unsupported and not fully understanding themselves potentially leading to mental health issues.

Why Women and Girls May Be Misdiagnosed, Underdiagnosed or not Diagnosed at all

Girls who have overt symptoms such as obvious self-stimulating behaviours (stims), extreme difficulties with speech and language, severe difficulties with social communication, or significant cognitive challenges, are usually referred for assessment and diagnosed at a younger age. But girls whose symptoms are subtle, or whose intelligence level allows them to mask symptoms, may only be diagnosed as pre-teens or teens.

Our culture may be to blame for some missed diagnoses in girls. In general, girls are expected to be quieter and less assertive than boys. A girl who appears shy and withdrawn may be seen as acceptably “feminine,” while a boy with the same behaviours is considered to be atypical. Similarly, a girl who seems “spacey” and unengaged is often described as “dreamy,” while a boy who behaves similarly may attract negative attention.

No single symptom is enough to suggest autism. Moreover, while some symptoms may become increasingly obvious to you as your daughter grows older, you should be able to look back and realize that they have been present since her toddler years. In addition, symptoms of autism should be severe enough to limit daily function. In other words, if your daughter has one or two of the symptoms of autism but is well-adjusted and successful in other ways it’s unlikely that she’s autistic.

If you see several of these issues, they seem to be prevalent over time, and they interfere with your daughter’s ability to function successfully, you might wish to consider having your daughter assessed for autism.

Possible signs of autism in girls

  • Your daughter relies on other children (usually girls) to guide them and speak for them throughout the school day.
  • Your daughter has “passionate” and limited interests that are very specific and restricted. For instance, while many girls may be fans of a particular TV show, a girl with autism may collect information and talk endlessly about the characters, locations, props, or actors, but know little or nothing about the plot or genre of the show.
  • Your daughter is unusually sensitive to sensory challenges such as loud noise, bright lights, or strong smells. (This symptom is as common among boys as among girls.) Sensory challenges in childhood are not unique to autism, but they are one symptom of the condition.
  • Your daughter’s conversation is restricted to her topics of interest. She may share her areas of specific and restricted fascination but have no interest in hearing another person’s response. This may interfere with her ability to join groups or make friends.
  • Your daughter has a low frustration level and finds it difficult to moderate her feelings when she is frustrated. She may have age-inappropriate “meltdowns.” This may interfere with her relationships with teachers or lead to behavioural interventions such as detentions or even exclusion from school.
  • Your daughter experiences an unusual degree of depression, anxiety, or moodiness. Again, these symptoms are not unique to autism, but autism is associated with both mood disorders and obsessive-compulsive disorder.
  • Your daughter has a difficult time making or keeping friends; she may seem “clueless” when it comes to non-verbal social cues (other people turning away, facial expressions, etc.). She may also have a difficult time imitating other girls’ behaviours, fashion choices, or hairstyles even though she may want to “fit in.”
  • Your daughter is usually described as “quiet” or “shy” in school and other challenging social situations. Being quiet or shy isn’t a symptom of autism, but often difficulty with receptive and/or expressive language can make it difficult to jump into conversations, raise your hand, or respond quickly to social situations.
  • Your daughter is unusually passive. While some people with autism are quite active, passive behaviours (while socially acceptable in school) can be a sign that your daughter isn’t quite sure what to do or say and has chosen the safe route of doing or saying as little as possible.
  • Your daughter appeared to be developing typically as a young girl but finds social communication to be increasingly difficult as she enters her teen years. (Studies suggest that girls with high functioning autism or Asperger syndrome may find ways to cope with and mask difficulties with social interaction, often by allowing others to speak for them. This strategy works well until social expectations become more complex and demanding in the early teenage years.)
  • Your daughter has epileptic seizures (this has been found, in one study, to be more common among girls with autism than boys).

Supporting Autistic Girls

If you do feel that the above describe your daughter, and you decide to seek an assessment for autism, make sure the team assessing your daughter has specific experience working with girls on the spectrum.  Remember that it can be hard to diagnose high functioning autism in a girl who has learned how to mask her symptoms.

It is also important to know that there are a wide range of support mechanisms you can implement at home including regularly asking your daughter about their feelings at home or at school, pay attention to their sensory difficulties and observe patterns and frequency of every behaviour traits. Moreover, depending on her needs and challenges, you may decide to consider a variety of educational options. Individualized special needs plans can help at school; you may also decide to consider private school options (If you can afford it) as autistic girls often do better in smaller settings.